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Eva Kurniawati
Tatalaksana nutrisi pasien luka bakar berat = Nutritional management in severe burned patients
"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.
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."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
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Tata laksana nutrisi pada pasien penyakit ginjal kronik dengan riwayat diabetes mellitus dan hipertensi = Nutrition management in ckd patient with dm and ht history
"[Pendahuluan:
Penyakit ginjal kronik (PGK) adalah kondisi hilangnya fungsi ginjal progresif dan ireversibel yang sangat mungkin mengancam jiwa pasien. Penyebab terbanyak PGK adalah diabetes mellitus (DM) dan hipertensi (HT) yang juga memiliki efek terhadap organ lain terutama jantung. Hal ini mengakibatkan disfungsi ginjal berat pada pasien seringkali ditemukan bersama dengan disfungsi jantung. Tata laksana nutrisi optimal diperlukan untuk mendapatkan hasil klinis yang baik.
Presentasi kasus:
Empat pasien perempuan, usia 49-67 tahun dengan riwayat DM dan HT, datang ke RS dengan keluhan sesak nafas, penurunan kesadaran, dan edema. Pasien didiagnosis dengan congestif heart failure (CHF), PGK (G5, G4, G4, dan G3), HT, DM tipe 2. Berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang didapatkan bahwa pasien berisiko malnutrisi, anemia, hiperuricemia, dan dislipidemia. Selama perawatan, pasien mendapatkan nutrisi secara bertahap sampai mencapai kebutuhan energi total, protein 0,8 g/kg BB, minyak ikan 2 g/hari, multivitamin, dan kalsium, disertai pembatasan asupan garam. Hasil pemantauan menunjukkan bahwa keempat pasien mengalami perbaikan klinis, namun tetap mengalami peningkatan kreatinin.
Kesimpulan:
Tata laksana nutrisi pasien PGK membutuhkan strategi pemberian nutrisi yang lebih komprehensif, tidak hanya dengan melakukan pembatasan asupan protein., Introduction:
Chronic kidney disease (CKD) is life threathening condition caused by lost of kidney function progressively and irreversibly. Diabetes Mellitus (DM) and hypertension (HT) are the most common etiology of CKD, which also have impact to other organs such as heart. It make clinical manifestation in CKD patients often found with heart dysfunction, named as cardiorenal syndrome. Optimal nutrition therapy is needed to achieve good clinical outcomes.
Case presentation:
Four female patients, ages 49-67 years old with history of DM and HT, came to hospital with chief complain dyspneu, decreased conciousness, and oedema anasarca. Patients had diagnose with CHF, PGK, anemia, DM, and HT. Data from anamnesis, physical, and laboratorium examination showed that all pasien have malnutrition risk, anemia, dyslipidemia, and hiperuricemia. During hospitalization, nutrition had given gradually to reach total energy needs, protein 0,8 g/kg BW, fish oil 2 g/day, multivitamin, calcium and salt restriction to recommended daily intake value. Monitoring result show that all patients have clinically improvement, but not creatinin level which act as marker of kidney damage.
Conclusion:
Nutrition management in CKD patients need comprehensif strategy, not only with restriction protein intake.]"
Fakultas Kedokteran Universitas Indonesia, 2014
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UI - Tugas Akhir  Universitas Indonesia Library
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Dian Permatasari
Tatalaksana nutrisi pada Tuberkulosis paru dengan infeksi Human Immunodeficiency Virus (HIV) dan Kaheksia = Nutrition management in pulmonary tuberculosis with HIV infection and cachexia
"ABSTRAK
Tuberkulosis (TB) merupakan penyebab utama penyakit dan kematian di dunia. Hubungan antara TB dan malnutrisi telah lama diketahui. Berkembangnya TB secara progresif menyebabkan wasting dan hilangnya massa otot, serta hipoalbuminemia yang juga terlihat pada infeksi human immunodeficiency virus (HIV). Koinfeksi TB/HIV menyebabkan peningkatan metabolisme, gangguan fisik, dan masalah nutrisi. Selain itu, adanya penyakit infeksi kronik seperti halnya TB paru dan HIV/AIDS disertai dengan penurunan BB dapat menyebabkan kaheksia. Serial kasus ini bertujuan untuk mempelajari dan menerapkan terapi nutrisi sebagai bagian dari tatalaksana TB paru, infeksi HIV, dan kaheksia. Seluruh pasien dalam serial kasus ini adalah pasien TB paru dengan malnutrisi berat dan kaheksia. Dua dari empat pasien disertai infeksi HIV. Pemberian nutrisi disesuaikan dengan kondisi, penyakit penyerta, dan kebutuhan yang bersifat individual. Kebutuhan energi basal dihitung dengan persamaan Harris-Benedict dengan kebutuhan energi total setara dengan 35?40 kkal/kg BB. Makronutrien diberikan dalam komposisi seimbang dengan protein 15?20% total kalori (1,5-2 g/kg BB). Suplementasi mikronutrien diberikan sesuai dengan angka kecukupan gizi. Nutrien spesifik berupa omega-3 dan asam amino rantai cabang (AARC) diberikan untuk memperbaiki kaheksia. Keluaran yang dinilai meliputi kondisi klinis, asupan, dan toleransi asupan. Dua dari empat pasien memberikan keluaran klinis lebih baik, namun peningkatan BB tidak signifikan.ABSTRACT Tuberculosis (TB) is a leading cause of illness and death of people globally. The association between TB and malnutrition has long been known. Progressive tuberculous disease results in wasting and loss of muscle mass and hypoalbuminaemia, which are also seen in HIV infection. Co-infection with HIV and TB poses an additional metabolic, physical, and nutritional burden. In addition, chronic infecton disease such as pulmonary TB and HIV/AIDS accompanied with weight loss leads to cachexia. The aim of this case series was to study and apply nutrition therapy as integral part of pulmonary TB, HIV infection and cachexia treatment. All patients in this reports with diagnosis of pulmonary TB with severe malnutrition and cachexia. Two of four patients diagnosed with HIV infection. Nutrition therapy was given individually according to the clinical condition and underlying disease. Harris-Benedict equation was used to calculate basal energy requirement with total energy requirement equivalent to 35?40 kcal/body weight. Balanced macronutrient composition was given with protein 15?20% of total requirement (1,5-2 g/body weight). Micronutrient recommendation was given to fulfill one fold recommended daily allowance. Omega-3 and branched-chain amino acid (BCAA) was given as specific nutrients to improved cachexia. Outcome measurements included clinical condition, intake analysis, and intake tolerance. Two of four patient had improved in clinical outcome but there was no significant difference in weight gain."
Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Tumalun, Victor Larry Eduard
Tatalaksana nutrisi pada pasien diabetes melitus tipe 2 dengan penyulit infeksi = Nutrition therapy in type 2 diabetes mellitus with comorbid infection
"Latar Belakang: Insidensi dan prevalensi diabetes melitus tipe 2 (DMT2) terus meningkat. Penurunan imunitas yang terjadi pada DMT2 dapat meningkatkan risiko infeksi. Kontrol gula darah yang baik bermanfaat dalam pengendalian infeksi dan pencegahan komplikasi makro dan mikrovaskuler tetapi penelitian yang melibatkan pasien DMT2 usia lanjut masih belum konklusif. Serial kasus ini dilakukan untuk melihat efektivitas kontrol gula darah terhadap kesintasan pasien DMT2 yang dirawat di rumah sakit, dan untuk implementasi tatalaksana nutrisi sesuai kebutuhan dan kondisi klinis pasien.
Metode: Pasien pada serial kasus ini berusia antara 47 ? 65 tahun. Penyulit infeksi pada keempat pasien ini yaitu gangren diabetikum, selulitis, dan sepsis dengan infeksi paru dan infeksi saluran kemih. Tatalaksana nutrisi pasien dilakukan sesuai dengan rekomendasi American Diabetes Association dan Therapeutic Lifestyle Changes disesuaikan dengan kondisi klinis dan toleransi pasien. Perhitungan kebutuhan nutrisi menggunakan rekomendasi untuk perawatan pasien sakit kritis bagi pasien yang dirawat di intensive care unit (ICU), dan menggunakan perhitungan dengan formula Harris-Benedict bagi yang dirawat di ruangan dengan faktor stres sesuai derajat hipermetabolisme pasien. Pasien dipantau selama 7 ? 11 hari. Edukasi diberikan kepada pasien dan keluarga selama perawatan dan saat akan pulang.
Hasil: Dalam pemantauan, tiga pasien menunjukkan perbaikan klinis, toleransi asupan, dan laboratorium, dan dapat dipulangkan, sedangkan satu pasien meninggal dunia.
Kesimpulan: Kontrol gula darah, asupan nutrisi yang adekuat, dan edukasi yang sesuai, dapat meningkatkan kesintasan pasien DMT2 dengan penyulit infeksi yang dirawat di rumah sakit.
Background: The incidence and prevalence of type 2 diabetes mellitus (T2DM) is increasing. Immune disfunction in T2DM patient may increase the risk of infection. The appropriate blood glucose control has a benefit in infection control and macro and microvascular complication prevention. The Studies of glycaemic control included older patients did not find convincing evidence. The aim of this case series is to assess the association between glycaemic control and clinical outcome of hospitalized T2DM patient with comorbid infection, and to provide appropriate nutrition therapy based on individual nutrition needs.
