a. guntur h - jadeiisic2013 · bagian alergi-imunologi dan penyakit tropik-infeksi bagian ilmu...
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A. Guntur H
Sub. Bagian Alergi-Imunologi dan Penyakit Tropik-Infeksi
Bagian Ilmu Penyakit Dalam RSUD.Dr. Moewardi / FK. UNS. Surakarta
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
INTRODUCTION
• Infection disease patients → Malnutrition
• Malnutrition → long time treatment & healing; mortality and morbidity
• Macronutrition-micronutrition: Supportif treatment
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
METABOLIC DISFUNCTION
• Critical infection ( CI ) may have problem of
metabolism : 10% - 20 % ( Harris -
Benedict).
• At CI : nutrition requirement increase up to
50 %.
• Glucose : Glucogenolysis and
Gluconeogenesis
• Increased Metabolism rate → CO2
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
• Lipid : increased Lipooxidation
• Protein : proteolitic muscle cell → body weight
loss; immune respons ; disparity of amino
acid profile ; plasma glutamin; decreasing
amino acid level.
• Vitamin rate decreased
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
Biological body response either innate or adaptive
immune system on exogenous agent to keep
homeostasis ;
1. to neutralize immunogen
2. to eliminate tissue damage
3. inhibiting excessive proliferations
IMMUNE RESPONS
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
Physical barrier Complement Innate NK cells Phagocytic cells - neutrophils - macrophages IMMUNITY Eosinophils Mast Cells
Humoral ( B cells) Specific CMI ( T cells)
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
Nutrition and Immune Function
Nutrients are required to help the immune
system meet the increased demand for
building blocks and energy during processes
such as :
regulation of biosynthesis (folate, iron, zinc,
magnesium),
cell signaling (calcium, sodium, potassium)
protection against damage (copper, zinc,
selenium, anitoxidants such as vitamin C dan E)
Redoxon Immune Cocktail Panel Meeting Consiederation for the Redoxon Immune Cocktail Clinical Trial – 20th July 2005
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
Nutrition and Immune Function
Micronutrients that have been demonstrated in human and animal
studies to be essential for an optimal immune response include :
essential amino acids,
linoleic acid,
vitamin A,
vitamin B6,
folic acid,
vitamin B12,
vitamin C,
vitamin E,
zinc, copper, iron and selenium.
Redoxon Immune Cocktail Panel Meeting Consiederation for the Redoxon Immune Cocktail Clinical Trial – 20th July 2005
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
Celluler Reconstruction
Celluler Protection
Co-Enzym Reaction – Signalling
VITAMIN
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
VITAMINS
Vit B1 (Thiamin)
The Importance of vitamins is used to :
- Carbohydrate Metabolism
- Increase the energy
- Improve the nerve function
- Reduce the burden of nerve function
- Metabolism regulator
- Strengthen heart muscle contraction
- Lactic Acid ↓
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
Siklus krebs atau siklus
asam sitrat atau siklus
asam trikarboksilat, terjadi
di mitokondria. Merupakan
mekanisme secara umum
yang melengkapi oksidasi
molekul-molekul bahan
bakar terutama acetyl
CoA, hasil dari dekar-
boksilasi oksidasi piruvat
dan tiamin pirofosfat
(TPP). Acetyl CoA masuk
dalam siklus dan akan
melewati sepuluh tahap
reaksi yang hasilnya
adalah energi (ATP) dan
CO2.
Di kutip dari : Mihardja, 2004 Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
Neurologic & cardiovasculer disturbances :
periferal neuritis , sensoric disturbances.
depressive, fatigue, bad tempered, and altered ability to recall and concentration.
Improvement of lactic acid.
