Fisiologi Demam n Hipertermia

8/17/2019 Fisiologi Demam n Hipertermia

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DEMAM

Bagian FisiologiFakultas Kedokteran

Universitas Muhammadiyah Purwokerto


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Pendahuluan

•


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• -i9ertemia menandakan setia99eningkatan suhu tu:uh di atas

rentang yang diangga9 normal

• Demam :iasanya digunakan untuk9eningkatan suhu tu:uh yang

dise:a:kan 9eningkatan titik 9atokanhi9otalamus oleh 9irogen endogenselama in;eksi dan 9eradangan


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%'P% P)*+,+-)

• )U-U D%UKU* DE&8A& (E*M.ME(E*$

A%//A

*EK(UM

'A8%&A

*.&88A MU/U( 3oral5

• )U-U *EK(A/1'A8%&A/ =," .*A/

A%//A


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•Suhu tubuh diatur oleh hi.otalamus

(thermoregulatory /enter#

•Suhu tubuh diatur oleh hi.otalamus

(thermoregulatory /enter#

(hermoregulatory >enter

9roduksi 9anas3otot he9ar5

dissi9asi 9anas3kulit 9aru5


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)ormal body tem.erature homeostasis

hipotalamusT>37.5℃T


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MAJOR THERMOREGULATORY

ATH!AY" #.

"$i% temperature

Peripheral

thermoreceptors

(in skin)

Central thermoreceptors

( hypothalamus,other areas

of CNS & abdominal

organs)

&or' temperature

H(pothalami) th'rmor'*ulator(

i%t'*rati%* )'%t'r


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MAJOR THERMOREGULATORY ATH!AY" ##.

+'ha,ioral

a-aptatio%s

H(pothalami) th'rmor'*ulator( i%t'*rati%* )'%t'r

Control of

heat production

or loss

Motor

%'uro%s

"(mpath'ti)

nervous system

"(mpath'ti)

nervous system

Control of

heat

production

uscle tone,

shi,'ri%*

Sceletalmus)l's

Skin blood ,'ss'ls

Skin

,aso)o%stri)tio%,aso-ilataio%

Control of

heat loss

Skins!eat *la%-s

"/'ati%*

Control of

heat loss


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ME .U(PU( )%&@A/ ika suhu meningkat

di atas suhu set 9oint3 +!7 o#5

ME .U(PU( )%&@A/ ika suhu di :awah

suhu set 9oint3< +!7 o#5

RESEPTORSENSITIF PANAS

(AREA PRE OPTTIKHIPOT ANTERIOR)

RESEPTORSENSITIF PANAS

(AREA PRE OPTTIKHIPOT ANTERIOR)

rese.tor lainnya di

,+01% SP1)0 C- &4')

51P%50'+S

im9uls


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5i.ertermi

(T > set-point )

Fisiologis

Patologis

Demam

(T＝ set-point )

Peningkatansuhu tubuh

(>0.5 °C)

%i.e .eningkatan suhu tubuh


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emam

(ro*'%s

"levated set#point

aintaining an abnormally elevated $emperature

%(basal metabolic rate) increases

T ? 0 El',at'- s't1poi%t


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o,'rpro-u)tio%

o2 h'at

imp'-im'%t i%

h'at loss

-(s2u%)tio% o2 o-(

t'mp'ratur' )'%t'r

Passive incease o!

bo"# tempeatue

(69 C#

$> s'tpoi%t

5i.ertermi


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ATHOGENE"#" O4 4EER


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S'$'N


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• Peningkatan suhu tubuh akan menyebabkan:

• inhibisi s sim.atis vasodilatasi

.emb darah kulit & stimulasi kel

keringat eva.orasi• Penurunan suhu tubuh menyebabkan:

• aktivasi s sim.atis vasokonstriksi

& .enghambatan keringat .roduksi.anas di otot .ele.asan

neurotransmitter .eningkatan suhu

tubuh

• Peningkatan suhu tubuh akan menyebabkan:• inhibisi s sim.atis vasodilatasi

.emb darah kulit & stimulasi kel

keringat eva.orasi• Penurunan suhu tubuh menyebabkan:

• aktivasi s sim.atis vasokonstriksi

& .enghambatan keringat .roduksi.anas di otot .ele.asan

neurotransmitter .eningkatan suhu

tubuh


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• reaksi ase akut suatu ineksi demam• .irogen yg dikeluarkan menyebabkan

