Refleksi Kasus DHF + warning sign

8/17/2019 Refleksi Kasus DHF + warning sign

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SMF/Lab Ilmu Kesehatan Anak Refleksi Kasus

Fakultas Kedokteran Umum

Universitas Mulawarman

DEMAM ERDARA! DE"#UE

Disusun Oleh:

Radhi$ana %utri &'(&&()&*(

Pembimbing:

dr+,illiam S-+A

Dibawakan Dalam Ran.ka u.as Ke-aniteraan Klinik

SMF/Lab Ilmu Kesehatan Anak

Fakultas Kedokteran UmumUniversitas Mulawarman

RSUD Abdul ,ahab S0ahranie Samarinda

1&(2


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DAFAR ISI

BAB 1 PENDAHULUAN.......................................................................................1

BAB 2 STATUS PASIEN........................................................................................2

BAB 3 TINJAUAN PUSTAKA.............................................................................1

BAB PE!BAHASAN........................................................................................32

BAB " PENUTUP.................................................................................................3"

DA#TA$ PUSTAKA.............................................................................................3%

1


3/37

A (

%E"DA!ULUA"

Dem&m be'(&'&h (engue &(&l&h )en*&+i, (em&m &+u, *&ng (iseb&b+&n

-leh se'-,i)e i'us (engue ./i'us (engue (i,ul&'+&n +e)&(& m&nusi& mel&lui

gigi,&n n*&mu+ Aedes aegypti. Aedes albopictus, Aedes polynesiensis (&n

bebe'&)& s)esies *&ng l&in (&)&, 0ug& menul&'+&n i'us ini n&mun me'u)&+&n

e+,-' *&ng +u'&ng be')e'&nDeng&n (emi+i&n ine+si i'us (engue (&)&,

men*eb&b+&n +e&(&&n *&ng be'm&&m4m&&m mul&i (&'i ,&n)& ge0&l&

5&sim,-m&,i+6 Dem&m Dengue &,&u ben,u+ *&ng lebih be'&, *&i,u Dem&m

Be'(&'&h Dengue 5DBD6 (&n Dengue S*-+ Sin('-m 5DSS6. 1

7e0&l& +linis DBD *&i,u (i,&n(&i (eng&n (em&m ,inggi men(&(&+ ,&n)&

seb&b *&ng 0el&sbe'l&ngsung ,e'us mene'us sel&m& 248 h&'i 5be'si&, bi&si+6

m&nies,&si )e'(&'&h&n *&ng bi&s&n*& be'u)& : u0i ,-u'ni9ue, )-si,i )e,e+i&

e+im-sis &,&u )u')u'& )e'(&'&h&n mu+-s& s&lu'&n e'n& (&n ,em)&, be+&s

sun,i+&n hem&,emesis &,&u melen& )embes&'&n h&,i (eng&n h&sil l&b-'&,-'ium

,e'(&)&, ,'-mb-si,-)eni& (&n )ening+&,&n hem&,-+'i,. 1 2

P&(& ,&hun 1%; )en*&+i, DBD (il&)-'+&n (i Su'&b&*& (&n J&+&',&

seb&n*&+ "; +&sus (eng&n 0uml&h +em&,i&n *&ng s&ng&, ,inggi 2 -'&ng5 case

fatality rate 143


4/37

A 1

SAUS %ASIE"

Identitas -asien

4 N&m& : An. /

4 Jenis +el&min : Pe'em)u&n

4 Umu' : 8 ,&hun

4 Al&m&, : Jl. P. Su'*&n&,& S&m&'in(&

4 An&+ +e : 1 (&'i 3 be's&u(&'&

4 !$S : ; A)'il 2=1%

Identitas 3ran. ua/,ali

4 N&m& A*&h : N*. S

4 Umu' : % ,&hun

4 Al&m&, : Jl. P. su'*&n&,& S&m&'i(&

4 Pe+e'0&&n : I$T

4 Pen(i(i+&n Te'&+hi' : SD

Anamnesa

An&mnes& (il&+u+&n )&(& ,&ngg&l A)'il 2=1% )u+ul 11.3= >ITA (i 'u&ng

!el&,i $SUD A>. S0&h'&nie S&m&'in(&. All-&n&mnes& -leh ibu )&sien

Keluhan Utama

Dem&m.

Riwa$at %en$akit Sekaran.

Dem&m (i&l&mi se0&+ h&'i S!$S. Dem&m n&i+ ,u'un ,e'u,&m& s&&,

)&sien minum -b&, )enu'un )&n&s. D&'i )eng&+u&n ibu )&sien s&&, ini (em&m

lebih en(e'ung ,u'un. P&sien 0ug& meng&l&mi mun,&h se0&+ 2 h&'i S!$S

mun,&h (i&l&mi se,i&) )&sien m&+&n (&n minum mun,&h be'isi m&+&n&n (&n

,i(&+ men*em)'-,. Sel&in i,u )&sien 0ug& mengeluh+&n n*e'i )e'u, *&ng (i&l&mi

se0&+ )&gi S!$S. P&sien 0ug& meng&l&mi +eluh&n suli, BAB se0&+ h&'i S!$S

n&su m&+&n menu'un (&n ibu )&sien meng&+u b&h?& )&sien +u'&ng m&u minum

(&n m&+&n sel&m& s&+i,. BAK (&l&m b&,&s n-'m&l. P&sien sem)&, be'-b&, +e

)us+esm&s (&n 'um&h s&+i, s?&s,& 2 h&'i S!$S (&n men(&)&,+&n )eng-b&,&n

2


5/37

n&mun +eluh&n ,i(&+ be'+u'&ng. P&sien ,i(&+ meng&l&mi mimis&n gusi be'(&'&h

m&u)un BAB hi,&m.

Riwa$at %en$akit Dahulu

• P&sien ,i(&+ )e'n&h meng&l&mi +eluh&n se'u)& sebelumn*&

• $i?&*&, &le'gi (&n &sm& (is&ng+&l

Riwa$at %en$akit Keluar.a

Ti(&+ &(& +elu&'g& *&ng meng&l&mi +eluh&n se'u)&. $i?&*&, ,e,&ngg&

(&n ,em&n se+-l&h )&sien *&ng meng&l&mi +eluh&n se'u)& 0ug& ,i(&+ &(&

se)enge,&hu&n ibu )&sien (&n )&sien.

%ertumbuhan dan %erkemban.an Anak

Be'&, b&(&n l&hi' : 3."== g'

P&n0&ng b&(&n l&hi' : "= m

Be'&, b&(&n se+&'&ng : 3" +g

Tinggi b&(&n se+&'&ng : 12" m

7igi +elu&' : ibu lu)&

Te'sen*um : ibu lu)&

!i'ing : ibu lu)&

Teng+u'&) : ibu lu)&

Du(u+ : ibu lu)&

!e'&ng+&+ : ibu lu)&

Be'(i'i : ibu lu)&

Be'0&l&n : ibu lu)&

Be'bi&'& 2 +&,& : ibu lu)&

!&su+ SD : % ,&hun

S&&, ini : +el&s 2 SD

Makan dan Minum Anak

ASI : *& s&m)&i umu' 2 ,&hun

Susu -'mul&@s&)i : se0&+ usi& 2 ,&hun s&m)&i s&&, ini

Bu&h : se0&+ usi& 1 ,&hun

3


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!&+&n&n )&(&,l&u+ : se0&+ usi& 1 ,&hun

%emeriksaan %renatal

Pe'i+s& (i : Pus+esm&s

Pen*&+i, +eh&mil&n : 4

Ob&,4-b&, *&ng se'ing (iminum : /i,&min (&n -b&, )en&mb&h (&'&h

Riwa$at Kelahiran

L&hi' (i : P'&+,e+ Bi(&n

Di,-l-ng -leh : Bi(&n

Usi& (&l&m +&n(ung&n : bul&n

Jenis )&',us : S)-n,&n )e' &gin&m

%emeliharaan %ostnatal

Pe'i+s& (i : Pus+esm&s

Ke&(&&n &n&+ : Seh&,

Keluar.a eren4ana

Kelu&'g& Be'en&n& :&

!em&+&i sis,em : Sun,i+ 3 bul&n

Riwa$at Imunisasi

P&sien b&'u men(&)&,+&n imunis&si 1 +&li.

