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Silaban, Dorna Yanti Lola
Terapi medik gizi klinik pada diabetes melitus tipe 2 dengan berbagai komplikasi = Medical nutrition therapy in type 2 diabetes mellitus with various complications
"Latar Belakang: Diabetes melitus DM merupakan penyakit epidemik yang mengalami peningkatan dari tahun ke tahun di seluruh dunia. Jumlah penderita DM ini diperkirakan akan mencapai 552 juta orang pada tahun 2030. Kadar glukosa darah KGD yang tidak terkontrol merupakan penyebab terjadinya komplikasi makrovaskuler dan mikrovaskuler sehingga meningkatkan angka morbiditas, mortalitas dan lama rawat inap. Terapi medik gizi klinik adekuat dan sesuai dengan kondisi klinis pasien dapat mencegah, memperlambat dan memperbaiki komplikasi akibat DM.
Metode: Pasien serial kasus dengan diagnosis DM tipe 2 disertai berbagai komplikasi, berusia 48 ndash;71 tahun. Satu dari empat pasien mendapatkan nutrisi melalui nasogastric tube NGT , dan sisanya melalui oral. Terapi medik gizi diberikan pada keempat pasien sesuai dengan kondisi klinis masing-masing. Pemberian karbohidrat disesuaikan dengan kebutuhan pasien dan dosis insulin yang diperoleh pasien. Pemberian protein disesuaikan dengan fungsi ginjal masing-masing pasien.
Hasil : Keempat pasien mengalami perbaikan keadaan klinis antara lain luka pada kaki, sesak napas hilang, edema dan asites berkurang, ureum dan kreatinin membaik. Kasus pertama, kedua dan keempat mengalami perbaikan pada kadar glukosa darah, sedangkan kasus ketiga KGD masih tetap tinggi pada saat keluar dari RS. Keempat pasien pulang ke rumah dengan kondisi membaik.
Kesimpulan: Terapi medik gizi klinik yang adekuat untuk mengontrol KGD dapat membantu memperbaiki keadaan klinis dan mencegah perburukan pada pasien DM tipe 2 dengan berbagai komplikasi.
Background: Diabetes mellitus DM is an epidemic disease that is increasing year by year around the world. The number of DM patients is estimated 552 million people by 2030. Uncontrolled blood glucose level is one of the cause of macrovascular and microvascular complications that may increase morbidity, mortality and length of hospitalization. An adequate nutrition therapy in accordance with the clinical condition of the patient may help to prevent, delay and improve the complications due to DM.
Methods:All patients in these case series were diagnosed with type 2 DM accompanied by various complications, aged 48-71 years. One in four patients was administered nutrition through tube feeding, and the rest through oral. Nutrition therapy was given to all patients according to their clinical conditions. Carbohydrate was adjusted to the patient 39;s needs and the dose of insulin obtained by the patient. Protein administration was adjusted for each patient 39;s renal function.
Result:Four patients experience of improving of clinical conditions, such as breathlessness, reduced edema and ascites, decreased urea and creatinine levels. The first, second and fourth cases improve in blood glucose levels, while the third case remains to have high blood glucose level at the time of discharge. While all patients discharge from hospital with better condition.
Conclusion: An adequate clinical nutrition therapy to improve glycemic control is needed to improve clinical conditions and prevent deterioration in patients with type 2 DM with various complications. "
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
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Sanny Ngatidjan
Peran terapi medik gizi pada pasien Diabetes Melitus Tipe 2 dan Kaki Diabetik dengan Berbagai Penyulit = The Role of Medical Nutrition Therapy in Type 2 Diabetes Mellitus and Diabetic Foot with Various Complications
"Kaki diabetik merupakan komplikasi pada diabetes melitus (DM) tipe 2 tersering yang menyebabkan pasien menjalankan perawatan di rumah sakit. Penyulit lain pada DM tipe 2 berkontribusi terhadap peningkatan morbiditas dan mortalitas pasien. Terapi medik gizi pada pasien DM tipe 2 dan kaki diabetik dengan berbagai penyulit berperan penting dalam kontrol glikemik, mencegah perburukan status gizi, serta perbaikan penyembuhan luka. Serial kasus ini melibatkan empat pasien DM tipe 2 dan kaki diabetik dengan berbagai penyulit yang diberikan terapi medik gizi berupa asupan energi, makronutrien, mikronutrien, nutrien spesifik, dan edukasi gaya hidup. Pasien dilakukan pemantauan selama 19 hari sesuai fase proliferasi penyembuhan luka. Satu pasien dengan ketoasidosis diabetikum, satu pasien dengan hipertensi, dan dua pasien dengan diabetic kidney disease. Kontrol glikemik keempat pasien tercapai pada akhir perawatan di rumah sakit dan tidak didapatkan penurunan berat badan yang bermakna selama masa pemantauan. Penyembuhan luka berupa luka mengering, edema berkurang, dan timbulnya jaringan granulasi didapatkan pada tiga diantara empat pasien. Satu pasien tidak didapatkan penyembuhan luka yang signifikan karena adanya stenosis multipel pembuluh darah arteri di tungkai kiri. Terapi medik gizi pada pasien DM tipe 2 dan kaki diabetik dengan berbagai penyulit berperan pada perbaikan kontrol glikemik, mencegah perburukan status gizi, dan penyembuhan luka.
