otsuka-asering, kaen, proten, aminofluid sympo mks 7 april 2013

8/18/2019 Otsuka-Asering, Kaen, Proten, Aminofluid Sympo Mks 7 April 2013

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dr. Budhi SantosoMedical Consultan of PT Otsuka Indonesia

Emergency Medicine Lunch SymposiumMakassar, 7th April 2013


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SO!T C"!IC"L"M #IT$E

%.&ame ' Budhi Santoso(.Place)date of *irth ' +akarta, %- Mei %/-0.$ddress ' Mampang Indah II, Blok 1(, 1epok Sa2angan3.Marial status ' Married 2ith 3 children4.$lumny ' Medical 5aculty of Bra2i6aya "ni7, Malang,%0

/.8orking E9perienced ' /.%. Cipete Clinic, +akarta :%0;%3<

/.(. Puskesmas Moro Seneng;=epri, !iau :%3;%-</.0. Schering $> :Med $d7isor' %?;(@@@</.3. Otsuka Indonesia :Med;Consultant' (@@%;(@@-<

-.Training E9perienced ' -.%.>CP ad7ance course, Schering $>;Berlin, %? -.(.Communication on 5amily Planning, S2eden %

-.0.$"CO>S Congress, Philadelphia;"S$, (@@@

-.3.Schering internal leadership course, 1usit, Thailand,-.4.Critical Care $nnual and Pensa Meeting' Bali (@@(-./.$TLS ad7anced, !SCM (@@0-.-. Indonesian >CP, !SCM (@@3-.?.Critically ill in children' Malang, (@@4.-..Critical care 2orkshop, Sura*aya, (@@/, (@@--.%@.$minouid 8orkshop,Tokushima, +apan, (@@?, (@%@

-.%%.Espen Congress, Barcelona Spain, Sept (@%( -.%(.Safety, Ecacy and P# 6oint seminar, +apan;Indonesian 51$,(@%0


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Yang pentingkasih obat,

infus no.12 ?

Cairan Infus

@#$%^&,Wes, e!es,..e!es,bab"as angine......


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Ente harus makanobat seumur hidup !!!

Waduh, lamaamat, dok !!

Enggak, lama,Tergantung berapalama Ente hidup !!!


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Infus Rasional bilapaham 4 hal:

1. Indikasinya2. Fisiologi infus saat masuk tubuh3. Patofisiologinya yang sering

(Resusitasi vs Rumatan)4. Pemilihan infus yang teat

Lobo, et all 2010


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!"(#l! 1$$.$ m%&')

!31R*

!!"2+,-$

!!!2+3R

"!!2+3R

!+!3, /*

LactateRisk ofHyperchloremicacidosis

Intracell

distribution

OsmFluid

CAIRAN RE!I"AI #AN$ %LA&I'( )I*AAI

(#l! 1$4 m%&')

0tsuka /#% internal surveys data 21

5acts'5acts'


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,

Pasien ria 2 th masuk R* dg keluhan utama demamsudah $ hari tidak turun letih insomnia dan dysesia

PF 5 somnolen u6at 7P 1$', 8R 94 RR 12:

bibir e6ah!e6ah lidah kering ; agak kotor faring tidak hieremis. 77 + kg


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iu"asi kasusdemam tifoid, dimana tidak ada asupan oral sama sekali karena pasien dispepsia dan anoreksia

*RO)! AA -./ N*C -./ "otalkalori-kcal/

Na+ -mE0/ + -mEa/

1 *%RI/> ! ! 13 4

1 ?I/0F5I- 3 +$ 42 3$ 2

2 *a6het PR0


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siu"asi kasus demam tifoid, dimana tidak ada asupan oral

sama sekali karena pasien dispepsia dan anoreksia

*RO)! AA -./ N*C -./ "otalkalori-kcal/

Na+ -mE0/ + -mEa/

1 %/ ?>3 ! 1 4 $ 2

1 ?I/0F5I- 3 +$ 42 3$ 2

2 *a6het PR0


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!ES"SIT$SI!ES"SIT$SI !"M$T$&!"M$T$&

