NUTRISI_TROPIS

8/18/2019 NUTRISI_TROPIS

1/38

ANDI FARADILAH ANDI FARADILAH

Nutrition DepartmentNutrition Department

Faculty of MedicineFaculty of Medicine

20120133

NUTRITIONAL CARE ININFECTION-TROPISM

DISEASE


2/38

Sub-topic

Nutrition in ICUNutrition in HIV-AIDS

Nutrition in Thypoid


3/38

ImportanceImportance

Renal function

Microcirculation

environment

extracellullar

intracellular

Cardiac function Pulmonary function

Energy provision

Protein synthesis

OOD

Carbohydrates

fats proteinelectrolytes

trace elements

vitamins special

substrates!ody reserve

s

"ade#uate fed$

!ody reserves

"malnourished$

%nta&e


4/38

Immune response during Inflammation and infectionImmune response during Inflammation and infection

SIRS TNFα, IL-1β,IL-6, IL-12,IFNγ , IL-3

IL-10, IL-4, IL-1r, !ono"yt#

HLA-D$%uppr#%%ion

CARS

dy%

%nsult

"trauma sepsis$

% n f l a m m a t

o r y b a l a n c e

' ( ) %

P R O

)issue inflammation

Early organ failure anddeath

#'%

I((uno%uppr#%%ion

*nd %nfectionsDelayed

MOF and

deathGriffiths, R. “Specialized nutrition support in the critically ill: For

whom and when? Clinical Nutrition: arly !nter"ention# Nestle

Nutrition $or%shop Series


5/38

Metabolic Response to Stress

In)o*)#% (o%t (#t+o*i" pth&y%

A""#*#rt#d (#t+o*i%( o *#n +ody (%%

N#ti)# nitro#n +*n"# !u%"*# &%tin


6/38

Hypermetabolic Response to Stress— Pathophysiology

'lgorithm content developed by +ohn 'nderson PhD and ,anford C- .arner PhD *///-


7/38

Ebb Phase Flow Phase

I((#dit#.hypo)o*#(i, %ho"',ti%%u# hypo/i

D#"r#%#d "rdi"output

D#"r#%#d o/y#n"on%u(ption

Lor#d +odyt#(p#rtur# In%u*in *#)#*% drop

+#"u%# *u"on i%#*#)t#d

Fo**o&% uid r#%u%"ittionnd 2 trn%port

In"r#%#d "rdi" output

+#in% In"r#%#d +ody

t#(p#rtur# In"r#%#d #n#ry

#/p#nditur# Tot* +ody prot#in

"t+o*i%( +#in% !r'#d in"r#%# in *u"o%#

produ"tion, FFA%,"ir"u*tinin%u*in*u"on"orti%o*


8/38

Hormonal Stress Response Aldosterone— "orti"o%t#roid tht "u%#% r#n*%odiu( r#t#ntion

Antidiuretic hormone ADH5 .%ti(u*t#% r#n*tu+u*r &t#r +%orption

Th#%# "on%#r)# &t#r nd %*t to %upport"ir"u*tin +*ood )o*u(#

ACTH— "t% on dr#n* "ort#/ to r#*#%# "orti%o*(o+i*i#% (ino "id% ro( %'#*#t* (u%"*#%5

Catecholamines .#pin#phrin# ndnor#pin#phrin# ro( r#n* (#du** to %ti(u*t#h#pti" *y"o#no*y%i%, t (o+i*ition,*u"on#o#n#%i%


9/38

Nutrition trials in ICU

S(**, und#rpor#d H#t#ro#n#ou% nd "o(p*#/ pti#nt% !i/#d nutrition* %ttu%

Di7#r#nt ##din r#i(#n% Und#r##din 8 i*ur# to d#*i)#r nutri#nt% )#r##din 8 d)#r%# (#t+o*i" #7#"t% Hyp#r*y"#(i

S"i#nti9" +%i% #%%#nti*


10/38

What is the evidence in ICU?