The most common cause of complication and hospitalization in type 2 diabetes mellitus (T2DM) patients are those associated with diabetic foot (DF). Complication of T2DM contribute to increasing morbidity and mortality. Medical nutrition therapy in patients with T2DM and DF with various complication plays an important role in management of glycemic control, worsening nutritional status, and repair wound healing. This case series include four patients T2DM and DF with various complication that given nutritional medical therapy consisting of energy intake, macronutrients, micronutrients, spesific nutrient, and healthy lifestyle education. Patients was monitored for 19 days according to the proliferation phase of wound healing. One patient with diabetic ketoacidosis, one patient with hypertension, and two patients with diabetic kidney disease. All patients got glycemic control during hospitalization. No significant weight loss was observed during monitoring period. Wounds in three of the four patients appeared to heal with dry wound, reduced edema, and formation of granulation tissue. One patient found insignificant wound healing due to multiple arterial stenosis in the left leg. Medical nutrition therapy with type 2 diabetes and diabetic foot with various complications plays an important role in management of glycemic control, preventing worsening nutritional status, and repair wound healing."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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Kwan Francesca Gunawan
Terapi medik gizi pada pasien diabetes melitus tipe 2 dengan obesitas dan kaki diabetik = Medical nutrition therapy in type 2 diabetes mellitus patients with obesity and diabetic foot
"ABSTRAK
Diabetes melitus DM merupakan suatu epidemik global. Obesitas merupakan faktor risiko tersering pada terjadinya DM tipe 2. Salah satu komplikasi yang sering dialami oleh penderita DM ialah kaki diabetik. Pada pasien DM dengan obesitas dan kaki diabetik, terapi medik gizi penting untuk mencapai target berat badan, menjaga kadar glikemik, serta mencegah komplikasi DM. Selain itu pemberian nutrisi yang adekuat juga penting untuk mendukung penyembuhan luka. Pasien pada serial kasus ini berusia antara 41 ndash;59 tahun dengan dengan proporsi yang sama antara laki-laki dan perempuan. Keempat pasien memiliki status gizi obes dengan IMT sebesar 26-54,4 kg/m2. Awitan DM pada keempat pasien diketahui bervariasi antara 1-13 tahun. Terapi medik gizi diberikan sesuai dengan klinis, hasil laboratorium, dan asupan terakhir masing-masing pasien. Dari hasil pemantauan didapatkan bahwa dengan terapi nutrisi yang diberikan terjadi penurunan berat badan sebesar 3,2-4,8 kg 3,2-5,8 dan penurunan nilai HbA1c sebanyak 0,3-0,7. Selain itu juga didapatkan ukuran luka yang mengecil dan gejala neuropati berkurang. Pada pasien DM tipe 2 dengan obesitas dan kaki diabetik, terapi medik gizi yang adekuat berkaitan dengan penurunan berat badan, perbaikan kontrol glikemik, dan penyembuhan luka yang baik.
ABSTRACT<>br>
Diabetes mellitus is now a global epidemic. Obesity is a common risk factor in the occurrence of type 2 diabetes. One of the complications that are often experienced by people with diabetes is diabetic foot. In diabetic patients with obesity and diabetic foot, medical nutrition therapy is important to achieve targeted body weight, maintain glycemic levels, and prevent diabetes complications. Good nutrition is also essential for wound healing. This case series consists of four patients who are between 41-59 years old and obese with BMI of 26-54.4 kg/m2. The onset of DM in all four patients is known to vary between 1-13 years. Nutritional therapy is given in accordance with the clinical, laboratory outcomes, and patients' daily intake. It was found that medical nutrition therapy can lead to weight loss of 3.2-4.8 kg (3.2-5.8%) and decreased HbA1c by 0.3-0.7%. It was also observed that the wound size and neuropathy symptoms are reduced. Adequate medical nutrition therapy in type 2 DM patients with obesity and diabetic foot is associated with weight loss, improved glycemic control, and good wound healing."
