Pocket Book Koas PPDS Anak Pediatri

0

Pocket Book of PEDIATRICS

Nadiya Elfira Bilqis Koas IKA Periode 14 November 2016 – 8 Janari 201!

0

1

"af#ar Isi

1$ Pedia#ri %a&a# "arra# ''$$ '''''''''''$ 2$ Perina#olo(i ''''''''' '''''''''''$ )$ *en#ilasi +e,ani, ''''''$$'''''''''''$ 4$ Aler(i Immnolo(i '''''''$'$''''''''$ -$ .ema#olo(i /n,olo(i '''''$''''''''''$ 6$ Infe,si dan Penya,i# rois '''''''''''$ !$ Kardiolo(i''''''''''''''''''''$'''$ 8$ esirolo(i'''''''''''''''''$'''''$ 3$ %as#roen#erolo(i '''''$''''''''''''$ 10$ .ea#olo(i''''''''''''''''''''''$ 11$ Nefrolo(i '''''''''''''''''''$'''$ 12$ Neroedia#ri ''''''''$$ '''''''''''$ 1)$ N#risi dan +e#aboli, '''$$'''''''''''$ 14$ mb Kemban(

''''''''''''''''$

1-$ 5ar# ''''''''''''''''''''''''$$$

1

2

.a, Ana, 7NI5E 13839 : ∗ .a, id ∗ .a, #mb ,emban( ∗ .a, erlindn(an ∗ .a, ar#isiasi Prinsi medi;al e#i;s : ∗ do no arm non
∗ Asa fisi,>biomedis9

∗ Asi emosi>,asi sayan(9 ∗ As s#imlasi men#al9 Keb#an dasar mansia +ary " ?eridan9 : 1$ ?el#er @ ro#e;#ive ;are 2$ ood )$ arm# @ ;lo#in( 4$ res air @ snli(# -$ A;#ivi#y @ res# 6$ Preven#ion of illness @ in=ry !$ rainin( in abi#s @ s,ills #o main#enan;e of life .EP : .is#ory – ECamina#ion – o(i;al ded;#ion – Plan of a;#ion D Infe,si a,# : nemonia diare ;ama, menin(i#is dsb D +asala ,ronis : maln#risi (a(al #mb B5 D BB d( ,elainan ;on(eni#al D %(n #mb ,emban( D %(n erila, ) #, en;e(aan le#;er9 : 1$Pen;e(aan rimer – aya sebelm #imbl enya,i# d( men(ran(i fa,#or resi,o romo#if reven#if9

2

3 2$Pen;e(aan se,nder – men;e(a enya,i# m=d sim#oma#i, d( de#e,si dini @ en(oba#an ,ra#if9 )$Pen;e(aan #ersier – men;e(a ,omli,asi reabili#a#if9 Per#mban =anin in#ra#erin 7?IA JANIN BB PB K 8m( 1( 2-;m 12m( 1-( !-;m 16m( 100( 1!;m 20m( -00( 28m( 1000( )-;m )2m( 1-00( )4m( 2000( )6m( 2-00( 4!;m ));m )8m( )000( 40m( )2-0( -0;m )4;m Kenai,an BB bayi selama #an er#ama ri&lanIII ri&lan ri&lan III ri&lan I*

"

23;m )2;m

!00<1000 (>bl -00<600 (>bl )-0<4-0 (>bl 2-0<)-0 (>bl

a= er#mban 10r BB -bl 2CBB 1# )CBB 2# 4FBB

1# 4# 6# 1)# d&s

7,ran lin(,ar ,eala K )4;m K 6bl 44;m 0<)bl 1# 4!;m )<6bl 2# 43;m 6<12bl )# -0 ;m "&s -- ;m

1-CB 2CB 1-CB1# )F#bl 2CB1#

)-±1- ;m G2;m>bln G1;m>bln G0-;m>bln

3

4

Besar ,eala saa# lair H  PB d&s H 1>8 B 7,ran lin(,ar len(an a#as Ersi (i(i ana, -<3 bl 1 b blan %i(i sln( #an %i(i #e#a 1 # 6<8 b 6<10 in;i;i;s A 6
) 4 6 6 ) 4 14 16

-

-

6 ! 8 3 10 11 12 ! !8 83 3- 10 - 6 ! 8 3 10 11 12 18 20 22 223 )2 -)6

10

-

)3

-

B ana, ♀ H B aya G B ib G 1)L>2 ± 8$- ;m B ana, ♂ H B aya G B ib – 1)L>2 ± 8$- ;m *i#al ?i(n AP?9 M1#

. 110<160

BP !0<30

 )0<40

2<-# 3-<140 80<100 2-<)0 -<12# 80<120 30<110 20<212# 60<100 100<120 1-<20 BP H 80G2n9 * H -,( ?* 1- ml>,( EB* H 80 ml>,( Per,iraan BB ana, AP?9 : BB H 2nG49 ,( *i#al ?i(n AAP
4

5 0<)bln 8-<20140 80<160 )bln<2# 100<130 1)0 !-<160 2<10# 60<140 80 60<30 10# 60<100 !-0<30 " 1<10 #9 H !0 s>d 30 G 2n mm.( # aC )6)<)!2°5 # r; )6-<)!8 °5 ?bayi ,omli,asi: Normal : )66<)!4 °5 <io(li,emia .io#ermi rin(an : )6<)6)6- °5 < asidosis me#aboli, .io#ermi sedan( : )2<)6 °5 < (an((an .io#ermi bera# : M )2 °5 embe,an dara < io,sia < Plm aemorr(

Prema#r 0<)bln )<6bln 6<12 bln 1<)# )<6# 6<12# 12#

. 120<1!0 100<1-0 30<120 80<120 !0<110 6-<110 60<3--<8-

BP -->)-46->4-<8->-!0>-0<30>680>--<100>630>--<10->!0 3->60<110>!100>60<120>!110>6-<1)->8-

 40
a,ine : 0<2 bln  60>m# a,i,ardi : 2<12 bln  160>m# 2<12 bln -0>m# 1<2 #  120>m# 1<-# 40>m# 2#120>m#  - #  )0>m# Pedoman nasional asma ana,9

5

6

PEDIATRI GAWAT DARURAT

Komosisi ;airan #b : ∗ 5airan E,s#raseller 20<2-O BB9 o 5airan In#ers#i#iel 1-O BB9 o 5airan in#ravas,ler -O BB9 - ?el dara 40O ± 80 ml>,(9 - Plasma 60O ± 4- ml>,(9 ∗ 5airan In#raseller )0<40O Bb9 ∗ 5airan ranseller 1<)O BB9 ∗ Jarin(an i,a# @ #lan( !<3O9 5 Neona#s !-<80O BB Ana, 60
EB* Prema#r

3- ml>,(

Neona#s 8- ml>,( Bayi 80<8- ml>,( Ana, 6-,( "&s l,9 !0 ml>,( "&s r9 6- ml>,(

Keb#an ;airan n#, ana, sesai BB ≤ 2- ,( 100 ml>,(>24 = 26<)0 ,( !- ml>,(>24 = )1<40 ,( 60 ml>,(>24 = 41<-0 ,( -0 ml>,(>24 = Keb#an ;airan n#, ana, sesai mr 0<)bln 1-0<1!ml>,(>r 1<)# 4<6bln

120<1-0 ml>,(>r 4<6# 30<120 ml>,(>r !<12 # 60<30 ml>,(>r 12 # )0<60 ml>,(>r

140<1-0ml>,(>r

!<3 bln 12-<1-0 ml>,(>r 10<12 bln 110<12- ml>,(>r

6

7 Keb#an ;airan n#, ana, sesai mr AP?9 1<12 bln 100<120 ml>,(>r 1<2 # 30<120 ml>,(>r 2<1- # -0<30 ml>,(>r  1- # 20<)- ml>,(>r Keb#an ;airan n#, ana, sesai mr Nelson9 )r 80<100ml>,(>r 10r 12-<1-0ml>,(>r ) bln 140<160ml>,(>r 6 bln 1)0<1--ml>,(>r 3 bln 12-<14-ml>,(>r 1# 120<1)-ml>,(>r 2# 11-<12-ml>,(>r 4# 100<110ml>,(>r 6# 30<100ml>,(>r 10# !0<8-ml>,(>r 14# -0<60ml>,(>r 18# 40<-0ml>,(>r Peri#n(an ;airan rma#an iv .alliday @ ?e(ar9 100 ml>,( ≤ 10 ,( 10<20 ,( 1000 G -0 ml>,( dia#as 10 ,( 20,( dia#as 20 ,( "asar enen#an defi;i# ;airan : 5 ↓ BB M -O in(an M 2 d# -<10O ?edan( 2<) d# 10<1-O Bera#  ) d#  1-O a#al

M -0 ml>,( -0<100 ml>,(  100 ml>,(

Keb#an ;airan d deidrasi sedan( -<8O9 BB,(9 M! !<11 12<18 18 r,e1 220 161)2 88

7

8 r,e2 161)2 88 88 r,e) 1)2 88 88 88 Kore,si d obesi#as : BB real2 %an((an ,eseimban(an ;airan Kasa ?aline eC;ess air @ Na 〉〉

"e;om %%A overload

?aline defi;i# air @ Na 〈〈 a#er eC;ess air 〉〉 Na 〈〈 a#er defi;i# air 〈〈 Na 〉〉

%I roblem : %EA iles eri#oni#is dema .io Na dema o#a, IK ↑9 ebris lama ierven#ilasi

Penan(anan "iresis ± di(i#alis> ino#roi, ,> ." eidrasi  es#ri,si ;airan inf N? ± Na5l )O eidrasi "-N?

7I" E?PIA/ E?PIA/ +A"I?IB7I/ "I?E?? "EPE??I/N N Blood loss ?e#i; so;, orei(n body 5onvlsion %as#roen#eri#is 5ardia; disease 5ro aised I5P Brns AnaylaCis As#ma Poisonin( 7I" /??

↓

↓

↓

5I57A/ AI7E

↓

↓

E?PIA/ AI7E

↓ 5A"IA5 AE?

Tanda-tanda gawat (APLS) : Q Air&ay @ Brea#in( :  re#ra,si in#er;os#als sb;os#al s#ernal9 sara nafas #ambaan s#ridor &eeRin( (rn#in(9 en((naan o#o# nafas #ambaan m$

8

9 s#ernomas#oid9 ernafasan ;in( idn( flarin(9 ECas#ion>fa#iqe  re#erminal si(n S "eresi ??P I5P ↑ in#o,si,asi ensefaloa#i9 nero< ms;lar disease (a(al nafas #ana (C #a,ine  .yoCia #a,i,ardia  bradi,ardia .yoCia  ;a#  ;yanosis .yoCia>yer;anea  (elisa  ,esadaran ↓ Q 5ir;la#ion : . lse volme ;aillary refill BP ?yo,  asidosis me#aboli; ?yo,  (elisa  ,esadaran ↓ ?yo,  rine o## M1 ml>,(>= bayi M2 ml>,(>=9 "isabili#y : A*P7 il os#r  io#oni, de;or#i,asi de;erebrasi esirasi  5eyne
BAI .ead #il# Ini#ial brea# 5e, nadi e,ni, o,asi asio ?i,ls>mn#

Ne#ral

ANAK KE5I ?niffin(

ANAK BE?A ?niffin(

-

-

-

Bra;ial> femoral &o fin(er> en;ir;lin( 1 =ari di b&

5aro#id /ne and 1 =ari di a#as Cioid

5aro#id &o and 2 =ari di a#as Cioid

-:1 12

1-:2 4

nile line ):1 30:)09 20

Kondisi y( memerl,an AP? : <  60C>mn# re#ra,si ; merin#i < . M60C>mn# a#a 160C>mn# ?a/2 ↓ sianosis < Kesadaran ↓ ,e=an( demam d( e#e,ia

9

10 < rama l,a ba,ar 10O PB

Syok Klasifi,asi syo, : < ?yo, iovolemi, deidrasi erdaraan l,a ba,ar obs#r,si %I eri#oni#is ?N "B"9 < ?yo, dis#rib#if anafila,sis nero(eni, se#i,9 < ?yo, ,ardio(eni, < aind2-O 2-<40O 40O . a,i,ardia a,i,ardia  a,i>bradi,ardia "s N N>↓ # N N lema 5ea# ,e;il #b 5 2<)d#, )<-d#, -d#, Kli# "in(in +o##led "eadly ale ;a#  a,ine a,ine ?i(in(res Kesadaran %elisa e#ar(i eson #o ain

+e,anisme ,omensasi d io#ensi :  Barorese#or " M 60 mm.(9  vaso,ons#ri,si #a,i,ardia  Kemorese#or " M 60 mm.(9  io,sia asidosis  vaso,ons#ri,si r(s ernafasan o 5erebral is;iemi; re;e#or " M 40 mm.(9  massif syma#e#i; dis;ar(e  eson moral  ↑ einefrin noreinefrin vasoressin Kor#isol @ A".  vaso,ons#ri,si ↑ reabsorbsi air di (in=al  % ↓ ↑ AA  vaso,ons#ri,si re#ensi air @ (aram ole (in=al  A#o#ransfsi

