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"Tujuan pembuatan laporan serial kasus adalah diketahuinya peran tatalaksana nutrisi pada pasien stroke iskemik (SI). Kasus berupa empat pasien SI perempuan yang dirawat di ruang rawat inap divisi cerebrovascular disease (CVD) Departemen Neurologi RSUPNCM Jakarta yang mendapat tatalaksana dan pemantauan asupan nutrisi selama minimal lima hari. Data yang diambil meliputi usia, status gizi, faktor risiko/penyebab, hasil laboratorium, asupan nutrisi (makro dan mikronutrien), serta kapasitas fungsional (skor indeks Bartel). Karakteristik pasien dengan rentang usia 50-60 tahun, status gizi awal berdasarkan indeks massa tubuh/IMT pada 50% pasien termasuk kategori status gizi lebih, 25% status gizi obes dan 25% status gizi kurang (KEP 1). Asupan kebutuhan energi basal (KEB) berkisar 1200-1500 kkal (20-25 kkal/kgBB) dalam bentuk makanan cair per NGT dan kebutuuhan energi total (KET) 1700-2000kkal (27-32 kkal/kgBB) dengan pencapaian asupan oral sekitar 80-90%. Asupan protein antara 0,7-1,5 kg/kgBB, dengan komposisi lipid 25-30% dan KH 55-62% KET. Mikronutrien yang diberikan antara lain vitamin B (B1, B6, B12), asam folat, vitamin C serta mineral tablet CaCO3. Perbaikan kapasitas fungsional berdasarkan indeks Bartel terjadi sesuai peningkatan asupan nutrisi.

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The purpose of case series report were to know the role of nutritional management for patients with ischemic stroke. The caseswere four female ischemic stroke patients treated in Division of cerebrovascular disease (CVD) Department of Neurology RSUPNCM Jakarta who received treatment and monitoring of nutrition for a minimum of five days. Data taken included age, nutritional status, risk factors, causes, laboratory results, intake of nutrients (macro and micronutrients), and functional capacity (Bartel index scores). Characteristics of patients was age 50-60 years, with nutritional status 50% of patients overweight, 25% obes and 25% underweight/malnutrition based on body mass index / BMI. The basal energy requiment range were 1200-1500 kcal (20-25 kcal / kg) in the form of liquid food per NGT and the total energy requiment 1700-2000kcal (27-32 kcal / kg) by oral intake of achieved 80-90%. Protein intake between 0.7 to 1.5 kg / kg, the lipid proportion 25-30% and carbohydrate 5-62% of total energy. The micronutruients which were administered including vitamin B (B1, B6, B12), folic acid, vitamin C and minerals tablet CaCO3. The improvement of functional capacity by Bartel index occurred in conjunction with increased nutrients intake."

"Tatalaksana nutrisi pada pasien cedera kepala sedang dan berat mencakup pemberian makronutrien mikronutrien nutrien spesifik pengelolaan cairan dan elektrolit serta pemantauan dan evaluasi Dukungan nutrisi yang adekuat perlu diberikan pada pasien cedera kepala agar meningkatkan perbaikan kondisi optimal pasien Sebagian besar pasien cedera kepala memiliki status gizi yang baik sebelum terjadinya trauma Pemenuhan nutrisi yang optimal dapat turut menunjang perbaikan inflamasi metabolisme dan menjaga tidak terjadi penurunan status gizi Pasien pada serial kasus ini seluruh pasien laki laki mempunyai rentang usia 19 sampai 49 tahun Adanya penyakit penyerta mempengaruhi luaran akhir pasien cedera kepala Terapi nutrisi diberikan sesuai dengan kebutuhan setiap pasien Kebutuhan energi total dihitung berdasarkan perkiraan kebutuhan energi basal menggunakan persamaan Harris Benedict dikalikan faktor stres 1 4 1 6 dan pemberiannya disesuaikan dengan kondisi klinis pasien Kebutuhan protein 1 5 2 g kg BB hari dan lemak 20 30 Pemantauan mencakup tanda klinis toleransi asupan makanan kapasitas fungsional keseimbangan cairan parameter laboratorium dan antropometri Pemberian nutrisi pada pasien cedera kepala berat dengan sakit kritis bersifat individual dan mencakup semua aspek Tatalaksana nutrisi yang baik dan dilanjutkan dengan edukasi pada pasien dan keluarga diharapkan dapat meningkatkan kualitas hidup pasien cedera kepala dengan meminimalkan komplikasi yang dapat terjadi