Depok: Fakultas Kedokteran Universitas Indonesia, 2017
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Cut Hafiah Halidha Nilanda
Terapi medik gizi pada pasien stroke hemoragik denganhipertensi dan diabetes melitus tipe 2 = Medical nutrition therapy in hemorrhagic stroke patients with hypertension and diabetes mellitus type 2
"ABSTRAK
Latar Belakang: Stroke hemoragik merupakan penyakit serebrovaskular yang ditandai dengan pecahnya pembuluh darah sehingga terjadi perdarahan pada otak. Penyebab tersering stroke hemoragik adalah hipertensi. Selain itu penyebab lainnya seperti diabetes melitus dan obesitas dapat menjadi penyulit keadaan klinis pasien. Stroke hemoragik dan beberapa penyulit akan menyebabkan disfungsi neurologis dan disfungsi motorik, yang keduanya akan menyebabkan penurunan asupan nutrisi. Penurunan asupan nutrisi dapat disebabkan penurunan kapasitas fungsional dan gangguan proses menelan atau disfagia. Nutrisi yang tidak adekuat dapat menyebabkan kualitas hidup menurun serta risiko serangan stroke berulang. Terapi medik gizi klinis berperan memberi nutrisi optimal, membatasai natrium, mengontrol glukosa darah dan mengatasi defisiensi mikronutrien. Metode:Serial kasus ini terdiri dari empat kasus stroke hemoragik pada pasien perempuan dan laki-laki dengan rentang usia 50 ndash;65 tahun, dengan penyulit seperti disfagia, penurunan kesadaran, dan perdarahan GIT, disertai penyakit penyerta yaitu Hipertensi dan DM tipe 2. Kasus pertama dan kedua mengalami gejala disfagia dan membutuhkan dukungan nutrisi melalui jalur enteral. Kasus ketiga terdapat penurunan asupan makanan karena penurunan kapasitas fungsional yang terjadi. Kasus keempat mengalami penurunan kesadaran dan perdarahan saluran cerna serta membutuhkan dukungan nutrisi secara enteral dan parenteral. Keempat pasien memiliki indeks massa tubuh obes 1. Masalah nutrisi yang dihadapi keempat pasien ini adalah asupan makro dan mikronutrien yang tidak optimal, jalur pemberian nutrisi, kebutuhan nutrisi yang tidak terpenuhi selama sakit. Terapi medik gizi klinik diberikan sesuai rekomendasi stroke hemoragik ddengan hipertensi dan DM tipe 2. Hasil :Kasus pertama hingga kasus ketiga mengalami perbaikan keadaan klinis, antara lain peningkatan kemampuan menelan, perbaikan tekanan darah, kadar glukosa, dan kapasitas fungsional. Kasus keempat meninggal dunia pada hari perawatan ke-8 akibat edema paru dan gagal jantung. Kesimpulan: Terapi medik gizi klinik yang diberikan dapat membantu keadaan klinis dan kapasitas fungsional pada pasien stroke hemoragik dengan Hipertensi dan DM tipe 2.
ABSTRACT<>br>
Background Hemorrhagic stroke is a cerebrovascular disease characterized by rupture of blood vessels resulting in bleeding in the brain. The most common cause of hemorrhagic stroke is hypertension. In addition, other causes such as diabetes mellitus and obesity could worsening the patient's clinical situation. Hemorrhagic strokes and some complications will cause neurologic dysfunction and motoric dysfunction, both of which will lead to a decrease in nutrient intake. Decreased nutritional intake could caused due to decreased functional capacity and impaired ingestion or dysphagia. Inadequate nutrition can lead to decreased quality of life as well as the risk of recurrent stroke. Medical clinical nutrition therapy plays an optimal role in nutrition, restricting sodium, controlling blood glucose and overcoming micronutrient deficiencies. Methods This case series consists of four cases of hemorrhagic stroke in female and male patients with age range 50-65 years, with complications such as dysphagia, consciousness derivation, and gastrointestinal bleeding, accompanied by comorbidities susch as Hypertension and type 2 DM. The first and second cases have symptoms of dysphagia and require nutritional support through the enteral route. The third case there is a decrease in food intake due to decreased functional capacity that occurs. The fourth case has consciousness derivation and gastrointestinal bleeding that requires support of enteral and parenteral nutritions. All of patients had obesity 1 body mass index. Nutritional problems faced by these four patients were unoptimal macro and micronutrient intake, nutritional pathways, unfulfilled nutritional needs during illness. Medical clinical nutrition therapy is given as recommended by hemorrhagic stroke with hypertension and type 2 diabetes mellitus Result The first case to the third case has improved clinical conditions, including increased ability to swallow, improvement of blood pressure, glucose levels, and functional capacity. The fourth case died on the 8th day of treatment due to pulmonary edema and heart failure. Conclusion Clinical nutrition therapy provided could improved clinical and functional capacity in hemorrhagic stroke patients with hypertension and type 2 DM."
Depok: Fakultas Kedokteran Universitas Indonesia, 2017
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Fenny Amaliya
Terapi medik gizi pasien diabetes melitus tipe 2 dengan tuberkulosis paru dalam memperbaiki kontrol glikemik = Medical nutrition therapy on type 2 diabetes mellitus with lung tuberculosis may improve glycemic control
"Diabetes melitus tipe 2 merupakan masalah kesehatan yang masih dihadapi di Indonesia. Hiperglikemia menyebabkan risiko komorbiditas meningkat salah satunya tuberkulosis paru. Pasien DM dengan TB paru meningkatkan morbiditas dan mortalitas. Dukungan nutrisi dilakukan untuk membantu memperbaiki kadar glukosa darah. Energi yang mencukupi dan pemberian serat merupakan tatalaksana gizi yang dapat membantu memperbaiki kadar glukosa darah. Serial kasus ini melaporkan empat pasien diabetes melitus tipe 2 dengan tuberkulosis paru yang memiliki rentang usia 49-57 tahun dan status gizi yang bervariasi. Terapi medik gizi diberikan sesuai dengan rekomendasi nutrisi untuk pasien diabetes melitus. Pemenuhan kebutuhan mikronutrien diberikan dengan suplementasi. Hasilnya yaitu kadar glukosa darah dua orang pasien dalam rentang normal 140-180 mg/dl, dengan asupan sesuai target kebutuhan dan komposisi protein 16-20%, lemak 20-18%, karbohidrat 52-64% dan serat 10-20 g/hari. Namun dua pasien dengan status gizi obes kadar glukosa darah masih belum terkontrol dan asupan energi belum mencapai target kebutuhan karena anoreksia dan infeksi yang belum teratasi. Kesimpulannya dukungan nutrisi dengan energi dan serat sesuai rekomendasi dapat membantu memperbaiki kadar glukosa darah.
