tatalaksana dbd dewasa

8/17/2019 Tatalaksana DBD Dewasa

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Dengue Case Management

Leonard Nainggolan

Div. Tropical and Infectious DiseaseDept. Internal Medicine

Faculty of Medicine Universitas Indonesia


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Pathogenesis and Patophysiology

Virulence and viral load

Immune complex disease

T-cell-mediatedADE

Complement

Autoimmune disease

Apoptosis

Innate immunityCytokine Tsunami

Genetic


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Lei HY et al. Immunopathogenesis of Dengue infection. J Biomed 2001


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CAPILLARY

ENDOTHELIUM


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Hydrostatic pressure > Oncotic pressHydrostatic pressure


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8/30Nature Reviews Nephrology 6, 361-370 (June 2010)


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The oveent o! aterial is generally a""oplishe# via routes situate# either across (i.e.,transcellular) or in between (i.e., paracellular) the "ells !oring the $arrier% &hile thepara"ellular transport o""urs via the inter"ellular 'un"tions, there are at least three transcellularroutes #es"ri$e# so !ar(a) water an# sall ole"ules are ove# via membrane transporters that have a #ierent

#istri$ution*orientation on opposite !ronts o! a $arrier "ell+(b) transcytosis, #ene# as the transport o! a"roole"ular "argo !ro one !ront o! a polarie#

"ell to the other within e$rane-$oun#e# "arrier(s), an#(c) pores or channels whi"h are patent openings through the $arrier "ells with or without


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Lei HY et al. Immunopathogenesis of Dengue infection. J Biomed 2001


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Hematokrit


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lasi!ikasi Dengue "#$%& '(()*


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Pemeriksaan Penun+ang

!eeling, ". #. et al.

%&aluation o' diagnostic tests dengue.Nature Reviews Microbiology , *+-*+ (/0)

N*0• .rotein non-stru/tural,

pa#a #engue• ensitivitas #ete/si N1

(pa#a in!e/si prier) 0

• ensitivitas enuruanpa#a in!e/si se/un#er

(60-40)


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1engue 2ase 3anagement


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Dengue guidelines for diagnosis, treatment, prevention, and control.World Health Organization, UNICE, UND!. Ne" Edition #$$%.


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,ani!estasi linis"Clinical Guidance of Dengue Virus Infection. CDC '(()*


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"esuscitation"esuscitation 3anagement3anagement

NutritionNutrition2rystalloid2rystalloid

Repla"e a"ute loss(heorrhage, 5 loss, Thir#

"opartent)

Repla"e a"ute loss(heorrhage, 5 loss, Thir#

"opartent)

1% Noral reuireents (&8 9 urine9 !ae"es)2% Nutritional upport

1% Noral reuireents (&8 9 urine9 !ae"es)2% Nutritional upport

4luid "eplacement4luid "eplacement

2olloid%lectrolyte%lectrolyte

Repair


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22

Tatalaksana Tersangka DBD

:ea tinggi, en#a#a/ ;7 hari8esu, ti#a/ a#a .<

5da kedaruratanyo/=e'ang=esa#aran enurun

per#arahan

6idak ada kedaruratan

78i 6orni9uet

positi' negati'

6rombosit


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>


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=eluhan :D:(=riteria &E@ 17)

E$, Et ening/attro$o noral*turun

E$, Et noraltro$o ; 100%000

E$, Et noraltro$o 100%000-1F0%000

E$, Ettro$o noral

@$servasiRawat 'alan

.eri/sa E$, Et8eu/o, Tro$*2G 'a

@$servasiRawat 'alan

.eri/sa E$, Et8eu/o, Tro$*2G 'a

Rawat Rawat

.enanganan .roto/olRawat 6nap Cntu/ :D:

( .roto/ol 2 )

!"O6O2OL 1Management of Probable Dengue Infection

Without Shock


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uspe"t :EBpontaneous an# >assive Dlee#ing( - )

ho"/ (-)

- E$, Et (n)- .latelets; 100%000- Arystalloi# in!usion H- E$, Et, .lt every 2G hours

- E$, Et in"rease 10-20- .latelets; 100%000- Arystalloi# n!usion H- E$, Et, .lt every 12 hours HH

- E$, Et in"rease 20- .latelets; 100%000

.roto"ol I Blui# Repla"eent:EB with in"rease# Et 20

* Daily rystall!i" #!lume re$uire"% According to formula &'(( ) ( + ,-!"y .eig/t in kg 0 (1

!"ample of calculation for #od$ %eight of && 'g 1&00 ( 20 " )&&*20+ , 2200 ml

)-an American Health rgani/ation

Dengue and Dengue Hemorrhagic eer uidelines for -reention and 3ontrol.

