sptl gizi 2012

8/12/2019 Sptl Gizi 2012

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DEPARTEMEN IKARSMH PALEMBANG

Gizi Buruk Kode ICD :E 40,E 41,E 44.0, E

44.1,E 4,E 4!, E

4",E 4#

No Doku$e%&&&&.

No.Re'i(i!)!011

H*+*$*% :1)1"

P*%du*% Pr*kekK+i%i(

T*%--*+ Re'i(i1 ko/er !011

Die*k*% +e,Keu* Di'i(i Nuri(i d*% Pe%2*ki Me*/o+ik

Dr. 3u+iu( A%z*r, S.A

Dei%i(i Ter+i* (*%-* kuru( d*% **u ede$* d*% **u BB)TB **u BB)PB

5 6 "SD /erd*(*rk*% -r*ik eru$/u*% 7H *u% !00 u%uk

*%*k 8 # *u% d*% -r*ik CDC !000 u%uk *%*k 9 # *u%

Eio+o-i Sekru$ e%2e/*/ : I%*ke kur*%- ke$i(ki%*%, keid*k*u*%,

e%2*ki;, e%2*ki (i(e$ik

P*o-e%e(i(Sik+u( i%ek(i, di*re d*% kur*%- -izi 2*%- dier/er* o+e

i$u%odei(ie%(i, *roi)di(u%-(i or-*%, $*+*/(or/(i)$*+di-e(i,

kei+*%-*%)dei(ie%(i $e%i%-k*, k**/o+i($e $e%i%-k*

dei(ie%(i $*kro)$ikro%urie% -*%--u*% eru$/u*%

$*+%uri(i

Be%uk K+i%i(K+*(iik*(i;

K+*(iik*(i /erd*(*rk*% k+i%i(:

• M*r*($u(

• M*r*($ik k<*(iorkor

• K<*(iorkor

A%*$%e(i(• Se=*k k**% u/u $*ki% kuru( d*%)**u i$/u+%2* ede$*

• Se=*k k**% er=*di e%uru%*%)i+*%-%2* %*(u $*k*% d*%

$e%>*ri *kor redi(o(i(i

• Ri<*2* $*k*% (e/e+u$ (*ki, ri<*2* e$/eri*% ASI d*%

MP ASI

• Ge=*+* d*% *%d* e%2*ki e%2er*)2*%- $e%d*(*ri

$i(*+%2* di*re, u/erku+o(i(, /*uk kro%ik, >*>i%-*%, d*%

>*$*k, (er* *%d*6*%d* dei(ie%(i $*kro)$ikro%urie%

• K**% diure(i( er*kir

• Ri<*2* u$/u ke$/*%-

• Ri<*2* i$u%i(*(i

8/12/2019 Sptl Gizi 2012


Pe$erik(**% i(ik K+*(iik*(i /erd*(*rk*% k+i%i(:

• Gizi /uruk de%-*% ede$*

• Gizi /uruk *%* ede$*

Gizi Buruk dengan Edema

• Peru/**% (*u( $e%*+: **i( ? re<e+

• R*$/u ii(, ke$er**% ( <*r%* r*$/u =*-u%-, $ud*

di>*/u *%* (*ki, $ud* ro%ok

• 7*=* $e$/u+* d*% (e$/*/

• P*%d*%-*% $** (*2u

• Pe$/e(*r*% *i

• Mi%i$*+ *d* kedu* u%--u%- k*ki, /er(i* ii%- ede$*

• Der*=* ede$*:

@ Kedu* u%--u%- k*ki

@@ Tu%-k*i ? +e%-*% /*<*

@@@ Se+uru u/u <*=* ? eru;

• Der*=* ede$* u%uk $e%e%uk*% =u$+* >*ir*% 2*%-

di/erik*%

• o $e%-e>i+ ioroi;

• Ke+*i%*% ku+i /eru* /er>*k $er* $ud* 2- $e+u*( ?