Type 2 diabetes still a major health problem in Indonesia. Hyperglycemia increase the risk of comorbidity include lung tuberculosis. Since morbidity and mortality of patients with type 2 diabetes and lung tuberculosis increase, nutrition therapy may improve blood glucose level. Provide adequate energy and fiber as a part of medical nutrition therapy for maintain the blood glucose level. This is a case series of four patients with type 2 diabetes and lung tuberculosis, age 49-57 years old, having various nutritional status. The medical nutritional therapy was given to patients according to the diabetes mellitus guidelines. Supplementation were administered to fulfill their requirement. Result: the blood glucose level of two patients within normal range 140-180 mg/dl, with adequate energy intake, protein 16-20%, fat 20-28%, and carbohydrate 52-64% and fiber 10-20 g/day. However the others with obesity remains uncontrolled glucose level, despite of their low intake of energy. It occured due to anorexia and untreated infection. Conclusion: Medical nutritional therapy with adequate energy and fiber may improve the blood glucose level."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
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Anak Agung Eka Widya Saraswati
Terapi Medik Gizi pada Pasien Diabetes Melitus Tipe 2 dengan Sakit Kritis = Medical Nutrition Therapy in Type 2 Diabetes Mellitus Patients with Criticall Illness
"Pasien diabetes melitus tipe 2 (DMT2) berisiko mengalami komplikasi akibat hiperglikemia yang memperberat morbiditas, dan berkontribusi terhadap terjadinya sakit kritis. Tata laksana nutrisi pada kondisi tersebut bertujuan untuk mengatasi hiperglikemia, yang diharapkan dapat meningkatkan luaran klinis, mencegah progresi komplikasi, mempersingkat fase sakit kritis serta lama rawat rumah sakit (RS). Dua dari empat pasien berjenis kelamin perempuan dan siasanya laki-laki, dengan rentang usia 55–67 tahun. Dua pasien mengalami gagal nafas, satu pasien dengan status epileptikus berulang, dan satu pasien dengan perburukan intra operasi sehingga membutuhkan perawatan intensif. Semua pasien mengalami komplikasi DMT2. Status gizi pasien secara berurutan adalah malnutrisi sedang, berat badan lebih, obes I, dan malnutrisi berat. Tiga pasien mendapatkan terapi medik gizi sejak fase akut awal sakit kritis, sedangkan sisanya setelah lebih dari tujuh hari perawatan intensif. Terapi medik gizi yang diberikan selama perawatan intensif, meliputi pemenuhan energi, makronutrien, dan mikronutrien sesuai dengan kondisi klinis, status gizi serta metabolik, dan toleransi asupan pasien. Asupan energi dari keempat pasien di rentang 20–29 kkal/kg BB/hari dan asupan protein mencapai 1,3 g/kg BB/hari. Rerata asupan lemak dan karbohidrat berturut-turut 20–29% dan 51–67% total kalori. Semua pasien mendapatkan mikronutrien sesuai penyakit pasien. Pemenuhan nutrisi spesifik, berupa monounsaturated fatty acid (MUFA) berasal dari nutrisi enteral yang mengandung nutrisi tersebut. Selama perawatan semua pasien masih mengalami hiperglikemia, namun bila dibandingkan dengan awal perawatan, dua pasien telah mengalami perbaikan glikemik dan perbaikan penanda inflamasi serta infeksi, sedangkan sisanya masih mengalami hiperglikemia. Durasi perawatan intensif dan perawatan RS yang lebih panjang ditemukan pada pasien dengan status gizi malnutrisi, kontrol glikemik yang belum baik, dan inflamasi yang belum tertangani. Semua pasien dapat melewati fase sakit kritis dan step down ke ruang rawat biasa. Akan tetapi, dua pasien dengan malnutrisi dan hiperglikemia meninggal dunia di ruangan biasa akibat perburukan infeksi dan inflamasi. Sementara itu, sisanya mengalami perbaikan di ruang rawat biasa dan diizinkan rawat jalan. Keparahan penyakit, komplikasi, morbiditas, status gizi serta metabolik, dan kontrol glikemik memengaruhi luaran klinis dan tingkat mortalitas pada pasien DMT2 dengan sakit kritis.