10

11

+e,anisme ,omensasi menyebab,an : - *aso,ons#ri,si las  erfsi erifer M - e, nadi menyemi# " ↓ s>d ## - a,i,ardia - .io,sia =ar  is,emia  me#ab anaerob  asidosis me#aboli, - .iovolemia  aliran dara lamba#  er#,aran /2 @ 5/2 lb lama  beda P/2 @ P5/2 ar#eri @ vena  Anafiaktik C : - .ead do&n /2 mas,er 4<8 lm - >N? 10<20 ml>,( dlm 20 mn#  lan( 2C  Plasma 10 ml>,( - Adrenalin 1:1000 001 ml>,( s; maC 0) ml9  lan( #ia 10<1- mn# -- "ifenidramin ,> "oamin 2 m(>,( im>iv  0-<1 m(>,(>C im a#a -

m(>,(>C o 5+ 01 m(>,(>C #id 5ime#idine -<10 m(>,(>C qid a#a ani#idine 1 m(>,(>C #id .idro,or#ison 4<10 m(>,( iv  4<8 m(>,(>r #id "eCame#ason 0-<1 m(>,( iv  1-<6 m(>,( qid Aminofilin 4,( iv slm 20 mn#  3 m(>,(>r #id a#a β
C ;airan : 1$ ela;emen# : %I loss =am

reidr

;ea#:  defi;i# dlm <1

reidr lamba# :  defi;i# dlm 8 =am  defi;i# dlm 16 =am Bleedin(  EB M 10O : #aa EB  1-O : >N? 2<4 C EB EB  )0O : Plasma e,sander .b M 8 (>dl .;# M 2-O : ransfsi 2$ +ain#enan;e : Keb ;airan ∼ BB G 10<1-O>↑1°5 =, )!8°59

11

12 I 10 ml>,( neona#s 2- ml>,(9 )$ N#ri#ion : KI d syo, iovolemi, (a(al nafas sesis Pemilian ;airan : < ela;emen# : ?yo,  >N? %EA  >N? .?" "10 0$18 N? ".  "%%A  "- 2-O ,eb9 < +ain#enan;e : 0<2 r < BB M 1-00 (  "10 BB  1-00 (  ") r–) bln < BB M 1-00 (  "10 0$18 N? BB  1-00 (  "- 0$18 N? ) bln–) #  "- 0$22- N?  ) #  "- 0$4- N? < N#ri#ion : K. < "10 "2m, < In#raliid>Iveli 10O : 0- (>,(>r  ds# Pro# < Aminofsin aed -O : 0- (>,(>r  ds#

Jenis ;airan : < Kris#aloid   A N? "- "-A "-N? .?" KaEN )B9 "-N? KaEN 1B9 "-N? KaEN )A9 "- 0$18 N? KaEn 4B G 12- ;; "40O9 "10 0$18N? KaEn 4A G 2- ;; "40O9 5airan I   N? 5airan II  "-N? G NaBi; 1- mEq>l G K5l 10 mEq>l "- G Na5l 1-O G NaBi; G K5l 5airan III  "10N? G NaBi; ! mEq>l G K5l - mEq>l > neona#s M ) bln BB M 4 ,(   dosis9 < Koloid  "eC#ran Plasma Albmin .E? !o"ek#i $i%oa&'ineia : a H 08 C BB C ∆ Alb 1 (>,(>C9 Alb 20O  aC1009>20 H -a ;; Alb 2-O  aC1009>2- H 4a ;; Alb )O P9  aC1009>) H ))))a ;; +aC 10<20 ;;>,(>r ,e; 1 ml>m#9 Pre : rosemid 1<2 m(>,( iv

12

13

Re#'#ita#i cai"an :

P"9

?yo, iovolemi,

↓

>N? 20<)0 ml>,( bols dlm se;ea#nya 10<1- mn#9 "aa# dinai,,an samai 60 ;;>,( dalam 1 =am

↓ a#a Plasma>P5 G N? 10 ml>,( bols A#a B 20ml>,( bols d# dilan( #ia 20<)0 mn#9

↓ "

↓ ↓

↓

" N

↓

C ;airan C ;airan Einefrin "ob#amin 01<1 µ(>,(>mn# 2<20 µ(>,(>mn# a#a a#a

"oamin "oamin -<10µ(>,(>mn# 2<20 µ(>,(>mn# a#a a#a Noreinefrin Einefrin 01<2 µ(>,(>mn# 00-<0) µ(>,(>mn# Lan'tan * defi#it : .?" !0<80 ml>,( dlm 6<8 =am Keb Na H 06 C BB C ∆ Na Keb K H 04 C BB C ∆ K  =, #d, ada (C ,linis #nda s>d rod rine G beri,an slm )<4 r ,e; maC ) meq>,(>24 =am9 ma#an > main#enan;e : .?" dlm )6<48 =am ≤ 10 ,( 4 ml>,(>=am 10<20 ,( 40 G 2 ml>,(>= ≥ 10 ,( 20,(>= ≥ 20 ,(

13

14 5a# : e#esan H Σ ;airan C Σ #e#es>ml9>&a,# Inf ma,ro 1-<20 ##s>ml mi,ro 60 ##s>ml Σ #e#esan>meni#9 H I*" ml>=am9 : ) Pena#ala,sanaan ?yo, dr$?e#ya B ?eminar #erai ;airanKediri20109 ?yo, iovolemi #ana ,C: • Kris#aloid 10<20;;>,( dalam 1-<)0 meni# d# dilan( 2C ,> "Gnadi #d, ade,a#rine 0!;;>,(>=am → PI579 • Alb -O 10;;>,( • P 10<20 ;;>,( • "eC#ran 40 10<20 ;;>,(T .E? 6O 10;;>,( selama 40 meni#$ Do%ain : 2<-µ(>,(>mn#  ino#roi, vasodila#asi end or(an β2 a(onis9 -<10 µ(>,(>mn#  ↑ ,on#ra,si mio,ard ↑ 5/ β1 a(onis9 10<10 µ(>,(>mn#  vaso,ons#ri,si ↑ BP α1 a(onis9 mis : "oa ) µ(>,(>mn# C d( BB 10 ,(  )C)C10 H 30 m( sediaan 40 m(>ml  22- ;; G 4!!- ;; "- ,e; 1 ;;>= sediaan 20 m(>ml  4- ;; G 4-- ;; "- ,e; 1 ;;>= =, dosis ↑ - µ(>,(>mn#  ,e; 16 ;;>=

Do%aidr$?e#ya B Kediri 2010Garma,olo(i@#erai7I200!9 Pre,sor NE doaminer(i, adrener(i, dan meleas,an NE9 "iberi,an ada io#ensi>erfsi br, den(an irama =an#n( s#abil  "o renda 2<- U(>,(>mn#9:efe, doaminer(i, di d (in=almesen#erim ,oroner →me ↑ sir,lasi (in=alGslani,9  "o -<10 U(>,(>mn# adrenose#or V1 → ino#roi,>↑ ,on#ra,#ili#as mio,ard #ana menimbl,an erb resis#ensi erifer9  "o 10 U(>,(>mn# W1 d →vaso,ons#ri,si dan e ↓ aso,an o,si(en  "o  20 U(>,( → ari#mia Ke;ea#an : dosis C BB C 60 > en(en;eran -0 m( dalam -0 ;; ;airan IHen(en;eran 1000 C9

14

15 Do&'tain : -<20 µ(>,(>mn#  ↑ ,on#ra,si mio,ard↑ 5/ β1 a(onis9 mis : "ob µ(>,(>mn# C d( BB 10 ,(  )C-C10 H 1-0 m( sediaan 2- m(>ml  6 ;; G 44 ;; "- ,e; 1 ;;>= sediaan 12- m(>ml  12 ;; G )8 ;; "- ,e; 1 ;;>= Do&'tain dr$?e#ya B Kediri 2010Garma,olo(i@#erai7I200!9 ?ele,#if a(onis V1dibandin(,an V2 → me↑ ,on#ra,#ili#as mio,ard d(

efe,W$minimal ada deny# =an#n( dan vaso,ons#ri,si vaso,ons#ri,si mll "o 2<- U(>,(>meni# daa# di ↑ ber#aa 2<- U(>,(>mn# ma,s 40 U(>,(>mn#$ Einefrin dr$?e#ya B Kediri 2010Garma,olo(i@#erai7I200!9 Efe, adrener(i, W dan V → me↑ ,on#ra,#ili#as mio,ard deny# =an#n( dan ;ra =an#n( me ↑ ,eb#an o,s mio dosis 01<2 µ(>,(>mn#$ "o renda M 0) µ(>,(>mn#9 → V "o #in((i 00) µ(>,(>mn#9 → W Noreinefrin dr$?e#ya B Kediri 2010Garma,olo(i@#erai7I200!9 Pre,sor einefrin adrenose#or W dominan G V modera# "o 00-<01- µ(>,(>mn#

15

16

PKB 7nair 200-

%an((an ,eseimban(an asam basa .enderson .asselba;s9 Primer Asidosis resira#ori, Al,alosis resira#ori,

5/2

↑

5/2

↓

Komensasi . ↓ 0$0- #ia 5/2 ↑ 10 mm.( a,# : .5/) ↑ 1 mEq> #ia 5/2 ↑ 10 mm.( ,roni, : .5/) ↑ 4 mEq> #ia 5/2 ↑ 10 mm.( . ↑ 0$1 #ia 5/2 ↓ 10 mm.( a,# : .5/) ↓ 2 mEq> #ia 5/2 ↓ 10 mm.(

16

17

Asidosis me#aboli, Al,alosis me#aboli,

.5/) ↓ .5/) ↑

,roni, : .5/) ↓ -<6 mEq> #ia 5/2 ↓ 10 mm.( "a di(i# bl,( . H .5/) G15/2 ↓ 1$- mm.( #ia .5/) ↑ 1 mEq> G 8 "a di(i# bl,( . H .5/) G15/2 ↑ 0$-<0$6 mm.( #ia .5/) ↑ 1 mEq>

. AsidemiaM!49

Al,alemia!49

Asidosis Al,alosis .5/) M 24 P5/2 M 40 +e#aboli,

P5/2  40

.5/)  2

esira#ori,

+e#aboli,

esira#ori, 5amran

5amran

%an((an ,eseimban(an asam basa ?#e&ar#9 esira#ori, +e#aboli, : Ion ,a# < &a#er eC;ess>defi;i# < ;lor eC;ess>defi;i# < niden#ifed anion Ion lema – serm albmin < fosfa# anor(ani,

17

Asidosis . M !)↑ 5/2 ↓ ?I" ↓ Na ↓ ?I" ↑ 5l ↓ ?I" ↑ FA ↑ Alb ↑ Pi

Al,alosis .  !4↓ 5/2 ↑ ?I" ↑ Na ↑ ?I" ↓ 5l

↓ Alb ↓ Pi

18

%(n er#,aran /2 @ 5/2 menyebab,an io,sia>ano,sia a/2 ↓9 @ ier,anea a5/2 ↓9  d# #=d asidosis resira#ori,> ;amran me#aboli, o, me#abolisme anaerob asam la,#a# ↑9 Penyebab io,semia .ioven#ilasi +isma#; *>P  #o  sn#

Penya,i# y( menyer#ai Kln??P Kln aren,im ar : nemoni erdrn edema Kln =an#n( ba&aan . lmonal

A%" Pa5/2

↑

Pa5/2 ↑ Pa5/2 N>↓  #C /2 a/2 #d, ↑

Komosisi ;airan #b : air ele,#roli# @ non ele,#roli# Ele,#roli# #dd : ion ,a#  anor(ani, Na K +( 5a 5l9 @ or(ani, la,#a# ,e#on dsb9 ion lema  vola#il 5/2 .5/)9 @ non vola#il H A .b albmin fosfa#9 Asidosis y( di,ore,si adala asidosis o, ion anor(ani, =, asidosis o, ion or(ani,  #C y rimer ,e; =, . M !$09 ?I" H Na G K G 5a G +(L – 5l G anion ,a# lainL N 40 mEq> Anion (a H Na G KL – 5l G .5/)L mEq> N 8<16 mEq> ?I" M  asidosis ?I"   al,alosis A% ↑  nmeasred anion /smolali#as serm H 2Na G KL G %l,osa>189 G B7N>2$89 m/sm> N : 2!-<23- m/sm> ↓ d ioalbmin emodilsi io5a io+( ↑ d ((l (in=al deidrasi la,#aemia ,e#onemia /smolali#as rine H 4BJL desimalnya sa=a9 N : 20<100 m/sm>

%an((an ,eseimban(an asam basa .enderson .asselba;s9 .

