CRITICAL ILLNESS

Dr. Syafri Guricci, M.Sc

Respon Metabolik Infeksi dan Injury

Tiga komponen utama, Yaitu : Hipermetabolisme Proteolisis dengan kehilangan nitrogen Percepatan Utilisasi Glukosa dan

Glukoneogenesis

Perubahan metabolik paling banyak adalah perubahan dari penyimpanan sampai utilisasi dari cadangan lemak, protein, dan glikogen

Hipermetabolisme Meningkatkan energi expenditur Peningkatan konsumsi oksigen dalam tubuh, termasuk

otot skeletal, splanchnic bed, dan ginjal. Peningkatan metabolic Rate merupakan separuh dari

hasil inefisiensi glukosa yang digunakan pada area yang luka dan infeksi

Glukosa menjadi sumber energi utama dan mengubah laktat melalui glikolisis anaerobic

Proteolisis dan kehilangan Nitrogen Proteolisis dan penggunaan asam amino untuk

produksi energi Ureagenesis dan ekskresi urin nitrogen Sintesis Hepatic dari protein fase akut Produksi hepatik dari albumin dan prealbumin

Utilisasi Gluconegenesis Glicogenolisis Gluconeogenesis Kadar glukosa darah

Respiratory Central hypoxic and hypercapnic drivers Respiratory muscles Lung tissue {parencyma}O2 consumption

and CO2 production Hypophosphatemia can have profound

effect on ventilation

Effect on integrity of the immune system.latory Drivenphragm and the function of of respiratory muscle

In Emphysema, hiperventilated lung alter fiber length of the respiratory muscle and impaired their efficiency

In malnutrition , diaphragm, intercostal, and accessory muscle are catabolized for energy resulting in a decrease in inspiratory capasity

intake lead to drop of albumin, high lower the oncotic pressure and results in pulmonary edema.

Undernutrition affects on the pulmonary parenchyma by diminishing collagen syanthesisi and increasing proteolysis----- may manifest as decrease surfactant production and alveolar collapse

sufficiency-----increase metabolic rate-----O2 consumption and CO2 Production ----- CO2 retention----respiratory failure

Remember that hypermetabolic, stressed patient respond differentlythan normal patient <tility

May complicate respiratory failure by tissue oxygen delivery and respiratory muscle function Oto pneumonia and sepsis.

Epidemiologic studies have found strong relation between malnutrition and pneumonia

Cell mediated immunity decreased----altered immunoglobulin production and impaired resistance of the tracheobronchial mucosa to bacterial infections Evaluate energy needs and provide an appropriate amount --- do not overfeed or underfeed

Ensure protein balance

Monitor fluids and electrolytes, especially phosphorus

Evaluate vitamins and mineral status as indicated

Consider high fat, low CHO in patient with persistent hypercapnia

Diagnosis TubercolosisTreatment consists of five steps :

1. Collection of appropriate samples for smears and culture.2. Identification of any organisms seen on acid-fast stains of

the specimens with prompt initiation of therapy.3. Appropriate selection of antimicrobials.4. Notification of public health authorities for assistance

identifying case contacts and inclusion into programs of directly observed therapy (DOT) programs if appropriate, and most importantly.

5. Physician follow-up patient condition and culture results to ensure appropriateness of antibiotics.

DOT programs have been show to be feasible, efficacious, and cost effective even in impoverished regions. Additionally, DOT programs also improve compliance in all patients.

Pada TBC :

1. Akibat panas supribeasl bakteri basil TBC yang rakus protein maka terjadi Nitrogen balanced negatif. Oleh karena itu untuk penderita TBC pemberian protein sedikit lebih tinggi dr 0,8 per kg BB.

AIDSLike other infections, HIV interacts with malnutrition in a vicious, devastating cycle. Left untreated, HIV infection progresses to acquired immunodeficiency syndrome (AIDS). Malnutrition and HIV interact on several other levels, as well :

Low vitamin A levels in pregnant women increase the rate of HIV transmission to their unborn babies.

HIV is transmitted to infants in breast milk, but in impoverished regions, substitutions for breast milk typically increase infantile diarrhea, malnutrition, and death.

AIDS leaves mothers too weak to feed and care for their children.

AIDS disables parents so they cannot work to support and feed their families.

Reduces levels of micronutrients in an HIV-infected person are associatedwith faster progression of HIV disease and AIDS.

Weight loss and muscle wasting in an infected person are associated with faster progression of HIV disease and AIDS.

Infections that accompany AIDS cause fever and diarrhea, making malnutrition worse.

Severe protein-energy malnutrition (PEM) is characteristic of untreated AIDS and frequently the ultimate cause of death.

As of 2004, 39.4 million people were living with HIV. Sub-Saharan Africa had 25.4 million people infected with HIV. Southeast Asia had 8.2 million people infected with HIV. Without treatment of a cure, these people are doomed to death, usually within 10 years of the initial infection. The fate of severe PEM in millions of people appears unavoidable. If we do not arrest the continued transmission of HIV, the number of PEM victims will climb even higher.

TIGA BELAS PEDOMAN UMUM GIZI SEIMBANG

1. Makanlah aneka ragam makanan.2. Makanlah makanan untuk memenuhi kecukupan

energi.3. Makanlah makanan sumber karbohidrat

setengah dari kebutuhan energi.4. Batasi konsumsi lemak dan minyak sampai

seperempat dari kecukupan energi.5. Gunakan garam beryodium.6. Makanlah makanan sumber zat besi,

7. Berikan ASI saja pada bayi sampai umur 6 bulan dan tambahkan MP-ASI sesudahnya.

8. Biasakan makan pagi.

9. Minumlah air bersih yang aman dan cukup jumlahnya.

10. Lakukan kegiatan fisik secara teratur.

11. Hindari minum-minuman beralkohol.

12. Makanlah makanan yang aman bagi kesehatan.

13. Bacalah label pada makanan yang dikemas