Patients with type 2 diabetes mellitus (T2DM) are at risk of experiencing complications due to hyperglycemia which aggravate morbidity, and contribute to the incidence of critical illness. Nutritional management in this condition aims to overcome hyperglycemia, which is expected to increase clinical outcomes, prevent progression of complications, shorten the critical illness phase and length of hospital stay (LOS). Two out of four patients are female and the rest are male, with an age range of 55–67 years. Two patients experienced respiratory failure, one patient with recurrent status epilepticus, and one patient with intraoperative deterioration requiring intensive care. All patients had complications of T2DM. The nutritional status of the patients was moderate malnutrition, overweight, obese I, and severe malnutrition, in order. Three patients received nutritional medical therapy since the initial acute phase of critical illness, while the rest after more than seven days of intensive care. Nutritional medical therapy that is given during intensive care, includes the fulfillment of energy, macronutrients, and micronutrients in accordance with the clinical condition, nutritional and metabolic status, and tolerance of patient intake. Energy intake of the four patients ranged from 20–29 kcal/kg BW/day and protein intake reached 1.3 g/kg BW/day. The mean intake of fat and carbohydrates was 20–29% and 51–67% of total calories, respectively. All patients received micronutrients according to the patient's disease. The fulfillment of specific nutrients, in the form of monounsaturated fatty acids (MUFA), comes from enteral nutrition that contains these nutrients. During treatment, all patients still had hyperglycemia, but when compared to the initial treatment, two patients had improved glycemic control, inflammatory and infection marker, while the rest still had hyperglycemia. Longer duration of intensive care and hospitalization was found in patients with malnourished nutritional status, poor glycemic control, and unwell treated inflammation. All patients can pass through the critical illness phase and step down to regular ward. However, two patients with malnutrition and poor hyperglycemia died in the regular ward due to worsening infection and inflammation. Meanwhile, the rest were allowed outpatient care. Disease severity, complications, morbidity, nutritional and metabolic status, and glycemic control affect clinical outcomes and mortality rates in critically ill T2DM patients."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
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Siska Wiramihardja
Terapi medik gizi klinik pada Intestinal Failure dengan berbagai etiologi = medical therapy of clinical nutrition for Intestinal Failure with several etiologies
"[ABSTRAK
Latar belakang: Intestinal failure (IF) merupakan masalah pascabedah dengan
outcome yang buruk. Saat ini telah terdapat rekomendasi terapi gizi pada IF
berdasarkan etiologinya, namun belum ada laporan serial kasus yang memaparkan
aplikasinya.
Presentasi Kasus: Pasien dalam serial kasus ini terdiri dari 3 perempuan dan 1
laki-laki, berusia 21?42 tahun. Terhadap pasien ditegakkan diagnosis IF dengan
berbagai etiologi, yaitu 3 pasien dengan fistula enterokutan (FEK) dan 1 pasien
dengan short bowel syndrome (SBS) end jejunostomy. Terapi gizi pada pasien IF
berdasarkan etiologinya. Pada pasien FEK high output, kebutuhan energi 1,5?2
kali resting energy requirement (RER) atau 37?45 kkal/kg BB/hari, protein 1,5?2
g/kg BB/hari. Pada FEK low output kebutuhan energi 1?1,5 kali KEB (25?30
kkal/kg BB/hari), protein 1?1,5 g/kg BB/hari. Pada pasien FEK yang mendapat
terapi konservatif, didapat outcome peningkatan kadar albumin serum dan berat
badan, serta produksi fistel yang berkurang. Pasien FEK dengan persiapan
rekonstruksi usus halus terdapat perbaikan keadaan umum dan peningkatan kadar
albumin serum. Pada pasien SBS, terkait kondisi pascabedah maka terapi gizi
sesuai rekomendasi Enhanced Recovery After Surgery (ERAS), dengan
kebutuhan energi 25?30 kkal/kg BB/hari dengan komposisi makronutrien yang
seimbang. Pada pasien ini dilakukan distal feeding dan pengaturan laju tetesan
kimus untuk mencegah sindrom dumping. Pasien SBS didapat outcome
peningkatan 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 poor
outcome. Nowadays, many of nutritional management recommendations based on
etiologies of IF, but no report about those application.
Case Presentation: Three female and one male patients were included in this case
series, aged 21?42 years old. Nutritional needs in IF patients are determined by
their etiologies. IF in this case series caused by enterocutaneous fistula (ECF)
and short bowel syndrome (SBS). Nutritional needs on ECF patients depend on
their fistula production. In patients with high output ECF, energy requirement is
in 1.5?2 resting energy requirement (RER) or 37?45 kcal/kg BW/day, protein
1,5?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 given
conservative therapy, serum albumin and body weight increased, while the fistula
production decreased. In patients with preoperative of intestine reconstruction
surgery, there were improvement in general condition with the increase of serum
albumin. In SBS patients, related to the postoperative condition, energy was given
according to Enhanced Recovery after Surgery (ERAS) recommendation 25?30
kkal/kg BW/day with balance of macronutrient composition. In SBS end
jejunostomy patient the food was given through distal feeding with adjusted
chymus drip to prevent dumping syndrome. There were increased in serum
albumin 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 poor
outcome. Nowadays, many of nutritional management recommendations based on
etiologies of IF, but no report about those application.