/eru/* <*r%* $e%=*di >ok+* kei*$*% d*% erke+u*(crazy pavement dermatosis;

• Seri%- di(er*i e%2*ki i%ek(i u$u$%2* *ku; *%e$i*

d*% di*re

Gizi buruk tanpa edema

• T*$*k (*%-* kuru(, i%--* (eeri u+*%- er/u%-ku(

ku+i

• 7*=* (eeri or*%- u*

• Ce%-e%-, re<e+

• Ku+i keriu, =*ri%-*% +e$*k (u/kui( (*%-* (ediki (*$*i

id*k *d* >e+*%* +o%--*r baggy pants;

• Peru u$u$%2* >eku%-

• Tu+*%- ru(uk $e%o%=o+ I-* -*$/*%-, piano sign” ;

• Seri%- di(er*i e%2*ki i%ek(i u$u$%2* kro%i( /eru+*%-;

di*re er(i(e%

8/12/2019 Sptl Gizi 2012


Krieri* Di*-%o(i( Dasar Diagnosis:

• (i* 8 # *u% de%-*% -ro< >*r 7H !00, (>ore 5

6" SD

• (i* 9 # *u% $e$*k*i CDC !000, BB)TB : 5 0

• K+*(iik*(ik*% /erd*(*rk*% $*%ie(*(i k+i%i(

Langkah Diagnosis:

• Te*k*% Gizi Buruk

• Te*k*% k+*(iik*(i ) /e%uk k+i%ik Gizi Buruk

• Te*k*% ko%di(i

• Te*k*% di*-%o(i( e%2*ki 2*%- $e%2er*i $e%d*(*ri d*%

e%2er*;, (e>*r* rui%:

TBC (*%d*rd roe(i TBC

ISK (*%d*rd roe(i ISK

I%ek(i e+i%-* kro%i( ) $*(oidii( (*%d*r roe(i THT

• C*ri e%2e/*/ +*i% $e*/o+ik) e%dokri%, e%2*ki =*%u%-

/*<**%;

Indikasi Rawat: Se$u* e%deri* Gizi Buruk /er* dir*<*.

Tatalaksana

1. enatalaksanaan

8/12/2019 Sptl Gizi 2012


!. 1" Langkah dalam # $ase

%o. Tindakan&tabilisasi

Transisi

' ()1*

Rehabilitasi

+g #),

Tindak

Lan-ut

+g )/,' 1)/ ' #)

1 A*(i)>e-*

io-+ike$i*

! A*(i)>e-*

ioer$i*

" A*(i)>e-*

deidr*(i

4Per/*iki --%

e+ekro+i

# /*i i%ek(i

Per/*iki de.

%urie% $ikroT*%* Fe @Fe

M*k*%*% (*/.

Tr*%(

M*k*%*% u$/u

ke=*r

Si$u+*(i

10Si*k*% i%d*k

+*%=u

B. 0rutan elaksanaan

B.1. +enetapkan 2ondisi berdasarkan:

Tanda Baha3a 4

Tanda enting

2ondisi

I II III I5 5

Re%=**% So>k; @ 6 6 6 6

Le*r-i( Tid*k S*d*r; @ @ 6 @ 6

Mu%*)Di*re)Deidr*(i @ @ @ 6 6

B./. &tabilisasi

B./.1. &tabilisasi !wal

P*(ik*% **k* *d* -*%--u*% u%-(i 'i*+ e%uru%*% ke(*d*r*%,

re(2ok, -*%--u*% k*rdio'*(ku+er d*% er%**(*%; ) *%d* /**2*

2*%- $e%-*%>*$ keidu*% e%deri* (eeri io-+ike$i*, ioer$i*,

i%ek(i /er* (e(i(; d*% deidr*(i)-*%--u*% ke(ei$/*%-*% >*ir*%,

e+ekro+i, d*% *(*$ /*(*.

B././. &tabilisasi Lan-utan

B.#. Tatalaksana $ase &tabilisasi !wal dan Lan-utan &etiap 2ondisi

B.#.1. 2ondisi I

8/12/2019 Sptl Gizi 2012


Stabilisasi awal

/ -am I :

- ! 16! +)$e%i, *(*%- NGT

- P*(*%- IFD RLG # RL @ D10 1:1;

- D10 I /o+u( do(i( # $+)k-BB

-

ReSoM*+ # $+)k-BB)NGT

• 3*$ I: IFD RLG # 1# $+)k-BB (e+*$* 1 =*$ #

()$e%i)k-BB $*kro;

• 3*$ II:

6 N*di ku*, rek %**( J IFD (*$*i 1 =*$ /eriku%2*,

ReSoM*+ (e(u*i ke$*$u*%;

6 N*di d*% rekue%(i %**( e* i%--i IFD RLG # 4 $+)

k-BB)=*$ 1 ()k-BB)$e%i;

1" 6am II

6 IFD dieru(k*% (e$e%*r*;

6 ReSoM*+ (e+*%-6(e+i%- i* =*$ de%-*% F6#

6 ASI @; dieru(k*% (ee+* F6#

6 C** %*di, rekue%(i %**( i* 1 =*$

Stabilisasi lanjutan bila telah:

- Reidr*(i F6# ) ! =*$

- Di*re 6; re(o$*+ (o

- Di*re @; re(o$*+ e* di/erik*% (ei* di*re

A%*k 5 ! *u% : #06100 >>)di*re

A%*k ! *u% : 1006!00 >>) di*re

Di*re ) $u%* /erkur*%- d** $e%-*/i(k*% (e/*-i*% /e(*r F6#

F6#)" =*$ (i(*%2* +e<* NGT;

Bi(* $e%-*/i(k*% (e/*-i*% /e(*r F6#

F6#)4 =*$

B.#./. 2ondisi II

8/12/2019 Sptl Gizi 2012


Stabilisasi awal : 6 Bo+u( D10 I # $+)k-BB

- NGT D10 +*r. Gu+* 10 #0 $+

2 Jam I : ReSoM*+ or*+)NGT i* "0, # $+)k-BB)k*+i, C**

%*di, %**( i* "0

10 Jam II :

Me$/*ik Me$/uruk

ReSoM*+6 F6# ) 1 =*$

C** %*di, %**( i* 1 =*$ IFD **+*k(*%* ko%di(i I;

Reidr*(i Re(o$*+ d*% F # (e+*%-6(e+i%- i* =*$

Di*re 6; re(o$*+ (o

Di*re @; re(o$*+ : 6 A%*k 5 ! *u% : #06100 >>)di*re

- A%*k ! *u% : 1006!00 >>) di*re

B.#.#. 2ondisi III

Stabilisasi awal : #0 $+ D10 **u +*r. Gu+* P*(ir 10 r*+)NGT;

2 Jam I : ReSoM*+ or*+)NGT i* "0, # $+)k-BB)k*+i

C** %*di, %**( i* "0 T*/e+ 4, Buku I H*+. 10;

10 Jam II :

Me$/*ik Me$/uruk

ReSoM*+6 F6# ) 1 =*$

C** %*di, %**( i* 1 =*$ IFD **+*k(*%* ko%di(i I;

Reidr*(i Re(o$*+ d*% F # (e+*%-6(e+i%- i* =*$

Di*re 6; re(o$*+ (o

Di*re @; re(o$*+ : 6 A%*k 5 ! *u% : #06100 >>)di*re

- A%*k ! *u% : 1006!00 >>) di*re

8/12/2019 Sptl Gizi 2012


B.#.*. 2ondisi I5

Stabilisasi awal : 6 Bo+u( D10 I # $+)k-BB

- #0 $+ D10 **u +*r. Gu+* P*(ir 10 r*+)NGT;

2 Jam I :

F6# i* "0 $e%i, =u$+* 2*%- *ru( di/erik*% i* ! =*$ NGT;

C** %*di, %**( i* "0 T*/e+ #;

Le*r-i( @; Le*r-i( 6;

F6# ) "0, =u$+*)! =*$ NGT; 10 =*$ /eriku%2*:

C** %*di, rekue%(i %**( d*% F6# 6 F6#)! =*$ or*+)NGT;

i* "0 6 N*di, %**(, ke(*d*r*% i*

Pe%2e/*/ +*i%O 1 =*$

6 ASI

Le*r-i( 6;

Stabilisasi lanjutan: F6#)! =*$

Bi+* d** $e%-*/i(k*% (e/*-i*% /e(*r F6#

F6#)" =*$ (i(*%2* +e<* NGT;

Bi(* $e%-*/i(k*% (e/*-i*% /e(*r F6#

F6#)4 =*$

B.#.. 2ondisi 5

Stabilisasi awal : 6 # $+ D10 **u +*r. Gu+* P*(ir 10 or*+

6 C** %*di, %**(, ke(*d*r*%

2 Jam I : F6#)"0, (e+*$* ! =*$ (e(u*i BB

T*/. F6# de%-*%)*%* ede$*;