Imunis&si Usi& s&&, imunis&si

I II III I/ B--s,e' I B--s,e' II

BC7 @@@@@@@@@@@@ @@@@@@@@@@@@ @@@@@@@@@@@@ @@@@@@@@@@@@ @@@@@@@@@@@@P-li- 4 4

C&m)&+ 4 @@@@@@@@@@@@ @@@@@@@@@@@@ @@@@@@@@@@@@ @@@@@@@@@@@@

DPT @@@@@@@@@@@@ 4 4

He)&,i,is

B

@@@@@@@@@@ 4 4

%EMERIKSAA" FISIK

Dil&+u+&n )&(& ,&ngg&l = A)'il 2=1%

4


7/37

Kes&n umum : ,&m)&+ s&+i, se(&ng

Kes&(&'&n : C-m)-smen,is

Tanda Vital

- Te+&n&n D&'&h : 1==@8= mmHg

4 #'e+uensi n&(i : 1= @meni, 'egule' +u&, &ng+&,

4 #'e+uensi n&)&s : 2 @meni,

4 Tem)e'&,u' : 3% -C )e' &+sill&

Antropometri

Be'&, b&(&n : 3" +g

P&n0&ng B&(&n : 12" m

S,&,us 7ii : 7ii lebih 5+u'& CDC F 11"


8/37

6


9/37

• Ke)&l&

$&mbu, : >&'n& hi,&m ,i(&+ mu(&h (i&bu,

!&,& : K-n0ung,i& &nemis 54@46 sle'& i+,e'i+ 54@46 )u)il is-+-'

(i&me,e'3mm@3mm 'ele+s &h&*& 5@6 m&,& -?-ng

54@46

Hi(ung : Se+'e, hi(ung 546 )e'n&&s&n u)ing hi(ung 546

!ulu, : !u+-s& bibi' ,&m)&+ +e'ing si&n-sis 546 li(&h be'sih

&'ing hi)e'emis 546 )embes&'&n ,-sil 546

• Lehe' : K&+u +u(u+546 )embes&'&n +elen0&' ge,&h bening546

• Th-'&+s

o Pulm-

Ins)e+si : Ben,u+ (&n )e'ge'&+&n sime,'is 'e,'&+si sub-s,&l 546

'e,'&+si su)'&s,e'n&l 546

P&l)&si : #'emi,us '&b& sime,'is

Pe'+usi : S-n-' (i semu& l&)&ng&n )&'u

Aus+ul,&si : esi+ule' selu'uh l&)&ng&n )&'u

o C-':

Ins)e+si : I+,us -'(is ,&m)&+

P&l)&si : I+,us -'(is ,e'&b& (i ICS / 2 0&'i l&,e'&l (&'i le, mi(l&iul&'

line

Pe'+usi : B&,&s 0&n,ung:

K&n&n : ICS III 'igh, )&'&s,e'n&l line

Ki'i : ICS / 2 0&'i l&,e'&l (&'i le, mi(l&iul&' line

Aus+ul,&si: S1(&n S2 ,ungg&l 'egule' S3 (&n S ,i(&+ ,e'(eng&'

• Ab(-men

Ins)e+si : (is,en(e( 546 (&'m s,eiung546 (&'m -n,-u'546

P&l)&si : S-el n*e'i ,e+&n e)ig&s,'ium56 he)&,-meg&li 546

s)len-meg&li 546 ,u'g-' +uli, b&i+.

Pe'+usi : Tim)&ni

7


10/37

Aus+ul,&si : Bising usus 56 +es&n n-'m&l

E+s,'emi,&s : A+'&l h&ng&, 56 -e(em 546 C$T G 2 (e,i+ si&n-sis 546

)e,e+i& 56 5'um)le lee( ,es,6

8


11/37

%emeriksaan %enun0an.

%emeriksaan Laboratorium

an..al &5/&6/1&(2

7(6+*&8

&5/&6/1&(2

71*9&&8

&'/&6/1&(2

7&:9&&8

&'/&6/1&(2

7()9&&8Darah Len.ka-

Leu+-si, .1== "."== ".3== %.23=

Hb 18 13= 1"8 1%=

H, 3"< 3 %< "<

Pl, 1%2.=== 11.=== %.=== %.===

Kimia Darah

7DS 1==

Elektrolit Serum

N& 13"

K 3Cl 1=3

an..al &'/&6/1&(2

71*9&&8

(&/&6/1&(2

7&:9&&8

(&/&6/1&(2

7()9&&8

(&/&6/1&2

7('9&&8

Darah Len.ka-

Leu+-si, 3.8== ".3== %.23= ".3"=

Hb 1%= 1"2 1%= 1

H, "< %< "< 3<

Pl, .=== %.=== %.=== 1.===

an..al (&/&6/1&(2

71*9&&8

((/&6/1&(2

7&:9&&8

((/&6/1&(2

7('9&&8

(1/&6/1&(2

7&:9&&8

Darah Len.ka-

Leu+-si, %.1== %.%== 8.8== 8."=

Hb 138 128 12 121

H, 1< 38< 38< 3<

Pl, 3.=== ".=== ".=== 1=.===

an..al (*/&6/1&(2

7&:9&&8

Darah Len.ka-

Leu+-si, 8."1=

Hb 121

H, 3<

Pl, 1=.===

(1/&6/1&(2

Ig7 4

Ig!

9


12/37

DIA#"3SIS

Di&gn-sis U,&m& : DH# g'&(e I ?i,h ?&'ning sign

Di&gn-sis L&in :4

Di&gn-sis K-m)li+&si : 4

%E"AALAKSA"AA" 9

• I/#D $L 3= ,)m

• Ce+ DL @ ; 0&m

• P&'&e,&m-l 3 ,&b

•Obse'&si i,&l sign

10


13/37

Follow U- Ruan.an

T&ngg&l S O A P

=@=@2=1%

BBF 1;" +g

Dem&m 546 mu&l 56

n*e'i )e'u, 56

Dem&m H4

K-m)-smen,is

TD: 1==@8= N : 1= @I $$ :

2 @I

T:3%

-

C &nemis 54@46 i+,e'i+ 54@46 es 5@6 S1 S2 ,ungg&l

'egul&' NTE56 &+'&l h&ng&,

56 C$T G2 $um)le lee( 56

DH# g'&(e I ?i,h

?&'ning sign

4 I/#D $L 3= ,)m

4 Ce+ DL @ ; 0&m

4 P&'&e,&m-l 3 ,&b4 Obse'&si i,&l sign

4 An,&si(& s*'. 3 ,h I

1=@=@1%

BBF 3" +g

Dem&m 546 mu&l 56

n*e'i )e'u, 56

Dem&m H4"

K-m)-smen,is

TD: 1==@%= N : 82 @I $$ : 1%

@I

T:3%8-C &nemis 54@46 i+,e'i+

54@46 es 5@6 S1 S2 ,ungg&l

'egul&' NTE 56 &+'&l h&ng&,

56 C$T G2

DH# g'&(e I ?i,h

?&'ning sign

4 I/#D $L 8 @+gBB@0&m sel&m&

4; 0&m. Ce+ i,&l sign ul&ng. Bil&

b&i+ l&n0u, I/#D $L "