Case Presentation: Three female and one male patients were included in this case
series, aged 21–42 years old. Nutritional needs in IF patients are determined by
their etiologies. IF in this case series caused by enterocutaneous fistula (ECF)
and short bowel syndrome (SBS). Nutritional needs on ECF patients depend on
their fistula production. In patients with high output ECF, energy requirement is
in 1.5–2 resting energy requirement (RER) or 37–45 kcal/kg BW/day, protein
1,5–2 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 given
conservative therapy, serum albumin and body weight increased, while the fistula
production decreased. In patients with preoperative of intestine reconstruction
surgery, there were improvement in general condition with the increase of serum
albumin. In SBS patients, related to the postoperative condition, energy was given
according to Enhanced Recovery after Surgery (ERAS) recommendation 25–30
kkal/kg BW/day with balance of macronutrient composition. In SBS end
jejunostomy patient the food was given through distal feeding with adjusted
chymus drip to prevent dumping syndrome. There were increased in serum
albumin and body weight of the patients.
Conclusion: Adequate support medical therapy of clinical nutrition in IF patients give good outcome. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
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Khrisnugra Ramadhani Rasyi, supervisor
Tatalaksana nutrisi pada pasien diabetes melitus tipe 2 dengan komplikasi sistem kardiovaskular = Nutritition therapy in type 2 diabetes mellitus with cardiovascular system complications
"[ABSTRAK
Latar belakang: Prevalensi Diabetes Melitus Tipe (DM) tipe 2 semakin meningkat setiap tahun. Kontrol glisemik yang buruk, hipertensi, dislipidemia, dan kebiasaan merokok serta menopause dapat meningkatkan risiko komplikasi penyakit kardiovaskular. Komplikasi kardiovaskular merupakan komplikasi paling sering ditemukan dengan angka mortalitas yang tinggi. Oleh karena itu, untuk menekan progresivitas komplikasi kardiovaskular diperlukan suatu terapi nutrisi medik yang adekuat sesuai dengan kondisi klinis dan edukasi dalam memodifikasi gaya hidup.
Metode: Pasien pada serial kasus berusia 55-65 tahun. Tiga pasien didiagnosis DM tipe 2 dengan gagal jantung, satu pasien dengan penyakit jantung hipertensi. Semua pasien memiliki skor skrining malnutrition screening tools (MST) ≥ 2. Dua pasien mempunyai status gizi obesitas, satu pasien berat badan dan pasien lainnya dengan berat badan normal. Kebutuhan energi basal (KEB) berdasarkan rumus Harris-Benedict dengan faktor stress 1,3-1,4 tergantung kondisi klinis dan penyakit penyerta. Komposisi makronutrien sesuai dengan rekomendasi American Diabetes Association dan Dietary Approach to Stop Hypertension. Pemberian mikronutrien dan nutrient spesifik diberikan pada satu dua kasus. Pasien dipantau selama 5-17 hari, meliputi keluhan subyektif, hemodinamik, toleransi dan analisis asupan, antropometri, pemeriksaan laboratorium, imbang cairan, dan kapasitas fungsional.
Hasil: Selama pemantauan di RS, keempat pasien menunjukkan perbaikan klinis yaitu tekanan darah turun dan kapasitas fungsional membaik. Satu pasien kadar glukosa darah dipertahankan < 200 mg/dL.
Kesimpulan: Terapi nutrisi medik yang adekuat dapat memperbaiki kondisi klinis pasien DM tipe 2 dengan komplikasi sistem kardiovaskular.
ABSTRACT
Background: The prevalence of type 2 diabetes mellitus (DM) is increasing every year. Poor glycemic control, hypertension, dyslipidemia, smooking and menopause increase the risk for cardiovascular complications. Cardiovascular complications is the most common complications in type 2 DM with a significant high mortality rate. Therefore, a medical nutrition therapy is required to decreased the progresitivity of the cardiovascular complication in DM, based on improvement of clinical conditions and lifestyle modifications.
Method: Patients in this case series were between 55-65 years old. There of those patients were diagnosed heart failure and one with hypertension heart disease. All patients had a screening score ≥ 2 with malnutrition screening tools (MST). Two of patients had nutritional status of obesity, one patients was overweight, and another patients was normoweight. Basal calorie requirement were calculating using Harris-Benedict formula with stress factor 1,3-1,4 adjusment according to clinical conditions and comorbidities. Macronutriens were given recommendations by The American Diabetes Association and Dietary Approach to Stop Hypertension. Two patients received micronutrien and specific nutrients. Monitoring was done for 5-17 days included subjective complaints, hemodynamic, tolerance and intake analysis, anthropometric measurement, laboratory test, fluid balance and functional capacity.
Results : All the patients showed the improvement of clinical conditions, blood control and functional capacity. Blood glucose levels of one patients was maintained to below 200 mg/dL
Conclusion: Medical nutrition therapy can improved clinical conditions of patients type 2 DM with cardiovascular complications., Background:
The prevalence of type 2 diabetes mellitus (DM) is increasing every year. Poor glycemic control, hypertension, dyslipidemia, smooking and menopause increase the risk for cardiovascular complications. Cardiovascular complications is the most common complications in type 2 DM with a significant high mortality rate. Therefore, a medical nutrition therapy is required to decreased the progresitivity of the cardiovascular complication in DM, based on improvement of clinical conditions and lifestyle modifications.