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Nutrition therapy in patients with moderate and severe traumatic brain injury includes the provision of macronutrient micronutrient specific nutrition fluid and electrolyte management with monitoring and evaluation Adequate nutrition support should be given in traumatic brain injury to optmalyze outcome patient Three from four this case series have a normoweight before trauma Nutritional support can improve metabolism decrease inflammation and manage nutritional status Patients in this case series all male have an age range from 19 to 49 kg years Their comorbid condition influence outcome of traumatic brain injury patient Nutritional support is given according to each patient rsquo s requirement which is calculated with basal energy requirement using Harris Benedict equation with stress factor 1 4 1 6 and the administration starts with individual condition which gradually increased to reach the total energy expenditure Protein requirement 1 5 2 g kg day and lipid requirement is calculated 20 30 total energy requirement Patient rsquo s monitoring include clinical signs food intake tolerance functional capacity fluid balance laboratory and anthropometric parameter were taken With the management of good nutrition expected quality of life of patients with moderate and severe traumatic brain injury various comorbidities would be better "

"Kanker kepala dan leher KKL merupakan penyakit yang berhubungan dengan malnutrisi Massa tumor perubahan metabolik dan efek samping terapi dapat menyebabkan berkurangnya asupan sehingga pasien jatuh pada kondisi malnutrisi Efek samping radiasi dapat berupa mual muntah mukositis xerostomia dan disfagia Tatalaksana nutrisi pada pasien KKL yang menjalani radioterapi bertujuan untuk meningkatkan mempertahankan status gizi mencegah terputusnya terapi meningkatkan kualitas hidup pasien dan meningkatkan angka harapan hidup Tatalaksana nutrisi meliputi pemenuhan kebutuhan makronutrien mikronutrien nutrien spesifik disertai konseling dan edukasi Serial kasus ini membahas tatalaksana nutrisi pada empat kasus KKL stadium IV yang menjalani radioterapi Keempat pasien menjalani skrining metoda malnutrition screening tool MST dengan nilai ge 2 kemudian mendapatkan tatalaksana nutrisi yang sesuai dengan kondisi pasien Kebutuhan basal masing masing pasien dihitung menggunakan rumus Harris Benedict dan kebutuhan total dihitung dengan cara mengalikan kebutuhan basal dengan faktor stres yang sesuai dengan kondisi klinik pasien Kebutuhan protein 1 5 2 5 g kgBB hari dan lemak sebesar 25 30 kebutuhan total sesuai kondisi pasien Pemantauan yang dilakukan mencakup keluhan subjektif klinis dan tanda vital gejala efek samping antropometri dan kapasitas fungsional Berdasarkan hasil pemantauan pada keempat pasien tatalaksana nutrisi yang diberikan dapat meningkatkan jumlah asupan dan meningkatkan berat badan pada pasien 1 2 dan 3 sedangkan pada pasien 4 dapat meminimalkan penurunan berat badan Tatalaksana nutrisi pada keempat pasien juga dapat meningkatkan kapasitas fungsional dan menunjang kelangsungan terapi Sebagai kesimplan tatalaksana nutrisi pada pasien KKL stadium IV yang menjalani radioterapi bersifat individual disesuaikan dengan kondisi metabolik dan efek samping terapi disertai dengan konseling dan edukasi untuk pasien dan keluarga Tatalaksana nutrisi yang baik dapat menunjang kelangsungan terapi pasien sehingga membantu memperpanjang angka harapan hidup pasien

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Head and neck cancer HNC is a malnutrition related disease Tumor mass metabolic alterations and radiation side effects like nausea vomiting mucositis xerostomia and dysphagia can decrease nutrition intake and leads to malnutrition The aim of nutritional management on HNC patients undergoing radiotherapy is to improve and maintain nutritional status prevent therapy interruption improve and increase patient's quality of life and life expectancy The nutritional management contains of macronutrient micronutrient and nutrition specific along with counceling and education This case series discusses the nutritional management in four cases of stage IV HNC undergoing radiotherapy The patients were screened by malnutrition screening tool MST with score ge 2 then given the provision nutritional management Patients'needs were calculated using the Harris Benedict formula by multiplying basal energy requirement with stress factor according to the patient's condition Protein need were 1 5 2 5 g kgBW and fat 25 30 of total energy requirement matched with metabolic conditions Monitoring includes subjective complaints clinical and vital signs symptoms of treatment's side effects antropometry and functional capacity Based on the monitoring results nutritional management of these four patients could increase dietary intake promote weight loss in patients 1 2 and 3 and minimize weight loss in patient 4 The treatment also could improve the patients'functional capacity and support continuation of radiotherapy Nutritional management of stage IV HNC patients undergoing radiotherapy is individualized tailored to the metabolic conditions and treatment's side effects along with counseling and education to patients and families With an adequate nutritional management it can support the continuity of therapy thus improving the patients'life expectancy"