Muscle Strength → lower extremity and cardiac muscle paralysis
Epigastric pain and queasy
Lactic acid ↑
Vit. B1 ( Thiamin) supplement is needed
Insuffiency Conditions :
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
Vitamin B6 :
Pyridoxine, pyridoxal, and pyridoxamine
Pyridoxal amino acid decarboxylation
converse metionin become cystein
Decrease homosistinurea
Role with vit. B12 and folic acid
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
(Guntur, 2004)
Vit B12
Influence the enzymatic metabolism
Influence intracell purin & pirimidin (DNA) metabolism
Co-working with folic acid to ;
prevent anemia
Maintain myelin sheath function
Insuffiency conditions;
altered blood cell forming (eritrophoesis)
Neurologic disturbance : muscle pain
Damage of epithel cell in Gastro intestinal
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
FOLIC ACID
Metabolic functions :
PmGA
Purin Syntesis
Syntesis : Nukleotide pirimidin
Interconvertion : Homocystein methionin
Requirement :
Increase at : infection, anemia, ferocity ; CI
Definition of Folic :
Disturbance for nukleotida pirimidin Forming
DNA syntesis failure
Megaloblastic Anemia
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
THE ROLE OF FOLIC ACID
As Catalyst in purin nukleutide syntesis
Interconvertion amino acid; Serin → Glysin ;
histidin → glutamic acid ; homocystein →
methionin.
Homocystein → decrease Stress Cell
Pada CI , Infection disesase, anemia, cancer; folic
acid contents decrease → giving of acid folat
improve body condition
Folic acid - micronutrition ; as supportive therapy
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
ROLE OF FOLIC ACID
THF
5, 10-methylene THF
MTHFR
5-methyl THF
MS B12
Methionine
Homocysteine
Betaine
Cystathionine
CBS B6
SAH
SAM
Methyl
Transfer
Reactions
Guntur (2004)
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
HOMOCYSTEIN
• Endothel dysfunction
• Thrombocyte aggregation and fibrin
• Thrombosis
• Micro emboli
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
The FOLIC Requirement
Body Requirres 50 mcg folic daily, was used for :
The metabolism need more calories
Infection Disease
Anemia
Malignancy
Some reactions use single carbon :
1. To synthesize purin by forming Isonic Acid
2. To synthesize pyrimidin nucleutide
3. Amino Acid Interconversion
4. Glutamatic Acid
5. Homocystein with methionin (needed Vit. B12)
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
Vit. A, C and
E
• Protec barier membran,
• Increase IgA prevent to respirato track infecktion,
Activation macrophag
• Antioxidant
• Cell Wall protections
• May have potentiation effect with vitamin & mineral
• Increasing immune respons
• Increasing defens to viral infection
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
Zn : nucleic acid metabolism.
Protein Synthesis
Wound healing
Cell defense↑
Immune response ↑
Stimulatid to CD4
MINERAL
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
Selenium : Potentiation effect with vitamin E
Repairing cell wall
Co-enzyme in protein synthesis
Signaling to DNA repair selanometionin and cistein
Strong antioksidan
Selenium vit C and vit E using HIV treatmen
Fe (Ferrum) :
- Metabolic Neuron
- Oxydative Phosphorilation ATP
- Co-factor for Tirosin Hidroksilase, Triptofan
Hidroksilase – Metabolism : neurotransmiter,
RNA, DNA
- Metabolism rate Fe
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
Conclusion
More than 40% patients with former treatment, will
fall to severe malnutrition
Patients with critical condition (CI) will raise
metabolism energy counted 50 %.
By giving nutrition support adequadly to patient with
infection diseases & CI, can improve general
condition, reducing complications of infection,
mortality and prolong treatment.
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta
CI with complex circumtances influence glucose
matabolism, lipid, protein and Vitamins.
micronutrient plays a role in purin & pirimidin
synthesis → DNA and cell regeneration
Vitamin B1, B6, B12 and Zn, Fe and Selenium, folic
acid able to repair the metabolism and function of
vascular endothels, by reducing serum homocystein
Vitamins plays role as mikronutrient and as
supportive treatment at infection diseases and CI.
Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta