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"Latar Belakang: Kontak tubuh manusia dengan arus listrik dapat mengakibatkan trauma luka bakar. Pada Pasien luka bakar listrik, derajat keparahan trauma yang dialami pada organ dalam tidak sebanding dengan luka bakar di permukaan tubuh, sehingga dapat dikategorikan sebagai luka bakar berat. Terapi nutrisi merupakan bagian integral dalam tata laksana luka bakar sejak awal resusitasi hingga fase rehabilitasi. Saat ini sudah terdapat rekomendasi untuk tata laksana nutrisi luka bakar berat. Namun, belum terdapat rekomendasi yang spesifik mengenai tata laksana pada luka bakar listrik.Metode: Laporan serial kasus ini menjelaskan empat pasien kasus luka bakar listrik. Pasien mengalami berbagai penyulit yang kemudian mempengaruhi tata laksana nutrisi yang diberikan. Pasien pertama dengan trauma servikal, pasien kedua mengalami AKI dan penurunan fungsi hati, pasien ketiga mengalami syok sepsis, dan pasien keempat mengalami sepsis dan amputasi. Pemberian nutrisi dimulai sesuai dengan kondisi pasien. Target pemberian energi dihitung dengan menggunakan persamaan Harris-Benedict untuk kebutuhan basal, ditambah faktor stres 1,5-2. Protein diberikan 1,5-2 g/kg BB/hari hingga terjadi perbaikan. Karbohidrat dan lemak berturut-turut 60-65% dan <35%. Pemberian nutrisi diutamakan melalui oral dan enteral, sedangkan jalur parenteral hanya digunakan bila diperlukan untuk pemenuhan energi. Mikronutrien yang diberikan berupa multivitamin antioksidan, vitamin B kompleks dan asam folat.Hasil: Tiga pasien mengalami perbaikan klinis, kapasitas fungsional, dan laboratorium hingga diperbolehkan rawat jalan. Lama perawatan ketiga pasien tersebut berturut-turut 17 hari, 60 hari, dan 20 hari. Satu orang pasien meninggal akibat penyulit yang dialaminya yaitu syok sepsis yang menyebabkan gagal multi organ setelah dirawat selama 14 hari.Kesimpulan: Tatalaksana nutrisi yang optimal dan tepat sesuai dengan kondisi klinis pasien dapat menurunkan morbiditas dan mortalitas pasien dengan luka bakar listrik.

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Background: Contact to electricity can inflict burn injuries in human. In electrical burn injuries, the damages of the internal organs are not comparable to the burn injuries in the body's surface. Nutrition therapy is an integral part in burn management from the beginning of resuscitation to rehabilitation phase. Currently there have been several recommendations of nutrition management in severe burn injury. However there is still no recommendation that specifically recommend for nutrition management in patients with electrical burn injury.

Methods: The serial case report describes four patients with electrical burn injury. All patients had various complications that affected the nutrition management. First patient with cervical trauma, second patient had AKI and decreased liver function, third patient had septic shock, and fourth patient had sepsis and amputation. Nutrition was given individualy according to the patient clinical condition. Target of energy given calculated by Harris-Benedict equation for basal requirement with added stress factor 1,5-2. Protein was given 1,5-2 g/kg BW/day except patient with AKI protein restricted to 0,8-1 g/kg BW/day until improvement of renal function. Carbohydrates and lipids were given 60-65% and <35%, respectively. Oral or enteral nutrition was preferred while parenteral nutrition only given if required to meet the energy requirements. Micronutrients supplementation such as antioxidant vitamins, vitamin B complex, and folic acid were provided to patients.

Results: Three patients had the improvement in clinical condition, functional capacity, and laboratory results that allowed them to be discharged and had outpatient treatment. Length of stay of the patients were 17, 60, 20 days respectively. One patient died due to septic shock compilation that lead to multiple organ failure after 14 days of hospitalization.

Conclusion: Optimal and appropriate nutrition management adjusted to patient's clinical condition can reduced morbidity and mortality rate in the electrical burn injury patients."