C** %*di, rek. N**(, ke(*d*r*% d*% *(u*% F6#)"0

8/12/2019 Sptl Gizi 2012


10 Jam II:

6 F6#)! =*$ T*/e+ F6# de%-*%)*%* ede$*;

6 C** %*di, rek. N**(, *(u*% F6#)"0

6 ASI *%*r* F6#

Stabilisasi lanjutan: F #)! =*$

Bi+* d** $e%-*/i(k*% (e/*-i*% /e(*r F6#

F6#)" =*$ (i(*%2* +e<* NGT;

Bi(* $e%-*/i(k*% (e/*-i*% /e(*r F6# F6#)4 =*$

B.*. $ase Transisi

• P*(ik*% id*k *d* -e=*+* *d* (*diu$ (*/i+i(*(i, $u+*i e$/eri*%

$*k*%*% eror*+ de%-*% $e%i+*i ke*d**% di*re d*% $e$er*ik*%ke$*$u*% $*k*%, di-e(i, d*% */(or(i (*+ur*% >er%*.

6 F6# F6100)4 =*$, de%-*% 'o+u$e F # 2*%- er*kir T*/. F6#;

dier**%k*% ! *ri, >** %*di, rek. %**(, d*% *(u*% F6100)4 =*$

T*/e+ ;

6 H*ri ke6" F6100 T*/e+ F6100; i* 4 3*$ di%*ikk*% 10 $+ (*$*i

id*k $*$u $e%-*/i(kk*% id*k $e+e/ii =u$+* $*k(i$*+ !!0

>>)k-BB *d* */e+ F6100;

6 H*ri ke64 F6100)4 =*$ T*/e+ F6100;

Per**%k*% (*$*i *ri ke 614 **u (e(u*i de%-*% ko%di(i *%*k.

B.. $ase Rehabilitasi

• P*(ik*% id*k *d* -e=*+* *d* (*diu$ (*/i+i(*(i)r*%(i(i, ke$*$u*%

$*k*% /*ik.

BB 5 K- BB K-

6 F6100 6 F6100

6 M*k*%*% Lu%*k)Le$/ik 6 M*k. Lu%*k)Le$/ik d*% M*k. Bi*(*

6 S*ri /u* 6 Bu*

8/12/2019 Sptl Gizi 2012


8/12/2019 Sptl Gizi 2012


6adwal dan dosis emberian 5itamin !

Ge-ala 'ari 2e)1 'ari 2e)/ 'ari 2e)#

Tid*k *d* -e=*+* $** **u

id*k er%* (*ki >*$*k

d*+*$ " /u+*% er*kir

Di/eri

k*(u+

de%-*% do(i(

(e(u*i u$ur

Tid*k di/eri

k*(u+

Tid*k di/eri

k*(u+

Ad* (*+* (*u -e=*+*:

- Ber>*k ) Bio- N*%*)r*d*%-- +ku( keru- +ku( kor%e*- Per%* (*ki >*$*k d*+*$

" /u+*% er*kir

Di/erik*(u+

de%-*% do(i(

(e(u*i u$ur

Di/erik*(u+

de%-*% do(i(

(e(u*i u$ur

Di/erik*(u+

de%-*% do(i(

(e(u*i u$ur

D./. $e

Do(i( T*/+e Be(i d*% Siru Be(i u%uk A%*k $ur Bu+*% (*$*i # T*u%

Bentuk $ormula $e Dosis

T*/+e Be(i)Fo+* 0 $-

Be(i e+e$e%*+ d*% 0,!#

$- A(*$ Fo+*;

B*2i u(i* 61! /u+*% 1 Q (e*ri */+e 1#

$-;

A%*k u(i* 16# *u% 1 Q (e*ri */+e "0

$-;

&irup Besi

Sei* # $+ $e%-*%du%-

"0 $- Be(i e+e$e%*+

B*2i u(i* 61! /u+*% 1 Q (e*ri (e%dok e

1# $-;

A%*k u(i* 16# *u% 1 Q (e*ri 1 (e%dok e"0 $-;

C***%:

- Perik(* k*d*r H/ u%uk $e$*(ik*% **k* *d* *%e$i* /er*.- Fe di/erik*% (ee+* $e$*(uki *(e (*/i+i(*(i **u *ri ke614.- Fe di/erik*% (ei* *ri (e+*$* 4 $i%--u **u +e/i (*$*i k*d*r H/ %or$*+

(e+*$* ! /u+*% /eruru6uru.- Do(i( Fe: 16" $- Fe e+e$e%*+)k-BB)*ri.- Bi+* *d* +*kuk*% e$erik(**% H/ u+*%- i* 1 /u+*%.