Method:
Patients in this case series were between 55-65 years old. There of those patients were diagnosed heart failure and one with hypertension heart disease. All patients had a screening score ≥ 2 with malnutrition screening tools (MST). Two of patients had nutritional status of obesity, one patients was overweight, and another patients was normoweight. Basal calorie requirement were calculating using Harris-Benedict formula with stress factor 1,3-1,4 adjusment according to clinical conditions and comorbidities. Macronutriens were given recommendations by The American Diabetes Association and Dietary Approach to Stop Hypertension. Two patients received micronutrien and specific nutrients. Monitoring was done for 5-17 days included subjective complaints, hemodynamic, tolerance and intake analysis, anthropometric measurement, laboratory test, fluid balance and functional capacity.
Results :
All the patients showed the improvement of clinical conditions, blood control and functional capacity. Blood glucose levels of one patients was maintained to below 200 mg/dL
Conclusion:
Medical nutrition therapy can improved clinical conditions of patients type 2 DM with cardiovascular complications.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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Imelda Wiradarma
Terapi medik gizi pasien tuberkulosis paru dengan komplikasi tuberkulosis ekstrapulmonar dan malnutrisi = Medical nutrition therapy in pulmonal tuberculosis patients with complications extrapulmonary tuberculosis and malnutrition
"ABSTRAK
Latar Belakang: Status nutrisi seringkali berhubungan dengan infeksi tuberkulosis TB. TB aktif menyebabkan kehilangan berat badan dan berat badan kurang merupakan faktor risiko infeksi TB, baik melalui reaktivasi TB laten maupun penyakit primer yang progresif menjadi TB ekstrapulmonar TBEP. Defisiensi makro dan mikronutrien pada pasien malnutrisi akan mempengaruhi sistem cell-mediated immunity CMI. Selain itu infeksi TB juga meningkatkan kebutuhan energi, penurunan asupan makanan, penurunan berat badan, dan malabsorpsi makro dan mikronutrien sehingga terjadi wasting. Terapi medik gizi pada pasien TB paru dengan komplikasi TBEP dan malnutrisi bertujuan untuk memperbaiki parameter ststus nutrisi, mempertahankan imbang nitrogen dan mencegah proses wasting lebih lanjut. Metode: Pasien pada laporan serial kasus ini berusia antara 8 ndash;28 tahun menderita TB paru dengan komplikasi lesi TBEP yang berbeda-beda, yaitu: 1 limfadenitis TB, skrofuloderma, dan efusi pleura, 2 spondilitis TB, 3 TB intestinal pasca laparotomi dengan fistula enterokutan, serta 4 meningoensefalitis TB dan TB milier. Status gizi keempat pasien adalah 2 pasien malnutrisi berat dan 2 pasien malnutrisi ringan, dengan hasil skrining skor >2. Terapi medik gizi yang diberikan disesuaikan dengan kondisi klinis dan kelainan yang terdapat pada pasien. Keempat pasien diberikan suplementasi mikronutrien. Pemantauan yang dilakukan meliputi keluhan subjektif, tanda vital, analisis dan toleransi asupan, pemeriksaan laboratorium, kapasitas fungsional, serta pada pasien TB intestinal dilakukan pemantauan produksi fistel serta perubahan berat badan. Hasil: Tiga pasien mengalami perbaikan kondisi klinis, asupan makanan dan kapasitas fungsional, satu pasien perburukan dan meninggal. Kesimpulan: Terapi medik gizi yang adekuat pada pasien TB dengan TBEP dan malnutrisi dapat mempercepat pemulihan dan memperbaiki status nutrisi.Kata kunci: Malnutrisi, terapi medik gizi, tuberkulosis ekstrapulmonar, suplementasi mikronutrien, keluaran klinis.
ABSTRACT<>br>
Objective Nutritional status and tuberculosis TB infections are frequently related. Active TB leads to weight loss and undernutrition is a risk factor for TB infection, either through the reactivation of latent TB or progressive primary disease into extrapulmonary TB EPTB. Macro and micronutrient deficiencies in malnourished patients will affect the cell mediated immunity CMI system. TB infection also increases energy demand, decreased food intake, induced weight loss, and macro and micronutrient malabsorption resulting in wasting. The aims of nutritional medical therapy in pulmonary tuberculosis patients complicated by EPTB and malnutrition are to improve the parameters of nutritional status, maintain nitrogen balance and prevent further wasting. Methods Patients age on this case series report between 8 and 28 years old, have pulmonary tuberculosis with complications of different EPTB lesions 1 TB lymphadenitis, scrofuloderma, and pleural effusion, 2 spondylitis TB, 3 post laparotomy intestinal TB with enterocutaneous fistula, and 4 TB meningoencephalitis and miliary TB. The nutritional status of all patients was 2 patient had severe malnutrition and 2 patients had mild malnutrition. All patient had screening score 2. Nutritional therapy which was given to all patients, was adjusted to the clinical conditions and abnormalities suffered by the patient. All patients received micronutrient supplementation. Monitoring included subjective complaints, vital signs, analysis and intake tolerance, laboratory examination, functional capacity, and in one patient with intestinal TB, fistel production and weight changes. Results Three patients showed improved clinical conditions, dietary intake and functional capacity, one patient suffered deteriorated and died. Conclusion Adequate medical nutrition therapy in malnourished and EPTB patients can improve recovery and improve nutritional status.Keywords Malnutrition, medical nutrition therapy, extrapulmonary tuberculosis, micronutrient supplementation, clinical outcome."