"[Latar belakang: luka bakar akan memicu terjadinya respon inflamasi lokal dansistemik, yang dapat menimbulkan berbagai komplikasi. Pada pasien luka bakar,terjadi peningkatan kebutuhan akan zat gizi akibat kondisi hipermetabolik danhiperkatabolik yang terjadi. Tatalaksana nutrisi yang adekuat dibutuhkan untukmembantu kontrol respon inflamasi dan metabolik sehingga dapat menunjangpenyembuhan pasien. Metode: Dalam serial kasus ini terdapat empat pasien luka bakar berat yang disebabkan api dan listrik. Selama perawatan didapatkan berbagai penyulit yang mempengaruhi tatalaksana nutrisi yang diberikan. Pada pasien pertama terdapattrauma inhalasi, yang berkembang menjadi ARDS dan gagal nafas. Pada pasienkedua terdapat sepsis, yang berkembang menjadi syok sepsis dan gagal organmultipel. Pasien ketiga mengalami amputasi dan AKI, sedangkan pasien keempatmengalami rabdomiolisis, AKI, dan amputasi. Target energi dihitung berdasarkanformula Xie dan Harris Benedict, dengan target protein 1,7?2 g/kgBB, lemak 20?25% dan karbohidrat 60?65%. Nutrisi enteral dimulai dalam waktu 21?35 jampasca kejadian sebesar 13?20 kkal/kg/hari dengan metode pemberian dripintermittent. Pemberian nutrisi selanjutnya sesuaikan dengan toleransi, klinis, danpenyulit yang dialami pasien. Mikronutrien yang diberikan berupa multivitaminantioksidan, vitamin B, dan asam folat.Hasil: dua pasien pertama meninggal dalam perawatan, namun pasien pertamatelah mengalami perbaikan luas luka bakar dari 54% menjadi 32,5%. Dua pasienterakhir mengalami perbaikan kapasitas fungsional dan penyembuhan luka yangbaik. Kesimpulan: Tatalaksana nutrisi yang tepat dan adekuat sesuai dengan kondisi klinis pasien dapat menunjang penyembuhan serta menurunkan morbiditas dan mortalitas pasien.;Background: Burn injury initiates local dan systemic inflammatory reaction,resulting various complicating conditions. Nutritional requirement after majorburn significantly increased because hypermetabolic and hypercataboliccondition. Effective and adequate nutrition therapy is required to controlinflammatory dan metabolic response, therefore enchance healing process.Method: The current case series consists of four patients with severe burn injurycaused by flame and electricity. During hospitalization, complicating conditionsdeveloped in all patients which influenced nutrition therapy given to the patients.First patient had inhalation injury that developed into ARDS and respiratoryfailure, while sepsis that progress to septic shock and MODS occured in secondpatient. Third patient had amputation and AKI, while fourth patient experiencedrhabdomiolysis, AKI, and amputation. Target energy was calculated based on Xieand Harris-Benedict formula with target protein was 1,7?2 g/kgBB, lipid 20?25%,and carbohydrate 60?65%. Enteral nutrition was initiated within 21?35 hours postburn, started at 13?20 Kcal/kg/day with intermintent gravity drip method. Further,nutrition was given according to patients? tolerance, clinical condition, andcomplicating conditions. Micronutients supplementation with antioxidant, vitaminB, and folic acid were provided to all patients.Result: The first two patients died during hospitalization, however, there wasimprovement in first patient?s burn wound extent from 54% to 32,5% TBSA. Thelast two patients had satisfactory wound healing and improvement in functionalcapacity.Conclusion: Effective and adequate nutrition management inline with patient?s clinical condition lead to enhacement healing process, and reduced morbidity and mortality rate.;Background: Burn injury initiates local dan systemic inflammatory reaction,resulting various complicating conditions. Nutritional requirement after majorburn significantly increased because hypermetabolic and hypercataboliccondition. Effective and adequate nutrition therapy is required to controlinflammatory dan metabolic response, therefore enchance healing process.Method: The current case series consists of four patients with severe burn injurycaused by flame and electricity. During hospitalization, complicating conditionsdeveloped in all patients which influenced nutrition therapy given to the patients.First patient had inhalation injury that developed into ARDS and respiratoryfailure, while sepsis that progress to septic shock and MODS occured in secondpatient. Third patient had amputation and AKI, while fourth patient experiencedrhabdomiolysis, AKI, and amputation. Target energy was calculated based on Xieand Harris-Benedict formula with target protein was 1,7?2 g/kgBB, lipid 20?25%,and carbohydrate 60?65%. Enteral nutrition was initiated within 21?35 hours postburn, started at 13?20 Kcal/kg/day with intermintent gravity drip method. Further,nutrition was given according to patients? tolerance, clinical condition, andcomplicating conditions. Micronutients supplementation with antioxidant, vitaminB, and folic acid were provided to all patients.Result: The first two patients died during hospitalization, however, there wasimprovement in first patient?s burn wound extent from 54% to 32,5% TBSA. Thelast two patients had satisfactory wound healing and improvement in functionalcapacity.Conclusion: Effective and adequate nutrition management inline with patient?s clinical condition lead to enhacement healing process, and reduced morbidity and mortality rate., Background: Burn injury initiates local dan systemic inflammatory reaction,resulting various complicating conditions. Nutritional requirement after majorburn significantly increased because hypermetabolic and hypercataboliccondition. Effective and adequate nutrition therapy is required to controlinflammatory dan metabolic response, therefore enchance healing process.Method: The current case series consists of four patients with severe burn injurycaused by flame and electricity. During hospitalization, complicating conditionsdeveloped in all patients which influenced nutrition therapy given to the patients.First patient had inhalation injury that developed into ARDS and respiratoryfailure, while sepsis that progress to septic shock and MODS occured in secondpatient. Third patient had amputation and AKI, while fourth patient experiencedrhabdomiolysis, AKI, and amputation. Target energy was calculated based on Xieand Harris-Benedict formula with target protein was 1,7–2 g/kgBB, lipid 20–25%,and carbohydrate 60–65%. Enteral nutrition was initiated within 21–35 hours postburn, started at 13–20 Kcal/kg/day with intermintent gravity drip method. Further,nutrition was given according to patients’ tolerance, clinical condition, andcomplicating conditions. Micronutients supplementation with antioxidant, vitaminB, and folic acid were provided to all patients.Result: The first two patients died during hospitalization, however, there wasimprovement in first patient’s burn wound extent from 54% to 32,5% TBSA. Thelast two patients had satisfactory wound healing and improvement in functionalcapacity.Conclusion: Effective and adequate nutrition management inline with patient’s clinical condition lead to enhacement healing process, and reduced morbidity and mortality rate.]"

