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"Latar Belakang: Psoriasis merupakan penyakit inflamasi kronik yang dimediasi sistem imun, menyebabkan lesi kulit dan dapat mengenai sendi. Kondisi inflamasi sistemik meningkatkan risiko berbagai non-transmissible chronic disease dan menyebabkan kehilangan nutrien akibat hiperproliferasi dan deskuamasi epidermis, sehingga dapat menurunkan kualitas hidup. Terapi medik gizi dengan menjaga indeks massa tubuh dalam rentangan normal dan memenuhi kebutuhan vitamin A, E, C, D, dan asam folat, serta pemberian asam lemak omega-3 dapat menurunkan stres oksidatif dan inflamasi. Terapi diet, pengaturan aktivitas fisik, dan modulasi respons inflamasi sistemik menjadi tujuan terapi yang penting dan terintegrasi. Kasus: Pasien psoriasis berbagai tipe dengan penyulit, terdiri atas 3 orang laki-laki dan seorang perempuan, rentangan usia 28–64 tahun. Pasien pertama dengan SIDA, artritis dan hipoalbuminemia, pasien ke-2 hipoalbuminemia, pasien ke-3 artritis, dan pasien ke-4 dengan obesitas. Terapi medik gizi yang diberikan meliputi diet cukup energi, protein tinggi, dan lemak sedang sesuai kodisi pasien, serta beberapa vitamin. Pemantauan dilakukan minimal selama 6 hari meliputi keluhan subjektif, keluaran klinis, hasil laboratorium, antropometri, kapasitas fungsional, dan analisis asupan 24 jam. Nutrisi ditingkatkan bertahap sesuai keluaran klinis dan toleransi. Mikronutrien yang dapat diberikan adalah vitamin B kompleks, C, dan asam folat. Semua pasien mendapat edukasi gizi. Hasil: Asupan energi keempat pasien dapat meningkat bertahap hingga mencapai KET saat pulang. Peningkatan kadar albumin tanpa koreksi infus albumin terjadi pada 2 pasien, penurunan albumin pada 1 pasien, dan pada 1 pasien tidak dilakukan pemeriksaan ulang. Kapasitas fungsional semua pasien mengalami perbaikan saat pulang. Tidak terjadi perubahan berat badan pada 3 pasien, namun 1 pasien mengalami penurunan selama dirawat. Kesimpulan: Terapi medik gizi yang adekuat menunjang proses penyembuhan, serta memperbaiki parameter laboratorium dan kapasitas fungsional.

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Background: Psoriasis is a chronic inflammatory disease mediated by the immune system causing skin lesions and may also affect the joints. Systemic inflammatory conditions increase the risk of various non-transmissible chronic diseases, loss of nutrients through hyperproliferation and desquamation of the epidermis that may reduce quality of life. Medical therapy in nutrition by maintaining body mass index within normal range and fulfillment the requirement of vitamins A, E, C, D, and folic acid, and supplementation of omega-3 fatty acids can reduce oxidative stress and inflammation. Dietary therapy, management of physical activity, and modulation of systemic inflammatory responses are the important and integrated therapeutic goals.

Case: Psoriasis patients of various types and complications with the range of age 28–64-years-old, consist of 3 males and 1 female. The first patient with HIV-AIDS arthritis and hypoalbuminemia, the second with hypoalbuminemia, the third with arthritis, and the fourth with obesity. The medical therapy in nutrition include diet that sufficient in energy, high protein, and moderate fat corresponding to the patients’ condition with supplementation of some vitamins. Monitoring was carried out for at least 6 days that include subjective complaints, clinical outcomes, laboratory results, anthropometric, functional capacity and 24-hour dietary intake analysis. Nutritional intake was gradually increased according to the clinical outcomes and tolerance. Micronutrients that can be given were vitamins B complex, C, and folic acid. All patients received nutrition education.

Results: Nutritional intake of all patients increased gradually and achieved the total energy requirement before discharged from the hospital. There were increased of albumin levels without albumin infusion in 2 patients, decreased in 1 patient, and no albumin levels’ reexamination in 1 patient. Functional capacity improved in all patients before discharged from the hospital. There were no changes in the body weight of 3 patients. However, 1 patient experienced decreased of body weight during hospotalisation.

Conclusion: Adequate medical therapy in nutrition supports the healing process, and improves laboratory parameters and functional capacity."

"Kaki diabetik merupakan komplikasi pada diabetes melitus (DM) tipe 2 tersering yang menyebabkan pasien menjalankan perawatan di rumah sakit. Penyulit lain pada DM tipe 2 berkontribusi terhadap peningkatan morbiditas dan mortalitas pasien. Terapi medik gizi pada pasien DM tipe 2 dan kaki diabetik dengan berbagai penyulit berperan penting dalam kontrol glikemik, mencegah perburukan status gizi, serta perbaikan penyembuhan luka. Serial kasus ini melibatkan empat pasien DM tipe 2 dan kaki diabetik dengan berbagai penyulit yang diberikan terapi medik gizi berupa asupan energi, makronutrien, mikronutrien, nutrien spesifik, dan edukasi gaya hidup. Pasien dilakukan pemantauan selama 19 hari sesuai fase proliferasi penyembuhan luka. Satu pasien dengan ketoasidosis diabetikum, satu pasien dengan hipertensi, dan dua pasien dengan diabetic kidney disease. Kontrol glikemik keempat pasien tercapai pada akhir perawatan di rumah sakit dan tidak didapatkan penurunan berat badan yang bermakna selama masa pemantauan. Penyembuhan luka berupa luka mengering, edema berkurang, dan timbulnya jaringan granulasi didapatkan pada tiga diantara empat pasien. Satu pasien tidak didapatkan penyembuhan luka yang signifikan karena adanya stenosis multipel pembuluh darah arteri di tungkai kiri. Terapi medik gizi pada pasien DM tipe 2 dan kaki diabetik dengan berbagai penyulit berperan pada perbaikan kontrol glikemik, mencegah perburukan status gizi, dan penyembuhan luka.

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The most common cause of complication and hospitalization in type 2 diabetes mellitus (T2DM) patients are those associated with diabetic foot (DF). Complication of T2DM contribute to increasing morbidity and mortality. Medical nutrition therapy in patients with T2DM and DF with various complication plays an important role in management of glycemic control, worsening nutritional status, and repair wound healing. This case series include four patients T2DM and DF with various complication that given nutritional medical therapy consisting of energy intake, macronutrients, micronutrients, spesific nutrient, and healthy lifestyle education. Patients was monitored for 19 days according to the proliferation phase of wound healing. One patient with diabetic ketoacidosis, one patient with hypertension, and two patients with diabetic kidney disease. All patients got glycemic control during hospitalization. No significant weight loss was observed during monitoring period. Wounds in three of the four patients appeared to heal with dry wound, reduced edema, and formation of granulation tissue. One patient found insignificant wound healing due to multiple arterial stenosis in the left leg. Medical nutrition therapy with type 2 diabetes and diabetic foot with various complications plays an important role in management of glycemic control, preventing worsening nutritional status, and repair wound healing."

"Latar Belakang: Diabetes melitus DM merupakan penyakit epidemik yang mengalami peningkatan dari tahun ke tahun di seluruh dunia. Jumlah penderita DM ini diperkirakan akan mencapai 552 juta orang pada tahun 2030. Kadar glukosa darah KGD yang tidak terkontrol merupakan penyebab terjadinya komplikasi makrovaskuler dan mikrovaskuler sehingga meningkatkan angka morbiditas, mortalitas dan lama rawat inap. Terapi medik gizi klinik adekuat dan sesuai dengan kondisi klinis pasien dapat mencegah, memperlambat dan memperbaiki komplikasi akibat DM. Metode: Pasien serial kasus dengan diagnosis DM tipe 2 disertai berbagai komplikasi, berusia 48 ndash;71 tahun. Satu dari empat pasien mendapatkan nutrisi melalui nasogastric tube NGT , dan sisanya melalui oral. Terapi medik gizi diberikan pada keempat pasien sesuai dengan kondisi klinis masing-masing. Pemberian karbohidrat disesuaikan dengan kebutuhan pasien dan dosis insulin yang diperoleh pasien. Pemberian protein disesuaikan dengan fungsi ginjal masing-masing pasien. Hasil : Keempat pasien mengalami perbaikan keadaan klinis antara lain luka pada kaki, sesak napas hilang, edema dan asites berkurang, ureum dan kreatinin membaik. Kasus pertama, kedua dan keempat mengalami perbaikan pada kadar glukosa darah, sedangkan kasus ketiga KGD masih tetap tinggi pada saat keluar dari RS. Keempat pasien pulang ke rumah dengan kondisi membaik. Kesimpulan: Terapi medik gizi klinik yang adekuat untuk mengontrol KGD dapat membantu memperbaiki keadaan klinis dan mencegah perburukan pada pasien DM tipe 2 dengan berbagai komplikasi.