.erubahan .d set .oint

• reaksi ase akut suatu ineksi demam• .irogen yg dikeluarkan menyebabkan

.erubahan .d set .oint

endogen

ekso

genP%*.8E&

%/7 7C %/6 %/ %/77 %&F%&F (&F (&FC

Endotoksin3li9o9olisak arida5 dari:akterigramnegati;

.9sonisasi olehkom9lemen di;agositer olehmakro;ag

9roduksi


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JEN#"1JEN#" 6EMAM

A. MENURUT L#N#"NYA

+. MENURUT ENYE+A+NYA

&. MENURUT LAMANYA


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A. MENURUT L#N#"NYA

8. 6EMAM "ET#

1 6EMAN "ET#A MALAM HAR#

1 TURUN AG# HAR# 9: &

1 T#6A "AMA# NORMAL

1 MENGG#G#L 6AN ER#NGAT

1 ALAU TURUN "AMA# NORMAL

6EMAM HET#


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JAM⇒

"ET#

* + +- *NORMAL

HET#

GAM+AR 6EMAM "ET# ;

HET#

9 O &


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9. REM#TTEN 4EER

1 "UHU TURUN "ET#A HAR#

T#6A "AMA# NORMAL1 ER+E6AAN "UHU < 9: &

./ ⇒ * + +- NORM


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3. #NTERM#TTEN 4EER = 1 "UHU TURUNNORMAL "ET#A HAR#

1 AR#A"# "UHU > 9: & 1 +#LA EA 6AN NA6#R +E"ARHET#

"ET#

000000 +- *01110001

S2H2

./ ⇒

N/3> 9: &


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? 6EMAM TERT#ANA

1 6EMAM #NTERM#TTEN

1 HAR# 8 ; 3 6EMAM1 HAR# E 9 A#RE"#A NORMAL

NORMA"UHU

HAR# 8 9 3


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•6EMAM UARTANA

1 6EMAM #NTERM#TTEN "ET#A

HAR# 8 ; @ 1 HAR# E 9 ; 3 NORMAL

"UHU

HAR#

NORMAL

+ 4 5

@ "U"TA#NE6 4EER ONT#NYUB


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@. "U"TA#NE6 4EER ONT#NYUB

? "EANJANG HAR# TETA 6EMAM? AR#A"# "UHU < 8: &

? "UHU TURUN T#6A "AMA# NORMAL

"UHU

JAM C 89

NORM

8D

< 8: &


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5. RELA"#NG 4EER 0 "#L# 4EER

? 6EMAM +E+ERAA HAR#

? NORMAL +E+ERAA HAR#

? 6EMAM LAG# +E+ERAA HAR#

1 MALAR#A UARTANA

1 RELA"#NG 4EER

1 ENY. HO6G#N

EL1E+"TE#N

4EER


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"UHU NORMA

8 9 3 @ 5 C 7 D


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+. 6EMAM MENURUT ENYE+A+NYA

8. #N4E"#

9. ENY. OLLAGEN

3. ENY. ""

@. TUMOR GANA"

5. ENY. 6ARAH

C. ENY. AR6#OA"ULER


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7. ENY. GA"TRO#NTE"T#NAL

D. ENY. EN6OR#N

. TRAUMA 4#"#

8F. +AHAN19 #M#A

88. GGN +ALAN" &A#RAN

89. "#OGEN#

83. 4A"#"#4AL"E 4EER6EMAM AL"U

8@. 4UO 4EER O4 UNNO!N OR#G#NB


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&. 6EMAM MENURUT LAMANYA =

8. 6EMAM TR##AL = 6EMAM 813 HAR#

1 UR#NE.

9. 6EMAM TANGGUNG= 6EMAM @17 HAR#

1 RUT#N

1 M#RO+#OLOG#

1 "EROLOG#.