"[ABSTRAKSerial kasus ini bertujuan untuk mempelajari dan menerapkan terapi nutrisi sebagai bagian dari terapi tuberkulosis (TB) paru. Komplikasi yang menyertai TB paru dapat meningkatkan morbiditas dan mortalitas. Seluruh pasien serial kasus ini dalam kondisi malnutrisi dan terdapat komplikasi yang menyertai masingmasing kasus berupa drug-induced hepatotoxicity, peritonitis TB, diabetes melitus tipe 2, dan pneumotoraks dengan dispepsia. Pemberian nutrisi disesuaikan dengan kondisi, penyakit penyerta, dan kebutuhan yang bersifat individual. Kebutuhan energi basal dihitung dengan persamaan Harris-Benedict dengan kebutuhan energi total setara dengan 35?40 kkal/kg BB. Makronutrien diberikan dalam komposisi seimbang dengan protein 15?20% kebutuhan energi (1,2?1,5 g/kg BB). Saran pemberian mikronutrien minimal mencapai angka kecukupan gizi. Pasien yang mendapat obat antituberkulosis berupa isoniazid disarankan mendapat suplementasi vitamin B6 dengan dosis tertentu untuk mencegah neuritis perifer. Outcome yang dinilai meliputi kondisi klinis, asupan, dan toleransi asupan. Pemberian terapi nutrisi sebagian besar pasien dimulai dari kebutuhan energi basal yang pada akhir masa perawatan dapat mencapai target kebutuhan energi total. Pemantauan jangka panjang pasca rawat inap, disarankan tidak hanya menilai outcome berdasarkan perubahan berat badan, namun dilakukan penilaian komposisi tubuh, terutama massa lemak, karena pada kasus TB terjadi abnormalitas metabolisme yang disebut anabolic block.

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ABSTRACTThe aim of this case series was to study and apply nutrition therapy as integral part of pulmonary tuberculosis (TB) therapy. Pulmonary TB with complications was associated with increased of morbidity and mortality. Malnutrition was coexisted with several complications such as drug-induced hepatotoxicity, peritoneal TB, type 2 diabetes mellitus, and pneumothorax with dyspepsia. HarrisBenedict equation was used to calculate basal energy requirement with total energy requirement equivalent to 35?40 kcal/body weight. Balanced macronutrient composition was given with protein 15?20% energy requirement (1,2?1,5 g/body weight). Micronutrient recommendation was given to fulfill one fold recommended daily allowance. Patients with isoniazid therapy needed to get pyridoxine supplementation to prevent peripheral neuritis. Outcome measurements included clinical condition, amount of intake, and intake tolerance. Most patients were given initial nutrition therapy from basal energy requirement and has shown increment. At the end of hospitalization, all of patients could achieve total energy requirement. Due to abnormality of metabolism, usually termed as anabolic block, it was recommended not only to measure body weight as primary outcome, but also body composition., The aim of this case series was to study and apply nutrition therapy as integral part of pulmonary tuberculosis (TB) therapy. Pulmonary TB with complications was associated with increased of morbidity and mortality. Malnutrition was coexisted with several complications such as drug-induced hepatotoxicity, peritoneal TB, type 2 diabetes mellitus, and pneumothorax with dyspepsia. HarrisBenedict equation was used to calculate basal energy requirement with total energy requirement equivalent to 35–40 kcal/body weight. Balanced macronutrient composition was given with protein 15–20% energy requirement (1,2–1,5 g/body weight). Micronutrient recommendation was given to fulfill one fold recommended daily allowance. Patients with isoniazid therapy needed to get pyridoxine supplementation to prevent peripheral neuritis. Outcome measurements included clinical condition, amount of intake, and intake tolerance. Most patients were given initial nutrition therapy from basal energy requirement and has shown increment. At the end of hospitalization, all of patients could achieve total energy requirement. Due to abnormality of metabolism, usually termed as anabolic block, it was recommended not only to measure body weight as primary outcome, but also body composition.]"

"[ABSTRAKPasien penyakit ginjal kronik derajat 5 mengalami suatu keadaan di mana ginjal sama sekali tidak dapat mempertahankan homeostasis metabolisme tubuh sehingga membutuhkan terapi pengganti ginjal. Terapi pengganti ginjal yang paling sering dipilih oleh pasien PGK derajat 5 adalah hemodialisis. Perubahan metabolik pada PGK derajat 5 dengan hemodialisis dapat disebabkan oleh gangguan fungsi ginjal dan proses hemodialisis. Perubahan metabolik tersebut antara lain gangguan keseimbangan cairan, dan asam basa serta gangguanmetabolisme protein, karbohidrat, dan lemak. Dibutuhkan terapi terintegrasi pada pasien PGK yang terdiri atas terapi farmakologi, terapi pengganti ginjal, terapi nutrisi dan dukungan psikologis. Peran nutrisi dalam menurunkan komplikasi dan meningkatkan kualitas hidup sangat penting dalam tatalaksana pasien PGK. Pemberian nutrisi pada pasien PGK dengan hemodialisis bertujuan untuk mengatasi gejala akibat gangguan ginjal dan mencegah komplikasi akibat progresivitas kerusakan ginjal. Pemberian nutrisi yang tepat dapat dilakukan dengan memahami patofisiologi yang terjadi pada pasien PGK dan proseshemodialisis yang dipilih sebagai terapi pengganti ginjal. Berdasarkan hal tersebut, dilaporkan empat serial kasus pada pasien PGK derajat 5 dengan hemodialisis rutin. Diberikan terapi nutrisi sesuai panduan yaitu energi 30-35 kkal per kg berat badan, protein 1,2 g per kg berat badan, lemak 25-30% energi total, dan karbohidrat 60-65% energi total. Diketahui bahwa penyebab asupan tidak terpenuhi adalah keadaan klinis yaitu sesak, penurunan kesadaran, dan gangguan saluran cerna yaitu mual dan muntah.

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ABSTRACTStage 5 of chronic kidney disease represents total inability of kidneys to maintain body homeostasis normally. At this stage, it is necessary to use methods that substitute kidney function such as hemodialysis, peritoneal dialysis, or kidney transplantation. The most used method is hemodialysis. Metabolic changes in stage 5 of chronic kidney disease can be caused by kidney disease itself and also hemodialysis treatment. Metabolic complications of chronic kidney disease and hemodialysis include changes in acid-base balance and metabolism of proteins,carbohydrates and lipids. Patients need integrated therapy that consist of medicine, kidney function substitution, nutrition, and psychological support. Nutrition therapy is important in chronic kidney disease therapy because it can help to decrease complication and to increase quality of life. The purpose of nutrition therapy in chronic kidney disease are to overcome the symtoms and to prevent the complication that caused by kidney disease. Nutrition therapy can be done properly by understand the pathophysiologycal mechanism and the process of hemodialysis. Based on the description, four cases of stage 5 of chronic kidney disease with hemodialysis are reported here. The nutrition which is given consist of energy 30-35 kkal per kg body weight, protein 1,2 g per kg body weight, lipid 25-30 % total energy, and carbohydrate 60-65 % total energy. There is inadequacy of intake due to clinical conditions such as dispnoe, the decreased of consciousness, and intestinal disturbance like nausea and vomit. Stage 5 of chronic kidney disease represents total inability of kidneys to maintain body homeostasis normally. At this stage, it is necessary to use methods thatsubstitute kidney function such as hemodialysis, peritoneal dialysis, or kidney transplantation. The most used method is hemodialysis. Metabolic changes in stage 5 of chronic kidney disease can be caused by kidney disease itself and also hemodialysis treatment. Metabolic complications of chronic kidney disease and hemodialysis include changes in acid-base balance and metabolism of proteins, carbohydrates and lipids. Patients need integrated therapy that consist of medicine, kidney function substitution, nutrition, and psychological support. Nutrition therapy is important in chronic kidney disease therapy because it can help to decrease complication and to increase quality of life. The purpose of nutrition therapy in chronic kidney disease are to overcome the symtoms and to prevent the complication that caused by kidney disease. Nutrition therapy can be done properly by understand the pathophysiologycal mechanism and the process of hemodialysis. Based on the description, four cases of stage 5 of chronic kidney disease with hemodialysis are reported here. The nutrition which is given consist of energy 30-35 kkal per kg body weight, protein 1,2 g per kg body weight, lipid 25-30 % total energy, and carbohydrate 60-65 % total energy. There is inadequacy of intake due to clinical conditions such as dispnoe, the decreased of consciousness, and intestinal disturbance like nausea and vomit., Stage 5 of chronic kidney disease represents total inability of kidneys to maintainbody homeostasis normally. At this stage, it is necessary to use methods thatsubstitute kidney function such as hemodialysis, peritoneal dialysis, or kidneytransplantation. The most used method is hemodialysis. Metabolic changes instage 5 of chronic kidney disease can be caused by kidney disease itself and alsohemodialysis treatment. Metabolic complications of chronic kidney disease andhemodialysis include changes in acid-base balance and metabolism of proteins,carbohydrates and lipids. Patients need integrated therapy that consist of medicine, kidney function substitution, nutrition, and psychological support. Nutrition therapy is important in chronic kidney disease therapy because it can help to decrease complicationand to increase quality of life. The purpose of nutrition therapy in chronic kidney disease are toovercome the symtoms and to prevent the complication that caused by kidneydisease. Nutrition therapy can be done properly by understand thepathophysiologycal mechanism and the process of hemodialysis. Based on the description, four cases of stage 5 of chronic kidney diseasewith hemodialysis are reported here. The nutrition which is given consist ofenergy 30–35 kkal per kg body weight, protein 1,2 g per kg body weight, lipid25–30 % total energy, and carbohydrate 60–65 % total energy. There isinadequacy of intake due to clinical conditions such as dispnoe, the decreased of consciousness, and intestinal disturbance like nausea and vomit.]"