D.#. !sam $olat

# $-)*ri *d* *ri er*$*, (e+*%=u%2* 1 $-)*ri

D.*. Elekmin dan Re&o+al +i* +*$ir*%;

8/12/2019 Sptl Gizi 2012


E. Trans8usi

6ika 'asil emeriksaan 'b atau 't Tatalaksanan3a

6 H/ 5 4,0 -)d+ Berik*% r*%(u(i d*r* (e-*r (e/*%2*k

10 $+)k-BB d*+*$ <*ku " =*$. Bi+* *d*

*%d* -*-*+ =*%u%- -u%*k*% Packet Red

Cell u%uk r*%(u(i d*+*$ =u$+* 2*%-

(*$*

A*u

6 H/ 4,06,0 -)d+ di(er*i di(re(

er%**(*% **u *%d* -*-*+

=*%u%-

Berik*% Furo(e$id 1 $-)k-BB (e>*r* I

*d* (** r*%(u(i di$u+*i.

He%ik*% (e$u* e$/eri*% >*ir*% +e<*

or*+)NGT (e+*$* *%*k dir*%(u(i.

Ko$+ik*(i d*%

Pro-%o(i(

• 3*%-k* e%dek :

G*%-u*% u%-(i 'i*+ 2*%- d** $e%-*%>*$ keidu*%

k*re%* io-+ike$i*, ioer$i*, deidr*(i d*% -*%--u*%

ke(ei$/*%-*% e+ekro+i6*(*$ /*(* (er* i%ek(i /er*

(eike$i*;, *$/**% e%2e$/u*% e%2*ki e%2er*.

• 3*%-k* *%=*%- : stunting , /erkur*%-%2* oe%(i u$/u

ke$/*%-

M*+%uri(i 2*%- dir*<*: ke$*i*% !06"0, *k*% $e%i%-k*

/i+* k*d*r *+/u$i% 5 1,# -, -+uko(* d*r* 5 " $$o+)L **u

5 #0 $-)d+, (uu rek*+ 5 "#,#oC d*% *d*%2* i%ek(i /er*.

Ge=*+* (i(*: e%>**i*% u$/u ke$/*%- er*$/*

er$*(uk e%uru%*% i%e+e-e%(i, eru*$* =ik* $*+%uri(i er=*di

*d* u(i* kur*%- ! *u%.

D**r keu(*k**% 7H, Se'ere M*+%uriio%. D*+*$ :Po>ke Book o Ho(i*+ >*re or>i+dre%, !00: 1"617H, Guide+i%e( or e i%*ie% re*$e% o (e'ere+2

$*+%ouri(ed >i+dre%, !00"De*re$e% Ke(e**% RI, Peu%=uk Tek%i( T**+*k(*%* A%*k GiziBuruk, !00

8/12/2019 Sptl Gizi 2012


L*i%6+*i% A+-*ri$*,Prooko+, Pro(edur,

S*%di%- rder; Lampiran

$ormula &usu untuk 2E

Bahan $ $ 1"" $ 1#

Su(u Ski$ -; !# "0 0Gu+* -; 100 #0 #

Mi%2*k -; "0 0 #

E+ek$i% $+; !0 !0 !

Air 1000 1000 1000

Larutan Re&o+al

r*+i 7H 1 L 1

Gu+* -; #0

E+ek$i% $+; 40

Air $+; !000

Larutan Elekmin

KC+ -; !!4

Trio*(iu$ Cir* -; 1

M*-%e(iu$ C+orid* -;

i%> A>e*e -; ,!

Coer Su+*e -; 1,4

Sodiu$ (e+e%*e 0,0!

Air $+; !#00

sptl gizi 2012

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