"Pasien pada serial kasus ini adalah empat pasien dewasa dengan luka bakar berat, masuk perawatan dalam kondisi resusitasi. Status nutrisi sebelum sakit adalah overweight dan satu pasien normoweight. Inisiasi nutrisi enteral dilakukan 15-39,5 jam pasca kejadian. Pemberian nutrisi dimulai dari hipokalori (<20 Kkal/kgBB/hari), ditingkatkan bertahap menuju kebutuhan energi total yang dihitung berdasarkan formula Xie dengan berat badan sebelum sakit. Selama perawatan di ICU, pasien mencapai kalori sebesar 60-96% KET, protein sebesar 0,6-1,9 g/kgBB/hari, komposisi lemak dan karbohidrat berturut-turut sebesar 15-25%, dan 50-64%. Jalur pemberian nutrisi parenteral dengan central venous cathether (CVC) sedangkan enteral dengan nasogastric tube (NGT) tetes lambat secara intermiten. Mikronutrien yang diberikan berupa multivitamin antioksidan, vitamin B kompleks dan asam folat. Pemantauan terapi nutrisi meliputi tanda klinis, toleransi asupan makanan, kapasitas fungsional, imbang cairan, parameter laboratorium dan antropometri. Pada kelompok survivor diberikan edukasi nutrisi terkait penyembuhan luka dan preservasi massa otot.