Perbaanrimer .5/) ↓ Asidosis me#aboli; M !)5/2 ↑ Asidosis resira#ori, .5/) ↑ Al,alosis me#aboli;  !45/2 ↓ Al,alosis resira#ori,

.ar(a normal : . !)-
18

esony(diara,an 5/2 ↓ Komensasi ernafasa .5/) ↑ Komensasi (in=al 5/2 ↑ Komensasi ernafasa .5/) ↓ Komensasi (in=al

.5/) 20<26 mEq>l BE 0 ±2$- mmol>l

19 /2

!-<100 mm.(

?a/2 3-<38O

?e;ara ;ea# (an((an ,eseimban(an asam#ida, normal  !$)-#ida, normal )-<4- mm(9 )$ Konsen#rasi bi,arbona# normal>#ida, normal 22<26 meq>l9 4$ ?be an#ara ) dan <) 5ara mda n#, analisis asamnai,9 dan  asam #rn9  asidosis resira#ori, a#a sebali,nya )$ an(,a ,e#i(a lia# sbe ,omonen me#aboli,9 nilai sbe sesai   sesai : me#aboli, ,e;ali ada fa,#or resira#ori, yan( menyebab,an erbaan sbe a,iba# me,anisme ,omensasi$ ;on#o : sbe ne(a#if dan  #rn  asidosis me#aboli, a#a sebali,nya 4$ an(,a ,e ema# bera# rin(an ,elainan  melia# ,adar a;o2 dan sbe -$ an(,a ,elima lia# ,omensasi ,omensasi en complete compensation9 se#ia ) mmeq>l sbe H - mm( a;o2 6$ an(,a ,eenam sesai,an den(an ,eadaan ,linis asien

19

20 !eainan Al,alosis

De"aat ?an(a# bera# Bera# ?edan( in(an +inimal Normal +inimal in(an ?edan( Bera# ?an(a# bera#

Normal Asidosis

P$ Asam

Al,ali

Pco+ Asam

Paco+ ($g) M18 18<22-<)0 )0<)4 )4<)! )!<4) 4)<46 46<-0 -0<---<62 62

S&e Al,ali

Inte"%"eta#i Asidosis esira#ori, Komensasi

Normal

Asidosis

!o%en#a#i ?be ida, Pen Komensasi +e#aboli, Normal ?be Normal

esira#ori, +rni

ida, Ada Komensasi Pa;o2 ida, Pen Komensasi esira#ori, Normal ?be ida, Pen Komensasi +e#aboli, Normal ?be Normal ida, Ada Komensasi Pa;o2 ida, Pen Komensasi esira#ori, Normal

Al,ali

Asam

Asidosis +e#aboli, Komensasi

Al,ali

Asam

Al,alosis esira#ori, Komensasi

Normal

Al,alosis esira#ori, +rni

Al,ali

Al,alosis +e#aboli, Komensasi

Asam

S&e (e,*) M1) 1)<3 3<6 6<4 4<2 2 s>d <2 <2 s>d – 4 <4 s>d <6 <6 s>d <3 <3 s>d <1) M<1)

20

21 Keb#an ele,#roli# n#, Ion Kadar normal NaG 1)-<14- meq>l KG )-<-- meq>l GG 5a 22<2! meq>l 5l 100<110 meq>l +(GG 1!<2- meq>l P/4 %l;

omeos#asis #b Keb#an )<4 meq>,(>r 2<) meq>,(>r -0<100 m(>,(>r 2<4 meq>,(>r 04<03 meq>,(>r 1-<-0m(>,(>r 100<200m(>,(>r

%an((an ,eseimban(an ele,#roli# .ier Na .io Na .ier K

.io K .io 5a

Kasa ebris diare G deidrasi oversoo# #C asidosis /verload #C ;airan rod rine 〉〉 rema#re9 %%A asidosis ne,rosis d #rama ;ombs#io

%e=ala Iri#able s>d ,e=an( e#ar(i s>d ,oma Ari#mia ven#ri,ler P*59 *>* ;ardia;

arres# %I roblem : diared iles ((n nero< ms;ler 5*? 5N? Asfi,sia rema#re I"+ &i;in( s>d ,e=an(

Kore,si asam basa @ ele,#roli# NaBi; 84O 06 C BB C ∆ .5/)  bols G  dri9 P. M !2 NaBi; 84O 0) C BB C BE ;;  bols G  dri9 NaBi; 84O 1<2<4 meq>,( bols aa slm 10<1- mn# J, ≠ B%A G

.io Na

.ier K

.io K

Na meq>100 ;airan rma#an Na5l) )O - ml>,(;;dri 1 =am Na5l 1-O 0$6 C BB C ∆ Na9>2- ;; dri 6 =am 5a (l; 10O 0-<1 ml>,( iv>io slm 2<- mn# NaBi; 1<) meq>,( "-0O 0-<1 ml>,( G Inslin 1 7I>)( (l KG 2 meq>100 ;; ;airan rma#an K5l !4O 04 C BB C ∆ K9 ;; dri 6 =am K5l )O syr 2$-<- ;;>,(>r =, KG  2-9

21

22

.io 5a .io +(

5a (l;onas 10O 0-<1 ml>,( iv aa elan 5a5l 10O 02 ml>,( iv elan +(?o4 02 meq>,(>r dri  14 meq>,(>r o

.io Na M1)09 .ari K Kediri 200!9

.ier Na M1-09 Prof ?darya# 200! %as#roen#erolo(i9 .ier Na 14-9 .ari K Kediri 200!9

.ier K --9 .ari K Kediri 200!9

.io K M)-9 .ari K Kediri

0$6 B9 C BB C ∆ Na NH1)-9 ?im#oma#i, : Ke;ea#an 1 mEq>>=am ma,s ) mEq>>=am9 s>d %C <9a#a 12- mEq> ?alin ier#onis )O %C <9 : lebi erlaan io#onis Kenai,an #ida, lebi 10<1- mEq> Na5l )O H 0-1 mEq>mlT -OH086 mEq>ml9 "efisi# 5airan 9H08CBBCXserm Na>1409<1Y "iberi,an dalam 2 ari den(an menamba,an ada ;airan rma#an Ke;ea#an enrnan 10 mEq>ari ?im#oma#i, > 180 mEq> ?yo, syo, d( ,ris#aloid → a#asireidrasi ?elan=#nya d( free water deficit {Na #er,r>Na diara,an14-99CB 9YCB9 Prinsi ,e;ea#an enrnan Z iona#remia ?im#oma#i, :  5a (l; 60<100 m(>,( iv>io elan ida,  100m(> meni#9 → 5a %l; 10O :06<1 ml>,(  G neblisasi alb#erol 01<0) m(>,( a#a  ?alb#amol iv 4<- U(>,( dalam 20 meni#  NaBi; 1<) meq>,( bols elan =(n di;amr ;al;im9  %l 1(>,( G inslin I9 027>( (l, dri 1-<)0 meni# bisa dilan( s#l 1 =am  ?odim olys#yrene slfona#e KayeCala#e9 oral>n(#>re;#al 1<2 (>,( dlm sorbi#ol>deC#rose  ransfsi #,ar>dialisis  %a(al (in=al <9→loop /thiazide diuretic Asim#oma#i, : ,ran(i mas,an K oba#i eny dasar ;airan bebas K ?im#oma#i, sedan(,(>=am ma,s 1 mEq>,(>=am9 dien;er,an erifer 1 mEq>10ml;en#ral 1mEq>-

22

23 ml9 Evalasi 4 =am s#l mas, Asim#oma#i, : K;l oral 0- mEq>,(>domals 409 C 2 dosis .io K "iberi,an dalam )<4 ari d(n ,e;ea#an #ida, ) M)-9 mEq>,(>=am Prof ?darya# Keb#an KGmEq9>rH 2-CBB  1>)C[KCBB 200! Preara# K;l !4O 1 mEq>1 ml %as#roen#erolo(i9 200!9

.io 5a M889 Prof ?darya# 200! %as#roen#erolo(i9 .io +( +ar,2002C ;airanele,#roli# dan me#aboli,9

5a (l;onas 10O 01<02 (>,( iv aa elan 1-<)0 meni# Kroni, → 5a eroral

Kedarra#an: +(?o4 2<4 ( dlm -0 ;; "-O dalam -<10 meni#  48 mEq>>24 =am dalam ),(>r dalam 4<6 do

"era=a# Penrnan Kesadaran PKB II Palemban( 200!9 5omosmen#is e#ar(i

: sadar en reson ade,a# : ,esli#an dalam memer#aan,an ,eadaan sadar

23

24 ?omnolen Aa#is>ob#dansi ?#or 5oma

?adar>ban(n ,omos men#is9 /b#dansi aa#is9

e#ar(i somnolen9

?#or ?oor9

5oma

: n(an#, reson #d s#imls lal #idr la(i : esonsif #erada s#imls lain selain nyeri : resonsive anya #erada nyeri : #d, resonsif #erada nyeri !ete"angan Keadaan san(a# #an((a #erada lin(,n(an bai, ada man #ida, ada ran(san(an %an((an ,esadaran rin(an diser#ai ber,ran(nya era#ian #erada lin(,n(an se,i#ar ,omni,asi masi daa# dilan(sn(,an seba(ian$ esonsive #erada ran(san(an selain ran(san(an nyeri Pasien #ama, men(an#, samai #er#idr a,an #e#ai masi daa# dian(n,an samai sadar den(an ran(san(an a#a sara a#a nyeri$ Pada saa# asien sadar daa# ber,omni,asi den(an emeri,sa a,an #e#ai aabila di#in((al,an asien a,an #er#idr la(i

%an((an yan( menyeraiseba(ian #idr dalam dan,esadaran anya daa# diban(n,an den(an ran(san( nyeri yan( ,a# dan berlan( ,ali ,omni,asi minimal rea,si ada bera (era,an menola, sa,i# dan men(eran($ esonsive anya #erada nyeri %an((an ,esadaran yan( bera# asien #ama, #idr dalam #ana daa# diban(n,an dan #ida, ada rea,si #erada berba(ai ran(san(an$ ida, resonsive #erada nyeri

?mber : eni;el %+$ 5lini;al Pedia#ri; nerolo(y 200: aler# and a&a,e • Aler# • *oi;e : resond #o voi;e even #o( no# aler# • Pain : rea;# #o a ainfl s#imls • 7n;on;ios : does no# rea;# #o ain .anife#ta#i !ini# / tingkat gangg'an di SSP PKB IIPalemban( 200!9 Tingkat Re#%on oto"ik P'%i Ge"akan B. Pe"nafa gangg'an #an

24

25 Keda i#dra&al ,or#e,s alams "e,or#i,asi len(an fle,si #er#ari, ,e a#as dada9 +idbrain "e,or#i,asi >de;erebrasi

Pons

"e;erebrasi len(an e,s#ensi ro#asi in#erna9

+edlla

Ke;il ea,#if

+idosi#i on ida, rea,#if Pinoin#

n(,ai lema le,si

?on#an ,on=(asi (era,an oriRon#al

5eyne
Ke ara la#eral ,ersa,an N III9

Keara medial ,ersa,an N *I9 Efe,<9

Bio#

Ke;il A#a,si, .orner syndr Poa %e"nafa#an PKB IIPalemban( 200!G"C fisi, ada Ana, 13319 5eyne Ane diser#ai ierne ?#o,es Pernafasan ;ea# dalam dii,#i lamba#dan(,al dan a .ierven#ilasi +e#aboli; asidosis menyelr Anes#i, A#a,si, .ioven#ilasi Kssmal Bio#

E *

Edema ar nero(eni, Beren#inya insirasi ,elainan ons>medlla9 ida, ada ola ,elainan medlla9 Kelainan di AA? 5ea# dan dalam Pola ernafasan yan( sama se,ali #ida, #era#r

4 ) 2 1 -

%las(o& 5oma ?;ale 4<1- #9 oen son#aneosly verbal ;ommand ain no resonse orien#ed @ ;onverses

4

disorien#ed @ ;onverses

5ildren\s 5oma ?;ale M 4 #9 oen son#aneosly rea;# #o see; rea;# #o ain no resonse orien#ed #o sonds in#era;# smile follo& ob=e;# ;onsolable ;ryin( inaroria#e

25

26 in#era;# in;onsis#en#ly ;onsolable ;ryin( moanin( 2 in;omreensible sonds in;onsolable ;ryin( irri#able 1 no resonse no resonse 6 obeys #o verbal ;ommand obeys #o verbal ;ommand lo;alise ain s#imli lo;aliRe ain s#imli 4 fleCion &i# ain &i#dra&s in resonse #o ain + ) fleCion abnormal fleCion abnormal de;or#i;a#e9 2 eC#ension eC#ension abn de;erebra#e9 1 no resonse no resonse ?,or %5? N : M 6 bln ] 3 2<- # ] 1) 5edera ,eala : rin(an 1)<16<12 bln ] 11  - # ] 14 sedan( 3<12 1<2 # ] 12 bera# )<8 )

inaroria#e &ords

Blan#yre 5oma ?;ale for reverbal yon( ;ildren9 1 a#;es or follo&s fa;e or ob=e;# E 0 ail #o &a;# or follo& 2 5ries aroria#ely &i# ainfl s#imls or 1 sea,s * 0 +oan or abnormal ;ry &i# ainfl s#imls No vo;al resonse #o ainfl s#imla#ion 2 o;aliRes ainfl s#imls + 1 i#dra&s limb from ainfl s#imls 0 No resonse or inaroria#e resonse 5lini;al aearan;e  ell aearin( : smiles layfl no# irri#able aler# qi;,ly feeds &ell ;ries s#ron(ly b# easily ;onsoled by a ;are(iver no si(n of deydra#ion eC#remi#ies in, and &arm  Ill aearin( : brief smile irri#able &i# ;ryin( and sobbin( s#ill resonsive #o a ;are(iver less layfl or a;#ive #an sal oor feedin( si(ns of mild or modera#e deydra#ion (ood erieral erfsion  oCi; aearin( : irri#able @ no# easily ;onsolable oor or absen# eye ;on#a;# failre #o in#era;# &i#

