Professional Documents
Culture Documents
1.Name
2.Place/date of birth
3.Address
4.Marial status
5.Alumny
:
:
:
:
:
6.Working Experienced :
Budhi Santoso
Jakarta, 17 Mei 1967
Mampang Indah II, Blok D2, Depok Sawangan
Married with 4 children
Medical Faculty of Brawijaya Univ, Malang,1993
6.1.
6.2.
6.3.
6.4.
7.Training Experienced :
7.1. GCP advance course, Schering AG-Berlin, 1998
7.2. Communication on Family Planning, Sweden 1999
7.3. AUCOGS Congress, Philadelphia-USA, 2000
7.4. Schering internal leadership course, Dusit, Thailand, 2
7.5. Critical Care Annual and Pensa Meeting: Bali 2002
7.6. ATLS advanced, RSCM 2003
7.7. Indonesian GCP, RSCM 2004
7.8. Critically ill in children: Malang, 2005.
7.9. Critical care workshop, Surabaya, 2006, 2007
7.10.Aminofluid Workshop,Tokushima, Japan, 2008, 2010
7.11.Espen Congress, Barcelona Spain, Sept 2012
Cairan Infus
@#$%^&,
Wes, ewes,..ewes,
bablas angine......
Yang penting
kasih obat,
infus no.
12 ?
Waduh, lama
amat, dok !!
Enggak, lama,
Tergantung berapa
lama Ente hidup !!!
Facts:
CAIRAN RESUSITASI YANG LAZIM DIPAKAI
Fluid
Osm
NS
308
RL
273
Intracell
Risk of
Lactate
distribution Hyperchloremic
acidosis
+
(Cl- 154 mEq/L)
+
RA
273
D5
278
RS
310
+
(Cl- 155.5 mEq/L)
Simulasi kasus:
Simulasi kasus:
AA (g)
NPC (g)
Total
kalori(kcal)
1 L ASERING
1 L AMINOFLUID
30
75
420
2 Sachet PROTEN
20
53
424*
TOTAL
50
128
844
Na+ (mEq)
K+ (mEa)
130
35
20
165*
24
simulasi kasus :
AA (g)
NPC (g)
Total
kalori(kcal)
Na+ (mEq)
K+ (mEa)
1 L KAEN MG3
100
400
50
20
1 L AMINOFLUID
30
75
420
35
20
2 Sachet PROTEN
20
53
424*
TOTAL
50
128
1232
85
40
RESUSITASI
RUMATAN
atau koloid
20-30 ml/kg/jam (diare, DSS)
2-3 L/10-15 menit (perdarahan)
65ml/jam
Resuscitation
Maintenance
Otsuka
could
offer to you
Hypovolemic shock
Stable
Hemodynamic
ASERING
First Line
Ringers acetate
Acetate Ringers
Indications of ASERING
First line in replacement fluid for
resuscitation: gastroenteritis, burn,
hemorrhagic shock, DSS with or
whithout hepatic insufficiency
Intra operative
Priming solution for cardiopulmonary
bypass (CPB)
Safe replacement fluid for children
ASERING
Ringers acetate
First Line
Fluid Resuscitation Therapy
Asering Benefit:
1. Komposisi mirip dengan plasma, tepat untuk menggantikan
kehilangan akut cairan ekstraseluler. ( 2 )
2. Kecepatan metabolisme asetat 250-400 mEq/jam , sedangkan
laktat 100mEq/jam, asetat lebih cepat mengkoreksi asidosis.( 3)
3. Asetat memerlukan sedikit O2 dan melepaskan sedikit CO2.( 4 )
4. Metabolisme asetat terutama di otot, tidak terganggu pada kelainan hati (1)
1. Loren A et al. Oxidation of lactate and acetate in rat skeletal muscle. Journal of Applied
Physiology 1997 ; 83 ( 1 ) : p. 32 - 39.
2. Heimberger DC,M.Roland RW. Handbook of Clinical Nutrition.Mosby 1997
3. Anderud T, Lund T. Intensive Care of Patients with Burns. Tidskr Nor Laegenforen 1989;
p.3197 - 3199.
4. Ringer acetate solution in clinical practice. Medimedia.1999
General Benefit
Average pH
Ringers lactate
6.75
ASERING
Normal saline
6.25
In conclusion,
patients with severe sepsis who received fluid resuscitation with HES 130/0.42, as
compared with those who received Ringer's acetate, had a higher risk of death at 90
days, were more likely to receive renal-replacement therapy, and had fewer days
alive without renal-replacement therapy and fewer days alive out of the hospital.