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Patients in the case report were four adult patients with severe burns and admitted to the hospital under resuscitation conditions. Three patients were overweight and one was normoweight Enteral nutrition was initiated within 15–39.5 hours post injury. Nutrition administration began from hypocalory (<20 kcal/kg/day), then increased gradually to the total energy requirement using Xie formula based on the pre-illness weight. In the ICU, energy intake achieved 60-96% of total requirement, protein was 0.6 to 1.9 g/kgBW/day, fat, and carbohydrate were 15-25% and 50-64% respectively. Parenteral nutrition was given via central venous cathether while enteral nutrition was dripped intermittently. Micronutrients were given as multivitamin antioxidants, vitamin B complex, and folic acid. The survivors were given nutrition education related to wound healing and preservation of muscle mass."

"ABSTRAKLatar belakang: Prevalensi obesitas di seluruh dunia telah diketahui mengalami peningkatan yang signifikan dalam tiga dekade terakhir. Tingginya prevalensi obesitas tersebut dapat memengaruhi peningkatan prevalensi pasien luka bakar dengan obesitas yang dirawat di unit luka bakar. Pasien luka bakar dengan obesitas mengalami fenomena 'second hit', yaitu peningkatan respon hipermetabolisme pasca luka bakar akibat inflamasi kronik yang sebelumnya sudah dialami. Masalah tersebut memiliki kaitan erat dengan nutrisi sehingga membutuhkan terapi medik gizi yang optimal untuk memodulasi respon hipermetabolisme yang meningkat pada pasien luka bakar dengan obesitas. Metode: Pada serial kasus ini terdapat empat pasien luka bakar berat karena api. Keempat pasien tersbeut memiliki status nutrisi obes berdasarkan kriteria indeks massa tubuh IMT menurut WHO untuk Asia Pasifik. Target kebutuhan energi dihitung menggunakan formula estimasi Xie dengan berat badan kering. Terapi medik gizi diberikan sesuai panduan terapi medik gizi pasien sakit kritis berupa nutrisi enteral dini dengan target energi awal 20-25 kcal/kg BB dengan target protein 1,5-2 gram/kg BB. Terapi medik gizi selanjutnya diberikan sesuai dengan klinis dan toleransi pasien. Mikronutrien yang diberikan berupa vitamin C, vitamin B, asam folat, dan seng.Hasil: Tiga pasien meninggal selama perawatan karena syok sepsis yang tidak teratasi, sedangkan satu pasien mengalami perbaikan luas luka bakar dari 47 menjadi 36 luas permukaan tubuh LPT serta peningkatan kapasitas fungsional. Kesimpulan: Status nutrisi obesitas pada pasien dalam serial kasus ini dapat menjadi faktor yang memperberat penyulit yang dialami. Terapi medik gizi yang adekuat dapat menunjang proses penyembuhan luka serta meningkatkan kapasitas fungsional.

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ABSTRACT<>br>Background The prevalence of obese patients presenting to burn unit facilities is expected to increase over the next three decades due to global epidemic of obesity. Given that the metabolic derrangements seen in burn mirror those found in association in obesity, it is plausible that excess adipose tissue contributes to a 'second hit' phenomenon in patients affected by burn injury. Optimal and adequate medical nutrition therapy is required in order to modulate the inflammatory and metabolic response, therefore enhance burn wound healing.Methods The current case series consist of four severly flame burned patient. The nutritional status of these patients was moderately obese according to WHO criteria for Asia Pacific. Enery requirement was calculated using the Xie formula based on patient rsquo s dry weight. Medical nutrition therapy was initiated with eraly enteral nutrition started at 20-25 kcal kg day with protein target at 1,5-2 gram kg day. Micronutrient supplementation was also given to these patients. Results Three patients died during hospitalization due to septic shock. The last patient had satisfactory wound healing and improved functional capacity at discharge. Kesimpulan: Obesity in this case series may be one of the risk factor for mortality. Adequate medical nutrition therapy inline with patient's clinical condition leads to enhancement healing process and improved functional capacity."