1ESI>& TE!$PI C$I!$& I#

Infus Natrium > 100 mEq/L atau koloid 2030 ml/k!/"am #diar$, %&&' 23 L/101( m$nit #p$rdarahan'

Natrium r$ndah #(0100 mEq' )alium s$suai k$*+ arian -am*ahan mikromin$ral, tr El$m$nt dan as+ amino 21 #misal 2( k! 102101 ( (ml/"am

(00 ml/ "am


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Resuscitation Maintenance

Historical Perspective of Infusion Preparation


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4tsuka.ould

o5$r to 6ou


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Hypovolemic shock

StableHemodynamic


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Ringer’s acetate

®

®

Acetate Ringer’s

irst Line

luid Resuscitation Therapy

ASERING


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A First line in replacement fluid forresuscitation: gastroenteritis, burn,

hemorrhagic shock, D ith orhithout hepatic insufficiencyA "ntra operativeA #riming solution for cardiopulmonary

bypass $%#&'A afe replacement fluid for children

Indi6ationBs of AERIN$1


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ASERING®Ringer’s acetate

First Line

Fluid Resuscitation Therapy

( Direkomendasikan oleh W)H)*) untuk

pasien Demam &erdarah Dengue

$D&D')

W.H.O. SEA Dept. of Communicable Disease. Regional Guidelineson Dengue / DHF Pe!ention and Contoll. Regional Publ. "#. $###.

( #ada stroke akut, pemberian +E"-.

sesuai dengan konsep menghindari /+0T+T)

( #encampuran +E"-. dengan 1234g*5 sebanyak 62 cc, akan meningkatkan

tonisitas infus men7adi "*T*-"0)Hadi Panata. Clinical E%peience of Ringe&s acetate 'it( )agnesium sulp(ate adminstation in

Acute *sc(emic Sto+e. Poceeding of P*, PERDOSS*. "--$.

Dama'an *. Paenteal Fluid ,(eap in Sto+e Patients. Poceeding of P*, PERDOSS*. "--$.


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! Loren A et al. Oxidation of lactate and acetate in rat skeletal muscle. Journal of AppliedPhysiology 199 ! "# $ 1 % & p. #' ( #9!

"! )eim*erger +,-.Roland R/. )and*ook of ,linical 0utrition.os*y 199 #. Anderud - Lund . 2ntensi3e ,are of Patients 4ith 5urns. idskr 0or Laegenforen 19"9!

p.#19 ( #199.6. Ringer acetate solution in clinical practice. edimedia.1999

! #omposisi mirip dengan plasma$ tepat untu% mengganti%an

%ehilangan a%ut cairan e%straseluler!$ 1 '

"! #ecepatan metabolisme asetat "&'(4'' m)*+,am $ sedang%anla%tat ''m)*+,am$ asetat lebih cepat meng%ore%si asidosis!

$ 8'

-! .setat memerlu%an sedi%it /" dan melepas%an sedi%it 0/")$ 5 '

4! Metabolisme asetat terutama di otot$ tida% terganggu pada %elainan hati$6'

Aserin. 1 2enefit3


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A Rin.er4s lactate 5678

A AERIN$1 7

A Normal saline 5698

A:era.e pH

General Beneft


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nesthesiology 2 /ov:93($)11+!3iskaser F@ 7ellomo R 8ayhoe ? *tory - Poustie * *mith 7 etis 7ennett ?

Role of um rime in the etiology and athogenesis of6ardioulmonary

byass!asso6iated a6idosis.

Plasmalyte 14, vs Polygeline" Ringer in 22 atients

Cith the 8aema66el!RingerDs rime the metaboli6 a6idosis Eashyer6hloremi6 (∇ #l! "9.$ m%&'l: #I +.!11.$).Cith Plasmalyte the a6idosis Eas indu6ed by an in6rease in unmeasuredanions most robably a6etate and glu6onate.