O2 2-4 L/menit
RA/RL 20 ml/kg bolus dalam 30 menit
Syok teratasi
RA/RL 10 ml/kg/jam
3 ml/kg/jam
Ht turun
Ht tetap/naik
FFP 10 ml/kg Dextran 20 ml/kg
Asering /
MgSO4
Syntocinon
Aminophylline
Adonna
JAN 2012
TERAPI CAIRAN
RESUSITASI
Kristaloid
Koloid
RUMATAN
Elektrolit
NUTRISI
Aminofluid
Seri KA-EN
Mengganti kehilangan
1. Menjaga homeostasis haria
akut (hemorrhage,
2. Terapi suportif
GI loss, rongga ke3)
Memepercepat penyembuhan
Facts:
RL
5% Dextrose
5% Dextr. in Ringers
are still widely used
for maintenance therapy *****
RL 2 L
KA-EN 3B 2 L
Natrium
50 100 mEq
260 mEq
100 mEq
Kalium
45 65 mEq
8 mEq
40 mEq
Infus RL bukan
Untuk Terapi Rumatan
Anak BB = 20 kg
Kebutuhan
Air 1.5 L
RL 1.5 L
Natrium
60 100 mEq
195 mEq
75 mEq
Kalium
20 - 50 mEq
6 mEq
30 mEq
Ref. :
1. Rice H. Fluid Therapy for the Pediatric
Surgical Patient. Emedicine. 2003 July.
www.emedicine.com/ped/topic2954.htm
2. Piwko, J.G. and Michael G.C. Neonatology Considerations
for the Pediatric Surgeon. Emedicine. 2004.
www.emedicine.com/ped/topic2982.htm
Infus RL bukan
Untuk Terapi Rumatan
Prevalences of
Hypokalemia
Chief Investigator
Centre
No of
% hypokalemia
patients on admission
% hypokalemia
on Discharge
Untung Sudomo
RSPAD
100
28
45
Djoko Widodo
RSCM
105
22.9
52.4
Nasronudin
RS Sutomo 110
36.36
50.91
1.
2.
3.
Sudomo, Untung. Marissa Ira. Gastroenterogy hepatoloy and digestive endoscopy vol.5. Ed: Dec 2004. Page: 115-120
Widodo D, Setiawan B, Khie Chen. The prevalence of hypokalemia in hospitalized patients with infectious diseases problems at
Ciptomangun-kusumo Hospital Jakarta. Acta Med Indones, 2006;38(4):202-5
Nasronudin et al. The Prevalence of hypokalemia and Hyponatremia in Infectious Diseases Hospitalized Patients. Medika 2006 Vol
XXXII,No 12, p 732-734
Na+ 35 K+ 20
Na+ 77
Dehydrated
Previously well-nourished
Or slightly undernourished
Metabolically Non-stressed
Anorexia
Fatigue
Complete
Electrolyte, 3% AA,
5-10% glucose
maintenance
KAEN3B
AMINOFLUID
Previously malnourished
Or undernourished or
Metabolically stressed
Hypoalbuminemia
Debilitated
If EN entirely impossible
Parenteral Nutrition :
10 % AA, High NPC
(glucose , lipid)
NEOPAREN/MIXID
AMINOFLUID
Glucose
7.5
Amino acids
3%
Aminofluid
Electrolytes
(Na, K, Cl, Mg, Ca, P)
Zinc
By SS 2006-2007
36
2000
2000
2000
30-40 ml/kg/hari
Na+
70
100
260
1-2 mEq/kg/hari
K+
40
40
1-2 mEq/kg*/hari
Cl-
70
100
218
sesuai kebutuhan
Mg++
10
8-20 mEq/hari
Ca++
10
10-15 mEq/hari
20
20-40 mEq/hari
Zn
10 mol
2.5-5 g
Asam amino
AA 60 g
0.8 g/kg/hari
Glukosa
150 g
54 g
BCAA
BBB
Appetite
Fatigue
(Serotonin)
Tryptophan
80%
(Serotonin)
E. Blomstrand A Role for Branched-Chain Amino Acids in Reducing Central Fatigue J. Nutr.,
February 1, 2006; 136(2): 544S - 547S
3 GOLDEN WAYS
Infeksi/Trauma
Inflammation, fever,
hyperventilation
Dehydration,
dry tongue
& mouth
LOSS OF
APPETITE
Cytokines
(TNF,IL-1,IL-6)
serotonin
Melanocortin
2
3
Tryptophan/BCAA ratio centrally
combat fatigue syndrome
Best Recommended in
Following Conditions:
Febrile illnesses
Dehydrated and anorexic, dyspeptic patients
Gastrointestinal diseases, post resuscitation of
severe diarrhea, colonoscopy, gastroparesis
Acute Infectious diseases
Early post operative maintenance (straightforward
surgery)
Hyperemesis gravidarum (after 0.9% NaCl)
Stroke (after metabolic and electrolyte correction)
Precautions:
Renal Failure associated with hyperkalemia
Heart Failure
Small children
Penyakit
Gastrointestinal
DBD
Infeksi akut/
Demam
Hiperemesis
gravidarum
Neurologi
Aminofluid
Diabetes
Mellitus
Postoperatif
Sepsis
POD1
+
ASERING-5
NPC
AA
Na+
K+
500 kcal
30 g
165 mEq
24 mEq
POD 2
NPC
AA
Na+
K+
600 kcal
60 g
70 mEq
40 mEq
POD 3
NPC
AA
Na+
K+
300 kcal
80 g
35 mEq
20 mEq
Aminofluid 500 mL
pOsm: 816 mOsm/L
Na : 35 mEq
K : 20 mEq
Asering 500 mL
pOsm: 274 mOsm/L
Na : 130 mEq
K : 4 mEq
Hypovolemic shock
Stable
Hemodynamic
AMINOFLUID
JAN 2012
3.
4.
Have a nice
day