[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 pooroutcome. Nowadays, many of nutritional management recommendations based onetiologies of IF, but no report about those application. Case Presentation: Three female and one male patients were included in this caseseries, aged 21?42 years old. Nutritional needs in IF patients are determined bytheir etiologies. IF in this case series caused by enterocutaneous fistula (ECF)and short bowel syndrome (SBS). Nutritional needs on ECF patients depend ontheir fistula production. In patients with high output ECF, energy requirement isin 1.5?2 resting energy requirement (RER) or 37?45 kcal/kg BW/day, protein1,5?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 givenconservative therapy, serum albumin and body weight increased, while the fistulaproduction decreased. In patients with preoperative of intestine reconstructionsurgery, there were improvement in general condition with the increase of serumalbumin. In SBS patients, related to the postoperative condition, energy was givenaccording to Enhanced Recovery after Surgery (ERAS) recommendation 25?30kkal/kg BW/day with balance of macronutrient composition. In SBS endjejunostomy patient the food was given through distal feeding with adjustedchymus drip to prevent dumping syndrome. There were increased in serumalbumin 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 pooroutcome. Nowadays, many of nutritional management recommendations based onetiologies of IF, but no report about those application. Case Presentation: Three female and one male patients were included in this caseseries, aged 21–42 years old. Nutritional needs in IF patients are determined bytheir etiologies. IF in this case series caused by enterocutaneous fistula (ECF)and short bowel syndrome (SBS). Nutritional needs on ECF patients depend ontheir fistula production. In patients with high output ECF, energy requirement isin 1.5–2 resting energy requirement (RER) or 37–45 kcal/kg BW/day, protein1,5–2 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 givenconservative therapy, serum albumin and body weight increased, while the fistulaproduction decreased. In patients with preoperative of intestine reconstructionsurgery, there were improvement in general condition with the increase of serumalbumin. In SBS patients, related to the postoperative condition, energy was givenaccording to Enhanced Recovery after Surgery (ERAS) recommendation 25–30kkal/kg BW/day with balance of macronutrient composition. In SBS endjejunostomy patient the food was given through distal feeding with adjustedchymus drip to prevent dumping syndrome. There were increased in serumalbumin and body weight of the patients. Conclusion: Adequate support medical therapy of clinical nutrition in IF patients give good outcome. ] |
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