26

27 aren#s or ob=e;# in environmen# le#ar(i; or nresonsive #oo &ea, #o feed seiRre or si(n of menin(eal irri#a#ion e#e;ie rra si(ns of severe deydra#ion oor erfsion mo##led ;ool eC#remi#ies ale #ready lses  60C>mn# re#ra;#ions (rn#in( anea ;yanosis resira#ory failre ale /bserva#ional ?;ore Normal 1 ^ali#y of ;ry

?#ron( or none

ea;#ion #o aren#\s

5ries brief or no ;ry

s#imla#ion

and ;on#en# If a&a,e s#ays a&a,e or if aslee a&a,ens qi;,ly

?#a#e varia#ion

5olor

.ydra#ion

Pin,

Normal #r(or

+odera#e imairemen# 2 imer or sob 5ries on and off Eyes ;lose briefly &en a&a,e or a&a,ens &i# rolon(ed s#imla#ion Pale eC#remi#ies or a;ro;yanosis ?,in @ eyes normal mo#

sli(#y dry esonse #o ?miles or aler#s Brief smile or so;ial ;onsis#enly9 aler# over#res ?,or : M 11  M)O robabili#y of serios illness 11<1-  26O robabili#y of serios illess  1 32O robabili#y of serios illness

?evere imairmen# ) ea, or moanin( i( i;ed ;on#inos ;ry or ardly resonse Persis#en# ;ry &i# li##le resonse

No arosal and falls aslee

Pale or ;yano#i; or mo##led or asen ?,in do(y or #en#ed dry m;os membranes sn,en eyes No smile anCios dll no aler#in( #o so;ial over#res

Defini#i SEPSIS (Go#tein B0 +1120 Ped C"it Ca" .ed)

27

28 SIRS e resen;e of a# leas# #&o of #e follo&in( for ;ri#eria one of w$ic$ '#t &e a&no"a te%e"at'"e o" e'kocyte co'nt3 _ 5ore #emera#re of )8$-`5 or M)6`5 by re;#al bladder oral or ;en#ral ;a#e#er robe9 _ a;y;ardia defined as a mean ear# ra#e 2 ?" above normal for a(e in #e absen;e of eC#ernal s#imls ;roni; dr(s or ainfl s#imliT or o#er&ise neClained ersis#en# eleva#ion over a 0$-< #o 4<r #ime eriod 4R for ;ildren M1 yr old: brady;ardia defined as a mean ear# ra#e M10# er;en#ile for a(e in #e absen;e of eC#ernal va(al s#imls V blo;,er dr(s or ;on(eni#al ear# diseaseT or o#er&ise neClained ersis#en# deression over a 0$-<r #ime eriod$ _ +ean resira#ory ra#e 2 ?" above normal for a(e or me;ani;al ven#ila#ion for an a;#e ro;ess no# rela#ed #o nderlyin( neroms;lar disease or #e re;ei# of (eneral anes#esia$ _ e,o;y#e ;on# eleva#ed or deressed for a(e no# se;ondary #o ;emo#eray
28

29 Septic shock ?esis and ;ardiovas;lar or(an dysfn;#ion as defined in able 4"gan Dy#f'nction C"ite"ia Cardiovascular dysfunction "esi#e adminis#ra#ion of iso#oni; in#ravenos flid bols40 m>,(in1r _ "e;rease in BP yo#ension9 M-# er;en#ile for a(e or sys#oli; BP M2 ?" belo& normal for a(e / _ Need for vasoa;#ive dr( #o main#ain BP in normal ran(e doamine - U(>,(>min or dob#amine einerine or noreinerine a# any dose94R _ &o of #e follo&in( 7neClained me#aboli; a;idosis: base defi;i# -$0 mEq> In;reased ar#erial la;#a#e 2 #imes er limi# of normal /li(ria: rine o## M0$- m>,(>r Prolon(ed ;aillary refill: - se;s

5ore #o erieral #emera#re (a )`5 Respiratoryb

_ Pa/2>I/2 M )00 in absen;e of ;yano#i; ear# disease or reeCis#in( ln( disease 4R _ Pa5/2  6- #orr or 20 mm .( over baseline Pa5/24R _ Proven needc or -0O I/2 #o main#ain sa#ra#ion 32O 4R _ Need for nonele;#ive invasive or noninvasive me;ani;al ven#ila#iond Neurologic

_ %las(o& 5oma ?;ore 11 4R _ A;#e in men#al s#a#s &i# a de;rease in %5? ) oin#s;an(e from abnormal baseline Hematologic

_ Pla#ele# ;on# M 80000>mm) or a de;line of -0O in la#ele# ;on# from i(es# vale re;orded over #e as# ) days for ;roni; ema#olo(y>on;olo(y a#ien#s9 4R _ In#erna#ional normaliRed ra#io 2 Renal

29

30 _ ?erm ;rea#inine 2 #imes er limi# of normal for a(e or 2
_ o#al bilirbin 4 m(>d no# ali;able for ne&born94R _ A 2 #imes er limi# of normal for a(e b a;#e resira#ory dis#ress syndrome ms# in;lde a Pa/2>I/2 ra#io 200 mm .( bila#eral infil#ra#es a;#e onse# and no eviden;e of lef# ear# failre$ A;#e ln( in=ry is defined iden#i;ally eC;e# #e Pa/2>I/2 ra#io ms# be )00 mm .(T croven need assmes oCy(en reqiremen# &as #es#ed by de;reasin( flo& &i# sbseqen# in;rease in flo& if reqiredT din os#oera#ive a#ien#s #is reqiremen# ;an be me# if #e a#ien# as develoed an a;#e inflamma#ory or infe;#ios ro;ess in #e ln(s #a# reven#s im or er from bein( eC#ba#ed$ Te"inoogi ?I?  2 ,ri#eria ars ada abnormali#as s>le,osi#:  .ier#ermi   a,i,ardi .

)8$-c59 a#a io#ermi M )6c59  2?" Z mr #ana s#imls e,s#ernal oba# ran(san( nyeri a#a ersis#en 0-<4 =am9 a#a bradi,ardi . ra#a%A9  e,osi#osis a#a le,oeni b,an s,d , ,emo#C9 a#a I ra#io 10O Infe,si mi,roor(anisme G reson imn G %C KC – Kolonisasi +i,ror(anisme G reson imn <$ %C KC < Peny$Inf +i,roor(anisme G reson imn G %C KC G Ba,#eriemia +i,roor(anisme a#o(en G dlm sir,lasi ?esis ?I?G%C KC eny infe,si bera# ?I? a,iba# infe,si9 ?indrom ?esisG %(n erfsi or(an ?esis ?esis bera# ?esis G 1 dr disfC 5*>"?>disfC 2>or(an lain

30

31 ?yo, ?e#i, +/"?

?indrom sesisGio#ensi>disfC 5* #ida, reson d( ressi#asi ;airan ade,a# Ke(a(alan beberaa or(an

(Go#tein B0 +1120 Ped C"it Ca" .  #a,i bradi 0
.ed)

"s M6M!M100 M34 M10M11!

e,osi# )4000 13-00a#aM-000 1!-00a#aM-000 1--00 a#a M6000 1)-00a#aM4-00 11000 a#a M4-00

"5 : Eo>Ba>?#>?(>y>+o : 1<4>0<1>2<->)6<66>22<40>4<8 e,osi#osis ba,#eri9  e,oeni virs9 I ra#io H ?#>?#G?(9  sesis =, 20O AN5 H ?#G?(9Ce,osi#>100  sesis =, M1-00 a#a 8000

Kriteria DIC : (DIC jk skor ≥ 5) rombosi# "P>"< "imer P ibrino(en

0

1

2

 100$000

-0$000 <100$000

M -0$000

M-00 M)d#, 100

)

-00<1000 1000 4<6d#,

6d#,

M100

5IRS I?  2 ,ri#eria :   60C>mn# a#a M )0C>mn# a#a ane ± re#ra,si dan desa#rasi /2  M )0 5 a#a  )!- 5 5  ) d#, e,osi# M 4000 a#a  )4000

31

32 ?esis   1 ,ri#eria I? G (C ,linis infe,si ?esis bera#  sesis G io#ensi a#a disfn(si or(an #n((al ?yo, sesis  sesis bera# G io#ensi d( ressi#asi ;airan @ oba# ino#roi, +/"?  disfn(si ml#ior(an d C y( md# #C o#imal %C ,linis infe,si :

Klinis

.emodinami, Perfsi =arin(an

Inflamasi

7mr a,#or resi,o ?mber

? #b #d, s#abil M)6 5 a#a  )! 59 . 180C>mn# a#a M 100C>mn#   60C>mn# a#a M )0C>mn# a#a ane ± re#ra,si dan desa#rasi /2 e#ar(i In#oleransi (l,osa %"A  1!0 m(>dl a#a M 4- m(>dl9 In#oleransi minm " 2?" sesai sia bayi "s M -0 mm.( sia 1 r9 "s M 6- mm.( sia 1 bln9 5  ) d#, Asam la,#a# lasma  ) mmol>l e,osi#osis  )4000 e,oenia M 4000 Ne#rofil mda  10O I> rasio 02 16 ? NA (ene 5 : G rombosi#oenia M 100000 5P  10 m(>dl Pro;al;i#onin  81 m(>dl I- a#a I8  !0 (>ml

Early onse# sesis ≤ !2 = Prema#ri#as amnioni#is infe,si ma#ernal %eni#al> =alan lair

32

a#e onse# sesis  !2 = Prema#ri#as in(,n(an>

33

%e=ala +or#ali#as CAIRA6 I65US

lminan ml#i sys#em nemonia -<-0O

noso,omial Pro(resif lamba# fo,al menin(i#is 10<1-O

Na K 5l .5/) a,#a# Kalori /sm mEq> mEq> mEq> mEq> mEq> K;al> m/sm> N?>P 1-4 1-4 )08 -O " 200 2!8 10O" 400 --6 " N? )8)8200 )-) KaEn 1B )8)81-0 28"N?  !! !! 200 428 KaEn)A 60 10 -0 20 108 230 .?" 61 1!-2 26- 100 236 KaEn)B -0 20 -0 20 108 230 "10$18N? )1 )1 400 61KaEn 4A KaEn 4B KaEn+()

Na5l )O Na5l 1-O Na.5/) 84O !-O K5l

 in(er Aserin( ""-

)0 )0 -0

0 8 20

20 28 -0

10 10 20

160 1-0 400

282 284 63-

Na K 5l .5/) Eqivalen mEq>2-mmEq>2-mmEq>2-mmEq>2-m 1 ;; 128 128 064 64 2221 2-

2-

1

Na K 5a 5l a,#a# Ase#a# Kalori /s mEq> mEq> mEq> mEq> mEq> mEq> K;al> m/s 1)0 4 ) 103 28 2! 14! 4 41--)1 1)0 4 ) 103 28 2! 1)0 4 ) 103 28 200 -8 14! 4 41--200 -8

33

34 Aserin(-

1)0

4

)

103

28

200

5ara memba# ;airan : "1-O "12-O

H "-O !1-;; G "40O 28-;; H "10O 8)-;; G "40O 16-;; H "-O !8-;; G "40O 21-;; H "10O 31!;; G "40O 8);;

"10O0$18N? "-O 81-;; "40O1-O 14-;; "10 H "10O G 6 ;; GNa5l H KaEn 4A G 2- ;; "40O "10 0$22-N? H "10O G !- ;; Na5l 1-O "10 0$4-N? H "10O G 1- ;; Na5l 1-O "- 0$18?5N-O9 H "-O G 6 ;; Na5l 1-O H KaEn 4B G 12- ;; "40O H "-O<1009G100;; N? "10 0$18N? H "10 N? G ! ;; NaBi; 84O G - ;; K5l !-O .?" H "- N? G 1- ;; NaBi; 84O G 10 ;; K5l !-O "!-O H"-:"10H1:1

34

--

35

EAlb
"/?I?

IN"IKA?I

01<0$) ml>,( ivioe#

5ardia; arres#

20 ml>,( ivio 10 ml>,( neona#s9

.io#ensi o, iovolemi,

Na5l NaBi,03O> 84O  2<4 mEq>,( iv Asidosis me#aboli, 1mEq>ml "iaReam 0- m(>,(  -<20 µ(>,(>= Ke=an( - m(>ml Nalo,son 02 ml>,( ive#ims; "eresi o, nar,o#i,a 04 m(>ml 01 ml>,( neona#s9 "oamin -<20 µ(>,(>m# .io#ensio,5/ ↓ "ob#amin -<20 µ(>,(>m# ?yo,o,5. %l,osa 40O 0$-<1 (>,( 2<4 ml>,(9 .io(li,emia -,( iv slm 20 m# Aminofilin As#ma  3 m(>,(>r #id 2- m(>ml ?alb#amol erb#aline Adrenalin 1:1000

2-,( s; maC 0) ml9 4,( iv  4,(>r #id 0-<1 m(>,( bols  1-<6 m(>,( iv qid 2 m(>,( ivim  ) m(> ,(>r #id 0-<1(>,(iv 1<2m(>,(>iv

IK ↑ /li(riadema

Ini#ial defib "5 so;,9 Amiodaron ido,ain

2J>,( 2<4J>,( 4J>,(

Plseless **

+a(nesim

2-<-0 m(>,( ivio

Adenosin A#roin slfa#

01m(>,(ivio 002 m(>,( ivioe#

.idro,or#ison "eCame#ason 4 m(>ml "ifenidramin +ani#ol rosemid

-m(>,(ivio 1 m(>,( ivio#

35

As#ma As#ma Anafila,sis Anafila,sis Anafila,sis Anafila,sis

Plseless** orsade de Poin#es ?#a#s as#ma#i,s ?* Asis#ol Bradi,ardia

36

An#ibio#i,a /BA Pen* Pen Pro;ain Ami;illin AmoCi;illin 5o
"/?I? !-<12-m(>,(>Coqid 100000<2-0000 ni#> ,(>r im bid 2-<-0 m(>,(>C iv Y M! r bid ! r #id 12-<2- m(>,(>C o qid !-<1- m(>,(>C o #id 10<2- m(>,(>C #id 2-<-0 m(>,(>C iv>o qid 1-<2- m(>,(>C o bid 10<2- m(>,(>C o #id 2-<100 m(>,(>r #id -0<1-0 m(>,(>r iv #id 2-<100 m(>,(>C iv>im bid -0<180 m(>,(>r iv bid -0<100 m(>,(>r iv bid

Eri#romisin Klindamisin ARi#romisin ?iramisin

)0<-0 bid 2-<-0 m(>,(>C m(>,(>C im iv bid 4 m(>,(>C o bid 20<40 m(>,(>C iv #id 1<2- m(>,(>C im Y M! r bid ! r #id -,(>C im Y M! r bid ! r #id M 6 m( : )<4 m(>,(>C im bid  6 m( : 2<) m(>,(>C im #id !-<12- m(>,(>C o qid 2<10m(>,(iv>o qid -<12m(>,(>ro -0<100m(>,(>ro#id

e#rasi,lin Kloramfeni,ol iamfeni,ol 5irofloCasin 5olis#in Ko#rimo,saRol *an;omisin osfomisin +e#ronidaRol A;i;lovir

62-<12- m(>,(>C qid 12-<2- m(>,(>C qid )0<-0m(>,(>rqid 10<1- m(>,(>C o bid )0000<60007>,(>Co#id 4<10 m(>,(>C +P o bid 10<12-m(>,(>C ivqid 100<200 m(>,(>r iv dri bid !- m(>,(>C iv>o qid -<20m(>,(>Civ>o#id

Ne#ilmisin

36

37 %an;i;lovir +ebendaRol l;onaRol %riseoflvin I*I% ®%amavenin P

-m(>,(>Civbid 100 m( o ) r a#a -00 m( o 1 r )<6m(>,(>ro 10<1- m(>,(>r o 1<) ml>,( iv

Kr(man\s Infe;#ios "iseases of 5ildren 2004 ?mba#an salran naas a#as diba(i i 4 dera=a# Z k"ite"ia 7ack#on 1$ Ja;,son I di#andai den(an sesa, s#ridor insirasi rin(an re#ra,si sras#ernal #ana sianosis$ →,onserva#if an#i inflamasi an#ibio#i,a o,si(en in#ermi##en9 2$ Ja;,son II : Ja;,son I #e#ai lebi bera# diser#ai re#ra,si sra dan infra,lavi,la sianosis rin(an s#ridor insirasi dan asien #ama, mlai (elisa$ → In#basi endo#ra,ea dan #ra,eos#omi )$ Ja;,son III : Ja;,son II ber#amba bera# G re#ra,si in#er,os#al ei(as#rim s#ridor insirasi – e,sirasi dan sianosis lebi =elas$ → In#basi endo#ra,ea dan #ra,eos#omi 4$ Ja;,son I* di#andai den(an (e=ala Ja;,son III diser#ai &a=a yan( #ama, #e(an( dan #er,adan( (a(al naas →,ri,o#iro#omi

37

38

*ENIA?I +EKANIK Indi,asi 1$ Indi,asi absol#   anea ber,ean=an(an (prolonged apnea)  Pa/2 M -0 mm.( d( i/ 2  080 ,e; d PJB siano#i,9  Pa5/2  60 mm.( d( ersis#en# a;idemia  ,e(a(alan o#imalisasi C "? y( #l mend#,an 5PAP d(  i/2  60↓ saa nafas 〈〈 eisode anea 〉〉 sianosis #d, l( d( #C /2 #a,i,ardia " ↓ ;a# syo, bradi,ardia < %an((an o,si(enasi di mana Pa/ 2 M 40<-0 mm.( d( /2 100O9 < %an((an ven#ilasi di mana Pa5/ 2  60<6- mm.( BB?  -0 mm.(9 Setting awa (%d') : i/2 30<3-O ,onsen#rasi /2 21<100O9 <m# d(  y( 〉〉 → ↑ +* 5/C9 ↑ e,s,resi 5/2 ↓ Pa5/29 d 1:) rasio insrasim# aliran /2>m#9 <+AP 10<12 ;m .2/ BB M 8 d# di↑,an d( : ↑ PIP ↑ PEEP ↑ lo& ↑ I:

38

39

i/2 PEEP PIP re, I lo&

"? ∼ ,eb 4<20<240<60 04 4<8

+A? ∼ ,eb 4<)0<)≥ 60 0-

Ane ∼ ,eb 2<)

∼ BB 10<)0 04<8

BB ∼ ,eb 2 12<20 20<60 0) 6<8

PP.N ∼ ,eb 2M 20<2)0<60 02

Q i/2 sesai ,eb n#, memer#aan,an Pa/ 2 -0<80 mm.( @ ?a/ 2 : 30<3-O QQ PIP #e,anan renda #e#ai ;, n#, men(an(,a# dindin( #oraC BB by M1000 (  PIP : 12<14 1000–2000 (r  PIP :1-<20 2000 (PIP: 20–2-9 Indi,a#or a&al +* : e,sansi dada  ,onfirmasi d( 5* osisi E #ea# diafra(ma normal ,eda ar men(emban( bai,9 G Pa5/2 roorsional #d min#e ven#ila#ion ↑ +* → ↓ Pa5/29 < ↑ +* d( ↑ PIP a#a ↑ ra#e < ↓ +* d( ↓ PIP a#a ↓ ra#e G Pa/ 2 roorsional #d i/ 2 @ +AP  ↑ i/2 a#a +AP a,an ↑ o,si(enasi9 +AP adala roorsional #erada PIP PEEP I dan I : E ra#io < J, Pa5/ 2 normal → ↑ i/2 ↑ PEEP  ↑ I ;ara ini =aran( di(na,a9 < J, Pa5/ 2 #in((i → ↑ PIP a,an ↑ Pa/2 dan ↓ Pa5/29 < J, Pa5/ 2 renda → ↑ i/2 ↑ PEEP ↑ I

Pandan erbaan se##in( : 1$ +AP Parame#er y( d# menai,,an +AP di#rn,an er#ama ,ali H PIPCi9 G PEEPCe9L>iGe9 2$ e,anan #in((i lb berbaaya drd ,onsen#rasi o,si(en y( #in((i )$ PIP di#rn,an 2<) ;m.2/ #ia ,ali  bar i/2 di#rn,an 2<10O #ia ,ali  PEEP d #e#a dier#aan,an a(ar alveoli #e#a #erb,a

39

40 4$ Penrnan ,onsen#rasi o,si(en rs l ;ea# =, Pa/2  100 mm.( a#i<a#i ,era;nan o,si(en9 aala(i d( ,onsen#rasi o,si(en100O -$ Perbaan se##in( ven#ila#or rs dii,#i analisa (as dara 1-<)0 meni# se#ela emasan(an>erbaan se##in( ven#ila#or ;P5/2 a#a ?a/29 dan moni#orin( s#a#s ,linis enderi#a 6$ Ji,a analisa (as dara membr, ,embali ,e se##in( semla a#a se##in( disesai,an d( ,eadaan enderi#a !$ Penyaian : =, B%A 12 = #era,ir bai, 5F bai, P5*  40O  20<2->m# i/2 M -0O PIIP>PEEP 22>) beri +e#ylCan#ine 12<24 = sbl disai i/2 di ↑,an 10O slm 20< )0 m# sy #d, #=d #ransien# io,sia9 ↓ ra#e -<10 C>mn# =, C d# men#oleransi s>d 1 =  5PAP endo#ra;eal d( PEEP )<4 slm 2<4 = i/2 di↑,an -O  ;e, B%A s#l 5PAP  = =, #d, ada dis#ress naas @ B%A dbN  e,s#basi  /2 ead boC BB 1-00 (9 > nasall 5PAP BB M1-00 (9 PPEP 4< -  = diser#ai naas )<4 =>C oral feedin( slm 12< 24 5F fisio#C =, #imbl s#ridor nebs#o adrenalin 0-<1 ml 1>10000 dlm 1 ml P9 a#a in= deCame#ason 02- m(>,( iv d( rma#an 01 m(>,( iv 6 @ 12 = beri,#nya Penga"'$ %e"'&a$an #etting % d BGA : < i/2 ↑  Pa/2 ↑ < PEEP ↑  Pa/2 ↑ Pa5/2 ↑ < PIP ↑  Pa/2 ↑ Pa5/2 ↓ <  ↑  Pa5/2 ↓

< I ↑ < E ↑

 

Pa/2 ↑ Pa5/2 ↑

Pe"'&a$an #etting &d#" $# BGA B, A=ar Neona#olo(i9: Pa/2 enda enda enda in((i

Pa5/2 in((i Normal enda in((i

An=ran

↑ PIP ↑ +AP ↑  ↑ i/2 ↑ +AP ## PIP dier#aan,an d( ↑ PEEP>↑ I 5e, PP.N sesis overven#ilasi ↑ i/2 ↑ +AP 5e, blo;,in( d #be ven#ila#or ↓ PEEP ↓ I ↑ 

40

41 in((i in((i Normal Normal Normal

enda Normal in((i enda Normal

↓ PIP ↓ i/2 ↓  ↓ PIP ↓ i/2 ↓ PEEP ↑  +AP dier#aan,an ↓  +AP dier#aan,an /bservasi =, memn(,in,an d# disai

Predi;#ed ?iRe 7n;ffed be H a(e >49 G 4 Predi;#ed ?iRe 5ffed be H a(e >49 G ) "e# of inser#ion ;m9 H a(e in years>29 G 12 Advan;ed Pedia#ri; ess;ia#ion Provider 5orse 2002<200)9 7sia

Neo Mbln Neo bln bln 6 #an 1 2 #an #an 4 #an 6 8 #an

arin(os,o

+iller 0

"iame#er dlm ia balon G><9 2-<) <9

+iller1

)<)-<9

+iller 2 +a;in#os 2

10 #an 12 #an ema=a

Ka#e#er \isa

8

-<6

3<10

)-<4 <9 +iller 2

Jara, (si
6<8

10

4<4<9 4-<<9 -<-<9 -<9 <>G9 6

8

11 12 14 116

6<>G9

8 8 10 10 10

1!