:r*y #nt#r* ##din i% +#%t Hyp#r*y"#(io)#r##din r# +d ;N (#t-n*y%#% "ontro)#r%i*

Nutrition* d#9"it & &or%# out"o(# :N & %pirtion nd VA;, ;N in#"tion :N nd ;N "n +# u%#d to "hi#)# o*% ;roto"o*% i(pro)# d#*i)#ry o ##d So(# nutri#nt% %ho& pro(i%in r#%u*t%


11/38

Nutritional management of severe sepsisand septic shock

:r*y nutrition* %upport i(pro)#% &ound h#*innd


12/38

Nutritional management of severe sepsisand septic shock

Su"h #nt#r* or(u*% (y )or+*y 7#"tth# r#%i%tn"# o th# ut to +"t#ri*trn%*o"tion or #/#rt dir#"t #7#"t% on th#+#h)ior o intr*u(in* +"t#ri

+ral $lutamine decreases bacterial translocation and improvessurvival in eperimental $ut-ori$in sepsis. JE J arenter

Enteral utr &''(/ &':0'


13/38

(Mal)nutrition detection(Mal)nutrition detection

Nutritional assessmentNutrition screening (within 24 hours)

Body mass index

Subjective global assessment or mini-

nutritional assessment

Weight loss > 10%Intae accounting (!"0%# chronic)


14/38

Nutrient Guidelines: Carbohydrate

Shou*d pro)id# 60 8 =0> "*ori#%

!/i(u( rt# o *u"o%# o/idtion ?

@ 8 = ('(in or = 'dyB

*ood *u"o%# *#)#*% %hou*d +# (onitor#d ndnutrition r#i(#n nd in%u*in du%t#d to(intin *u"o%# +#*o& 10 (d*

0',PE( !OD- +PE( *12**,' 344*


15/38

Nutrient Guidelines: Fat

Cn +# u%#d to pro)id# n##d#d #n#ry nd#%%#nti* tty "id%

Shou*d pro)id# 1 8 40> o "*ori#% Li(it to 2'dy or po%%i+*y 1 'dy

IVB Cution &ith u%# o t% in %tr#%%#d E

tru( pt% Th#r# i% #)id#n"# tht hih t ##din% "u%#d

i((uno%uppr#%%ion N#& or(u*% o"u% on o(#-3%

0',PE( !OD- +PE( *12**,' 344*


16/38

Nutrient Guidelines: Protein

1 8 20 'dy to %trt (onitor r#%pon%#

Nonprot#in "*ori#r( o nitro#n rtio or"riti"**y i** ? 100G1

i)in #/o#nou% % d#"r#%#% n#ti)#N +*n"# +y %upp*yin *i)#r % or prot#in%ynth#%i%

AS;:N D J;:N 2622SA, 1KK2


17/38

Nutrient Guidelines: Protein

In "riti"**y i** pti#nt% und#roin "ontinuou%r#n* r#p*"#(#nt th#rpy, %in*# %tudyindi"t#% tht protein intake !"# $ per k$per da% i% (or# *i'#*y to pro(ot# po%iti)# N

+*n"# ;?000015

And, &hi*# (or# po%iti)# N +*n"# i%%%o"it#d &ith d#"r#%#d (ort*ity, hih#r

prot#in int'# &% not %%o"it#d &ith(ort*ity.

ADA :AL 11-2=-0=


18/38

Fluid and Electrolytes

1luid 30-40 (L' or

1 to 1(L'"* #/p#nd#d

Electrolytes2itamins2Trace Elements

:nt#r* ##din%G +#in &ith $DAAI )*u#%

;NG u%# ;N do%in uid#*in#%

',PE( !OD- +PE( *12*5,' 344*


19/38

How much to give in ICU?

S"ho9#*d #utionHrri% #n#di"t Add A"ti)ity nd Str#%% "tor% # 10> or

+#d+ound M 20-60> or %#p%i%+urn% $ouh uid#G 2 "*'dy tot* #n#ry

In"r#%# to 30 % pti#nt i(pro)#% 02dy o Nitro#n 12'dy prot#in5


20/38

How much to give?

