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

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 . termasuk otot skeletal. splanchnic bed. dan ginjal. Hipermetabolisme     Meningkatkan energi expenditur Peningkatan konsumsi oksigen dalam tubuh.

 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 .

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 .   Effect on integrity of the immune system. diaphragm. and accessory muscle are catabolized for energy resulting in a decrease in inspiratory capasity . intercostal.

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 .  intake lead to drop of albumin.

stressed patient respond differentlythan normal patient < tility May complicate respiratory failure by tissue oxygen delivery and respiratory muscle function Oto pneumonia and sepsis.   sufficiency-----increase metabolic rate-----O2 consumption and CO2 Production ----. .CO2 retention----respiratory failure Remember that hypermetabolic.

do not overfeed or underfeed Ensure protein balance .   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 --.

   Monitor fluids and electrolytes. low CHO in patient with persistent hypercapnia . especially phosphorus Evaluate vitamins and mineral status as indicated Consider high fat.

2. .Diagnosis Tubercolosis 1. 3. and most importantly. Identification of any organisms seen on acid-fast stains of the specimens with prompt initiation of therapy. Treatment consists of five steps : Collection of appropriate samples for smears and culture. Notification of public health authorities for assistance identifying case contacts and inclusion into programs of directly observed therapy (DOT) programs if appropriate. 4. Appropriate selection of antimicrobials.

efficacious. DOT programs also improve compliance in all patients.5. and cost effective even in impoverished regions. DOT programs have been show to be feasible. Additionally. Physician follow-up patient condition and culture results to ensure appropriateness of antibiotics. .

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

Malnutrition and HIV interact on several other levels. devastating cycle.AIDS Like other infections. HIV interacts with malnutrition in a vicious. Left untreated. as well : Low vitamin A levels in pregnant women increase the rate of HIV transmission to their unborn babies. HIV infection progresses to acquired immunodeficiency syndrome (AIDS).  .

and death. . Reduces levels of micronutrients in an HIVinfected person are associatedwith faster progression of HIV disease and AIDS.    HIV is transmitted to infants in breast milk. malnutrition. but in impoverished regions. substitutions for breast milk typically increase infantile diarrhea. AIDS disables parents so they cannot work to support and feed their families. AIDS leaves mothers too weak to feed and care for their children.

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

4 million people infected with HIV.2 million people infected with HIV.As of 2004. Sub-Saharan Africa had 25. . 39.4 million people were living with HIV. Without treatment of a cure. these people are doomed to death. The fate of severe PEM in millions of people appears unavoidable. Southeast Asia had 8. If we do not arrest the continued transmission of HIV. usually within 10 years of the initial infection. the number of PEM victims will climb even higher.

4. Batasi konsumsi lemak dan minyak sampai seperempat dari kecukupan energi. Makanlah makanan sumber zat besi.TIGA BELAS PEDOMAN UMUM GIZI SEIMBANG 1. Makanlah makanan untuk memenuhi kecukupan energi. 3. Makanlah makanan sumber karbohidrat setengah dari kebutuhan energi. Gunakan garam beryodium. 5. Makanlah aneka ragam makanan. 2. 6. .

Makanlah makanan yang aman bagi kesehatan. 10. 8. Hindari minum-minuman beralkohol. Lakukan kegiatan fisik secara teratur. 12. 11. Minumlah air bersih yang aman dan cukup jumlahnya. Berikan ASI saja pada bayi sampai umur 6 bulan dan tambahkan MP-ASI sesudahnya. 13. Biasakan makan pagi.7. 9. Bacalah label pada makanan yang dikemas .