"Latar belakang: Karsinoma nasofaring merupakan salah satu keganasan yang dapat menyebabkan malnutrisi. Radioterapi dan kemoterapi merupakan bagian dari terapi yang dapat menimbulkan berbagai efek samping yang dapat mempengaruhi status gizi. Tujuan dari tata laksana nutrisi adalah meminimalkan penurunan massa tubuh, meningkatkan kualitas hidup, serta menurunkan angka mortalitas dan morbiditas. Tata laksana nutrisi yang diberikan meliputi pemberian makronutrien, mikronutrien, nutrient spesifik, konseling dan edukasi. Metode: Pasien serial kasus ini berjumlah empat orang dan berusia antara 38?69 tahun. Keempat pasien menjalankan terapi kemoradiasi. Hasil skrining pasien menggunakan malnutrition screening tools (MST) adalah SOH2. Kebutuhan energi total pasien dihitung menggunakan Harris-Benedict yang dikalikan dengan faktor stress sebesar 1,5. Pemantauan yang dilakukan meliputi keluhan subyektif, kondisi klinis, tanda vital, antropometri, massa lemak, massa otot, kapasitas fungsional, pemeriksaan kekuatan genggam tangan, analisis asupan, dan laboratorium. Monitoring dan evaluasi dilakukan secara teratur untuk memantau pencapaian target nutrisi. Hasil: Dukungan nutrisi pada keempat pasien dapat meningkatkan asupan, meminimalkan penurunan massa tubuh dan kapasitas fungsional pada pasien KNF yang menjalankan terapi kemoradiasi. Kesimpulan: Dukungan nutrisi yang diberikan pada pasien KNF yang menjalankan terapi kemoradiasi dapat meminimalkan penurunan status gizi dan kapasitas fungsional pasien. "

"Latar belakang: Kanker kepala dan leher merupakan salah satu kanker yang berisiko tinggi malnutrisi. Pada kanker kepala dan leher stadium lanjut lokal, radioterapi dengan atau tanpa kemoterapi merupakan terapi pilihan dan berkaitan dengan berbagai efek samping yang berperan dalam penurunan asupan makan dan berefek negatif pada status nutrisi. Tata laksana nutrisi bertujuan untuk mengurangi risiko malnutrisi, mendukung keberhasilan terapi kanker, meningkatkan kualitas hidup, serta menurunkan angka morbiditas dan mortalitas. Pemberian terapi nutrisi berupa konsultasi individu yang meliputi perhitungan kebutuhan energi, makronutrien, mikronutrien, dan nutrien spesifik, serta pemberian medikamentosa bila diperlukan. Metode: Pasien pada serial kasus ini berjumlah empat orang dengan rentang usia 3055 tahun. Dua dari empat pasien mendapat kombinasi kemoterapi. Hasil skrining keempat pasien dengan malnutrition screening tools (MST) didapatkan skor ≥2. Kebutuhan energi total dihitung menggunakan persamaan Harris-Benedict yang dikalikan dengan faktor stres sebesar 1,4. Pemantauan yang dilakukan berupa anamnesis keluhan subyektif dan analisis asupan, pemeriksaan fisik, antropometri, massa otot skelet, massa lemak, kekuatan genggam tangan, dan hasil laboratorium. Pemantauan dilakukan secara rutin dengan frekuensi satu kali per minggu untuk menilai pencapaian target nutrisi. Hasil: Terapi nutrisi dapat meningkatkan asupan protein dan nutrien spesifik, namun tidak dapat mencegah penurunan BB, massa otot skelet, dan kekuatan genggam tangan pada pasien kanker kepala dan leher stadium lanjut lokal yang menjalani terapi radiasi dengan atau tanpa kemoterapi. Kesimpulan: Tata laksana nutrisi pada pasien kanker kepala dan leher stadium lanjut lokal yang menjalani terapi kanker dapat memberikan efek positif pada asupan nutrien pasien.