G9! !<8 G9

12

18

12

20

12

essi#asi Neona#s Perinasia G b, a=ar neona#olo(i9 Uk'"an %i%a

Be"at

2) ))-<4

1000 M 1000<2000 2000<)000 )000 

U#ia ke$aian (gg) 28 M 28<)4 )4<)8 )8 

Kedalaman E : bera# badan bayi ,(9 G 2 "iame#er mm9 : sia (es#asi m((9 : 10

41

Daanya in#e"#i

6-
42

4k#igen Content 3 1$)4 C .b C ?/2 C 0$019 G 0$0)1 C Pa/29

PERI6AT4L4GI

"e#e,si dini bayi resi,o #in((i Kondisi ib Ib  40 # Ib M 16 # Pero,o, "iabe#es %an((an #iroid Kelainan =an#n( .ier#ensi Poliidramnion /li(odramnion APB KP" B/. Eilesi "r( abser Kondisi fe#al %emelli Bayi besar Kondisi ersalinan Prema#r Pos#da#e Ib febris Par#s re;ii#s Presen# sn(san( Ke# me,oneal ?e;#io ;ae;arian Kondisi lasen#a Ke;il

K+K ,elainan ,romosom rema#r  K+K P+  "? io(li,emi B+K>K+K I7" +5A  io>ier#iroid mo : P7 dlm A?I S9  K+K rema#r I7"  K+K asfi,sia ,e=an( m(?/4  io 5a9  anen;eals E ((n (in=al  renal a(enesis I7" lmonal iolasi  rema#r anemi I7"  infe,si  abor#s abi#alis>i,#ers 9 ydro;eals /5.9  erdaraan E? "ilan#in9 i,#ers *alim vs Bilirbin9  ,e#er(an#n(an oba#  

rema#r K+K asfi,si olisi#emia fe#o
"? asfi,sia infe,si  +A? asfi,sia I7"  infe,si  #rama lair I5. aralise diafra(ma lesi n reni;s9  asfi,si +A? PP.  "? NB 



K+K

42

43 Besar ?ol#io la;en#a Kondisi bayi Prema#r @ BB

 

idros foe#alis I"+ asfi,si anemi

"? I*. io(li,emi io#ermi infe,si ane (a(al nafas .IE : 5P +  insfisiensi la;en#a : I7" K+K infe,si io< (li,emi  

Asfi,sia bera# Pos#da#e

e#al moni#orin( : BB bmil (era, =anin ,adar oes#riol dlm rine bmil amnio;en#esis fe#al dis#ress : me,onem G9 amnios,oi ma#ri#as bayi seC ,ln ba&aan9 N?<"JJ normal 120<160>m# 1- d# saa# is M 120>m# fe#al dis#ress : #a,i,ardia> bradi,ardi )0<60 d# di lar is9 Per#mban =anin in#ra#erin rimes#er I < imno#olerans < embrio>or(ano< %enesis rimes#er II < er#mban la;en#a < emben#,an air ,e#ban < rod,si ormon lasen#a rimes#er III < er#mban =anin < enimbnan ma,anan < ;ad enyemrnaan f(s or(an

Pen(ar (ene#i,>Ra# #era#o(eni,  malformasi =anin : ,ln ,romosom "o&n\s9 ((n ,eseimban(a  andro(en<ro(es#eron andro(eni#al syndrome io(onadisme9 abor#s o, inf virs bella9>oba#>radiasi Imnisasi fe#oma#ernal AB/ @  an#a(onism9 ery#roblas#osis foe#alis a# #era#o(eni,  #C ro(es#erone : ,ln (eni#al eC#>((n ??P Infe,si  virs bella : ,ersa,an N *III les>/. : mi;ro;eals ydro;eals ;oroido re#ini#is I7%>maln#risi in#ra#erine rema#ri#as ((n omeos#a#is  io(li,emia yoCiam#9 bradi,ardi di lar is "JJ M 120>m# H fe#al dis#ress9

+anifes#asi ,linis ,elainan d neona#s Periodi; ane 5en#ral ;yanosis

Prema#r  =, ane  20 d# diser#ai sianosis @ bradi,adi : essi#asi SSS esira#ory insffi;ien;y : < lmonal    60>m# re#ra,si G < 5N?   ire(ler lema

43

44 < 5."  ersis#en# ;yanosis < dll  so;, io(li,emia ba,#eriemia ersis#en# fe#al ;ir;la#ion P59 Infe,si ((n 5N? ((n sir,lasi Infe,sioverea# Anemia erdaraan a,# io,sia io(li,emia so;, sesis adrenal failre

.yo#ermia ebris Pallor ailre fed &ell e#ar(y Irri#able .yera;#ive Ji##eriness 5onvlsi

I,#ers M 24 =am

Infe,si abdominal ;ondi#ion Infe,si in#ra asfi,si io(li,emia inborn error me#abolism Infe,si in#ra abdominal ;ondi#ion menin(eal irri#a#ion ;on(eni#al (la;oma Prema#re  io,sia io(li,emia io 5a ((n 5N? Normal =, eC# die(an( simle #remor ilan(9 io(li,emi I"+9 asfi,sia olisi#emia Asfi,sia I5. efsi sbdral io 5a io(li,emia io>ierna#remia def B6 inborn error me#abolism Eri#roblas#osis foe#alis sesis K+K9 /5.

Pemeri,saan fisi, BB P osisi K li#

Keala

+ a#a

. idn( +l#

osi#ion of ;omfor# normal9 in, normal9 allor  asfi,sia anemia syo, edema9 sianosis i,#ers le#ore olisi#emia9 verniC ;aseosa lan(o +on(olian so# eman(ioma ,ailer salmon a#; sider an(ioma or# &ine s#ain s#ra&berry mar,9> ,avernosm>;amran #e,ie>e,imose s,lerema neona#orm sesis9 moldin(>mola(e fon#anella mayor 20 ± 10 mm9 ;ranio#abes ;a# s;;edanem ;eal ema#oma menin(oen;ealo;ele idrosefals mi,rosefals ;ranios#enosis refle,s il nys#a(ms aniso,or s#rabisms ei;an#s "o&n\s syndrome9 sb;on=n;#ival> re#inal bleedin( ,on=n(#ivi#is (onoblenorroe 5rede : A(N/) 1O di(an#i e#ra;y;lin 1O9 a#resia ;oane rini#is le#i;a mi;ro>ma;ro(na#ia mi;ro>ma;ro(losss earl Es#ein re#en#ion ;ys#9 a#ea Bednar monilia albi;ans ;eilos;isis ala#os;isis (na#os;isis

44

45  elin(a  eer  oraC J an#n( P ar Ab domen

7 mbili;s

%e ne#alia

A ns EC#remi#as  efle,s

fis#la reari;lar #ber;loma maserasi bra;ial fis#la &ebbed ne;, (oi#er ;a# obs#im y(roma ;ys#i; lymoma ;oli #or#i;olis b#, silindris fnnel ;es# i(eon ;es# breas# enlar(emen# G &i#; mil, . 120<160>m# ba#as =#( sde mrmr G><  )0<60>m# ,d( irre(ler #ie abdominal o, osisi ;os#a #e(a, lrs d ver#ebrae9 b#, silindris s>d 2 m( menon=ol ,e la#eral ear al 1<2 ;m ba; =9 lien ##b dis#ended : iles as;i#es>#mor ;e,n( : ernia diafra(ma#i,a #dd 2 lais amnion>&ar#on =elly @ ,li#9  mmifi,asi 4<6 r =, leas  10 r &asada infe,si S omalo;ele (as#ros;iRis ernia mbili;alis fis#la>,is#a ra;s mbili;s ;#is>amnio#i;s l, – ndes;es;s #es#is ;ry#or;isms ydro;ele #es#is ernia s;ro#alis ei>yosadia r < labim mayor #d, men# se;re# ,e#ian 1<2 m(9 sdomens#rasi )<4 r9 a#resia ani l#, renda>#in((i9 fis#la re;#ova(inalis>a#resia re,#i aralise fra,#r ;on(eni#al dyslasia of #e i oly>synda;#ili a;ondrolasia sianosis erifer refl s;,in( roo#in( (rasin( moro l( s#l mr ) bln  en#in( n#, menilai f(s o#a, f(s saraf erifer ada> #d,nya fra,#r eC#remi#as d# membeda,an dema ;erebri @ erdaraan o#a, =,  6 bln ms G #d, normal9

+e;onem

fre,ensi @ ,onsis#ensi #in=a #(# ss y( diminm normal 6<8C>r mlai 1<2 =9 =,  10 =: in(a# ,ln ,on(eni#al S dara dlm #in=a rs dibeda,an asalnya – dr bayi>ib

7rine

24 =am er#amaS 1-<20 ;; r ,e<6 ± 200 ;; =,  24 = : anria>re#ensi erdaraan o#a,>dema ;erebri (C #d, sesifi, < ,esadaran ↓ #&i#;in( ,e=an( #oni,> ,loni, #an(isan melen(,in( e,sresi ma#a fiCed @ s#arin( nis#a(ms s#rabisms fon#anel #e(an( @ menon=ol9

rama air

A(ar ?;ore Aearan;e &arna ,li#9

1 ?elr #b #i>bir

2 Bdn mera Ka,i bir

45

) ?elr #b ,emeraan

46 Plse deny# nadi9 %rima;e refle,s9 A;#ivi#y #ons o#o#9 es effor# saa nafas9

ida, ada ida, ada n(lai ida, ada

M 100>mn# Perbaan mimi, E,s#remi#as a(a, fle,si ema #d, #era#r

 100>mn# Ba#,>bersin> menan(is E,s#remi#as fle,si (r, a,#if +enan(is ,a#

Penen#an ran( ra&a# bayi bar lair a&a# (abn( %9

an( #ransisi neona#s N9

Neona#al in#ensive ;are ni# NI579

an( isolasi 1 an( isolasi 2

Bayi normal s#abil ib bole % Bayi resi,o renda : a#erm BB 2-00( ,e; I"+9 K+K d( BB 2000( A? ! #d, ada ,ln ,on(eni#al bera# Bayi normal ib belm bole % Bayi resi,o renda Bayi y( mendaa# fo#o#erai Bayi d( fra,#r Bayi resi,o #in((i @ sedan( Prema#r K+K bera# M2000( I"+ %an((an ernafasan  ,elainan me#aboli, io5a io(li,emia io>ierNa ,e=an( anemia dsb9 ,elainan ;on(eni#al bera# ra @ os# o =,an ? lain #ana #anda infe,si Bayi d( er,iraan infe,si>,on#aminasi lair d,n9 Bayi y( sd =elas ada infe,si ra&a# lan( =,an ? lain d( #anda infe,si

46

47

Ballard J$ Pedia#ri;s 1331T41!<42)  Ballard ?;ore 9

47

48

48

49 b;en;o /$ Pedia#ri;s 1366T)!:40)

49

50

50

51 ia 6eonato"' Asfi,sia H io,sia ro(resif enimbnan 5/2>ier,anea dan asidosis resira#ori,>me#aboli,9 Asfi,sia neona#orm H ,ondisi BB #d, d# bernafas s;r son#an ade,a# dan #era#r Kondisi Ib Kondisi 7B Kondisi Pla;en#a Kondisi ali Psa#

.io,sia a,# : seda#if anes#esia .io,sia ,ronis : anemia y =an#n(>ar ,ronis .io#ensi ?*5 PE vasoresor P+ 7#erine Blood lo& m( 10 ± -0 ;;>m# m( )0 ;;>m#9 Ke;il infar, abr#io la;en#a revia les eri#oblas#osis foe#alis

± 130

Prolass lili#an era# menmbn( vaso,ons#ri,si

E? anal(esia anes#esia rama o#a, : I5. erniasi Asirasi me,onem Kondisi Kln ;on(eni#al : ernia diafra(ma#i,a a#resia ;oane Bayi obs#r,si sal nafas io(enesia> iolasia ar fnnel ;es# Pnemonia ;on(eni#al ersis#en#  #o  sn# myas#enia (ravis KC : PP.N +P. edema ar nemo#oraC o, ressi#asi9 infe,si o, #inda,an #d, s#eril9 ierbilirbinemia obs#r,si ss fn(sional io(li,emia s#ress l;er NE5 anria>oli(ria AN ?IA". .IE 5P> + I5.  #=d is,emia eriven#ri,el  oren;eali  edema ;erebri  ((n #iro;al;i#onin release  io 5a  ,e=an( s>d ,oma Z indi,asi 7?% ,eala serial 1<)<6 bln9 Gangg'an Pe"na%a#an %a&a# nafas neona#s  ,elainan sal nafas : < "? NB +A? a#ele,#asis serin(9 < nemonia +P. air lea,s iolasi ar ,d(9 < a#resia ,oane #mor ar =aran(9 ,elainan di lar ar : < =an#n( de,om ;ordis ,el ba&aan P*59

51

52 < me#aboli, asidosis io(li,emi ier#ermi9 < sir,lasi syo, olisi#emia9 < ??P I5. dema o#a,9 a,#or resi,o : K+K  . lmonal ersis#en B+K I"+9  "? Prema#r  ane "? Barrel ;es#  ernia diafra(ma#i,a +A? nemonia .P Bell saed ;es#  "? iolasia ar Poliidramnion  a#resia esofa(s E ernia diafra(ma#i,a /li(oidramnion  iolasia ar a(enesis (in=al

"" e#iolo(i (an((an ernafasan ada neona#s "C

+asa (es#a si

%C

5F

e#i,lo(ranler a##ern air Asfi,sia in#ra bron;o(ram bram ar#m sianosis I re#i;lo(ranlar "? H .+" Prema#r sesa, #a,ine a##ern re#ra,si merin#i II air bron;o(ram III b#s =an#n(<ar ,abr I* &i#e ln( Ber;a, infil#rasi ,asar A#erm +e;oneal s#ainin( ieraerasi sr( #d +A? ((n nafas s#l minm enmo#oraC> Pos#da#e nemomedias#inm d, sesifi, os# Bron;ovas,lar =elas NB

A#erm

+P.