"Latar Belakang: Penuaan merupakan proses fisiologis yang terjadi pada semua organ tubuh. Usia lanjut dan sejumlah komorbid yang terjadi seperti hipertensi, penyakit jantung koroner, diabetes melitus, penyakit paru obstruktif kronik dan penyakit ginjal kronik, merupakan faktor risiko mayor gagal jantung kongestif. Pasien usia lanjut dengan gagal jantung kongestif berisiko tinggi readmisi rumah sakit, malnutrisi, defisiensi mikronutrien, dehidrasi atau kelebihan cairan, dan mengalami penurunan ambang rasa. Pada tata laksana gagal jantung kongestif, penting untuk membatasi asupan natrium dan cairan yang dapat menyebabkan penurunan asupan nutrisi, sehingga terapi nutrisi diperlukan sejak awal perawatan. Metode: Laporan serial kasus ini memaparkan empat kasus pasien usia lanjut dengan gagal jantung kongestif, berusia 65-78 tahun dengan minimal satu penyakit komorbid yaitu hipertensi, penyakit jantung koroner, penyakit ginjal kronik, penyakit paru obstruktif kronik, dan diabetes melitus. Semua pasien memerlukan dukungan nutrisi. Dua pasien mengalami malnutrisi, satu pasien berat badan lebih dan satu pasien obes I. Masalah nutrisi yang didapatkan antara lain asupan makronutrien dan mikronutrien tidak adekuat dan komposisi nutrisi tidak seimbang selama sakit dan 24 jam terakhir, gangguan elektrolit, hiperurisemia, hiperglikemia, peningkatan kadar kolesterol LDL dan gangguan keseimbangan cairan. Terapi nutrisi gagal jantung kongestif diberikan pada semua pasien disesuaikan dengan penyakit komorbid masing-masing. Suplementasi mikronutrien dan nutrien spesifik diberikan pada keempat pasien. Pemantauan meliputi keluhan subyektif, hemodinamik, tanda dan gejala klinis, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan, dan kapasitas fungsional. Hasil: Keempat pasien menunjukkan peningkatan asupan nutrisi, perbaikan klinis berupa penurunan tekanan darah dan frekuensi nadi, serta peningkatan kapasitas fungsional. Kesimpulan: Terapi nutriso yang adekuat dapat memperbaiki kondisi klinis pasien usia lanjut dengan gagal jantung kongestif dan berbagai penyakit komorbid.

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Background: Aging is a physiological process, which is occurs in all organs. Elderly people and various comorbidities, such as hypertension, coronary artery disease, diabetes mellitus, chronic obtructive pulmonary disease and chronic kidney disease, are major risk factors of congestive heart failure. Elderly patients with congestive heart failure are at high risk of hospital readmission, malnutrition, micronutrients deficiency, dehydration or fluid overload and decreased sense of taste. In the congestive heart failure therapy, fluid and sodium intake restriction is important, however it may result in decreased nutrition intake so that is necessary to provide early adequate nutrition therapy.

Method: This serial case report describes four cases of congestive heart failure with various comorbidities in the elderly patients, aged 65-78 years old, with at least one comorbid, such as hypertension, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, and diabetes mellitus. All patients required nutrition support. Two patients classified as malnutrition, one overweight and one obese I. Nutrition problems in this serial case report are macromicronutrients intake, and nutrition composition imbalance during ill and 24 hours before hospitalized, electrolyte imbalance, hyperuricemia, hyperglycemia, elevated LDL cholesterol levels, and fluid imbalance. Nutrition therapy for congestive heart failure was given to all patients, and adjusted to the comorbidities in each patient. Micronutrients and specific nutrients supplementation were given to all patients. Monitoring include subjective complaints, hemodynamic, clinical signs and symptoms, analysis and tolerance of food intake, laboratory results, anthropometric, fluid balance, and functional capacity.