@+gBB@0&m

4 Ce+ DL @ 0&m

4 P&'&e,&m-l 3 ,&b

4 Obse'&si i,&l sign

4 An,&si(& s*'. 3 ,h I

11@=@1%

BBF 3" +g

Dem&m 546 mu&l 546

n*e'i )e'u, 546

K-m)-smen,is

TD: 1==@%= N : ;= @I $$ : 2=

@I

DH# g'&(e I 4 I/#D $L 3= ,)m

4 Ce+ DL @ 12 0&m

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14/37

Dem&m H4% T:3%8-C &nemis 54@46 i+,e'i+

54@46 es 5@6 S1 S2 ,ungg&l

'egule' &+'&l h&ng&, 56 C$T

G2

4 P&'&e,&m-l 3 ,&b


4 An,&si(& s*'. 3 ,h I

12@=@1%

BBF 3" +g

Dem&m 546 mu&l 546

Dem&m H48

K-m)-smen,is

TD: =@%= N : ; @I $$ : 2=

@I

T:3%"-C &nemis 54@46 i+,e'i+

54@46 es 5@6 S1 S2 ,ungg&l

'egule' &+'&l h&ng&, 56 C$T

G2

DH# g'&(e I 4 A Inus

4 Ce+ DL bes-+ )&gi

4 P&'&e,&m-l 3 ,&b

4 An,&si(& s*'. 3 ,h I

13@=@1%

BBF 3" +g

Dem&m 546 mu&l 546

Dem&m H4;

K-m)-smen,is

TD: =@%= N : 82 @I $$ : 2=

@I

T:3%"-C &nemis 54@46 i+,e'i+

54@46 es 5@6 S1 S2 ,ungg&l'egule' &+'&l h&ng&, 56 C$T

G2

DH# g'&(e I 4 P&sien b-leh )ul&ng

12


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A *

I";AUA" %USAKA

*+( Definisi

Demam Den.ue 7DD8+ (

!e'u)&+&n )en*&+i, (em&m &+u, sel&m& 248 h&'i (i,&n(&i (eng&n (u& &,&u lebih

m&nies,&si +linis seb&g&i be'i+u, :

&. N*e'i +e)&l&.

b. N*e'i 'e,'-4-'bi,&l.

. !i&lgi&@&','&lgi&.

(. $u&m +uli,.

e. !&nies,&si )e'(&'&h&n 5)e,e+ie &,&u u0i ben(ung )-si,i6.

. Leu-)eni&.

D&n )eme'i+s&&n se'-l-gi (engue )-si,i &,&u (i,emu+&n )&sien DD@DBD

*&ng su(&h (i+-ni'm&si )&(& l-+&si (&n ?&+,u *&ng s&m&.

#ambar *+ Kurva Suhu Demam Den.ue

Demam erdarah Den.ue 7DD8+(

Be'(&s&'+&n 'i,e'i& >HO 18 (i&gn-sis DBD (i,eg&++&n bil& semu& h&l (i

b&?&h ini (i)enuhi :

• Dem&m &,&u 'i?&*&, (em&m &+u, &n,&'& 248 h&'i bi&s&n*& bi&si+.

• Te'(&)&, minim&l s&,u (&'i m&nies,&si )e'(&'&h&n be'i+u, :

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& U0i ben(ung )-si,i.

b Pe,e+ie e+im-sis &,&u )u')u'&.

Pe'(&'&h&n mu+-s& 5,e'se'ing e)is,&+sis &,&u )e'(&'&h&n gusi6 &,&u

)e'(&'&h&n (&'i ,em)&, l&in.

( Hem&,emesis &,&u melen&.

#ambar 6+ Kurva Suhu Demam erdarah Den.ue

• T'-mb-si,-)eni& 50uml&h ,'-mb-si, [email protected]

• Te'(&)&, minim&l s&,u ,&n(&4,&n(& )l&sm& le&+&ge 5+eb--'&n )l&sm&6

seb&g&i be'i+u, :

& Pening+&,&n hem&,-+'i, 2=< (ib&n(ing+&n s,&n(&' sesu&i (eng&n

umu' (&n 0enis +el&min.

b Penu'un&n hem&,-+'i, 2=< se,el&h men(&)&, ,e'&)i &i'&n

(ib&n(ing+&n (eng&n nil&i hem&,-+'i, sebelumn*&.

T&n(& +eb--'&n )l&sm& se)e',i : eusi )leu'& &si,es &,&u

hi)-)'-,einemi&.

D&'i +e,e'&ng&n (i &,&s ,e'lih&, b&h?& )e'be(&&n u,&m& &n,&'& DD (&n DBD

&(&l&h (i,emu+&n +eb--'&n )l&sm& )&(& DBD.

*+1 Etiolo.i

14


17/37

Dem&m Dengue 5DD6 (&n Dem&m Be'(&'&h Dengue 5DBD6 (iseb&b+&n

i'us (engue *&ng ,e'm&su+ +el-m)-+ B Arthropod Borne Virus

(Arboviroses)*&ng se+&'&ng (i+en&l seb&g&i genus Flavivirus &mili Flaviviridae

(&n mem)un*&i 0enis se'-,i)e *&i,u DEN41 DEN2 DEN43 DEN4. Ine+si

s&l&h s&,u se'-,i)e &+&n menimbul+&n &n,ib-(i ,e'h&(&) se'-,i)e *&ng

be's&ng+u,&n se(&ng+&n &n,ib-(i *&ng ,e'ben,u+ ,e'h&(&) se'-,i)e l&in s&ng&,

+u'&ng sehingg& ,i(&+ (&)&, membe'i+&n )e'lin(ung&n *&ng mem&(&i ,e'h&(&)

se'-,i)e l&in ,e'sebu,. Sese-'&ng *&ng ,ingg&l (i (&e'&h en(emis (engue (&)&,

,e'ine+si -leh 3 &,&u se'-,i)e sel&m& hi(u)n*&.Keem)&, se'-,i)e i'us (engue

(&)&, (i,emu+&n (i be'b&g&i (&e'&h (i In(-nesi&. Di In(-nesi& )eng&m&,&n i'us

(engue *&ng (il&+u+&n se0&+ ,&hun 18" (i bebe'&)& 'um&h s&+i, menun0u++&n

b&h?& +eem)&, se'-,i)e (i,emu+&n (&n be'si'+ul&si se)&n0&ng ,&hun. Se'-,i)e

DEN43 me'u)&+&n se'-,i)e *&ng (-min&n (&n (i&sumsi+&n b&n*&+ *&ng

menun0u++&n m&nies,&si +lini+ *&ng be'&,.1

*+*


18/37

*+6 %ato.enesis

/i'us me'u)&+&n mi+'--g&nisme *&ng h&n*& (&)&, hi(u) (i (&l&m sel

hi(u). !&+& (emi +el&ngsung&n hi(u)n*& i'us h&'us be's&ing (eng&n sel

m&nusi& seb&g&i )e0&mu 5host 6 ,e'u,&m& (&l&m menu+u)i +ebu,uh&n &+&n

)'-,ein. Pe's&ing&n ,e'sebu, s&ng&, ,e'g&n,ung )&(& (&*& ,&h&n )e0&mu bil& (&*&

,&h&n b&i+ m&+& &+&n ,e'0&(i )en*embuh&n (&n ,imbul &n,ib-(i n&mun bil& (&*&

,&h&n 'en(&h m&+& )e'0&l&n&n )en*&+i, men0&(i m&+in be'&, (&n b&h+&n (&)&,

menimbul+&n +em&,i&n. 1

P&,-genesis DBD (&n DSS 5(engue s*-+ sin('-m6 m&sih me'u)&+&n

m&s&l&h *&ng +-n,'-e'si&l.Du& ,e-'i *&ng b&n*&+ (i&nu, )&(& DBD (&n DSS&(&l&h hi)-,esis ine+si se+un(e' 5teori secondary heterologous infection6 &,&u

hi)-,esis immune enhancementHi)-,esis ini men*&,&+&n se&'& ,i(&+ l&ngsung

b&h?& )&sien *&ng meng&l&mi ine+si *&ng +e(u& +&lin*& (eng&n se'-,i)e i'us

(engue *&ng he,e'-l-g mem)un*&i 'isi+- be'&, *&ng lebih bes&' un,u+ men(e'i,&

DBD@Be'&,. An,ib-(i he,e'-l-g *&ng ,el&h &(& sebelumn*& &+&n mengen&i i'us

l&in *&ng &+&n mengine+si (&n +emu(i&n memben,u+ +-m)le+s &n,igen &n,ib-(i

*&ng +emu(i&n be'i+&,&n (eng&n # 'ese),-' (&'i memb'&n sel le-+-si, ,e'u,&m&

m&+'-&g. Oleh +&'en& &n,ib-(i he,e'-l-g m&+& i'us ,i(&+ (ine,'&lis&si+&n -leh

,ubuh sehingg& &+&n beb&s mel&+u+&n 'e)li+&si (&l&m sel m&+'-&g.