A#erm

Pnemonia

s; ar#s ils rominen re;ii#a#s erieral s#rea;,in( #a,ine bera# self ieraerasi rin(an limi#in( 2<) r Kelar dara dari #ra;ea K7 =ele, : Ber;a, s(# ,asar s>d K+K asfi,sia bera# #i io#ermia olisi#emia sesis %C (a&a# nafas d( Ber;a, ,asar

52

53 (C infe,si io#ermi i,#ers ib febris ar#s lama KP" ,e#ban me,oneal ri&aya# asfi,sia rema#r la,i a(enesis ar Kelainan ??P

Abdomen s,afoid

Ada (brn ss dlm #ora,s

Per,si #imani Ada (brn dara di lar #ransilminasi G ar abd dis#ended ?ianosis  =, menan(is serin( Pembesaran =an#n( diser#ai bisin( K+K oli(oamnion idros foe#alis anemia sindr Po##er K+K asfi,sia #rama oba#an lair oba#<  #o  sn# sianosis ersis#en d( #C /2 %EA io#ermia I"+ ?yo, o, berba(ai ;e, .b>P*5 sebab

Kelainan =an#n( %an((an me#aboli, %an((an sir,lasi

Evalasi (a&a# naas d( "o&n s,or : re,

0 M60>i

5yanosis e#ra,si

ne(a#if ne(a#if

+erin#i

ne(a#if

Air en#ry

=elas

Nilai : M 4



60<80>i

1

d( dara ,amar rin(an #erden(ar d( s#e#os,o lema>#erlamba#

#ida, ada (a&a# naas

53

2 80>i d( eisodi; ane d( /2 40O sedan(
54 4
0 sin,ron d( dada

ari,an dada ba&a ari,an Cioid Naas ;in( idn(

ba&a < < <

+erin#i

1 #er#in((al d insirasi G G G #erden(ar d( s#e#os,o

<

2 dada a#as @ ba& berla&anan GG GG GG #erden(ar #ana s#e#os,o

Nilai : 2<4  (a&a# naas sedan( 8<10  (a&a# naas bera# ollo&  #(# e#ra;#ion s,or ?,or 1 2 ) 4

?aranafas .anya #erden(ar &,# insirasi dalam erden(ar say &,# nafas biasa erden(ar =elas &,# nafas biasa ?ara nafas bron;ial>eriel

Krei#asi .anya #erden(ar &,# insirasi dalam erden(ar di bbr lo,asi &,# insirasi erden(ar =elas d #ia insirasi

Nilai : !<10  #ia  =am 4fe#o
54

55 .yeroCi; #es# : /2 100O 1 lm 10 mn#  ?a/2 M 30O H PJB sianosis "" : PP.N  sianosis dis#res naas #a,ine re#ra,si merin#i9 d 6<12 = G me;onim s#ainin(>asfi,sia>ma#ernal N?AI" #rimes#er III C : olaRolin 0-<1 m(>,( bols elan  2<4 m(>,(>=am dri "oamin 10 µ(>,(>m# dri ± "ob#amin -<8 µ(>,(>m# dri

E%i#ode A%ne' Eisode ane H ane  20 d# diser#ai bradi,ardia . M 100>m#9 sianosis ?erin( d rema#r  anea of remar#ri#y>idioa#i; anea o, ima#ri#as ar M )! m( BB M 1000 ( #=d s#l =am ,e<1 s>d r ,e<2 a#a mr  ! r9

/ba# eofilin Aminofilin

"osisa&al 2-<6 m(>,( o 4,( iv

"osislan=#an 2<6 m(>,( o 2<4C>r ),( iv 2<4C>r

-<6 m(>,( iv

2-<8 m(>,( iv 2<4C>r 4<8 m(>,( re;#al 2<4C>r Kafein 2- m(>,( iv>o 10 m(>,( iv>o 2<4 C>r Kafein si#ra# -<10 m(>,( iv>o 20 m(>,( iv>o 1C>r "o,saram 0- m(>,( iv ?.AKE E? 1$ Asirasi 0- ;; ;airan re#ensi bayi rema#r M 1 =am 2$ "imas,,an dlm #abn( rea,si berisi 0- ;; P @ 1 ;; al;ool )$ abn( dile#a,,an #e(a, lrs d ra, @ dibiar,an 1- m# 4$ Pera#i,an by, (elembn( dara d erm,aan ;airan : a$ #d, ada (elembn(  ne(a#if ar ma#an( M 60O : resi,o #=d "?9 b$ 1>) erm,aan #er## (elembn(  ne(a#if ;$ 1>)<2>) erm,aan #er## (elembn(  osi#if

55

56

T45 Ca##ification ( G"o## and 8ogt) <ye I : /esoa(eal a#resia &i# no fis#la <ye II : No a#resia ;ommni;a#ion be#&een #ra;ea oesoa(s .<#ye fis#la9 <ye IIIA : /esoa(eal a#resia er se(men# ;ommni;a#in( &i# #ra;ea

<ye IIIB : /esoa(eal a#resia &i# blind er o; and lo&er se(men# ;ommni;a#in( &i# #e #ra;ea ;ommones#9 <ye III5 : /esoa(eal a#resia &i# bo# er and lo&er se(men#s ;ommni;a#in( &i# #e #ra;ea

Keb#an ;airan @ n#risi neona#s .ari 5airan 1 60ml>,(>r 2 !0ml>,(>r ) 80ml>,(>r 4 30ml>,(>r 100 ml>,(>r 6 110 ml>,(>r ! 120 ml>,(>r  10 1-0<200 ml>,(>r

Kalori 40,al>,(>r -0,al>,(>r 60,al>,(>r !0,al>,(>r 80 ,al>,(>r 30 ,al>,(>r 100 ,al>,(>r  120 ,al>(>r

56

BB -00
 0$->6= 1$0>6= 1$->6=

57 Keb#an ;airan BB Indi,asi 5ara emberian

Peroral BBs#abil Pasa 2<) =  ;oba minm er seen d( fre,ensi : BB M12-0(  24C>r BB 12-0<2000(  12C>r

Paren#eral BB?a#aBBd(,C *ia vena erifer  s( infs se# mi,ro d( s;lave no 2)<2-> veno;a# no 24



BB 2000( 8C>r .r ,e 1 60 ml>,(>r .r ,e 1 60 ml>,(>r .r ,e 2 30 ml>,(r .r ,e 2 80 ml>,(>r .r ,e ) 120 ml>,(>r .r ,e ) 100 ml>,(>r .r ,e 4 1-0 ml>,(>r .r ,e 4 120 ml>,(>r Beran(sr nai, s>d 180<200 Beran(sr nai, s>d 180<20 ml>,(>r ml>,(>r Jenis A?I is #e bes# S .r ,e 1 "10<1-O ;airan .+ en(en;eran anya .r ,e 2 "10O018N? > BB? a#a K7 =ele,  > dr(line  "-O G deC#rose -O9 Ke#eran(an J, fre,ensi minm 12C>r +o : BB *? in#a,e,(>r d# dieni d( ss 6-100;;9 Jmla ;airan

DE9IDRASI C : 1$ "efi;i# "eidrasi Bera# ?edan( in(an

Keb;airan +G1-0G2- ml>,( +G100G2- ml>,( +G-0G2- ml>,(

5araemberian 10<)0 ml>,(>2 =am sisanya 22 =am mera#a dlm 24 =am mera#a dlm 24 =am

Keb#an ;airan H main#enan;e G defi;i# G on (oin( losses 2$ +ain#enan;e .ari BB

A#erm 1 80ml>,(>r -0<60ml>,(>r 2 100 ml>,(>r 80<100 ml>,(>r ) 120 ml>,(>r 100<120 ml>,(>r 4 140 ml>,(>r 120<140 ml>,(>r )$ 5on;omi#an#>on (oin( losses : 2- ml>,(>r

57

58 Gangg'an Sa'"an Ce"na "" (an((an salran ;erna ada bayi bar lair KEAINANI?IK Per# bn;i# saa# lair Per# san(a# #e(an( +n#a
"IA%N/?I?BAN"IN% mor abdomen /bs#r,si salran ;erna ba( ba&a /bs#r,si salran ;erna ba(ian a#as ?esis en#eri#is

/bs#iasi d( diare "iare d(n dara

+alformasi anore,#al sindrom me,onem l Penya,i# .irsrn( ?esis en#ero,oli#is ne,ro#i,ans in#sssesi

AC : Aa,a bayi mn#a g a  mn#a se(era s#l minm er#ama : s#ri,#ra esoa(s ((n dia#as ailla va#eri mn#a berlan( &arna ,ei=aan @ eris#al#i, ↑ : ilori, s#enosis a#resia dodeni>ilem Aa,a bayi sda BAB dlm 24 =am er#ama g Belm  a#resia ani Ba(aimana fesesnya fre,ensi ,onsis#ensi9 g Ber,ali<,ali  ;air d( lendir : diare>%E sesis Aa,a ada dara dlm fesesnya g a  infe,si NE5 in#sssesi Aa,a bayi ;endern( le#ar(is ;o&on( #r(or #rn g %C deidrasi Ada,a air lir berlebian g a : a#resia esofa(s E J, er#anyaan #sb #er=a&ab ne(a#if  indi,asi r=,

Se%#i# 6eonato"' "C dini : oor feedin( no# doin( &ell>le#ar(i bera, i=a G lendirG ba ,as ins#able #emera#re>%"A ane ## by a#erm9 C : esi,o inf  Ami,(>r iv bid Ke# ,er>me,oneal>ib febris  Ami,(>r iv Ne#ilmisin -,(>r im )<- r #\ada erb  (an#i AB &> sesis Pnemonia  s# ,e# ,er )<- r #\ada erb  5loCa -0 m(>,(>r iv #id %en#a -,(>r im "iare  Kloramfeni,ol 2- m(>,(>r a#a 5efaleCin )0 m(>,(>r o ?esis  Ami,(>r iv

58

59 Kloramfeni,ol 2-<-0 m(>,(>r iv )<- r #\ada erb  +eronem )0<40 m(>,(>r iv a#a 5efeim 100 m(>,(>r iv 10<14 r Ami,asin 1- m(>,(>r im +enin(i#is  s# sesis )<- r #\ada erb  5ef#riaCon 200 m(>,(>r 21<28 r ab N neona#s EB* 8- ;;>,(9 " – .b 14<22 (>dl 5? – 30<34O Can#o,rom .;# 4 )<64O N>PG>Gs>d)bln9 Eri 4$2<6=#>mmh Pro# 200<220 m(>dl e#i,)dl e -000<)0000>mmh Eri 1000<2000>lb ro 1-0000<)-0000>mmh e 10<20>lb BBB blm semrna9

Hb eoat!s m( 0

BB BB BB?  2-00 ( 1-00<2-00 ( M 1-00 ( 1!8 (>dl 168 (>dl 1-6 (>dl

m( 1 m( ) m( m( 8<12

188 (>dl 1-) (>dl 148 (>dl 1-3 d>(l 1)2 (>dl 12 (>dl 12! (>dl 36 (>dl 82 (>dl 11 (>dl 10 (>dl ! (>dl

9i%ogikeia "C : A#erm  %"A M )0<40 m(>dl a#a %"A 40<60 m(>dl d( (e=ala Prema#r  %"A M 2-<)0 m(>dl s#l mr  !2 =am  %"A M 40 m(>dl I"+  ;e, %"A mr 0<)<6 =am ds# #ia 6 = s>d 2C N " ?E C : Asim#oma#i, : A?I dini>PA?I G deC#rose I*" "10O > bayi,( a#a "10<1-O 1<2 ml>,( bols  infs "1-O 4<8 m(>,(>m#  infs "10O 4<8 m(>,(>m#  oral feedin( rs ber#aa > ;e(a rebond io(li,emi9 %I H O deC# C ra#e ml>=9 C 016!9>BB ,(9 N 6<8 m(>,(>m#  10<1- m(>,(>m# Persis#en yo(ly;aemi  "10O dilan=#,an s>d 16<20 m(>,(>m# In#ra;able yo(ly;aemi !2=  .idro;or#ison - m(>,(>r iv>im bid9 a#a Prednison 2 m(>,(>r o

59

60

9i%e"&ii"'&ineia

7mr =am9 24M 24<48 48
o#al serm bilirbin m(>dl9 /bs o#o#C E GE GGG ≥ 12 ≥ 1≥ 20 ≥ 2≥ 1≥ 18 ≥ 2≥ )0 ≥ 1! ≥ 20 ≥ 2≥ )0

!eang Ke=an( d bayi  sb#le samar9 #oni, lo,al @ (eneral9 ,loni, lo,al @ ml#ifo,al9 mio,loni, fo,al ml#ifo,al (eneral9 E#io : < ?aa# lair : ,rn oba# d bayi @ ib #ms, Ra# anes#e#i,9 < .r 1 : ,ln me#aboli, io(li,emi io,alsemi iona#remi9 < .r 2<) : I5. dr( &i#dra&al menin(i#is .IE < .r  - : io,alsemi infe,si>sesis Kern i,#ers ,ln er#mba < .r  ! : me#adon &i#dra&al C : < enobarbi#al loadin( dose 10<20 m(>,( iv - m#  d# dilan( 2C selan( )0 m#9  s#l 12 = : rma#an )<- m(>,(>r bid eni#oin loadin( dose 1-<20 m(>,( iv )0 m#  s#l 12 = : rma#an 4<8 m(>,(>r bid < "10O 2 ml>,( iv bols aa elan < 5a (l; 10O 2 ml>,( iv bols aa elan < Pirido,sin -0 m( iv