Result: During monitoring in the hospital, all patients showed improved food intake, clinical outcomes, such as decreased of blood pressure, heart rate and increased of fungcional capacity.

Conclusion: Adequate nutrition therapy an important role in improving clinical conditions in the elderly patients with congestive heart failure and various comorbidities."

"Latar Belakang: Stroke iskemia merupakan disfungsi neurologik area tertentu atau menyeluruh akibat gangguan aliran darah ke otak yang dapat menyebabkan kerusakan jaringan. Berbagai faktor risiko yang tidak dapat dimodifikasi dan dapat dimodifikasi seperti usia, jenis kelamin, riwayat keluarga, hipertensi, diabetes melitus, obesitas berperan menyebabkan pembentukan aterosklerosis, iskemia serebral selanjutnya menyebabkan stroke iskemia. Stroke iskemia dan sejumlah penyulit akan menimbulkan defisit neurologi yang menyebabkan malnutrisi, dehidrasi, keluaran yang buruk dan kualitas hidup menurun. Terapi medik gizi klinis berperan memberi nutrisi optimal, membatasai natrium, mengontrol glukosa darah dan memperhatikan volume cairan yang diberikan sehingga status nutrisi tetap terjaga, memperbaiki keluaran, dan mencegah rekurensi. Metode: Serial kasus ini memaparkan empat kasus stroke iskemia pada pasien perempuan dan laki-laki dengan rentang usia 53 ndash;66 tahun, dengan penyulit seperti disfagia, perdarahan GIT dan pneumonia, disertai komorbiditas yaitu DM tipe 2, hipertensi, dan chronic kidney disease,. Keempat pasien membutuhkan dukungan nutrisi akibat komplikasi stroke iskemia yaitu disfagia dengan risiko terjadinya malnutrisi, dehidrasi dan ketidakseimbangan elektrolit. Satu pasien dengan berat badan normal, 1 pasien BB lebih, dan 2 pasien obes I. 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, anemia, hiperglikemia, dislipidemia, gangguan fungsi ginjal dan keseimbangan cairan. Terapi medik gizi klinik diberikan sesuai rekomendasi stroke iskemia dan disesuaikan dengan komorbidnya. Pemantauan pasien meliputi keadaan umum, hemodinamik, analisis dan toleransi asupan, monitoring terhadap kadar glukosa darah, fungsi ginjal, keseimbangan cairan, elektrolit dan kapasitas fungsional. Hasil :Ketiga pasien pada serial kasus menunjukkan perbaikan klinis, berupa tekanan darah terkontrol, kadar glukosa darah terkontrol, dan kapasitas fungsional yang membaik. Satu pasien meninggal pada hari perawatan ke-35 akibat sepsis. Kesimpulan:Terapi medik gizi klinik yang optimal dapat memperbaiki kondisi klinis pada pasien stroke iskemia dengan DM tipe 2 dan penyulitnya.

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Background: Ischemic stroke is a partial or comprehensive neurological disfunction caused by cerebral blood flow disturbance as basis of tissue damages. A diversity of non modified and modified risk factors such as age, sex, family history, hypertension, diabetes mellitus, and obesity act as underlying causes to atherosclerosis, ischemia cerebral, that lead to ischemic stroke. Ischemic stroke with accompanying comorbidity will inflict neurological deficit causing malnutrition, dehydration, bad outcome and the diminution quality of life. The role of nutritional medical therapy is pivotal for optimal nutritional support, sodium intake restriction, and glycemic control with the goal to maintain nutrition status, improve outcome and prevent recurrence.

Methods: The case series describes four ischemic stroke cases with complications such as dysphagia, gastrointestinal bleeding, and pneumonia, and aggravated by DM type II, hypertension, and chronic kidney disease comorbidity, in males and females aged 53 ndash 66 years old. Due to risk of malnutrition, dehydration and electrolyte imbalance caused by dysphagia, nutrition support was required by all patients to treat this ischemic stroke complication. One patient was normoweight, while three other cases included one overweight and two obese I patients. The nutritional problems faced by these four patients laid on the non optimal macro and micro nutrient intake, route of nutrient intake, nutrition composition imbalance during ill period, anaemia, hyperglycaemia, dyslipidemia, decrease of renal function, and fluid imbalance. Nutritional medical therapy was given according to recommendations for ischemic stroke and adjusted with its comorbidity. Patients rsquo monitoring was done including their general condition, hemodynamic, intake analysis and tolerance, monitoring in blood glucose, kidney function, fluid balance, electrolyte and functional capacity.

Result: Three patients in the case series showed positive changes in clinical conditions, shown by improvement in blood pressure, blood glucose, and functional capacity. One patient died on the 35th treatment day due of sepsis.