Dihi)-,esis+&n 0ug& mengen&i antibodi dependent enhancement 5ADE6 su&,u

)'-ses *&ng &+&n mening+&,+&n ine+si (&n 'e)li+&si i'us (engue (i (&l&m sel

m-n-nu+le&'. Seb&g&i ,&ngg&)&n ,e'h&(&) ine+si ,e'sebu, ,e'0&(i se+'esi

me(i&,-' &s-&+,i *&ng +emu(i&n men*eb&b+&n )ening+&,&n )e'me&bili,&s

)embuluh (&'&h sehingg& meng&+ib&,+&n +e&(&&n hi)--lemi& (&n s*-+.143

P&,-genesis ,e'0&(in*& s*-+ be'(&s&'+&n hi)-,esis ,he se-n(&'*

he,e'-l-g-us ine,i-n (&)&, (ilih&, )&(& 7&mb&' 1 *&ng (i'umus+&n -leh

Su&,,e ,&hun 188. Seb&g&i &+ib&, ine+si se+un(e' -leh ,i)e i'us (engue *&ng

be'l&in&n )&(& se-'&ng )&sien 'es)-ns &n,ib-(i &n&mnes,i+ *&ng &+&n ,e'0&(i

(&l&m ?&+,u bebe'&)& h&'i meng&+ib&,+&n )'-lie'&si (&n ,'&ns-'m&si lim-si,

(eng&n mengh&sil+&n ,i,e' ,inggi &n,ib-(i Ig7 &n,i (engue. Dis&m)ing i,u

'e)li+&si i'us (engue ,e'0&(i 0ug& (&l&m lim-si, *&ng be','&ns-'m&si (eng&n

&+ib&, ,e'(&)&,n*& i'us (&l&m 0uml&h b&n*&+. H&l ini &+&n meng&+ib&,+&n

16


19/37

,e'ben,u+n*& i'us +-m)le+s &n,igen4&n,ib-(i 5virus antibody complex6 *&ng

sel&n0u,n*& &+&n meng&+ib&,+&n &+,i&si sis,em +-m)lemen. Pele)&s&n C3& (&n

C"& &+ib&, &+,i&si C3 (&n C" men*eb&b+&n )ening+&,&n )e'me&bili,&s (in(ing

)embuluh (&'&h (&n me'embesn*& )l&sm& (&'i 'u&ng in,'&&s+ul&' +e 'u&ng

e+s,'&&s+ul&'.P&(& )&sien (eng&n s*-+ be'&, -lume )l&sm& (&)&, be'+u'&ng

s&m)&i lebih (&'i 3= < (&n be'l&ngsung sel&m& 24; 0&m. Pe'embes&n )l&sm&

ini ,e'bu+,i (eng&n &(&n*& )ening+&,&n +&(&' hem&,-+'i, )enu'un&n +&(&'

n&,'ium (&n ,e'(&)&,n*& &i'&n (i (&l&m '-ngg& se'-s& 5eusi )leu'& &si,es6.

S*-+ *&ng ,i(&+ (i,&nggul&ngi se&'& &(e+u&, &+&n men*eb&b+&n &si(-sis (&n

&n-+si& *&ng (&)&, be'&+hi' &,&l -leh +&'en& i,u )eng-b&,&n s*-+ s&ng&,

)en,ing gun& meneg&h +em&,i&n. Hi)-,esis +e(u& men*&,&+&n b&h?& i'us

(engue se)e',i 0ug& i'us bin&,&ng l&in (&)&, meng&l&mi )e'ub&h&n gene,i+ &+ib&,

,e+&n&n se?&+,u i'us meng&(&+&n 'e)li+&si b&i+ )&(& ,ubuh m&nusi& m&u)un

)&(& ,ubuh n*&mu+. E+s)'esi en-,i)i+ (&'i )e'ub&h&n gene,i+ (&l&m gen-m i'us

(&)&, men*eb&b+&n )ening+&,&n 'e)li+&si i'us (&n i'emi& )ening+&,&n

i'ulensi (&n mem)un*&i )-,ensi un,u+ menimbul+&n ?&b&h. Sel&in i,u bebe'&)&

s,'&in i'us mem)un*&i +em&m)u&n un,u+ menimbul+&n ?&b&h *&ng bes&'.

Ke(u& hi)-,esis ,e'sebu, (i(u+ung -leh (&,& e)i(emi-l-gis (&n l&b-'&,-'is.1

Seb&g&i ,&ngg&)&n ,e'h&(&) ine+si i'us (engue +-m)le+s &n,igen4

&n,ib-(i sel&in meng&+,i&si sis,em +-m)lemen 0ug& men*eb&b+&n &g'eg&si

,'-mb-si, (&n meng&+,ii,&si sis,em +-&gul&si mel&lui +e'us&+&n sel en(-,el

)embuluh (&'&h 5g&mb&' 26. Ke(u& &+,-' ,e'sebu, &+&n men*eb&b+&n )e'(&'&h&n

)&(& DBD. Ag'eg&si ,'-mb-si, ,e'0&(i seb&g&i &+ib&, (&'i )e'le+&,&n +-m)le+s

&n,igen4&n,ib-(i )&(& memb'&n ,'-mb-si, meng&+ib&,+&n )engelu&'&n ADP

5&(en-sin (i )h-s)h&,6 sehingg& ,'-mb-si, mele+&, s&,u s&m& i&in. H&l ini &+&nmen*eb&b+&n ,'-mb-si, (ih&nu'+&n -leh $ES 5'e,iul- en(-,heli&l s*s,em6

sehingg& ,e'0&(i ,'-mb-si,-)eni&. Ag'eg&si ,'-mb-si, ini &+&n men*eb&b+&n

)engelu&'&n )l&,ele, &+,-' III meng&+ib&,+&n ,e'0&(in*& +-&gul-)&,i +-nsum,i

5KID F +-&gul&si in,'&&s+ul&' (esemin&,&6 (i,&n(&i (eng&n )ening+&,&n #DP

5ib'in-gen (eg'e(&,i-n )'-(u,6 sehingg& ,e'0&(i )enu'un&n &+,-' )embe+u&n.12

Ag'eg&si ,'-mb-si, ini 0ug& meng&+ib&,+&n g&nggu&n ungsi ,'-mb-si,

sehingg& ?&l&u)un 0uml&h ,'-mb-si, m&sih u+u) b&n*&+ ,i(&+ be'ungsi b&i+.