-AH 4ashington5 D.3.5 1667 89+.

:: ;onitoring is ad


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.R@T@A@8 3 Management of D#F $ith Increa"e of#aematocrite %2&'

P t k l 4


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Protokol 4Penatalaksanaan Perdarahan Spontan

pada DBD Dewasa

5*7* 1=1

.er#arahan pontan #an >asi! - ?pista/sis ti#a/ ter/en#ali - 5ross heaturia

- Eeateesis #an atau elena - Eeatos/eia

- .er#arahan ota/

yo/ (-)

E$, Et, Tro$o, 8eu/o, .eeri/saan Eeostasis (=:)

5olongan #arah, u'i "o"o/ serasi

=: (-) Trans!usi /oponen #arah

H .RA (E$;10 g )

H BB.

H TA (Tro$%;100%000)

H .eantauan E$, Et, Tro$% Tiap G-6 'a

H Clang peeri/saan heostasis 2G 'a

/eu#ian

=: (9)

Trans!usi /oponen #arah

H .RA (E$;10 g*#8)

H BB.

H TA (Tro$%;100%000)

HH Eeparinisasi F000-10000*2G 'a #rip

H .eantauan E$, Et, Tro$% Tiap G-6 'a

H Clang peeri/saan heostasis 2G 'a/eu#ianAe/


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Management of Dengue Shock

S(ndrome5irway

=reathing @2 1-2 8*in with nasal "annuls, higher use a siple as/

2irculation "rystalloi# * colloid 10-20 8*/g D& loa#ing (! possi$le lessthan 10 in) % ?valuate D., .., pulse #iuresis a!ter 1F I 30 inutesResponse

HNot Response Not Response, sho"/ still

happen

Response

Arystalloi# 7 8*/g D& in 1 h

Arystalloi# F 8*/g D& in 1 h

Aonsi#er !or nutrition a!ter12 h (:K F ! no"ontrain#i"ation)

&ithin 2G-G4 h a!ter sho"/"ontrolle#, vital signs*Et sta$le,

urine output in"reasing

Arystalloi# 20-30 8*/g D& loa#ing !or 20-30 in

Not Response

Et in"rease Et #e"rease

2olloid 0/ mL:kg =# loading 'or 00? min

Dloo# trans!usion 108*/g D& "an $e repeate#

i! ne"essary

Not ResponseResponseH

2olloid until ma@ + mL:kg=#

Not ResponseResponseH

AL.top in!usion

Response

Arystalloi# 3 8*/g D& in 1 h

Response


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2A!

Aolloi#, i! aK #ose #oes not rea"he# yet or "rystalloi#*gelatin (i! "olloi# have rea"he# aK#ose) 10 8*/gD& in 10 in, "an $e repeate#until 30 8*/gD& + AL. target 1F-14 "E2@

Eypovolei" Norovolei"

>onitoring"rystalloi#!or 10-1F

in

Not Response


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Indikasi IC0

yo/ yang ti#a/ responsi! setelah 1 'a

yo/ $erulang

yo/ #engan per#arahan asi!

yo/ #engan /opli/asi lainnya, is%respiratory #istress, ense!alopati, gagal

'antung, gagal gin'al, /e'ang%

Departemen >esehatan ?I5 IDAI5 -A-DI5 -D@ -A>LI5 -!?DI3I C --I.200&. -edoman

atala'sana >linis Infe'si Dengue di @arana -ela$anan >esehatan. 200&. Ja'arta Dep'es.


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Human Bunction

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