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Introduction: Head and neck cancer is one of malignancy with higher risk of malnutrition. Treatment of choice for locally advanced head and neck cancer is radiotherapy with or without chemotherapy and is associated with various side effects that may decrease food intake and negatively affect nutritional status. The aim of nutrition management is to reduce the risk of malnutrition, to support the success of cancer therapy, to enhance the quality of life, and to reduce morbidity and mortality. Nutrition therapy in the form of consultation includes calculation of energy needs, macronutrient, micronutrient, and specific nutrients, as well as drug therapy when needed.

Methods: This case series consist of four patients between 3055 years old. Half of the patients received combination with chemotherapy. All patients had screening score with malnutrition screening tools (MST) ≥2. The total energy requirement was calculated using Harris-Benedict equation then multiplied with stress factor 1.4. Monitoring was done by anamnesis of subjective complaints and food intake, physical examination, anthropometric, muscle mass, fat mass, hand grip strength, and laboratory results. Monitoring was performed frequently once a week to assess the accomplishment of nutritional target.

Results: Nutrition therapy could improve intake of protein and specific nutrients, but couldn't prevent weight loss, a decrease in muscle mass and hand grip strength in locally advanced head and neck cancer patients receiving radiation therapy with or without chemotherapy.

Conclusion: Nutrition management in locally advanced head and neck cancer patients receiving anticancer therapy positively affect patient's nutrient intake."

"ABSTRAKLatar Belakang: Prevalensi gagal jantung semakin meningkat per tahun, 60-70% disebabkan penyakit jantung koroner (PJK). Beberapa faktor risiko penyebab gagal jantung yaitu DM, hipertensi, obesitas, sindrom metabolik, dan aterosklerosis. Patofisologi gagal jantung sangat kompleks dan melibatkan banyak sistem, terjadi hipermetabolisme yang dapat menyebabkan penurunanberat badan dan memicu terjadinya malnutrisi. Keadaan gagal jantung dekompensasi akut karena infark miokard lama membutuhkan penanganan segera di RS untuk menghindari komplikasi lebih lanjut.Metode: Laporan serial kasus ini memaparkan empat kasus pasien gagal jantung dekompensasi akut karena infark miokard lama, berusia antara 41 hingga 70 tahun, dan tiga diantaranya dengan riwayat DM tipe II. Semua pasien memerlukan dukungan nutrisi, tiga pasien memiliki status gizi obesitas dan satu pasien berat badan normal. Masalah berkaitan erat pada nutrisi keempat pasien adalah hipoalbuminemia, gangguan elektrolit, gangguan fungsi ginjal, gangguan fungsi hati, keseimbangan cairan, serta defisiensi mikronutrien. Perhitungan kebutuhan energi basal (KEB) dihitung berdasarkan rumus Harris Benedict dengan faktor stres sesuai kondisi klinis dan penyakit penyerta. Komposisi makronutrien diberikan menurutrekomendasi Therapeutic Lifestyle Changes (TLC) dan American Heart Association (AHA), pemberian protein disesuaikan dengan fungsi ginjal masing-masing pasien. Pemberian suplementasi mikronutrien juga diberikankepada keempat pasien. Pemantauan pasien meliputi keluhan subyektif, hemodinamik, analisis toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan dan kapasitas fungsional.Hasil: pemantauan selama di RS, keempat pasien menunjukkan perbaikan klinis, peningkatan toleransi asupan, perbaikan kadar elektrolit dan peningkatan kapasitas fungsional.Kesimpulan: Terapi nutrisi medik yang adekuat dapat memperbaiki kondisi klinis pasien gagal jantung dekompensasi akut karena infark miokard lama.

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ABSTRACT

Background: The prevalence of heart failure increase annually, 60-70% due to coronary heart disease (CHD). Some of the risk factors associated with heart failure are diabetes, hypertension, obesity, metabolic syndrome, and atherosclerosis. The phatophysiology of heart failure is very complex and involves many systems. The occurance of hypermetabolism can lead to weight loss and triger malnutrition. The state of acute decompensated heart failure due to old myocardial infarction require immediate treatment in hospital to avoid further complications.

Methods: This series of case report describes four cases of patients with acute myocardial heart failure, due to old infarction, aged between 41 to 70 years old, and three of them with a history of type 2 diabetes melitus. All patients required nutritional support, three patients had nutritional status of obese and one patient was normal in weight. The problems which closely linked to all nutrition of the four patients were hypoalbuminemia, electrolyte disturbances, impaired renal function, impaired liver function, fluid inbalance, and micronutrient deficiencies. Basal Energy Requirement was calculated using Harris Benedict formula with stress factors corresponding clinical condition and comorbidities. Macronutrients composition was given according to the recommendation of the Therapeutic Lifestyle Changes (TLC) and the American Heart Association (AHA), while the provision of proteins was

tailored with the kidney function of each patient. Micronutrients supplementation was also given to four patients. Patient monitoring parameters included subjective complaints, hemodynamic, analysis tolerance

of intake, laboratory tests, anthropometric, fluid balance and functional capacity.

Results: During the monitoring period in the hospital four patients showed clinical improvement, increased tolerance of intake, improved electrolyte levels and increased functional capacity.

Conclusion:Adequate medical nutrition therapy can improve the clinical condition of patients with acute decompensated heart failure due to old myocardial infarction."

"ABSTRAKLatar belakang: Luka bakar merupakan suatu trauma yang menyebabkan kerusakan dan kehilangan jaringan karena kontak dengan objek bersuhu tinggi. Kondisi tersebut memicu respons inflamasi lokal dan sistemik yang memicu komplikasi. Hipermetabolisme dan hiperkatabolisme yang terjadi memerlukan tatalaksana nutrisi adekuat untuk menurunkan respons inflamasi, mencegah wasting otot, meningkatkan imunitas, dan mempercepat penyembuhan luka.Metode: Empat pasien dalam serial kasus ini mengalami luka bakar berat karena api dengan berbagai pencetus. Dua pasien dalam serial kasus ini masuk perawatan lebih dari 24 jam pasca kejadian. Status nutrisi pasien obes derajat II 1 pasien dan obes derajat I 3 pasien . Target energi menggunakan metode Xie dan Harris ndash;Benedict dengan berat badan sebelum sakit. Pemberian nutrisi diberikan sesuai dengan rekomendasi untuk sakit kritis fase akut 20 ndash;25 kkal/kg BB. Nutrisi dini dilakukan pada dua pasien yang datang kurang dari 24 jam pasca kejadian. Nutrisi diberikan melalui jalur enteral dengan metode drip intermittent. Tatalaksana nutrisi selanjutnya disesuaikan dengan toleransi dan kondisi klinis yang dialami pasien.Hasil: Tiga pasien meninggal selama perawatan karena komplikasi sepsis Tatalaksana nutrisi dinaikkan bertahap sesuai kondisi klinis pasien. Pasien kasus keempat mengalami perbaikan dengan luas luka bakar 48,5 menjadi 11,5 dan peningkatan kapasitas fungsional, walaupun terjadi penurunan berat badan hingga 12 kg selama perawatan.Kesimpulan: Tatalaksana nutrisi yang adekuat dengan memperhatikan kondisi klinis serta parameter penunjang lainnya dapat menunjang proses penyembuhan luka serta menurunkan laju morbiditas dan mortalitas pada pasien luka bakar. Kata kunci: luka bakar berat, tatalaksana nutrisi.

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ABSTRACT

Background Burn injury is a trauma that caused damage and tissue loss due to contact with high temperature objects. That conditions will initiated local and systemic inflammatory reaction, which trigger complications after burn injury. Adequate nutrition management is needed in hypermetabolic and hypercatabolic condition to decrease the inflammatory response, prevents muscle wasting, improve immunity and wound healing.

Methods Four patients in this case series suffered from burn injury by fire with various origins. Two patients in this case series were treated more than 24 hours after trauma. Patients nutritional status were obese grade II 1 patient and grade I 3 patients. Energy requirement was measured by using Xie and Harris Benedict equations, with usual body weight. Nutrition was given base on recommendation for critically ill in acute phase, 20 ndash 25 kcal kg BW. Enteral nutrition was initiated for two patients who came less than 24 hours post burn, using intermittent drip method. The nutrition was adjusted daily depend on their clinical condition.

Results Three patients died during treatments for septic complications. Nutrients management gradually increase in accordance to clinical conditions. Patient in 4th cases experienced improvement with burn area decreased from 48,5 to 11,5 , also increasing on functional capacity, despite of weight loss up to 12 kg during treatment.

Conclusion Adequate nutritional management based on clinical conditions not only to reduce morbidity and mortality in burn patients, but also lead to improve healing process.. Keywords severe burn, nutrition management."

"Dukungan nutrisi bertujuan memperbaiki status gizi dan prognosis pasien bedah dengan status gizi malnutrisi Pasien yang menjalani pembedahan traktus gastrointestinal GI merupakan kelompok pasien berisiko tinggi mengalami malnutrisi Dilaporkan bahwa terdapat hubungan positif antara malnutrisi dengan morbiditas dan mortalitas pasca bedah lama perawatan RS re admisi RS kebutuhan pembedahan sekunder dan diagnosis atau terapi Serial kasus ini terdiri dari empat kasus dukungan nutrisi perioperatif pada pasien malnutrisi dengan berbagai indikasi pembedahan GI dan komorbid yang berbeda Pasien pada serial kasus ini berusia antara 45 hingga 70 tahun Seluruh pasien menjalani pembedahan mayor abdominal atas indikasi kanker GI Status gizi pasien adalah malnutrisi ringan hingga sedang Terapi nutrisi diberikan berdasarkan kebutuhan dan kondisi klinis pasien Kebutuhan energi basal dihitung menggunakan persamaan Harris Benedict Pemberian energi dimulai dari kebutuhan energi basal dan ditingkatkan bertahap hingga mencapai kebutuhan energi total Lama perawatan RS pada pasien ini antara 19 hingga 43 hari Monitoring yang dilakukan meliputi toleransi asupan kapasitas fungsional imbang cairan data antropometri dan laboratorium serta dilakukan edukasi dan konseling nutrisi setiap hari Secara umum pasien mengalami peningkatan kondisi umum status gizi toleransi asupan Periode perioperatif mempengaruhi toleransi pasien terhadap asupan makanan dan status GI Terapi nutrisi pada pasien bedah harus dilakukan secara individual sebagai bagian integral tata laksana pembedahan Dukungan nutrisi harus dilakukan pada periode pra intra dan pasca bedah untuk menyediakan nutrien yang adekuat agar dapat mengatasi perubahan metabolik pada pasien Dukungan nutrisi yang baik pada pasien bedah terutama dengan malnutrisi dapat memperbaiki prognosis pasca bedah dan akan meningkatkan kualitas hidup pasien.

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The aim of nutritional support is to improve nutritional status and clinical outcome in severely malnourished patients Patients who undergone gastrointestinal surgery constitute as important risk group for malnutrition It has been reported that there is a positive correlation between malnutrition and postoperative morbidity and mortality prolonged hospital stays re admissions secondary operation requirement and diagnosis treatment This case series consisted of four cases of periopertive nutrition support in malnutrition patients with different surgical indication and comorbidities The patients in this case series aged between 45 to 70 years old All patients undergoing major abdominal surgery for gastrointestinal cancer Patients have nutritional status ranged from mild nutrition to moderate malnutrition Nutritional therapy was given according to patients needs and clinical condition The basal energy requirement was calculated using the Harris Benedict equation The intake was given begin with basal energy expenditure and gradually increased to the total energy expenditure Monitoring includes food intake tolerance functional capacity fluid balance anthropometric and laboratory data The nutrition education and counseling was conducted everyday In general all the patients show improvement during monitoring The perioperative periode influenced patients tolerance to food intake and gastrointestinal status Nutrition therapy in surgical patient should be done individually as part of integrated therapy in surgical treatment The nutritional support was done in pre intra and post surgery to provide adekuat nutrient to blunt metabolic changes in this patients Each period of perioperative nutrition support have different function and procedure Good nutritional support in surgical patients specially with malnutrition will improved outcome of the surgery and eventually improved quality of life."