30 8 3(* uid'24 hour% +%#*in# Add 2-2(*'dy o uid or #"h d#r## o

t#(p#rtur#

A""ount or #/"#%% uid *o%%#%

Ad#ut# #*#"tro*yt#%, (i"ronutri#nt%, )it(in% A)oid o)#r##din

+#%ityG ##d to !$, dd %tr#%% "tor on*y i%#)#r# i# +urn%tru(


21/38

Hypocaloric Feedings

Hypo"*ori" ##din% h)# +##nr#"o((#nd#d in %p#"i9" pti#nt popu*tion%

Ar#%%i)# prot#in pro)i%ion 1-20('dy5

',PE( (utrition ,upport Practice Manual *nd Edition p- *64

7aloga .D- Permissive underfeeding- (e8 9ori:ons 344;


22/38

Increased


23/38

C%tokine

release &increase 'ree

radicals

I()* I()+

ReducedSubcutaneous

'at

Decrease

d ,P-

'(ORE

,)')=,

Increasedproteol%sis

&decreased

protein

s%nthesis &. replikasi

/irus

Stress

oksidati'

Increasedlipol%sis


24/38

HIV – AIDS (ESPEN RECOMMENDATION)

Nutrition* th#rpy i% indi"t#d &h#n%ini9"nt iht *o%% 4> in 3 (onth%5

Nutrition* th#rpy %hou*d +# "on%id#r#d&h#n th# !I i% o1O '(2

Dirrho# ndor (*+%orption r# no"ontrindi"tion to :N, +#"u%#GDirrho# do#% not pr#)#nt po%iti)##7#"t o or* nutrition* %upp*#(#nt% or TF

on nutrition* %ttu%


25/38

Th# "o(+intion o nor(* ood nd #nt#r*nutrition i% pproprit# in (ny "%#%

I or* int'# i% po%%i+*#, nutrition*int#r)#ntion %hou*d +# i(p*#(#nt#d ""ordin

th# o**o&in %"h#(# nutrition* "oun%#**in

or* nutrition* %upp*#(#nt%

tu+# ##din TF5

;N :"h o th# %t#p% %hou*d +# tri#d or 48O

#'% +#or# th# n#/t %t#p i% initit#d

HIV – AIDS (ESPEN RECOMMENDATION)


26/38

Nutritional interventionNutritional intervention

EnergyEnergy Energy requirements are no different from other

patient groups

The Harris and BennedictThe Harris and Bennedict determine BEEdetermine BEE

Energi requirements increase 13% for every degreeEnergi requirements increase 13% for every degree

Celcius above normalCelcius above normal

A general range for estimated energy A general range for estimated energy !!"#!!!!"#!!

Calori $3"&! Cal'gr B()Calori $3"&! Cal'gr B()tt


27/38

ProteinProtein

*rotein inta+e should achieve 1, g'+g b-'day in

stable phases . increased to 1, g'+g b-'day during

acute illness,

Fat

/n patients -ith diarrhoea and severe undernutrition

0CT containing formulae are advantageous,


28/38

Fluid

luid needs are the same as those of -ellindividuals2 ecept in the presence of severediarrhea2 nausea and vomiting and prolonged fever

Vitamin & mineral

0egadoses of vitamin and mineral should be

avoided


29/38

FOOD AND NUTRITION MANAGEMENTPACKAGE


30/38

INTERVENSI MAKANAN BERDASARKANMAKANAN YANG TERSEDIA DI INDONESIA

Tempe- Tini prot#in dn )it

12- "t#ri"id#dpt o+ti

dn "#h dir#

0elapa- !#nndun (#diu(

"hin% try*i"#rid#%- Su(+#r #n#ri yn

##'ti untu'(#nin't'np#(+#ntu'n %#* T4

- !udh di%#rp dn PNdirrho# #7#"t

1ortel- Tini 'ndunn -

"rot#ntin't'n i((un#+odi#% d#nn tin't CD4M

- #r%( d#nn )it(in :,Cntio'%idn (#nn'*

rdi'* +#+%5

2rokoli 3 kemban$ kol- Tini 'ndunn (in#r* G

QN, !n, F#, S#

- !#n"#h d#9%i#n%i %p#%i9'

- #run%i %#+i ntio'%idn

- ;#(+#ntu' CD4M


31/38

DEVELOPMENT OF FOOD INTERVENTION BASEON INDONESIAN FOOR FOR ODHA

Sa%uran hi4au dan kacan$ kacan$an- !#nndun )it(in dn tr"# #*#(#nt%- Tini '*%iu(- !#nin't'n CD4M