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Background: Diabetes mellitus DM is an epidemic disease that is increasing year by year around the world. The number of DM patients is estimated 552 million people by 2030. Uncontrolled blood glucose level is one of the cause of macrovascular and microvascular complications that may increase morbidity, mortality and length of hospitalization. An adequate nutrition therapy in accordance with the clinical condition of the patient may help to prevent, delay and improve the complications due to DM.

Methods:All patients in these case series were diagnosed with type 2 DM accompanied by various complications, aged 48-71 years. One in four patients was administered nutrition through tube feeding, and the rest through oral. Nutrition therapy was given to all patients according to their clinical conditions. Carbohydrate was adjusted to the patient 39;s needs and the dose of insulin obtained by the patient. Protein administration was adjusted for each patient 39;s renal function.

Result:Four patients experience of improving of clinical conditions, such as breathlessness, reduced edema and ascites, decreased urea and creatinine levels. The first, second and fourth cases improve in blood glucose levels, while the third case remains to have high blood glucose level at the time of discharge. While all patients discharge from hospital with better condition.

Conclusion: An adequate clinical nutrition therapy to improve glycemic control is needed to improve clinical conditions and prevent deterioration in patients with type 2 DM with various complications. "

"Sekitar 15-20% pasien poliklinik dan unit gawat darurat datang dengan masalah sawar kulit seperti pemfigus, toxic epidermal necrolysis (TEN), dan eritroderma. Masalah nutrisi terjadi pada penyakit sawar kulit melalui beberapa hal, yaitu kondisi hipermetabolisme sedang sampai berat, masalah pemenuhan nutrisi, kehilangan protein dari lesi kulit, dan efek samping metabolik akibat terapi steroid dosis tinggi jangka panjang. Empat pasien serial kasus dengan diagnosis pemfigus, TEN, dan eritroderma dengan masing-masing kondisi penyerta seperti gangguan hati, obesitas, DM tipe lain dan sepsis. Terapi medik gizi diberikan berdasarkan kondisi klinis, toleransi asupan, dan hasil laboratorium pasien. Target pemberian nutrisi dihitung menggunakan Harris Benedict dengan tambahan faktor stress 1,3-1,5. Diberikan nutrisi dengan komposisi seimbang, terdiri atas protein 1,32 g/kg BB ideal/hari, lemak 2530%, dan karbohidrat 4565%. Mikronutrien yang diberikan berupa vitamin B kompleks 3x1, asam folat 1x1 mg, vitamin A 12.000 IU, vitamin C 500-1000 mg, dan seng 2x20 mg. dari monitoring dan evaluasi dilaporkan bahwa pemberian mikronutrien pada penyakit sawar kulit dapat meningkatkan penyembuhan luka dan menurunkan risiko metabolik. Dari empat pasien serial kasus ini, didapatkan satu kasus mortalitas yaitu pada pasien dengan penyulit sepsis. Ketiga pasien kasus lainnya mengalami perbaikan kondisi klinis, penyembuhan luka baik, tidak ada infeksi dan komplikasi selama perawatan, kontrol glikemik baik, perbaikan kapasitas fungsional, dan lama rawat pasien lebih singkat. Ketiga pasien dipulangkan untuk rawat jalan. Terapi medik gizi yang optimal dapat memerbaiki luaran klinis serta menurunkan angka morbiditas dan mortalitas pasien pemfigus, TEN, eritroderma tanpa penyulit metabolik