Conclusion: Optimal nutritional medical therapy plays important role in improving clinical conditions of ischemic stroke patient with DM type 2 and other complications."

"ABSTRAKLatar Belakang: Penyakit autoimun terjadi karena tubuh tidak mampu untuk mengenali sel atau jaringan tubuh sendiri, sehingga tubuh memberikan respons seperti proses eliminasi antigen terhadap sel atau jaringan tubuh sendiri. Berbagai faktor risiko, antara lain genetik, lingkungan dan nutrisi berperan pada perkembangan penyakit autoimun. Saat penyakit autoimun telah menimbulkan gejala, pasien memiliki risiko mendapat nutrisi yang tidak adekuat. Selain itu, kondisi autoimun akan menimbulkan respons inflamasi terus-menerus di dalam tubuh. Bila kondisi ini terus berlanjut akan menyebabkan peningkatan status metabolisme, status nutrisi, status imun dan menimbulkan gangguan kapasitas fungsional pada pasien. Pasien dengan penyakit autoimun harus didukung dengan edukasi dan mendapat terapi nutrisi yang tepat dan adekuat, terutama saat menjalani proses terapi sehingga kebutuhan nutrisi dapat terpenuhi sesuai dengan kondisi pasien. Metode: Laporan serial kasus ini menguraikan empat kasus penyakit autoimun. Dua kasus merupakan kasus neurologi, sementara dua kasus lain adalah kasus penyakit kulit. Dua pasien memiliki status nutrisi malnutrisi berat, satu pasien berat badan normal berisiko malnutrisi dan satu pasien obes I berisiko malnutrisi. Terapi nutrisi sesuai mengacu pada diet seimbang. Semua pasien mendapat terapi nutrisi sejak dikonsulkan ke Departemen Medik Ilmu Gizi hingga hari terakhir perawatan di RS. Asupan energi dan protein diberikan meningkat bertahap sesuai dengan kondisi klinis dan toleransi pasien. Suplementasi mikronutrien diberikan kepada pasien. Pemantauan pasien meliputi keluhan subjektif, hemodinamik, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, imbang cairan, dan kapasitas fungsional. Hasil: Selama pemantauan di RS, asupan pasien dapat mencapai kebutuhan energi total dan mikronutrien diterima oleh pasien. Perbaikan klinis dan perbaikan kapasitas fungsional terjadi pada 3 pasien. Satu pasien mengalami perburukan dan meninggal akibat sepsis pada hari perawatan ke-33. Kesimpulan: Terapi nutrisi pada pasien autoimun dapat mendukung proses pengobatan berupa perbaikan kapasitas fungsional dan lama rawat 3 pasien.

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ABSTRACTObjective Autoimmune disease is a condition of body inability to recognize the cells or tissues itself. It will response as antigen elimination process against the cells or tissue itself. Autoimmune risk factors, such as genetic, enviromental and nutrients play a role in the development of autoimmune diseases. When the symptoms occur, the patient have a risk of inadequate nutrition. In addition, autoimmune condition will cause continuous inflammatory response. This situation will increase patients rsquo s metabolic, nutritional, and immune status. Thus, reduce the patient rsquo s functional capacity. Patient with autoimmune disease should be supported by appropriate and adequate nutrition education and therapy, especially during the therapeutic process so that the nutrition requirements can be fulfilled according to the patient 39 s condition. Methods These case report outlines four cases of autoimmune disease. Two cases are cases of neurology, while the other two cases are cases of skin disease. Two patients had severe malnutrition, one normoweight patient at risk for malnutrition and one obese patient at risk of malnutrition. Management of appropriate nutrition refers to a balanced diet. All patients received nutritional therapy from the Clinical Nutrition Department until the last day of hospitalization. The energy and protein intake increase gradually in accordance with improved clinical conditions and patient rsquo s tolerance. Supplementation of micronutrients is given to the patient. Patient monitoring includes subjective, hemodynamics, analysis and tolerance of intake, laboratory examination, anthropometry, fluid balance, and functional capacity Results During hospital monitoring, the patient 39 s nutrition intake can achieve the total energy and protein requirement as well as the micronutrients. Clinical condition and functional capacity improvements occurred in 3 patients. One patient had worsening condition and died due to sepsis in the 33rd day of treatment. Conclusion Nutritional therapy for patients with autoimmune disease can support the treatment process in improvement of functional capacity and length of stay."