3. 6EMAM "ER#U"= 6EMAM LE+#H 7 HAR#

1 #M#A 6ARAH 1 4OTO 1 +#O"#

1 #MUNOLOG# 1 EG

d FU. F.. 3FE'E* 1P@*E%A .F


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dG FU. H F.. 3FE'E* 1P@*E%A .FU&K&.I& 1 U&DE(E*M%&A(ED1U&D%A8&.)ED1 .B)#U*E .*%8%&H FEB*%)E( #AU)A %8&.(A

• DEMAM ++" #

• /AMA DEMAM + M%&88U

• U)A-A %&(E&)%F D% *) 3*AIA( %&AP5 /EB%-

7 M%&88U

• D%A8&.)%) BE/UM D%(E8AKKA&


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AU"A 4UO= 1 @F #N4E"#

1 9F NEOLA"MA

1 85 ENYA#T JAR#NGAN #AT

1 "#"ANYA95 +ER+AGA# "E+A+

1 518F TETA T#6A 6#ETAHU#

5eatstroke


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5eatstroke

Sun Stroke

• Caused by overe;.osure to sun and e;tremelyhigh tem.eratures

•

o//urs when the brain ails to /ontrol its own


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5eatstroke

Sun Stroke

• (he underlying >ause o; heat stroke is>onne>ted to the sometimes suddenina:ility to dissi9ate 3(o drive away5 :odyheat through 9ers9iration es9e>ially a;ter

strenuous 9hysi>al a>tivity

46

5 t t k


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5eatstroke

Sun Stroke

• (his a>>ounts ;or the eJ>essive rise in :ody

tem9eratureG

• %t is the high ;ever whi>h >an >ause 9ermanentdamage to internal organs and >an result indeath i; not treated immediatelyG

• *e>overy de9ends on heat duration andintensityG

• (he goal o; emergen>y treatment is to maintain4*


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Predisposing factors

• %n>reased heat 9rodu>tion

•

hy9erthyroidism eJer>ise se9sis

• %m9aired heat loss %m9aired sweating

• Drugs

anti>holinergi>s antiParkinsonian drugsantihistamines :utyro9henones9henothiaLines tri>y>li>s

• A:normal sweat glands sweat gland inury ;ollowing a>ute heat

stroke :ar:iturate 9oisoning >ysti> N:rosis healed thermal :urn

• salt and water de9letion diureti> indu>ed

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• .thers

• elderly high am:ient tem9erature andhumidity 9oor ventilation

la>k o; a>>limatiLation o:esity ;atigue DM

malnutrition al>oholism


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Clinical features

+ >ardinal signs are$• #&) dys;un>tion

• hy9er9yreJia 3>ore tem9erature 4=" #5

• hot dry skinG Pink or ashen de9ending on

>ir>ulatory stateG -owever may :e >lammyand sweat

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• K.MP*E)D%&8%&OOOOOOOO

• K.MP*E)

-A&8A(OOOOOOOO


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First Aid ;or -eatstrokeor )unstroke

• -EA()*.KE %) /%FE (-*EA(E&%&8

• *emove vi>tim to >ooler lo>ation out o; thesun

• /oosen or remove >lothing and immersevi>tim in very >ool water i; 9ossi:le

• %; immersion isnQt 9ossi:le >ool vi>tim withwater or wra9 in wet sheets and ;an ;orui>k eva9oration

• Use >old >om9resseses9e>ially to the head

ne>k area also to arm9its and groin5+


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5

.n>e in the hos9ital an eJamination is


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.n>e in the hos9ital an eJamination isdone and :lood tests are >arried out toassess the level o; salts in the :loodG

• (reatment o; heat stroke is usually >arriedout in a >riti>al >are unitG

• (he :ody tem9erature is lowered :ys9onging the :ody with te9id water orloosely wra99ing the 9erson in a wet sheetand 9la>ing him or her near a ;anG

• %ntravenous Ruids are givenG

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Pendekatan terhada9 9enderita dgn


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Pendekatan terhada9 9enderita dgndemam

Pendekatan

diagnosis

Pemeriksaan Fisis:

- Kronologi demam

& gejala/keluhanyg mendahului

- Pengukuran suhu

oral/rektal

Pemeriksaansitokin dari

sirkulasi

Kadar #reakti;9rotein

/au enda9 darahPemeriksaan /a:$

#B# (complete bloodcount)

-itung enis sel in;eksivirus netro9enia


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PEME*%K)AA& /AB.*A(.*%UM MEA*%PE&@EBAB DEMAM