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One in five to six patients at the polyclinic and emergency department present with skin barrier problems such as pemphigus, toxic epidermal necrolysis (TEN), and erythroderma. Nutritional problems occur in skin barrier disease through several things, namely moderate to severe hypermetabolic conditions, problems with nutritional compliance, loss of protein from skin lesions, and metabolic side effects due to long-term high dose steroid therapy. Three case series patients with pemphigus, TEN with hepatic complications, and erythroderma with obese nutritional status I and one case of pemphigus complicating sepsis and other types of DM. Nutritional medical therapy is given based on the clinical condition, intake tolerance, and laboratory results of the patient. The target of nutrition intake is calculated using Harris Benedict with a stress factor of 1.3-1.5, with a balanced composition, consisting of protein 1.3-2 g / kg ideal body weight / day, 25-30% fat, and 45-65% carbihydrates. The micronutrients were given in the form of 3x1 vitamin B complex, 1x1 mg folic acid, 12,000 IU vitamin A, 500-1000 mg vitamin C, and 2x20 mg zinc. Administration of micronutrients in skin barrier disease can improve wound healing and reduce metabolic risk. In four case series patients, there was one case mortality in a patient with complicated sepsis. The others had improved clinical conditions, good wound healing, no infection and complications during treatment, good glycemic control, improved functional capacity, and shorter patient length of stay. The three patients were discharged for outpatient care. Optimal nutritional medical therapy can improve clinical outcomes and reduce morbidity and mortality in patients with pemphigus, TEN, erythroderma without metabolic complications"

"Latar Belakang: Stroke iskemia merupakan disfungsi neurologik area tertentu atau menyeluruh akibat gangguan aliran darah ke otak yang dapat menyebabkan kerusakan jaringan. Berbagai faktor risiko yang tidak dapat dimodifikasi dan dapat dimodifikasi seperti usia, jenis kelamin, riwayat keluarga, hipertensi, diabetes melitus, obesitas berperan menyebabkan pembentukan aterosklerosis, iskemia serebral selanjutnya menyebabkan stroke iskemia. Stroke iskemia dan sejumlah penyulit akan menimbulkan defisit neurologi yang menyebabkan malnutrisi, dehidrasi, keluaran yang buruk dan kualitas hidup menurun. Terapi medik gizi klinis berperan memberi nutrisi optimal, membatasai natrium, mengontrol glukosa darah dan memperhatikan volume cairan yang diberikan sehingga status nutrisi tetap terjaga, memperbaiki keluaran, dan mencegah rekurensi. Metode: Serial kasus ini memaparkan empat kasus stroke iskemia pada pasien perempuan dan laki-laki dengan rentang usia 53 ndash;66 tahun, dengan penyulit seperti disfagia, perdarahan GIT dan pneumonia, disertai komorbiditas yaitu DM tipe 2, hipertensi, dan chronic kidney disease,. Keempat pasien membutuhkan dukungan nutrisi akibat komplikasi stroke iskemia yaitu disfagia dengan risiko terjadinya malnutrisi, dehidrasi dan ketidakseimbangan elektrolit. Satu pasien dengan berat badan normal, 1 pasien BB lebih, dan 2 pasien obes I. Masalah nutrisi yang dihadapi keempat pasien ini adalah asupan makro dan mikronutrien yang tidak optimal, jalur pemberian nutrisi, kebutuhan nutrisi yang tidak terpenuhi selama sakit, anemia, hiperglikemia, dislipidemia, gangguan fungsi ginjal dan keseimbangan cairan. Terapi medik gizi klinik diberikan sesuai rekomendasi stroke iskemia dan disesuaikan dengan komorbidnya. Pemantauan pasien meliputi keadaan umum, hemodinamik, analisis dan toleransi asupan, monitoring terhadap kadar glukosa darah, fungsi ginjal, keseimbangan cairan, elektrolit dan kapasitas fungsional. Hasil :Ketiga pasien pada serial kasus menunjukkan perbaikan klinis, berupa tekanan darah terkontrol, kadar glukosa darah terkontrol, dan kapasitas fungsional yang membaik. Satu pasien meninggal pada hari perawatan ke-35 akibat sepsis. Kesimpulan:Terapi medik gizi klinik yang optimal dapat memperbaiki kondisi klinis pada pasien stroke iskemia dengan DM tipe 2 dan penyulitnya.

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Background: Ischemic stroke is a partial or comprehensive neurological disfunction caused by cerebral blood flow disturbance as basis of tissue damages. A diversity of non modified and modified risk factors such as age, sex, family history, hypertension, diabetes mellitus, and obesity act as underlying causes to atherosclerosis, ischemia cerebral, that lead to ischemic stroke. Ischemic stroke with accompanying comorbidity will inflict neurological deficit causing malnutrition, dehydration, bad outcome and the diminution quality of life. The role of nutritional medical therapy is pivotal for optimal nutritional support, sodium intake restriction, and glycemic control with the goal to maintain nutrition status, improve outcome and prevent recurrence.