Depok: Fakultas Kedokteran Universitas Indonesia, 2017
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Eleonora Mitaning Christy
Terapi medik gizi pada pasien Ileostomi High Output = Medical Nutrition Therapy in Patients with High Output Ileostomy
"Ileostomi merupakan tindakan pembedahan pembuatan lubang (stoma) antara
ileum dan dinding abdomen, bertujuan untuk pengalihan feses. Ileostomi umumnya
dibuat pada pasien yang menjalani penanganan kanker kolorektal, neoplasma
stadium lanjut dengan infiltrasi usus halus, maupun peradangan saluran cerna.
Ileostomi high output (produksi stoma ileum >1500 mL/hari) dapat menyebabkan
gangguan keseimbangan cairan dan elektrolit, maupun malnutrisi pada pasien. Saat
ini belum ada pedoman tata laksana nutrisi komprehensif untuk pasien ileostomi
high output. Serial kasus ini bertujuan untuk mendukung terapi, mengatasi
malnutrisi, menunjang perbaikan klinis, sehingga dapat menurunkan morbiditas
dan mortalitas pasien ileostomi high output. Empat pasien ileostomi high output
dengan rentang usia 42 hingga 50 tahun mendapatkan terapi medik gizi selama
perawatan di rumah sakit. Tiga kasus merupakan kasus kronik dengan keganasan,
sementara satu kasus lainnya merupakan kasus akut yaitu adhesi dan perforasi
akibat hernia femoralis strangulata. Keempat kasus tersebut merupakan ileostomi
high output onset awal, yaitu yang terjadi kurang dari tiga minggu pasca pembuatan
stoma. Berdasarkan kriteria malnutrisi American Society for Parenteral and
Enteral Nutrition (ASPEN), keempat pasien ini tergolong malnutrisi berat. Terapi
medik gizi diberikan dengan prinsip pemberian makanan dan minuman porsi kecil
namun sering, restriksi cairan hipotonik, pemberian minuman berupa larutan
elektrolit-glukosa, pemberian medikasi anti motilitas, serta koreksi cairan dan
elektrolit menurut kebutuhan dan kondisi klinis pasien. Target asupan energi dan
protein pada keempat pasien dapat tercapai selama perawatan. Selama pemantauan,
keempat pasien mengalami penurunan output ileostomi, serta perbaikan
keseimbangan cairan dan elektrolit darah. Satu pasien mengalami perburukan klinis
dan meninggal akibat sepsis pada hari perawatan ke-18. Tiga pasien pulang dengan
kondisi klinis perbaikan. Satu pasien mengalami peningkatan output ileostomi saat
perawatan di rumah, kemudian dirawat kembali sepuluh hari setelah pulang karena
komplikasi anemia gravis dan ketidakseimbangan elektrolit, dan pada akhirnya
meninggal. Terapi medik gizi dapat menurunkan produksi stoma, memperbaiki
kadar elektrolit darah, serta memperbaiki keseimbangan cairan pada pasien
ileostomi high output.
Ileostomy is a surgical procedure to divert the ileum onto an artificial opening in
the abdominal wall, aimed for fecal diversion. Ileostomy is commonly created in
patients undergoing treatment for colorectal cancer, advanced neoplasms with
intestinal infiltration, or gastrointestinal inflammation. High output ileostomy
(stoma output >1500 mL per day) can cause imbalance of fluid and electrolytes,
and malnutrition in patients. At present, there is no comprehensive nutrition
management guideline for high output ileostomy patients. This case series aimed
to support therapy, prevent malnutrition, improve clinical condition, as well as to
reduce the morbidity and mortality of high output ileostomy patients. Four high
output ileostomy patients, with a range of age 42 to 50 years old received medical
nutrition therapy during their hospital stay. Three cases were chronic cases in
malignancy, while the other case was an acute case of adhesion and perforation due
to strangulated femoral hernia. All four cases were early onset high output
ileostomy, occurring in three weeks after stoma creation. Based on the American
Society for Parenteral and Enteral Nutrition (ASPEN) malnutrition criteria, these
four patients were classified as severe malnutrition. Medical nutrition therapy was
administered according to a set of principles: small frequent feeding and drinking,
hypotonic fluid restriction, oral electrolyte-glucose solution administration, antimotility
medication administration, as well as fluid and serum electrolyte
correction, according to patients' needs and clinical conditions. The target of energy
and protein intake in all patients were achieved during hospital stay. During hospital
monitoring, decreased ileostomy output as well as improvement in fluid and
electrolyte balance were observed in all patients. One patient clinically worsened
and died due to sepsis on the 18th day of hospital stay. Three patients showed
improvement in clinical condition and were discharged. One patient experienced an
increase in ileostomy output at home, and then readmitted ten days after hospital
discharge due to severe anemia and electrolyte imbalance and subsequently died.
Medical nutrition therapy may decrease output as well as improve fluid and
electrolyte balance in patients with high output ileostomy."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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