17


20/37

Di sisi l&in &+,i&si +-&gul&si &+&n men*eb&b+&n &+,i&si &+,-' H&gem&n

sehingg& ,e'0&(i &+,i&si sis,em +inin sehingg& mem&u )ening+&,&n )e'me&bili,&s

+&)ile' *&ng (&)&, mem)e'e)&, ,e'0&(in*& s*-+. J&(i )e'(&'&h&n m&si )&(&

DBD (i&+ib&,+&n -leh ,'-mb-si,)eni& )enu'un&n &+,-' )embe+u&n 5&+ib&,

KID6 +el&in&n ungsi ,'-mb-si, (&n+e'us&+&n (in(ing en(-,el +&)ile'. A+hi'n*&

)e'(&'&h&n &+&n mem)e'be'&, s*-+ *&ng ,e'0&(i.1

*+) #e0ala klinis

Ine+si i'us (engue ,e'g&n,ung (&'i &+,-' *&ng mem)eng&'uhi (&*&

,&h&n ,ubuh (eng&n &+,-'4&+,-' *&ng mem)eng&'uhi i'ulensi i'us.Deng&n

(emi+i&n ine+si i'us (engue (&)&, men*eb&b+&n +e&(&&n *&ng be'm&&m4m&&m mul&i (&'i ,&n)& ge0&l& 5&sim,-m&,i+6 (em&m 'ing&n *&ng ,i(&+ s)esii+

5un(ie'en,i&,e( eb'ile illness6 Dem&m Dengue &,&u ben,u+ *&ng lebih be'&,

*&i,u Dem&m Be'(&'&h Dengue 5DBD6 (&n Sin('-m S*-+ Dengue 5SSD6.3

18


21/37

Demam erdarah Den.ue / DD

1. Klinis

7e0&l& +linis *&i,u:

• Dem&m ,inggi men(&(&+ ,&n)& seb&b *&ng 0el&sbe'l&ngsung

,e'us mene'us sel&m& 248 h&'i be'si&, bi&si+.

• !&nies,&si )e'(&'&h&n *&ng bi&s&n*& be'u)&

o u0i ,-u'ni9ue, )-si,i

o )e,e+i& e+im-sis &,&u )u')u'&

o Pe'(&'&h&n mu+-s& s&lu'&n e'n& (&n ,em)&, be+&s

sun,i+&no Hem&,emesis &,&u melen&

• Pembes&'&n h&,i

• S*-+ (i,&n(&i n&(i e)&, (&n lem&h se',& )enu'un&n ,e+&n&n n&(i

hi)-,ensi +&+i (&n ,&ng&n (ingin +uli, lemb&b (&n )&sien ,&m)&+

gelis&h.14

2. L&b-'&,-'ium

• T'-mb-si,-)eni& G 1==.==@)l

• Keb--'&n )l&sm& *&ng (i,&n(&i (eng&n

o Pening+&,&n nil&i hem&,'-+'i, 2= <oPenu'un&n nil&i hem&,-+'i, 2= < se,el&h )embe'i&n

&i'&n *&ng &(e+u&,

oEusi )leu'& &si,es hi)-)'-,einemi&14

Du& +'i,e'i& +linis (i,&mb&h s&,u (&'i +'i,e'i& l&b-'&,-'ium u+u) un,u+

meneg&++&n (i&gn-se seme,&'& DBD.

De'&0&, )en*&+i, 5 >HO 186De'&0&, )en*&+i, DBD (i+l&sii+&si+&n (&l&m (e'&0&, 5 )&(& se,i&) (e'&0&, su(&h

(i,emu+&n ,'-mb-si,-)eni& (&n hem-+-nsen,'&si6

De'&0&, I Dem&m (ise',&i ge0&l& ,&+ +h&s (&n s&,u M s&,u m&nises,&si )e'(&'&h&n i&l&h u0i

,-u'ni9ue,6

De'&0&, II Se)e',i (e'&0&, 1 (ise',&i )e'(&'&h&n s)-n,&n (i +uli, (&n &,&u )e'(&'&h&n l&in.

De'&0&, III Di(&)&,+&n +eg&g&l&n si'+ul&si *&i,u n&(i e)&, (&n lem&h. Te+&n&n n&(i

menu'un5 2= mmhg &,&u +u'&ng6 &,&u hi)-,ensi. Si&n-sis (i se+i,&' mulu,. Kuli,

19


22/37

(ingin (&n lemb&b (&n &n&+ ,&m)&+ gelis&h.

De'&0&, I/ S*-+ be'&, n&(i,i(&+ (&)&, (i'&b& (&n ,e+&n&n ,i(&+ ,e'u+u'.

C&,&,&n : (e'&0&, III (&n I/ ,e'm&su+ (&l&m DSS.3

Sindrom S$ok Den.ue 7SSD8S*-+ bi&s& ,e'0&(i )&(& s&&, &,&u sege'& se,el&h suhu ,u'un &n,&'& h&'i +e 3

s&m)&i h&'i s&+i, +e48.P&sien mul&4mul& ,e'lih&, le,&'gi &,&u gelis&h +emu(i&n

0&,uh +e (&l&m s*-+ *&ng (i,&n(&i (eng&n +uli, (ingin4lemb&b si&n-sis se+i,&'

mulu, n&(i e)&,4lem&h ,e+&n&n n&(i G 2= mmHg (&n hi)-,ensi.Keb&n*&+&n

)&sien m&sih ,e,&) s&(&' se+&li)un su(&h men(e+&,i s,&(ium &+hi'. Deng&n

(i&gn-sis (ini (&n )engg&n,i&n &i'&n &(e+u&, s*-+ bi&s&n*& ,e'&,&si (eng&n

sege'& n&mun bil& ,e'l&mb&, (i+e,&hui &,&u )eng-b&,&n ,i(&+ &(e+u&, s*-+ (&)&,

men0&(i s*-+ be'&, (eng&n be'b&g&i )en*uli,n*& se)e',i &si(-sis me,&b-li+

)e'(&'&h&n heb&, s&lu'&n e'n& (&n DIC sehingg& mem)e'bu'u+ )'-gn-sis. P&(&

m&s& )en*embuh&n *&ng bi&s&n*& ,e'0&(i (&l&m 243 h&'i +&(&ng4+&(&ng

(i,emu+&n sinus b'&(i+&'(i &,&u &'i,mi& (&n ,imbul 'u&m )&(& +uli,.T&n(&

)'-gn-s,i+ b&i+ &)&bil& )engelu&'&n u'in u+u) (&n +emb&lin*& n&su m&+&n.

Pen*uli, SSD : )en*uli, l&in (&'i SSD &(&l&h ine+si 5)neum-ni& se)sis lebi,is6

(&n ,e'l&lu b&n*&+ &i'&n 5-e' hi('&si6 m&nies,&si +lini+ ine+si i'us *&ng ,i(&+

l&im se)e',i ense&l-)&,i (&n g&g&l h&,i.14"

*+2 %emeriksaan Laboratorium

A(& bebe'&)& )eme'i+s&&n l&b-'&,-'ium )&(& )en(e'i,& DBD *&i,u :

1. Hem&,-l-gi

• Juml&h Leu+-si,

Juml&h leu+-si, n-'m&l ,e,&)i bi&s&n*& menu'un (eng&n (-min&si

sel neu,'-il.Sel&n0u,n*& )&(& &+hi' &se (em&m 0uml&h leu+-s, (&n

neu,'-il be's&m&4s&m& menu'un sehingg& 0uml&h sel lim-si, se&'&

'el&,ie mening+&,. Pening+&,&n 0uml&h sel lim-si, &,i)i+&l &,&u

lim-si, )l&sm& bi'u 5LPB6 < (i (&e'&h ,e)i (&)&, (i0um)&i )&(&

h&'i +e,ig& s&m)&i h&'i +e,u0uh.1

• Juml&h T'-mb-si,

20


23/37

Penu'un&n 0uml&h ,'-mb-si, men0&(i 1==.===@l &,&u +u'&ng (&'i

142 ,'-mb-si,@LPB (eng&n '&,&4'&,& )eme'i+s&&n (il&+u+&n 1= l)b.