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In 6on6lusion

atients Eith severe sesis Eho re6eived fluid resus6itation Eith 8%* 13'.42 as6omared Eith those Eho re6eived RingerDs a6etate had a higher risk of death at 9days Eere more likely to re6eive renal!rela6ement theray and had feEer daysalive Eithout renal!rela6ement theray and feEer days alive out of the hosital.

ydro9yethyl Starch %0@)@.3( 7ersus !ingerDs $cetate in Se7ereSepsis

nders Perner ?.-. Ph.-. /i6olai 8aase ?.-. nne 7. >uttormsen ?.-. Ph.-. @yrki udmundurlemenHson ?.-. nders neman ?.-. Ph.-. ristian R. ?adsen ?.-. ?orten 8. ?Jller ?.-. Ph.-. @eanie ?. %lkKLr ?.-.one ?. Poulsen ?.-. sger 7endtsen ?.-. ?.P.8. Robert Cinding ?.-. ?orten *teensen ?.-. PaEel 7ereHoEi6H ?.-. Ph.-.Peter *Je!@ensen ?.-. ?orten 7estle ?.-. Ph.-. ristian *trand ?.-. Ph.-. @Jrgen Ciis ?.-. @onathan 0. Chite ?.-. laus @.


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)2) III = I>02 2!4 'menit

R'R 2 ml'kg bolus dalam 3 menit

yok teratasiyok teratasi yok tidak teratasiyok tidak teratasi

R'R 1 ml'kg'Kam

tabil dalam 9? @amtabil dalam 9? @am

R $ ml'kg'Kam 3 ml'kg'Kam*to N 4, Kam

-etran 4 1!2 ml'kg"eratasi"eratasi

"idak "eratasi"idak "eratasi

8t turun 8t teta'naik

FFP 1 ml'kg -etran 2 ml'kg

ri e'eki, (in)ra Ira!an atari. *ea +er)arah *engue. -I.1///


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Diagram 9. Alur tatalaksana Pemberian cairan Derajat IVProf. Soegeng, Tatalaksana DBD terkini, RSUD Dr Soetomo/FKUnair, 2006

Aserin.


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*%RI/> ; %/ 37

komatibel dengan obat dibaEah ini

A /i6holinA


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JAN’ 2012


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!ES"SIT$SI!ES"SIT$SI !"M$T$&!"M$T$&

&"T!ISI&"T!ISI)ristaloid)ristaloid

M$n!!anti k$hilan!an akut #h$morrha!$,

9I loss, ron!!a k$3'

M$n!!anti k$hilan!an akut #h$morrha!$,

9I loss, ron!!a k$3'

1+ M$n"a!a hom$ostasis hari2+ -$rapi suportif

M$m$p$r.$pat p$n6$m*uha

1+ M$n"a!a hom$ostasis hari2+ -$rapi suportif

M$m$p$r.$pat p$n6$m*uha

TE!$PI C$I!$&

=oloidElektrolitElektrolit

*eri !%/*eri !%/

minofluidminofluid


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are still widely usedfor maintenance therapy *****

RL

!" #e$trose

!" #e$tr% in Rin&ers

8hat are the impacts 8hat are the impacts

5acts'5acts'


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i0a tanpa ekseru a

atau - n0a,kan ?

+isa bisan0a 3tsukaa4a, tuh......sa0a pakai 5 26tts7iaintenane ti)akhipernatrei, ti)akhipoka"ei ??


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#ebutuhan .ir "''' m1 R1 " 1 #.()2 -3 ® " 1

2atrium &' '' m)* "5' m)* '' m)*

#alium 4& 5& m)* 6 m)* 4' m)*

Infus RL 'u(an)ntu( Terapi Rumatan

Ilustrasi 77 -eEasa (0rg Indonesia) O $ kg


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+nak && 9 12 kg

#ebutuhan .ir !& 1 R1 !& 1 #.()2 -3 ® $ !& 1

2atrium 5' '' m)* 7& m)* 8& m)*

#alium "' ( &' m)* 5 m)* -' m)*

Infus RL 'u(an)ntu( Terapi Rumatan

ef) :6) ice H) Fluid Therapy for the #ediatricurgical #atient) Emedicine) 1228 uly))emedicine)com;ped;topic1


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:r$;al$n.$s of6pokal$mia

Chief In:esti.ator Centre No ofpatients

B hypokalemiaon admission

B hypokalemiaon )ischar.e

!ntun. udomo R*A) DD 9 ?8

)@oko idodo RC' D8 996G 896?