Method: Patients in this case series were between 47 - 65 years old. There of those patients were diagnosed T2DM with comorbid gangrenous diabeticum, cellulitis, and sepsis with lung infection and urinary tract infection. Two patients need intensive care in ICU, and another patients in the ward. Two patients received nutrition therapy as critically ill condition, and the rest as American Diabetic Association recommendation, with basal calorie requirement were calculated using Harris-Benedict formula and stress factor suitable for metabolic changes. Monitoring was done for 7 - 11 days. Education was done for the patient and family during hospitalization and discharge planning.
Results: Three patients showed the improvement of clinical conditions, intake tolerance, and laboratory results, whatever one patient was pass away.
Conclusion: Glycaemic control, adequate nutrition intake, and intensive education, may improve survival rate in hospitalized T2DM patient with infection as comorbid."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Lily Indriani Octovia
Tatalaksana nutrisi pasien luka bakar berat dengan trauma inhalasi dan sepsis = Nutritional support in severe burns with inhalation injury and sepsis
"Latar belakang: luka bakar berat dapat disertai dengan trauma inhalasi, yang akan memicu respons lokal dan sistemik, sehingga menyebabkan berbagai komplikasi, termasuk systemic inflammatory response syndrome (SIRS) dan sepsis. Berbagai kondisi ini menyebabkan hipermetabolime dan hiperkatabolisme, yang membutuhkan tatalaksana nutrisi adekuat untuk membantu proses penyembuhan pasien. Berbagai kelompok ahli telah memberikan rekomendasi tatalaksana nutrisi pada luka bakar berat dan sakit kritis. Namun, akibat keterbatasan sarana dan prasarana, tidak semua rekomendasi dapat dilaksanakan, sehingga tatalaksana nutrisi diberikan secara optimal. Metode: serial kasus ini terdiri atas empat pasien luka bakar berat, yang disebabkan oleh api, dan disertai trauma inhalasi, yang menyebabkan berbagai komplikasi, sepsis, multiple organ dysfunction syndrome (MODS) dan multiple organ failure (MOF). Tatalaksana nutrisi diberikan secara bertahap sesuai dengan keadaan pasien. Pemberian nutrisi diawali dengan nutrisi enteral dini (NED) dalam waktu 2448 jam setelah luka bakar, sebesar 10 kkal/kg BB, menggunakan drip intermiten. Selanjutnya, nutrisi diberikan sebesar 2025 kkal/kg BB pada fase akut dan 2530 kkal/kg BB/hari pada fase anabolik. Setelah pasien keluar dari intensive care unit (ICU), target kebutuhan energi menggunakan persamaan Xie, dengan protein 1,52,0 g/kg BB/hari, lemak 2530%, dan karbohidrat (KH) 5565%. Mikronutrien diberikan berupa multivitamin antioksidan, vitamin B, asam folat, dan vitamin D. Pasien dalam serial kasus ini juga mendapatkan nutrisi spesifik glutamin sebesar 0,3 g/kg BB/hari, selama 510 hari. Hasil: tiga pasien mengalami perbaikan klinis, kapasitas fungsional, dan laboratorium. Pasien selamat dan dipulangkan untuk rawat jalan. Masa rawat pasien yang selamat berturut-turut 33 hari, 70 hari, dan 43 hari. Seorang pasien mengalami perburukan dan MOF, hingga meninggal dunia setelah dirawat selama 23 hari di ICU. Kesimpulan: tatalaksana nutrisi optimal dapat menunjang penyembuhan luka serta menurunkan angka morbiditas dan mortalitas pasien luka bakar berat dengan trauma inhalasi dan sepsis.
;Background: severe burn trauma combined with inhalation injury initiates local and systemic response, resulting in various complications such as systemic inflammatory response syndrome (SIRS) and sepsis. These conditions stimulate hypercatabolic process, leading to the increase of nutrition requirement. Adequate nutritional support is necessary in order to control both inflammatory and metabolic response, and also to improve healing process. To date, nutritional recommendations specific for severe burn trauma and critical illness have been established. However, many problems including patient?s condition and lack of resources exist, so optimal nutritional support that fits our settings was delivered. Method: this serial case focused on four severely burned patients caused by flame. Subjects with inhalation trauma and complications such as sepsis, multiple organ dysfunction syndrome (MODS), and multiple organ failure (MOF) were included in this study. Nutritional support was delivered according to clinical conditions, patient?s tolerance, and laboratory findings. Early enteral nutrition was initiated within 2448 hours post burns, starting from 10 kcal/kg BW/day with intermittent gravity drip method. Nutrition was gradually increased in order to reach the target of energy for critically ill patients, which is 2025 kcal/kg BW/day in acute phase or 2530 kcal/kg BW/day in anabolic recovery phase. Xie Equation was used to calculate target of total energy for burned patient. Protein requirement was 1.52.0 g/kg BW/day. Lipid and carbohydrate given were 2530% and 5565% from calorie intake, respectively. Micronutrient supplementation including antioxidants, vitamin B, folic acid, and vitamin D was also provided. Glutamin as specific nutrient was delivered by 0.3 g/kg BW/day in 510 days. Results: improvement of clinical condition, functional capacity, and laboratory parameters was observed in three patients, who could be discharged from hospital and asked to come back for outpatient care. Their lengths of stay were 33 days, 70 days, and 43 days, respectively. However, one patient experienced worsening of condition and died after 22 days of care in Intensive Care Unit (ICU). Conclusions: optimal nutritional support for severely burned patients with inhalation trauma and sepsis is necessary in order to improve healing process, as well as decrease morbidity and mortality."