P&(& umumn*& ,'-mb-si,-)eni& ,e'0&(i sebelum &(& )ening+&,&n

hem&,-+'i, (&n ,e'0&(i sebelum suhu ,u'un. Juml&h ,'-mb-si,

1==.===@l bi&s&n*& (i,emu+&n &n,&'& h&'i +e,ig& s&+i, s&m)&i

+e,u0uh.Pemei+s&&n ,'-mb-si, )e'lu (iul&ng s&m)&i ,e'bu+,i b&h?&

0uml&h ,'-mb-si, (&l&m b&,&s n-'m&l &,&u menu'un. Peme'i+s&&n

(il&+u+&n )e',&m& )&(& s&&,4s&&, )&sien )e',&m& (i(ug& men(e'i,&

DBD bil& n-'m&l m&+& (iul&ng )&(& s&+i, +e,ig& ,e,&)i bil& )e'lu

(iul&ngi se,i&) h&'i s&m)&i suhu ,u'un.1

• K&(&' Hem&,-+'i,

Pening+&,&n nil&i hem&,-+'i, mengg&mb&'+&n hem-+-nsen,'&si

sel&lu (i0um)&i )&(& DBD me'u)&+& in(i&,-' *&ng )e+& &+&n

,e'0&(in*& )e'embes&n )l&sm& sehingg& )e'lu (il&+u+&n )eme'i+s&&n

hem&,-+'i, se&'& be'+&l&. P&(& umumn*& )enu'un&n ,'-mb-si,

men(&hului )ening+&,&n hem&,-+'i,. Hem-+-nsen,'&si (eng&n

)ening+&,&n hem&,-+'i, 2=< &,&u lebih 5mis&ln*& (&'i 3"< men0&(i

2


24/37

b6 U0i +-m)lemen i+s&si

6 U0i ne,'&lis&si

(6 Ig! (&n Ig7 elis&

Ig! elis& )&(& ,&hun ,e'&+i' ini me'u)&+&n u0i se'-l-gi *&ng b&n*&+

se+&li (i)&+&i. H&l4 h&l *&ng )e'lu (i)e'h&,i+&n :

• P&(& h&'i 4" ine+si i'us (engue &+&n ,imbul ig! *&ng

+emu(i&n (ii+u,i ,imbuln*& ig7.

• Deng&n men(e,e+si ig! )&(& se'um )&sien &+&n se&'& e)&,

(&)&, (i,en,u+&n (i&gn-sis *&ng ,e)&,.1

• Ig! (&)&, be',&h&n (i (&l&m (&'&h s&m)&i 243 bul&n se,el&h &(&n*&

ine+si. Un,u+ mem)e'0el&s+&n h&sil u0i ig! (&)&, )ul& (il&+u+&n u0i

,e'h&(&) ig7.$&,i- Ig!@ Ig7 (&)&, menen,u+&n ine+si )'ime' &,&u

se+un(e'. Ji+& '&,i- ig! @ ig7 1.2 menun0u+&n ine+si )'ime' G 1.2

menun0u+&n ine+si se+un(e'.34"

. !en(e,e+si &n,igen i'us

22


25/37

NS1 &n,igen (&)&, (i(e,e+si )&(& h&'i 1 se0&+ mul&i (em&m (&n

menghil&ng se,el&h "4% h&'i.1

*+: Kom-likasia+ %erdarahan

Ji+& (i,emu+&n sumbe' )e'(&'&h&n sebis& mung+in (ihen,i+&n

)e'(&'&h&nn*&. P&(& DH# bis& ,e'0&(i )e'(&'&h se)e',i e)is,&+sis gusi

be'(&'&h )e'(&'&h&n s&lu'&n e'n&.Ji+& ,e'0&(i e)is,&+sis be'&, sege'&

,'&nsuse (&'&h un,u+ lie s&ing (&n 0&ng&n menunggu )enu'un&n

hem&,-+'i,. ,'&nsusi (eng&n 1= ml@+g P$C.

P&(& )e'(&'&h&n g&s,'-in,es,in&l H42 &n,&g-nis 5 '&ni,i(ine 1 mg @+g BB@

(-se 34 @h&@'i6.Ti(&+ &(& sumbe' *&ng men(u+ung )embe'i&n ,'-mb-si,

(&n ##P &,&u *-)'ei)i,&,e. %

b+ Asidosis metabolik

K-n,'-l +eseimb&ng&n &s&m b&s& (i,en,u+&n -leh gin0&l.P&'u (&n sis,em

bue'. P&(& DSS bis& ,e'0&(i &si(-sis me,&b-li +&'en& meng&l&mi s*-+

sehingg& meng&l&mi hi)-+si& 0&'ing&nme,&b-lime &n&e'-b (eng&n

mengh&sil+&n &s&m l&+,&,.

7e0&l& +linis 8

!&nies,&si +linis )&(& &si(-sis me,&b-li ,e'g&n,ung (e'&0&,

&&(emi&. P&(& se'um )H G 82 bis& ,e'0&(i g&nggu&n +-n,'&+si 0&n,ung

(&n mening+&,n*& 'isi+- &'i,mi& (eng&n &(&n*& &&(emi&,e'0&(i

)enu'un&n 'es)-n 0&n,ung ,e'h&(&) +&,e+-l&min )-,ensi ,e'0&(i se'&ng&n

hi)-,ensi )&(& &n&+ (eng&n +e+u'&ng&n -lume &i'&n &,&u s*-+.

A&(emi& 0ug& men*eb&b+&n &s-+-ns,'i+si )&(& &sul&' )ulm-n&l.

A+&n ,e'0&(i +-m)ens&si (eng&n hi)e'en,il&si 5 )e'n&)&s&n +ussm&u 6

&&(emi& men*eb&+&n +&lium be'ge'&+ (&'i in,'&selul&' +e e,'&selul&'.

&&(emi& *&ng be'&, bis& ,e'0&(i g&nggu&n me,&b-lism -,&+ sehingg&

,e'0&(i le,&'gi (&n -m&.8

23


26/37

4+ Ensefalo-ati den.ue

P&(& umumn*& ense&l-)&,i (engue (i(ug& ,e'0&(i seb&g&i

+-m)li+&si s*-+ *&ng be'+e)&n0&ng&n (isungsi h&,i e(em& -,&+ )e'(&'&h&n +&)il&' e'eb'&l g&nggu&n me,&b-li se)e',i hi)-+semi& &,&u

hi)-n&'emi& se',& ,h'-mb-sis )embuluh (&'&h -,&+ semen,&'& seb&g&i

&+ib&, (&'i DIC.8

P&(& ense&l-)&,i (engue +es&(&'&n )&sien menu'un s&m)&i

-m&. Ke0&ng )&'esis.Hi)e''ele+s )&(& )eme'i+s&&&n isi+.8

Pungsi lumb&l (i+e'0&+&n bil& s*-+ ,el&h ,e'&,&si (&n +es&(&'&n

,e,&) menu'un. P&(& ense&l-)&,i (engue (&)&, (i0um)&i )ening+&,&n

+&(&' S7OT @ S7PT PT (&n APTT mem&n0&ng hi)-gli+emi&

hi)-n&,'emi&.

d+ A4ute kidne$ failure

Au,e +i(ne* &ilu'e (isebu, 0ug& &u,e 'en&l insuiien* &(&l&h

sin('-m +lini+&l (eng&n ,e'0&(i )enu'un&n ungsi gin0&l se&'& ,ib&4 ,ib&

sehingg& ,e'0&(i g&nggu&n (&l&m mem)e',&h&n+&n h-me-s,&sis &i'&n (&n

ele+,'-li,.8

!&nies,&si +linis

P&(& )'e'en&l : Te'(&)&, ,&n(&4 ,&n(& hi)--lemi+ : n&(i e)&, (&n

lem&h &+&l (ingin+eh&us&n hi)-,ensi -',-s,&,i+. Penu'un&n

+es&(&'&n.T&+i)ne&. U'in -u,)u, menu'un.8

Sel&in i,u 0ug& h&'us lih&, ,&n(&4 ,&n(& )&(& g&nggu&n ele+,'-li,

se)e',i h*)e'+&lemi& bis& men*eb&b+&n &'i,mi& 0&n,ung &'(i& &''es,

+em&,i&n.ge0&l& (&'i &si(-sis me,&b-li.8

Peme'i+s&&n l&b-'&,-'ium

• Ele+,'-li,

• Hem&,-l-gi leg+&)