• 7G PEMG DA*A *U(%& ! DA*A-FE*%FE*

•

2G KU/(U*• +G )8.(1)8P( A/KA/%

F.)FA(A)E

AM%/A)E

• 4G U*%&E• ,G )UM)UM (U/A&8• 6G (E) %MU&./.8%)$ A)(. #*P

A&A• !G D//


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EMER#"AAN19 UNTU 4UO SERO-IMUNOLOGI

11111111111111111111111111111111111111111111111111111111111111111111111111111111111111

ENYE+A+ UJ# "EROLG# ENYA#T #RU" AUL +UNNEL MONONULEO

"U" #N4E"#O"A

+ATER# !#6AL 6EMAM T#4O#6

A"TO "TA4LOOU"

+ETA HEMOL#T#U"

!R6RL "#4#L#"

LETO"#RA A. LETO"#RO"#"

+RU&ELLA A. +RU&ELLO"#"

ROTOIOA "A+#N 4EL6MAN TOOLA"LA"MO"#"

#6T AME+#A"#"

HELM#NTE" #4AT 4#LAR#A"#" JAMUR H#"TOLA"M#N A. H.LA"MO"#"

MUOLA"M#" A. MY&OLA"MO"#"

LA#N1LA#N !E#L14EL# R#&ET"#A

!E"TERN +LOT H#A#6


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?)1S

,510)*)

C- 510)* P)S %+4+5

@* 510)*

,)+,S1 ,)%,0)*S+)* 2A

,)B,S1 -

, +-> , +P 1- A

BP-S1 P)*+P),-1)*% 3A

-1S1 *0 0,%-'*)%1, !9A

C// & %/N9/N9/ P/N/S 9: H'3/N:


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/N$'P'"$' ;/N /N/3:"S'


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Mekanisme anti piretik Mekanisme anti piretik

• Prinsi.: menurunkan kadar P*2 .d .usat termoregulasi• Penghambatan enDim siklo oksigenase

(hambat asam arakhidonat

P*2#

• Prinsi.: menurunkan kadar P*2 .d .usat termoregulasi• Penghambatan enDim siklo oksigenase

(hambat asam arakhidonat

P*2# Rejimen untuk menurunkan demamRejimen untuk menurunkan demam

• %uEuan : menurunkan set .oint demam .d

hi.otalamus & memasilitasi heat loss• Demam kebutuhan O2 meningkat (13

% setiap 1oC) memperburuk ggn

kardivask! paru "erebrovaskular

• %uEuan : menurunkan set .oint demam .d

hi.otalamus & memasilitasi heat loss• Demam kebutuhan O2 meningkat (13

% setiap 1oC) memperburuk ggn

kardivask! paru "erebrovaskular


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• setaminoen relati aman (as.irin &

)S1 trombosit F .erdarahan *1#

• Cooling blanket menurunkan suhu tubuh ( dengan anti.iretik#

• setaminoen relati aman (as.irin &

)S1 trombosit F .erdarahan *1#

• Cooling blanket menurunkan suhu tubuh ( dengan anti.iretik#

O+AT AAG E4 "AM#NG +#A"A OER6O"#"


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O+AT AAG E4. "AM#NG +#A"A OER6O"#"

8. Aspiri% 1 #ritasai ; p'r-araha% 1 Ul$us p'pti$um

Lamu%* 1 N'$rosis papil *i%Kal

1 !a$tu p'r-aha% 1 "'2al*i ti%itus

hip'r,'%tilasi

9. "alisil ami-

3. ara)'tamo 1 Ruam $ulit 1 N'$rosis *i%Kalh'par

1 Tromositop'%i

1 H'patitis $ro%i$

@. 4'%as'ti% 1 Ruam $ulit 1 A$ut= %'$. tu. *i%Kal

1 ro%is= A%'mia h'mo1

liti$ M'tH1'mia

1 N'2roto$si$

5. M'tamisol 1 Ruam $ulit


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*1 /minopirin # ruam kulit # karsinogenik

# nekrosis tubuler 71 perporasi

# ruam kulit # hepato>nefrotoksik

# ggn hematologik

-1 oksifenbuta=on # ? fenilbuta=on

81 mefenamat # dispepsi # ggn fgs hepar>ren

+@1 keto>ibuprofen # ggn sal1 cerna # saluran cerna

# sefalgia, vertigo # geAala SSP

++1 fenoprofen # dispepsi # sal1 cerna

# ruam kulit # SSP


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Fisiologi Demam n Hipertermia

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