Methods: The case series describes four ischemic stroke cases with complications such as dysphagia, gastrointestinal bleeding, and pneumonia, and aggravated by DM type II, hypertension, and chronic kidney disease comorbidity, in males and females aged 53 ndash 66 years old. Due to risk of malnutrition, dehydration and electrolyte imbalance caused by dysphagia, nutrition support was required by all patients to treat this ischemic stroke complication. One patient was normoweight, while three other cases included one overweight and two obese I patients. The nutritional problems faced by these four patients laid on the non optimal macro and micro nutrient intake, route of nutrient intake, nutrition composition imbalance during ill period, anaemia, hyperglycaemia, dyslipidemia, decrease of renal function, and fluid imbalance. Nutritional medical therapy was given according to recommendations for ischemic stroke and adjusted with its comorbidity. Patients rsquo monitoring was done including their general condition, hemodynamic, intake analysis and tolerance, monitoring in blood glucose, kidney function, fluid balance, electrolyte and functional capacity.

Result: Three patients in the case series showed positive changes in clinical conditions, shown by improvement in blood pressure, blood glucose, and functional capacity. One patient died on the 35th treatment day due of sepsis.

Conclusion: Optimal nutritional medical therapy plays important role in improving clinical conditions of ischemic stroke patient with DM type 2 and other complications."

"Latar Belakang: Gagal napas merupakan suatu sindrom pada sistem pernapasan yang gagal dalam fungsi pertukaran gas, sehingga menyebabkan hipoksemia dan/atau hiperkapnia. Pasien dengan gagal napas sangat memerlukan penggunaan ventilator mekanik. Terdapat hubungan antara malnutrisi dengan gagal napas. Terapi medik gizi pasien sakit kritis berupa nutrisi enteral dini dapat menjadi strategi terapi yang dapat mengurangi ketergantungan pada ventilator, mengurangi komplikasi, menurunkan lama rawat di ICU dan meningkatkan keluaran klinis pasien.Metode: Serial kasus ini melaporkan empat pasien sakit kritis dengan gagal napas yang dirawat di ICU RSUPNCM. Terapi medik gizi diberikan sesuai pedoman pada sakit kritis. Nutrisi enteral dini diberikan dalam 48 jam perawatan di ICU. Tiga pasien dapat mencapai target energi 25-30 kkal/kg BB, dan minimal protein 1,2 g/kg BB, sedangkan 1 pasien dengan obes I hanya dapat mencapai energi <70% dari kebutuhan energi total dan protein 0,6 g/kg BB. Mikronutrien diberikan dalam makanan cair. Volume makanan cair yang diberikan disesuaikan dengan imbang cairan pasien setiap hari.Hasil: Pasien pada serial kasus ini berusia 44-67 tahun, semua adalah laki-laki. Satu pasien dengan status gizi malnutrisi ringan, 2 pasien berat badan normal dan 1 pasien dengan obes 1. Dua dari empat pasien termasuk gagal napas tipe I akibat gagal jantung kongestif dengan edema paru. Dua pasien lainnya termasuk gagal napas tipe II akibat fasitis nekrotikan. Seluruh pasien mendapatkan nutrisi enteral dalam 48 jam pertama perawatan. Satu pasien dengan malnutrisi ringan, dan hipoalbuminemia berat mengalami perawatan >21 hari karena sulit weaningventilator dan masuk sebagai chronically crtically ill sedangkan tiga lainnya dengan BB normal dan obes mengalami <21 hari perawatan.Kesimpulan: Status gizi memengaruhi lama pemakaian ventilator mekanik. Terapi medik gizi dapat diterapkan pada semua pasien sesuai dengan komorbid dan dapat mendukung perbaikan keluaran klinis pasien.

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Background: Respiratory failure is a respiratory system syndrome of inadequate gas exchange, resulting hypoxemia and/or hypercapnia. Respiratory failure patient needs mechanical ventilation as the main therapy. Malnutrition and respiratory failure are related. Early enteral nutrition is a therapeutic strategy that can reduce dependence on mechanical ventilation, complications, length of stay in ICU and improve clinical outcomes in critically ill respiratory failure patients.

Methode: This case series report four critically ill patients with respiratory failure from the ICU of Cipto Mangunkusumo Hospital. Medical nutrition therapy is implemented according to the ESPEN clinical nutrition guideline in critically ill. Early enteral nutrition is given in 48 hours of ICU care. Three patients can reach the energy target of 25-30 kcal/kg ABW, and a minimum of 1.2 g/kg ABW protein, whereas 1 obese patient can only achieved <70% of estimated TEE and protein needs of 0.6 g/kg IBW. Micronutrients given within enteral formula. The volume of enteral nutrition is adjusted to patient's fluid balance every day.