• U'in leng+&)

• U'eum +'e&,inin

• #-,- ,h-'&+

24


27/37

Te'&)i

$ehi('&si (eng&n 2=ml@+g (&l&m 3= meni,. Ji+& ,i(&+ &(&

+ehil&ng&n (&'&h (&n hi)-)'-,einemi& 0&ng&n menggun&+&n &i'&n

+-l-i( .seb&i+n*& (i)&s&ng C/P un,u+ mem&ni,-' -lume (&'&h. 8

K-'e+si ele+,'-li,

H*)e'+&lemi& )'-se(u' menu'un+&n +&lium +&l&u men&)&i %

me9@L. (eng&n &'& b&,&si (ie, *&ng meg&n(ung +&lium (ibe'i+&n n&,'ium

)-l*s,*'ene sul-n&,e 5 +&*e&l&,e6 1 g@+g . +&l&u +&lium 8 me9@L

(ibe'i+&n &glu+-n&s n&,'ium bi&'b-n&,e insulin. 8

Hem-(i&lis& (il&+u+&n +&l&u :

• Pe'sis,en, h*)e'+&lemi&

• Asi(-sisme,&b-li+ )&'&' *&ng ,i(&+ 'es)-n )&(& -b&,.

• 7e0&l& neu'-l-gi5 g&nggu&n+es&(&'&n +e0&ng6

• BUN 1==41"= mg@(L 5 &,&u lebih 'en(&h ,&-i mening+&, (eng&n

e)&,.68

e+ Edema -aru

E(em& )&'u &(&l&h +um)ul&n &i'&n *&ng be'elebih&n )&(&

in,e's,i,i&l (&n 0&l&n n&)&s sehingg&,e'0&(i -+sigen (es&,u'&si )emnu'un&n

)&'u -m)li&ne 'es)i'&,-'i (is,'ess.8

!&nises,&si +linis

P&sien &+&n ,&m)&+ ses&+ (eng&n melih&, ,e'(&)&,n*& ,&+i)ne&

su&'& n)&s )&'u ,e'(eng&' '-n+i b&s&h (&n ?heeing. P&(& &'(i-geni

)ulm-n&'* e(em& &+&n ,e'(eng&' su&'& g&ll-) (&n J/P meing+&,.8

Te'&)i

P&(& e(em& )&'u n-n&'(i-geni+ (ibe'i+&n en,il&si *&ng u+u)

(&n -b&,i )en*eb&bn*&. P&(& e(em )&'u &'(i-geni (ibe'i+&n &gen,

in-,'-)i (&n sis,emi+ (il&,-' un,u+ menu'un+&n en,'i+el +i'i &,e'l-&(.

Diu'e,i (ibe'i+&n )&(& e(em )&'u *&ng be'hubung&n (eng&n -e'l-&(

&i'&n. 8

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f+ DI&l&u)un s*m),-m se'ingn*& hem-'&gi+ ,&)i bi&s&n*& (i&?&li

(eng&n &+,i&si )embe+u&n *&ng ,e'l&lu b&n*&+ sehingg& ,e'0&(i (eisiensi

&,-' / &,-' /III )'-,'-mbin ib'in-gen ,'-mb-si,. Bis& ,e'0&(i

,h'-mb-sis )&(& +uli, gin0&l (&n -'g&n l&inn*&.8

!&nies,&si +linis

DIC se'ing be'b&'eng&n (eng&n )en*&+i, sis,emi+ be'&, se'ingn*&

&(&l&h s*-+.Kuli, se'ing ,e'(&)&, )e,e+ie (&n e+im-sis.J&'ing&n ne+'-sis

*&ng melib&,+&n bebe'&)& -'g&n (&n )&ling lu&'bi&s& )&(& in&'+ lu&s

)&(& +uli, sub+u,&n gin0&l. Anemi& ,e'0&(i +&'en& hem-l*sis *&ng

be'+emb&ng (eng&n e)&,.8

Peme'i+s&&n l&b-'&,-'ium

Te'(&)&, (eisiensi &,-' II / /III ib'in-gen ,'-mb-si,

)e')&n0&ng&n PT (&n APTT. Peme'i+s&&n g&mb&'&n (&'&h ,e)i : ,e'(&)&,

'&gmen )&(& e'i,'-si, bu'' ell. D4 Dime' mening+&,.8

Te'&)i

!eng-b&,i )en*&+i, (&s&' *&ng memiu ,e'0&(in*& DIC.T'&nsusi

P$C )&(& hem-'&gi+. T'&nsuse )l&,ele, )&(& ,'-mb-si,-)eni& ,'&nsuse

'*-)'ei)i,&,e un,u+ h*)-ib'in-genemi&. D&n ,'&nsuse ##P )&(&

(eisiensi &+,-' )embe+u&n.

Pembe'i&n he)&'in )&(& DIC ,e'b&,&s )&(& )&sien (eng&n &sul&'

,'-mbsis (&n )'-il&+sis )&(& 'isi+- ,inggi ,'-mb-emb-li.8

*+' atalaksana DSS

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• A?&l )embe'i&n &i'&n $L 2= ml@+g b-lus )e',&m& (&l&m 1" meni,

• Ji+& +-n(isi memb&i+ be'i+&n $L 1= ml@+g un,u+ 1 0&m. L&lu $L

(i,u'un+&n 0&(i "4 8 ml@+g un,u+ 142 0&m 34" ml@+g@0&m un,u+ 24

0&m 243 ml@+g@0&m s,-) (&l&m ; 0&m.• Ji+& TT/ ,i(&+ s,&bil (&n hem&,-+'i, menu'un G = < )&(& &n&+

(&n (e?&s& )e'em)u&n G " < )&(& (e?&s& l&+i4 l&+i. C&'i ,&n(&4

,&n(& )e'(&'&h&n. T'&nsuse P$C.

• Ji+& hem&,-+'i, m&sih ,inggi be'i +-l-i( 1=42= ml@+g b-lus +e(u&

1= M 2= ml@+g (&l&m 3= meni, s&m)&i 1 0&m. Ji+& ,e'0&(i )e'b&i+&n

+linis (&n hem&,-+'i, s,&bil ,u'un +&n +-l-i( 841= ml@+g un,u+ 14

2 0&m l&lu g&n,i &i'&n +-l-i( 0&(i +'is,&l-i( (&n ,u'un+&n

&i'&nn*&.

• Ji+& +linis ,i(&+ &(& )e'b&i+&n (&n hem&,-+'i, m&sih ,inggi5"=


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*+(& %ro.nosis

Ang+& +em&,i&n )&(& DSS 124


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A 6

%EMA!ASA"

eori Fakta

#e0ala Klinis

Be'(&s&'+&n +'i,e'i& >HO 18 (i&gn-sis DBD

(i,eg&++&n bil& semu& h&l (i b&?&h ini (i)enuhi :

• Dem&m &,&u 'i?&*&, (em&m &+u, &n,&'& 24

8 h&'i bi&s&n*& bi&si+.

•Te'(&)&, minim&l s&,u (&'i m&nies,&si

)e'(&'&h&n be'i+u, :

&. U0i ben(ung )-si,i.

b. Pe,e+ie e+im-sis &,&u )u')u'&.

. Pe'(&'&h&n mu+-s& 5,e'se'ing e)is,&+sis

&,&u )e'(&'&h&n gusi6 &,&u )e'(&'&h&n

(&'i ,em)&, l&in.