Nasronudin R utomo D 565 8D6G

1. *udomo 5ntung. ?arissa Ira. >astroenterogy heatoloy and digestive endos6oy vol.$. %d -e6 24. Page 11$!122. Cidodo - *etiaEan 7 hie #hen.


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Ho< does maintenancefluid therapy e:ol:e,


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-a? @@

-a? =2 0? 12, glu 1@ g

-a? 8= 0? 12


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Pasien RaEat!Ina (di @eang)

-ehydratedPreviously Eell!nourished>ood aetite

-ehydratedPreviously Eell!nourished0r slightly undernourished?etaboli6ally /on!stressed

noreiaFatigue

Previously malnourished0r undernourished or ?etaboli6ally stressed8yoalbuminemia

-ebilitatedIf %/ entirely imossible

Fluid ; basi6ele6trolytemaintenan6e

#omlete%le6trolyte 3 $!1 glu6osemaintenan6e

Parenteral /utrition 1 8igh /P#(glu6ose liid)

AEN2 A'INOFL!I) NEO*AREN'II)


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&y 122AB122@ 8A

lucose

768

Amino acids

B

Electrolytes

-NaJ J ClJ '.J CaJ */

&inc

Aminofluid

A*IN+ L)I#

® ®


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%. 7lomstrand Role for 7ran6hed!#hain mino 6ids in Redu6ing #entral Fatigue @. /utr.

February 1 2=: 13=(2) $44* ! $4+*

"ryptophan

-erotonin/

222

Appetite

Fati.ue

2CAA

-erotonin/

?@F

$OL)EN .;S


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Infe%si+9rauma

Cytokines-"NFJILKJILK5/

InflammationJ fe:erJhyper:entilation

)ehydrationJ

dry ton.ue= mouth

serotonin 'elanocortin

)elayed .astric emptyin.

LO OFA**E"I"E

$OL)EN .;Shy Aminofluid1 is particularly helpful in infectionJtrauma or for post operati:e pts


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7est Re6ommended inFolloEing #onditions

A Febrile illnessesA -ehydrated and anorei6 dyseti6 atientsA >astrointestinal diseases ost resus6itation of

severe diarrhea 6olonos6oy gastroaresis

A 6ute Infe6tious diseasesA %arly ost oerative maintenan6e (straightforEard

surgery)A 8yeremesis gravidarum (after .9 /a#l)

A *troke (after metaboli6 and ele6trolyte 6orre6tion)

*recautions3ARenal Failure associated


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minofluid

Infeksi akut'-emam

Penyakit>astrointestinal

Postoeratif

8ieremesisgravidarum

/eurologi

*esis

-iabetes?ellitus

-7-


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P0- 2

+

/P# = k6al = g

/a" + m%& " 4 m%&


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P0- 3(stress metaboli6 sedang'berat)

+

/P# 3 k6al , g

/a" 3$ m%& " 2 m%&


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Hypovolemic shock

StableHemodynamic


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JAN’ 2012


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6) +gar rasional memberikan infus pahami 5 hal: "ndikasi,Fisiologi, #atofisiologi dehidrasi dan hipovolemi, ediaan infusyang ada dipasaran)

1) +sering $+' pilihan utama infus resusitasi dan memilikikelebihan dibanding / atau -, seperti: maintain suhu utama

perioperatif, D0+, %#&, mencegah asidosis laktat padaneonatus saat %

8) 0aen series di desain memenuhi kebutuhan maintenancedasar, misal: 0+E- 8& $-a? =2 mEC, 0?: 12mEC and glucose1@ gr'

5) +minofluid didesain sebagai infus maintenace terkini yang

sekaligus bisa mengatasi dehidrasi, mencegah anoreia danmengatasi fatigue sehingga mempercepat penyembuhanpasien raat inap

-ak$ om$ M$ssa!$


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Mencegah infus tidak adekuat, tidak

rasional


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a;$ a ni.$da6??

otsuka-asering, kaen, proten, aminofluid sympo mks 7 april 2013

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