Result: Patients were 44-67 years old, all males. One patient was with mild malnutrition, 2 patients were in normal weight and 1 patient was obese I. Two of them were diagnosed as respiratory failure type I due to congestive heart failure with pulmonary edema. The two others were respiratory failure type II due to necrotizing fasciitis. All patients received early enteral nutrition within 48 hours. One patient with malnutrition and severe hypoalbuminemia stayed for >21 days in ICU for mechanical ventilation need, and become a chronically crtically ill while others are <21 days.

Conclusion: Nutritional status affects mechanical ventilation dependence. Medical nutrition therapy can be applied to all patients according to their comorbidities and can improve clinical outcomes. "

"Latar Belakang: Tuberkulosis Paru (TB Paru) merupakan penyakit infeksi yang bersifat kronis dengan tingkat morbiditas dan mortalitas yang tinggi. Perubahan metabolisme akibat infeksi Mycobacterium Tuberkulosa(M.TB) dan aktivasi sistem neurohormal turut berperan terhadap terjadinya malnutrisi, yang dapat memberikan efek negatif terhadap prognosis pasien dengan TB Paru. Penderita TB Paru mengalami penurunan kapasitas fungsional dan kualitas hidup. Terapi Medik Gizi sejak awal diagnosis ditegakkan, akan mendukung proses pemulihan pasien TB.Kasus :Dalam serial kasus ini, dipaparkan empat kasus pasien TB Paru dengan berbagai faktor risiko, diantaranya adalah penyakit TB Paru, TB Miliar, PPOK et causa TB Paru, Meningitis TB. Pada awal pemeriksaan didapatkan adanya defisiensi asupan makronutrien dan mikronutrien, hipoalbuminemia, CRP yang meningkat, hemoglobin (Hb) yang turun, penurunan kapasitas fungsional dan kualitas hidup. Terapi medik gizi diberikan secara individual, sesuai dengan kondisi klinis, hasil pemeriksaan laboratorium, dan analisis asupan makan terakhir. Hasil:Tiga dari empat pasien mengalami peningkatan asupan, perbaikan kondisi klinis, dan kapasitas fungsional serta kualitas hidup pasien. Status nutrisi pasien tidak mengalami perburukan selama perawatan,Kesimpulan:Terapi Medik gizi yang adekuat pada pasien TB dapat mempertahankan status nutrisi pasien dan mendukung perbaikan kondisi klinis, kapasitas fungsional, serta kualitas hidup pasien.

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Background:

Pulmonary tuberculosis (pulmonary TB) is a chronic infectious disease with high morbidity and mortality. Changes in metabolism due to infection with Mycobacterium Tuberculosis and activation of the neurohormal system contribute to the occurrence of malnutrition, which can have a negative effect on the prognosis of patients with pulmonary TB. Patients with pulmonary TB have decreased functional capacity and quality of life.Early medical nutrition therapywill support the recovery process of pulmonary TB patients.

Case :

In this case series, four cases of pulmonary TB patients were presented with various risk factors, including pulmonary TB disease, miliar TB, COPD et causa lung TB, and TB meningitis. Deficiency of macro and micronutrient intake, hypoalbuminemia, increased CRP, decreased hemoglobin (Hb), decreased functional capacity and quality of life were found at the beginning of examination. Nutrition medical therapy is given individually, according to clinical conditions, results of laboratory examinations, and analysis of recent food intake.

Result :

Three out of four patients experience increased intake, improvement of clinical conditions, functional capacity and quality of life. The nutritional status of patients did not experience worsening during treatment.

Conclusion:

Adequate nutritional medical therapy in TB patients can maintain patient nutritional status and support improvement of clinical conditions, functional capacity, and quality of life."