(. Hem&,emesis &,&u melen&• T'-mb-si,-)eni& 50uml&h ,'-mb-si,

[email protected]

• Te'(&)&, minim&l s&,u ,&n(&4,&n(& )l&sm&

le&+&ge 5+eb--'&n )l&sm&6 seb&g&i

be'i+u, :

&. Pening+&,&n hem&,-+'i, 2=<

(ib&n(ing+&n s,&n(&' sesu&i (eng&numu' (&n 0enis +el&min.

b. Penu'un&n hem&,-+'i, 2=< se,el&h

men(&)&, ,e'&)i &i'&n (ib&n(ing+&n

(eng&n nil&i hem&,-+'i, sebelumn*&.

. T&n(& +eb--'&n )l&sm& se)e',i : eusi

)leu'& &si,es &,&u hi)-)'-,einemi&

• Dem&m (i&l&mi se0&+

h&'i S!$S. Dem&m n&i+

,u'un ,e'u,&m& s&&, )&sien

minum -b&, )eu'un )&n&s.

• P&sien meng&l&mi mun,&h

se0&+ 2 h&'i S!$S mun,&h

,i&) +&li m&+&n (&n minum

• N*e'i )e'u, 56 se0&+ )&gi

S!$S

%emeriksaan Fisik

De'&0&, )en*&+i, DBD (i+l&sii+&si+&n (&l&m

S: Dem&m 546 mu&l 56 n*e'i )e'u,

56. Dem&m H4

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(e'&0&, 5 )&(& se,i&) (e'&0&, su(&h (i,emu+&n

,'-mb-si,-)eni& (&n hem-+-nsen,'&si6

&. De'&0&, I: Dem&m (ise',&i ge0&l& ,&+ +h&s

(&n s&,u M s&,u m&nises,&si )e'(&'&h&n i&l&hu0i ,-u'ni9ue,

b. De'&0&, II: Se)e',i (e'&0&, 1 (ise',&i

)e'(&'&h&n s)-n,&n (i +uli, (&n &,&u

)e'(&'&h&n l&in.

. De'&0&, III: Di(&)&,+&n +eg&g&l&n si'+ul&si

*&i,u n&(i e)&, (&n lem&h. Te+&n&n n&(i

menu'un5 2= mmhg &,&u +u'&ng6 &,&u

hi)-,ensi. Si&n-sis (i se+i,&' mulu,. Kuli,

(ingin (&n lemb&b (&n &n&+ ,&m)&+

gelis&h.

(. De'&0&, I/: S*-+ be'&, n&(i,i(&+ (&)&,

(i'&b& (&n ,e+&n&n ,i(&+ ,e'u+u'.

C&,&,&n : (e'&0&, III (&n I/ ,e'm&su+ (&l&m DSS.3

O: 7CSF1"

TD: 1==@8= N : 1= @I $$ :2 @I

T:3%-C &nemis 54@46 i+,e'i+ 54@46

es 5@6 S1 S2 ,ungg&l 'egul&'

NTE56 &+'&l h&ng&, 56 C$T

G2 $um)le lee( 56

%emeriksaan %enun0an.

•Hem&,-l-gi

• $&(i-l-gi

• Di&gn-sis Se'-l-gis

P&(& )eme'i+s&&nhem&,-l-gi (i(&)&,+&n

)&sien n-'m&l +&(&ng

leu+-)eni& ,'-mb-si,-)eni&

(&n )ening+&,&n hem&,-+'i,.

P&(& )eme'i+s&&n se'-l-gis

(i(&)&,+&n Ig7 546 Ig! 56

%enatalaksanaan Te'&)i *&ng (ibe'i+&n :

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4 I/#D $L 3=

4 Ce+ DL @ ; 0&m


4 P&'&e,&m-l 3 ,&b

4 An,&si(& s*'. 3 ,h I

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A )

%E"UU%

)+( Kesim-ulan

Dem&m (i&l&mi se0&+ h&'i S!$S. Dem&m n&i+ ,u'un ,e'u,&m& s&&, )&sien

minum -b&, )enu'un )&n&s. D&'i )eng&+u&n ibu )&sien s&&, ini (em&m lebih

en(e'ung ,u'un. P&sien 0ug& meng&l&mi mun,&h se0&+ 2 h&'i S!$S mun,&h

(i&l&mi se,i&) )&sien m&+&n (&n minum mun,&h be'isi m&+&n&n (&n ,i(&+

men*em)'-,. Sel&in i,u )&sien 0ug& mengeluh+&n n*e'i )e'u, *&ng (i&l&mi se0&+

)&gi S!$S. P&sien 0ug& meng&l&mi +eluh&n suli, BAB se0&+ h&'i S!$S n&su

m&+&n menu'un (&n ibu )&sien meng&+u b&h?& )&sien +u'&ng m&u minum (&n

m&+&n sel&m& s&+i,. BAK (&l&m b&,&s n-'m&l. P&sien ,i(&+ meng&l&mi mimis&n

gusi be'(&'&h m&u)un BAB hi,&m. A(&)un h&sil )eme'i+s&&n isi+ *&ng

(i,emu+&n &(&l&h +es&(&'&n +-m)-smen,is )&(& )&sien ,&n(& i,&l (i(&)&,+&n

(&l&m b&,&s n-'m&l. P&(& e+s,'emi,&s (i,emu+&n 'um)le lee( 56 &+'&l h&ng&,

(&n C$T G 2 (e,i+. P&(& )eme'i+s&&n hem&,-l-gi (i,emu+&n n-'m&l +&(&ng

leu+-)eni& )ening+&,&n hem&,-+'i, (&n ,'-mb-si,-)eni& se',& Ig! )-si,i )&(&

h&sil )eme'i+s&&n se'-l-gis. P&sien ini (i(i&gn-sis Dem&m Be'(&'&h Dengue

(eng&n ,&n(& b&h&*& 5?&'ning sign6. Ji+& (i,el&&h be'(&s&'+&n &n&mnesis hingg&

)en&,&l&+s&n&&n m&+& (i(&)&,+&n +esim)ul&n b&h?& ,el&h sesu&i &n,&'& +&sus

(eng&n li,e'&,u' *&ng +&mi (&)&,+&n.

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DAFAR %USAKA

1. H S'i $ee+i S S-egeng > Suh&'*-n- S Th-m&s T&,& L&+s&n& Dem&m

Be'(&'&h Dengue (i In(-nesi& e( 3 B&(&n Pene'bi,&n De)&',emen

Keseh&,&n $e)ubli+ In(-nesi&. J&+&',&2==%h&l 14%%.

2. S. Sum&'m-7.He''* H. S'i $ee+i S. Hin('&I'&?&n. Bu+u A0&' Ine+si

Pe(i&,'i T'-)is Ine+si i'us (engue e( 2 B&(&n Pene'bi,&n IDAI

J&+&',&2==;h&l 1""4;1.

3. 7ui(elines #-' Di&gn-sis T'e,men, P'een,i-n &n( C-n,'-l e( 2==

>HO.

. C-m)'ehensie gui(eline -' )'een,i-n &n( -n,'-l - (engue &n( (engue

h&em-''h&gi ee'. In(i&: >HO SEA$O ,ehni&l )ubli&,i-n se'ies n-.%=.

2=11

". 7ui(elines -' lini&l m&n&gemen, - (engue ee' (engue hem-'&gi

ee' (engue sh-+ s*n('-me. In(i&: DI$ECTO$ATE O# N&,i-n&l /e,-'

B-'ne ise&se C-n,'-l P'-g'&mme. 2==;.

%. Ju'ie ! S-en&',- SS Os?&'i H A'ie S. Bu+u A0&' 7&s,'-en,e'-l-gi

He)&,-l-gi e( 1 B&(&n Pene'bi,&n IDAI J&+&',& 2=1= h&l 324=.

7. C&'l- >A Amb&l&&n&n N. Nels-n ,e,b--+ - )e(i&,'is. 1,h e(i,i-n

in,e'n&,i-n&l e(i,i-n. USA: Elseie' s&un(e's 2=11.). ";14= %3"43

1""%4.

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Refleksi Kasus DHF + warning sign

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