"Latar Belakang: Sindroma Guillain-Barre merupakan kondisi kritis dengan kebutuhan energi meningkat sesuai dengan hiperkatabolisme sehingga meningkatkan risiko malnutrisi. Malnutrisi dapat mengurangi kemampuan otot diafragma, dan meningkatkan risiko infeksi yang akan memperberat kondisi sakit kritis. Terapi medik gizi bertujuan menyediakan substrat energi, mengurangi responss metabolik terhadap stres, memicu responss imun, serta mempertahankan massa bebas lemak. Metode: Serial kasus ini melaporkan empat pasien sakit kritis dengan sindroma Guillain-Barre berusia antara 21-58 tahun. Keempat pasien memiliki status gizi obes berdasarkan kriteria World Health Organization WHO Asia Pasifik. Terapi medik gizi diberikan sesuai pedoman pada keadaan sakit kritis dimulai dengan enteral dini dengan target 20-25 kkal/kg BB fase akut dan protein 1,2-2 g/kg BB. Pemberian nutrisi ditingkatkan bertahap sesuai klinis dan toleransi saluran cerna. Mikronutrien diberikan vitamin D3, B, C, seng. Hasil: Tiga pasien pulang dengan perbaikan kekuatan motorik dengan lama perawatan intensif yang bervariasi, sedangkan satu pasien masih dalam perawatan karena membutuhkan ventilasi mekanik. Kesimpulan: Terapi medik gizi adekuat menunjang proses penyembuhan penyakit dan memperbaiki kapasitas fungsional. "

"Latar Belakang: Kolestasis adalah hambatan atau supresi sekresi empedu. Kolelitiasis dan obstruksi bilier akibat keganasan merupakan kasus kolestasis yang sering ditemui. Kolestasis dapat menyebabkan gangguan nutrisi dan berbagai komplikasi. Selain pembedahan, terapi nutrisi adalah pendekatan tata laksana pada pasien kolestasis untuk mempertahankan status nutrisi dan kapasitas fungsional. Kasus: Pasien dalam serial kasus ini terdiri atas tiga pasien laki-laki dan satu perempuan, berusia 36-55 tahun dengan diagnosis kolestasis akibat keganasan dan postcholecystectomy syndrome (PCS) dengan riwayat kolelitiasis. Satu pasien dengan keganasan dan dua pasien dengan PCS menjalani operasi bypass biliodigestif dan rekonstruksi, sedangkan satu pasien menjalani perbaikan kondisi klinis sebelum pembedahan. Terapi nutrisi yang diberikan meliputi diet tinggi protein dan rendah lemak dengan nutrien spesifik berupa MCT dan BCAA. Pada kasus pertama terapi nutrisi diberikan pascabedah. Selama perawatan ada kecurigaan leakage anastomosis, tetapi keluaran klinis membaik. Pasien kedua mendapat terapi nutrisi prabedah dan mengalami perbaikan kondisi klinis. Kedua pasien tidak mencapai target nutrisi walaupun toleransi makanan cair baik. Kasus ketiga dan keempat mendapat terapi nutrisi pra dan pascabedah dan pada akhir masa pemantauan, dapat mempertahankan status nutrisi. Pada keempat pasien, kapasitas fungsional dapat dipertahankan, bahkan mengalami perbaikan.Kesimpulan: Terapi nutrisi yang optimal dapat memberikan keluaran klinis yang baik pada pasien kolestasis. Pemberian nutrien spesifik berupa MCT dan BCAA diperlukan untuk meningkatkan toleransi asupan, mempertahankan status nutrisi, dan memperbaiki kapasitas fungsional pasien kolestasis.

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Background: Cholestatis is obstruction or suppression of bile secretion. Cholestasis may cause nutritional disturbance and other complication. Besides surgery, nutritional therapy is needed in cholestasis patient for maintaining nutritional status and functional capacity.

Cases: Four cases (three male and one female) of cholestasis with range of age between 36-55 years old are included in this case series. They were diagnosed with cholestasis because of cancer and post-cholecystectomy syndrome (PCS) with cholelithiasis history. One patient with cancer and two patients with PCS had the biliodigestive bypass surgery and reconstruction, while one patient was restoring her clinical condition before surgery. All patients were given high protein and low fat diet, with specific nutrient such as MCT and BCAA. The first patient received nutrition therapy during postoperative phase. During monitoring, he was suspected with leakage anastomosis, but in the end the outcome was good. Second patient got nutritional therapy in preoperative phase and got better clinical condition. Both patients couldnt reach the nutritional target although their tolerance of ONS was good. The third and the fourth patient got nutritional therapy in pre and postoperative phase and had maintained their nutritional status. In all patients, the functional capacity could be maintained and improved.

Conclusion: Optimal nutritional therapy is needed in cholestasis patients to get better clinical outcomes. Specific nutrients such as MCT and BCAA improve the nutritional tolerance, maintain the nutritional status, and improve the functional capacity."