"Luka bakar berat dapat menyebabkan respons hipermetabolisme dan hiperkatabolisme persisten dan berkepanjangan. Pasien luka bakar yang dirawat di rumah sakit (RS) sering memiliki komorbid, seperti obesitas, diabetes melitus tipe 2 (DMT2), dan hipertensi. Inflamasi kronik akibat obesitas dan komorbid pada luka bakar berat berperan di dalam terjadinya fenomena second hit yang dapat memperberat respons hipermetabolisme. Terapi medik gizi pada pasien luka bakar berat dengan obesitas dan penyulit metabolik bertujuan untuk mencegah penurunan berat badan, mempertahankan massa otot, mengurangi respons hipermetabolisme, menjaga kontrol glikemik dan tekanan darah, meningkatkan sistem imun, membantu penyembuhan luka, memerbaiki kapasitas fungsional, sehingga meningkatkan luaran klinis serta menurunkan risiko morbiditas dan mortalitas. Empat pasien serial kasus dengan luka bakar berat, derajat II-III, 29-38% luas permukaan tubuh (LPT), disebabkan oleh api dan listrik, memiliki status obes I serta komorbid DMT2 dan hipertensi. Terapi medik gizi pada pasien diawali dengan nutrisi enteral dini dalam waktu 24 jam pertama pasca luka bakar, sesuai dengan rekomendasi The European Society for Clinical Nutrition and Metabolism (ESPEN) serta Society of Critical Care Medicine (SCCM) dan American Society for Parenteral and Enteral Nutrition (ASPEN). Terapi medik gizi berdasarkan rekomendasi tersebut disesuaikan kondisi klinis, toleransi asupan, dan hasil laboratorium pasien. Target pemberian nutrisi menggunakan formula Xie, dengan komposisi seimbang, terdiri atas protein 1,5-2 g/kg BB ideal/hari, lemak 25-30%, dan karbohidrat 45-65%. Mikronutrien yang diberikan berupa vitamin B kompleks 3x1, asam folat 1x1 mg, vitamin C 2x250 mg, dan seng 1x20 mg. Keempat pasien serial kasus mengalami perbaikan kondisi klinis, penyembuhan luka baik, tidak ada infeksi dan komplikasi selama perawatan, tekanan darah dan kontrol glikemik baik, penurunan BB<10%, perbaikan kapasitas fungsional, dan lama rawat pasien lebih singkat. Keempat pasien dipulangkan untuk rawat jalan.Terapi medik gizi yang optimal dapat memerbaiki luaran klinis serta menurunkan angka morbiditas dan mortalitas pasien luka bakar berat dengan obesitas dan penyulit metabolik.

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Severe burn injury can cause a persistent and prolonged hypermetabolism and hypercabolism response. Severe burn injury patients treated in hospitals generally have comorbidities, such as obesity, DMT2, and hypertension. Chronic inflammation due to obesity and comorbidities in severe burn injury contributes to a second hit phenomenon in terms of augmenting the hypermetabolic response. Medical nutrition therapy in severe burn injury patient with obesity and metabolic disease is required in order to prevent weight loss, maintain muscle mass, reduce hypermetabolism response, maintain glycemic control and blood pressure, improve the immune system, help wound healing, improve functional capacity, therefore increasing clinical outcome and reduce the risk of morbidity and mortality. The case series consists of four patients with severe burn injury, degree II−III, 29−38% total body surface area, caused by fire and electricity, nutritional status obese I with DMT2 and hypertension. Medical nutrition therapy was initiated with early enteral nutrition within the first 24 hours after burn injury, according to ESPEN, SCCM and ASPEN recommendations and also adjusted based on clinical conditions, nutritional tolerance, and laboratory results. The nutrition target was calculated using Xie formula, with a balanced composition, consists of protein 1.5−2 g/kg ideal body weight/day, fat 25−30%, and carbohydrate 45−65%. Micronutrients supplementation given to these patients includes vitamin B complex 3x1 tablets, folic acid 1x1 mg, vitamin C 2x250 mg, and zinc 1x20 mg. Four patients had improvement in clinical condition and wound healing, no infections and complications during treatment, controlled blood pressure and glycemic, decreased body weight <10%, improvement in functional capacity, and shortened length of hospital stay. All four patients were discharged for outpatient care. Optimal medical nutrition therapy can improve clinical outcomes and reduce the morbidity and mortality rates in severe burn injury patients with obesity and metabolic disease."