Alpukat- ndunn *#(' 60>5 t#rtini dri +uh- 16> !UFA !ono-Un%turt#d Ftty A"id5%u(+#r #n#ri

t#r+i'- on%#ntr%i 5luthation t#rtini %#+i ntio'%idn%top

r#p*i'%i HIV


32/38

Gejala klinis dan keterkaitan dengangangguan gizi (1) Anoreksia 3 dis'a$ia- +t A$V p#nurunn n%u

('n- In#'%i (ur pd (u*ut%u*it (#n#*n

H* ini (#(#r*u'n t#rpi di#t*un', ('nn tid'

(#rn%n, ('nn dinin,(inu( (#**ui %#dotn hu%u%

Diare akut6malabsorbsi- Hi*nny t ii %#p#rti

)it(in E (in#r*

;#r*u "irn, +uh +uhnr#ndh %#rt, tini '*iu( E(n#%iu(

Hindri ('nn +#r*#(' dn u% +#r*#+ihn

Sesak na'as

- ('nn tini *#(' r#ndhH(#nurni C2

- ;or%i '#"i* tpi %#rin

5an$$uan pen%erapanlemak

- Di#t r#ndh n+ti

- on%u(%i (iny' n+ti(iny' '#d#*i, (iny' un, (iny' %&it5

- T(+hn )it A,D,:,


33/38

Gejala klinis dan keterkaitan dengangangguan gizi (3)

Demam- #+utuhn prot#in (#nin't

- !'nn *un' por%i '#"i*, u(*h *#+ih dri +i%

- !inu( *#+ih dri 2 *it#rO #*% %#hri Penurunan 22

- Di"ri p#ny#++ny- ;%ti'n p d in#'%i opurtuni%ti'

- !'nn TT; por%i '#"i* %#rin, r#ndh %#rt


34/38

DEMAM TIFOID

MetodeMetode KonvensionalKonvensional

Mulai bubur sarinMulai bubur saringg

MMenurunkan beban kerja ususenurunkan beban kerja usus

MMenurunkan perdarahanenurunkan perdarahan Netralisasi asam lambungNetralisasi asam lambung


35/38

DDiet yang dipakai sekarangiet yang dipakai sekarang

Makanan padat, rendah seratMakanan padat, rendah serat

-- DDefekasiefekasi bulk formingbulk forming - BB naik- BB naik

- Jumlah kalori segera terpenuhi- Jumlah kalori segera terpenuhi

-- DDipersiapkan lebih mudahipersiapkan lebih mudah

- meningkatkan selera makan- meningkatkan selera makan


36/38

DE! ENE"# !N## $"%!EN !N##DE! ENE"# !N## $"%!EN !N##

Diet yang mengandung energi dan protein diatasDiet yang mengandung energi dan protein diataskebutuhan normalkebutuhan normal

!ujuan diet &!ujuan diet &

- Memenuhi kebutuhan energi- Memenuhi kebutuhan energi dan protein untuk men'egahdan protein untuk men'egah

kerusakan tubuhkerusakan tubuh- -- Menambah BB hingga men'apai BB normalMenambah BB hingga men'apai BB normal

(yarat diet E!$! &(yarat diet E!$! &- Energi )*-)+ kklkg BBEnergi )*-)+ kklkg BB

- $rotein .-.,+ gkgBB$rotein .-.,+ gkgBB- /emak 0*-.*1 dari kebutuhan energi tot2/emak 0*-.*1 dari kebutuhan energi tot2- Karbohidrat, vitamin , mineral 'ukupKarbohidrat, vitamin , mineral 'ukup


37/38

SUMMARY

Speciali7ed nutrient needs o' the I,FECTI8,patient9

Increased calories to co/er ener$% costs o'h%permetabolic

Hi$h 'at diets" Ade:uate protein le/els to support

anabolism and the maintenance o' leanbod% mass""

Supplemental antio;idants to pre/ent orattenuate o;idati/e dama$e to tissue


38/38

NUTRISI_TROPIS

Documents

Transcript of NUTRISI_TROPIS