Professional Documents
Culture Documents
Dr Iyan Darmawan
Medical Director PT Otsuka
Points of Presentation
Body Composition
Classification of Parenteral Fluid Therapy
Hypercatabolism in Acute Infection
Effects of Undernutrition
Rationale of maintenance fluid tx
Case illustration
Points of Presentation
Body Composition
Classification of Parenteral Fluid Therapy
Hypercatabolism in Acute Infection
Effects of Undernutrition
Rationale of maintenance fluid tx
Case illustration
Classic Figures of Fluid
Compartments
Human body largely composed
Total Body Water of fluids
60% BW
Total body fluid ranges from 50
60%
smaller proportion in the elderly,
obesity,and female
ICF ECF
40 % BW 20 % BW
ISF
15% BW
Plasma
5% BW
Komposisi elektrolit cairan tubuh
Cairan ekstrasel Caiarn
Ion terbanyak
mEq/L intrasel
Plasma Interstisial di ekstrasel
Na+ 142 144 15
K+ 4 4 150
Kation
Na+
Ca2+ 5 2.5 2 Cl-
Mg2+ 3 1.5 27
Total 154 152 194
Ion terbanyak
Cl- 103 114 1 di intrasel
HCO3- 27 30 10
Anion
HPO42- 2 2 100
K+ Mg2+
SO42- 1 1 20
Asam organik 5 5 - HPO42-
Protein 16 0 63
Total 154 152 194
Ya Tidak
Ghattas H. INFECTION Nutritional Interactions Encyclopedia of Human Nutrition, 2005, Pages 47-54
Normal Metabolic Rate 25-30 kcal/kg/day
Impairment of immunocompetence
Proteolysis
Delayed wound healing
Lipolysis Organopathy Biological
maladaptation
Glycerol
Free fatty acids Nitrogen death
(ketone bodies)
(70%)
Glycogenolysis
Duration of Starvation
Glikogen hati
100 g
Cortisol
The Role of Protein and Amino Acids in Sustaining and Enhancing PerformanceNational Academy Press
Washington, D.C. 1999
TIMING OF Catabolic response - altered production and utilization
CATABOLIC of metabolic fuel, glucocorticoid release
RESPONSE TO
INFECTION Onset of catabolic phenomena (neg
balance Nitrogen, K,Mg,PO4,Zn SO4)
Anorexia
Diuresis (additional weight loss)
vomiting
Hypothermia
Impaired gut
integrity and
immunity Loss of strength
Anorexia
? Micronutrient deficiency
Points of Presentation
Body Composition
Classification of Parenteral Fluid Therapy
Hypercatabolism in Acute Infection
Effects of Undernutrition
Rationale of maintenance fluid tx
Case illustration
Rationale of Maintenance Fluid Tx
Despite thirst due to hypertonic dehydration, many patients may not
be able to ingest enough water and nutrient owing to abdominal
discomfort/pain, hepatomegaly
200 g
200 100 g
300 50 g
0g Perbaikan imbang N dan metabolisme
400 (Starvation) protein, serta penghambatan
katabolisme protein tubuh adalah
1 2 3 4 5 6 sangat penting
Lama puasa
JAMES L.GAMBLE 1957p134147
Pentingnya suplementasi Asam Amino
1989p4648
AMINO ACID SHOULD BE ADMINISTERED
SIMULTANEOUSLY WITH GLUCOSE
AA CHO
The significance of infusing amino acid
Starvation unavoidable nitrogen loss quantity
FAO/WHO
At least 100 g of glucose is 500mL x 2bags
necessary per day amino acid30g
100
Stool 12 When I convert it into
an amino acid
Skin 3
200g 50kg in weight
200 Others 2 26.3 g /day
100g
Glucose
300 0.054(g) 7.5*50(kg)1.3**26.3(g)
50g * convert nitrogen into quantity of amino acid 6.251.2
0g ** usually increase by 30% in consideration of
Starved individual difference
400
1 2 3 4 5 6
Period of starvation (days)
Patients in medical wards
Majority already in mild to
Suppressed level moderate dehydration,
of consciousness Hemodynamics not
severely compromised Anxiety, depression
Anorexia, or fear
nausea, or
distress
Malaise or fatigue
Inflexible mealtimes
Pemeriksaan fisik tambahan & Cairan apa yang dipilih dan berapa laju
tetesan ?
Infection may result in fluid,electrolyte and
hemodynamic disorders
Maintenance fluid should be encouraged
during febrile phase when oral intake is
severely compromised
A practical and complete maintenance solution
helps facilitate recovery after infection
Recognition of early stage of shock
(compensated shock) is mandatory where
isotonic (replacement) solution MUST BE
ADMINISTERED aggresively
Terima Kasih