"[ABSTRAK Latar belakang: Intestinal failure (IF) merupakan masalah pascabedah denganoutcome yang buruk. Saat ini telah terdapat rekomendasi terapi gizi pada IFberdasarkan etiologinya, namun belum ada laporan serial kasus yang memaparkanaplikasinya.Presentasi Kasus: Pasien dalam serial kasus ini terdiri dari 3 perempuan dan 1laki-laki, berusia 21?42 tahun. Terhadap pasien ditegakkan diagnosis IF denganberbagai etiologi, yaitu 3 pasien dengan fistula enterokutan (FEK) dan 1 pasiendengan short bowel syndrome (SBS) end jejunostomy. Terapi gizi pada pasien IFberdasarkan etiologinya. Pada pasien FEK high output, kebutuhan energi 1,5?2kali resting energy requirement (RER) atau 37?45 kkal/kg BB/hari, protein 1,5?2g/kg BB/hari. Pada FEK low output kebutuhan energi 1?1,5 kali KEB (25?30kkal/kg BB/hari), protein 1?1,5 g/kg BB/hari. Pada pasien FEK yang mendapatterapi konservatif, didapat outcome peningkatan kadar albumin serum dan beratbadan, serta produksi fistel yang berkurang. Pasien FEK dengan persiapanrekonstruksi usus halus terdapat perbaikan keadaan umum dan peningkatan kadaralbumin serum. Pada pasien SBS, terkait kondisi pascabedah maka terapi gizisesuai rekomendasi Enhanced Recovery After Surgery (ERAS), dengankebutuhan energi 25?30 kkal/kg BB/hari dengan komposisi makronutrien yangseimbang. Pada pasien ini dilakukan distal feeding dan pengaturan laju tetesankimus untuk mencegah sindrom dumping. Pasien SBS didapat outcomepeningkatan kadar albumin dan berat badan selama masa perawatan. Kesimpulan: Terapi medik gizi klinik yang adekuat memberikan outcome yang baik pada pasien IF.ABSTRACT Background: Intestinal failure (IF) is a postoperative complication with poor

outcome. Nowadays, many of nutritional management recommendations based on

etiologies of IF, but no report about those application.

Case Presentation: Three female and one male patients were included in this case

series, aged 21?42 years old. Nutritional needs in IF patients are determined by

their etiologies. IF in this case series caused by enterocutaneous fistula (ECF)

and short bowel syndrome (SBS). Nutritional needs on ECF patients depend on

their fistula production. In patients with high output ECF, energy requirement is

in 1.5?2 resting energy requirement (RER) or 37?45 kcal/kg BW/day, protein

1,5?2 g/kg BW/day. In low output ECF, energy requirement is 1?1.5 RER or 25?

30 kcal/kg BW/day hari, protein 1?1.5 g/kg BW/day. In ECF patients given

conservative therapy, serum albumin and body weight increased, while the fistula

production decreased. In patients with preoperative of intestine reconstruction

surgery, there were improvement in general condition with the increase of serum

albumin. In SBS patients, related to the postoperative condition, energy was given

according to Enhanced Recovery after Surgery (ERAS) recommendation 25?30

kkal/kg BW/day with balance of macronutrient composition. In SBS end

jejunostomy patient the food was given through distal feeding with adjusted

chymus drip to prevent dumping syndrome. There were increased in serum

albumin and body weight of the patients.

Conclusion: Adequate support medical therapy of clinical nutrition in IF patients give good outcome. , Background: Intestinal failure (IF) is a postoperative complication with poor

outcome. Nowadays, many of nutritional management recommendations based on

etiologies of IF, but no report about those application.

Case Presentation: Three female and one male patients were included in this case

series, aged 21–42 years old. Nutritional needs in IF patients are determined by

their etiologies. IF in this case series caused by enterocutaneous fistula (ECF)

and short bowel syndrome (SBS). Nutritional needs on ECF patients depend on

their fistula production. In patients with high output ECF, energy requirement is

in 1.5–2 resting energy requirement (RER) or 37–45 kcal/kg BW/day, protein

1,5–2 g/kg BW/day. In low output ECF, energy requirement is 1–1.5 RER or 25–

30 kcal/kg BW/day hari, protein 1–1.5 g/kg BW/day. In ECF patients given

conservative therapy, serum albumin and body weight increased, while the fistula

production decreased. In patients with preoperative of intestine reconstruction

surgery, there were improvement in general condition with the increase of serum

albumin. In SBS patients, related to the postoperative condition, energy was given

according to Enhanced Recovery after Surgery (ERAS) recommendation 25–30

kkal/kg BW/day with balance of macronutrient composition. In SBS end

jejunostomy patient the food was given through distal feeding with adjusted

chymus drip to prevent dumping syndrome. There were increased in serum

albumin and body weight of the patients.

Conclusion: Adequate support medical therapy of clinical nutrition in IF patients give good outcome. ]"