Depok: Fakultas Kedokteran Universitas Indonesia, 2016
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Zairida Rafidah Noor
Tata laksana nutrisi perioperatif pada pasien cholangiocarcinoma ekstrahepatik = Perioperative nutrition support in extrahepatic cholangiocarcinoma
"ABSTRAK
Latar belakang: Cholangiocarcinoma adalah keganasan traktus bilier yang dapat menyebabkan gangguan metabolisme dan malnutrisi. Terapi kuratif adalah dengan pembedahan. Saat ini telah terdapat pedoman tata laksana nutrisi perioperatif pada slauran cerna tetapi belum terdapat rekomendasi spesifik terkait cholangiocarcinoma.
Presentasi kasus: Pasien dalam serial kasus ini terdiri dari empat pasien laki-laki berusia γ1?6β tahun dengan diagnosis cholangiocarcinoma ekstrahepatik dengan rencana bedah elektif. Maka tata laksana nutrisi yang dilakukan adalah dukungan nutrisi perioperatif. Pasien diberikan diet tinggi protein dan rendah lemak dengan nutrien spesifik berupa MCT dan BCAA. Pada kasus pertama dukungan nutrisi perioperatif mencakup pra dan pasca operasi, outcome operasi baik dan target nutrisi tercapai. Pada kasus kedua pasien mengalami komplikasi fistula pankreas dan tuberkulosis usus sehingga toleransi terhadap dukungan nutrisi pasca operasi berjalan lambat dan tidak mencapai target. Pada kasus ketiga pasien diberikan dukungan nutrisi pra operasi dan selama pemantauan didapatkan perbaikan kondisi klinis dan target nutrisi tercapai. Pasien kasus kedua dan ketiga diberikan suplementasi enzim pankreas yang meningkatkan toleransi asupan. Pada kasus keempat pasien mengalami perburukan kondisi klinis selama pemantauan yang berkaitan dengan beratnya penyakit dan berbagai komplikasi sehingga tata laksana nutrisi yang diberikan tidak optimal.
Kesimpulan: Tata laksana nutrisi perioperatif yang adekuat dapat memberikan outcome yang baik pada pasien cholangiocarcinoma. Pemberian nutrien spesifik berupa MCT dan BCAA, dan suplementasi enzim pankreas bermanfaat meningkatkan toleransi asupan pada pasien cholangiocarcinoma.
ABSTRACT
Background: Cholangiocarcinoma is biliary tract malignancy that may alter metabolism function and cause malnutrition. Curative therapy is abdominal surgery. Recommendations regarding perioperative nutrition in abdominal surgery has been established but there is no specific recommendations for cholangiocarcinoma yet.
Case presentation: Four male with range of age between γ1 to 6β years old are included in this case series. All cases were diagnosed with extrahepatic cholangiocarcinoma and bound to elective surgery therapy. Thus all patients were given perioperative nutrition support. All patient were given high protein and low diet with specific nutrients such as MCT and BCAA. The first patient received perioperative nutrition during pre and post operation phase, operation outcome was good, and nutrition target was achieved. The second patient experienced complications of pancreatic fistula and intestine tuberculosis, resulting in slow response to nutrition therapy. The third patient received nutrition therapy during pre operation phase with good response and nutrition target was achieved. The second and third patient were given pancreatic enzyme supplementation that improved nutrition tolerance. The fourth patient?s clinical condition worsen during monitoring due to nature of the severe disease and presence of complications hence nutrition therapy worked poorly.
Conclusion: Adequate perioperative nutrition support in cholangiocarcinoma improves outcome. Specific nutrients such as MCT and BCAA, and pancreatic enzyme supplementation improves nutrition tolerance and contribute to achieving nutrition target in cholangiocarcinoma patients."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library