T etan'# 6eonato"' C : < "iaReam 0- m(>,( sosi#oria>im>iv  bila masi ,e=an(  enobarbi#al )0 m( im>iv dosis maC 120 m(>r9  rma#an : "iaReam 8<10 m(>,(>r iv m a#a 0- ml>,(>C bols #ia ) =am dosis ma,s 40 m(>,(>r9 < A? -000 7I im G I%. -00 7I im G  0- ml im < PP 100000 I7>,(>r im slm 10 ari BA:I DARI IBU 9EPATITIS B

60

61 "C : .BsA( mr 0<1<2 bln @ I(+ an#i .B; mr )<4 bln C : *a,sin .e B 0- ml im M12=9 G .BI% 200 7 im M24=9

BA:I DARI IBU TBC "C : 5F @ +#C mr 0<1<4<6 bln B5% #nda s>d 2 m( s#l #C IN. selesai9 C : rofila,sis IN. - m(>,(>r o slm 6 bln 8 m(  evalasi9 BA:I DARI IBU .ALARIA "C : i,#ers ea#oslenome(ali anemia demam malas minnm mn#a (C #imbl 14 = s>d 8 m( s#l lair9 ." #ia 2 m( slm 8 m( C : Kloro,in basa 10 m(>,( o  - m(>,(>C qid

BA:I DARI IBU SI5ILIS "C : edema ram ,li# le #elaa, #an(an>,a,i ,ondiloma ans rini#is idros fe#alis ea#oslenome(ali observasi slm 4 m(9 C : PP -0000 I7>,( im 1C

BA:I DARI IBU 9I8 (BI9A) Penlaran ver#i,al 14<40O  (C AI"? mr 1 # 2)O mr 4 # 40O %C : BB inf sal nafas berlan( P5P sesis moniliasis 7/ ea#oslenome(ali ensefaloa#i "C : "  ?el  5"4 M 2-00<)-00>ml P5 .I* "NA mr M 48= – 14 r < 1<2<)<6<12<18 bln  =, G ,onfirmasi d( P5 .I* NA ≥ 100000>ml9 I(% an#i .I* mr 18 bln EI?A
I(+>I(A an#i .I* C : < P+5 : +P 4 m(>,(>r s=, mr 4<6 m( s>d s#a#s</IP P5P9 IN. - m(>,(>r selama 6 blan =, ,on#a, B G /IP B9 < idvdin 2 m(>,(>C qid 6 m( > Nevirain 2 m(>,( o M12=9 KI : A?I imnisasi B5%

Kemorofila,sis bayi :  7n#, sema bayi lair dari ib .I* G9  "* mlai ari er#ama mr 12 =am9 selama 6 m((

61

62 N*P 1C dalam masa 48,(BB>C 4C>  Bayi rema#r M)4 m((9: 1- m(>,(BB 2C>ari selama 2 min(( ,emdian 2 m(>,(BB )C>ari "osis nevirain  2 m(>,(BB bila ib #ida, mendaa# A* 

Jad&al imnisasi C ana, den(an .I* menr# ./ 2001 *a,sin

B5% "P P/I/ +EA?E? .EPAII?B e#ans oCoid

Infe,si .I* Asim#om a#i, a a a a a a

Infe,si .I* ?im#oma#i,

ida, a ida, a a a

Jad&al imnisasi

air 61014 min(( 061014min(( 6 dan3 blan

?#adim .I* Ana, ./9 1$?#adim 1

• • •

2$?#adim 2  Infe,si salran naas a#as ,ronis a#a ,amb o#i#is media o#orea sinsi#is  2 eisode dalam 6 bln9     

ruritic papular eruption Herpes zoster  1 eisode dalam 6 blan9

7l,s oral re,rens  2 eisode dlm 6 bln9 !ineal gingiva erythema %E9 Keili#is an(laris

62

63



Pembesaran aro#is "erma#i#is seboroi,a



"nfe#si Human papilomavirus yan( las a#a infe,si



mols,m -O #b9 Infe,si =amr ,,



)$?#adim )  +aln#risi sedan( #ana e#iolo(i =elas yan( #ida, membai, den(an #erai s#andar  "iare ersis#en #ana e#iolo(i yan( =elas 14 ari9  "emam #ana e#iolo(i =elas in#ermi#en a#a ,ons#an 1bl9  Kandidiasis oral di lar masa neona#s9  $ral hairy leu#opla#ia /.9  B5 ar  "(aan nemonia ba,#eri ,amban bera# 2 eisode>6 bl9  

Necrotizing ulcerative gingivitis/peridontitis a,#



"(aan infe,si ba,#eri berlan( yan( bera# 2 eisode dalam 1 #an mis: emiema iomiosi#is infe,si #lan( a#a sendi a#a menin(i#is selain nemonia9 Infe,si .eres simle,s orolabial a#a ,li# y( ,ronis lamanya 1 blan9 B e,s#ra ar ?ar,oma Kaosi

Pnemoni#is limfoid in#ers#i#ialis IP9  Anemia M8 (>d9 ne#roenia M1$000>mm)9 a#a #rombosi#oenia M)0$000>mm)9 1 blan  Penya,i# ar #er,ai# .I* ,ronis #ermas, bron,ie,#asis  Kardiomioa#i a#a nefroa#i #er,ai# .I* 4$?#adim 4  +aln#risi bera# a#a wasting bera# #ana e#iolo(i =elas yan( #ida, membai, den(an #erai s#andar  Pnemonia nemosis#is

  

63

64    

        

Kandidiasis esofa(eal o,solasmosis ??P Ensefaloa#i .I* Infe,si 5+* re#ini#is a#a infe,si or(an lain selain a#ilima a#a ,el$ limfe den(an onse# d mr  1 blan9 +enin(i#is 5ry#o;o;;s a#a enya,i# e,s#ra ar lain9 ?e#ia mi,osis endemis disemina#a .is#olasma Ko,sidioidomi,osis a#a Penisiliosis e,s#ra ar9 Kri#osoridiosis Isosoriasis Infe,si +i,oba,#eria non<B disemina#a Kandidiasis #ra,ea bron,s a#a ar is#la re,#o
=an A* " +en(ran(i morbidi#as dan mor#ali#as ,arena .I* " +emerbai,i dan memeliara fn(si imn " +ene,an reli,asi virs selama mn(,in " +eminimal,an #o,sisi#as ,arena oba# " +emba# er#mban fisi, dan er,emban(an nero,o(ni#if normal " +emerbai,i ,ali#as id Indi,asi A* ?#adim 4 ./ ?#adim )

?#adim 2 ?#adim 1

: ?ema diberi A* 3 7mr M 1 #an sema diberi A* 7mr  1 #an dioba#i sema ,e;ali y( #er,ena B5 IP #romboenia dan /ral .airy e,ola,ia menr# asil 5"4 3 Ber(an#n( nilai 5"4 a#a 59 3 Tida, diberi A* ,e;ali bila 5"4 san(a# renda

e(imen A* lini er#ama ./ 2 NI ls 1 NNI:A II9L

64

65 A idovdine9G )5amivdin9 G N*Pneviraine9> E*EfavirenR9 # d4?#avdin9 G )5 G N*P>E* # AB5Aba;avir9 G )5 G N*P> E* e,omendasi ./>7NAI"? n#, men;e(a P5P Pnemo;ys#i; 5arinii Pnemonia9: # Ko#rimo,saRol 4<- m(>,(BB>ari sa# ari se,ali # mlai sia 6 min(( – 6 blan #

6ec"oti;ing Ente"ocoiti# ( Be# Staging )

65

66

ALERGI I.U64L4GI De"atiti# Ato%ik %C : < lesi a,#  ala
Kri#eria .anifin @ a=,a : Kri#eria mayor Bayi Kri#eria minor

Kri#eria mayor

Ana, Kri#eria minor

PK : "A "erma#i#is (a#al "erma#i#is #yi;al fa;ial> e,Rema#os eC#ensor> derma#i#is li,enifi,asi Ferosis> i,#iosis> yerlinear alms Perifoli,lar a;;en#a#ion 5roni; s;al s;alin( Periari;lar fissres Prri#s +orfolo(i @ dis#ribsi #yi;al esi y( meliba#,an m,a @ e,s#ensor slm bayi leCral li;enifi;a#ion @ lineari#y by adoles;ens "erma#i#is ,roni,>,amban Ferosis I,#iosis>almar yerlineari#y>,era#osis ilaris I(E rea;#ivi#y ↑ serm I(E A? ri;, #es# G9 .and>foo# derma#i#is ;eili#is "erma#i#is ,li# ,eala ;radle ;a9 Pe,a #d infe,si ,li# ? ares .?*9 Perifolli;lar a;;en#a#ion

66

67 "C : Bayi  2 ,ri#eria mayor a#a 1 ,ri#eria mayor G 1 ,ri#eria minor Ana,  ) ,ri#eria Kri#eria a=,a dan an(eland : Bayi : M 18O l# 1 18<-4O l# 2  -4O l# ) as lesi ,li# Ana, : M 3O l# 1 3<)6O l# 2  )6O l# ) emisi  ) bln># 1 Per=alanan emisi M ) bln># 2 enya,i# Kamban ) %a#al rin(an ((n #idr 1 In#ensi#as G 2 enya,i# %a#al sedan( ((n #idr G ) %a#al bera# ((n #idr G ?,or )<4 : rin(an -
⋅ .idrasi  mandi 1-<20 m# 2C>r d( sabn la;#i; a;id &a#erC s; 1C>r slm 6 m( > )C>m( slm 12 m( < IN s; 12 γ -0<100Aµ(>m>r < ?i,losorin - m(>,(>r om( slm 6 m( a#a (el -O e < a;rolims 01 O @ 00) O e 2dd a#a ime;rolims 1O < I*I% 04 (>,(>r ) r  an#i#o,sin an#iinflamasi an#ialer(i < Probio#i, %% 2C1 sa;e# slm 2 bln

Ae"gi .akanan Aler(i ma,anan ≠ in#oleransi ma,anan rC #o,si, me#aboli, indiosin,rasi9

67

68 %C : r#i,aria an(ionero#i, dem ;a# mn#a diare e,sema asma "C : "oble Blind Pla;ebo 5on#rolled ood 5allen(e  /en 5allen(e eliminasi @ rovo,asi #erb,a9 7=i ,li# ri;, #es#9 "iff ;on# : eosinofil  -O le,osi# -000>ml d( ne#roeni M )O 

I(E sesifi, @ #o#al  )0 7>ml a#oi inf arasi# deresi imn seller C : < An=ran > bayi d( ri&aya# a#oi : Pemberian A?I e,s,lsif s>d 6 bln Eliminasi ss sai s>d 12 bln Eliminasi #elr s>d 18<24 bln Eliminasi ,a;an(<,a;an(an @ i,an s>d ) #

"ie# aler(i : • Elimina#ion die#  B?IK Bis;o  mil, e(( soya ean#9 • +inimal die# 1 +odified o&e\s 19  air beras

• • •

da(in( sai ,elaa ,edelai bayam &or#el ba&an( (la (aram ss formla ,edelai +inimal die# 2 +odified o&e\s 29  air ,en#an( da(in( ,ambin( ,a;an( mera bn;is ,obis ba&an( formla idrolisa# ,asein E(( @ fis free die#  d C d( ,elan #ama r#i,aria an(ionero#i, dem e,sema .is o&n die# DIET ALERGI

• ?elama ) min(( indari ma,anan an#an(an #ermas, ma,anan den(an e&arna @ en(a&e# misalnya : 5i,i 5i#os dsb9

• ?e#ela beran#an( ) min(( @ (e=ala aler(i ilan(  se#ia min(( • •

daa# men;oba 1 =enis ma,anan an#an(an misalnya : ss sai9 diberi,an se#ia ari sedi,i#
68

69 ?ema ba #ms, bn ma,anan y( men(andn( ba misalnya : < sayr asam ra&on sayr nan(,a (de(9 sayr lab < saos #oma# sambal san#an < ;o,la# emin( ermen ?s sai @ bn ma,anan y( men(andn( ss sai : bis;i# ,e= es ,rim ,e ermen

?ema sayr dari dan ;asein : Nan .A N#rilon .A Enfamil .A Pe#i Jnior ?s formla ,edelai : N#rilon ?oya Nrsoy Prosobee a #eme @ rod,nya Ke y( #d, men(andn( ss sai @ #elr : ,e man(,o, ,e lais ,e bi,an(

elr ayam>bebe,>brn( @ da(in( ayam>bebe,>brn( #ms, bn ma,anan y( men(andn( #elr : ba,mi indomie ro#i ,e I,an air la# @ #a&ar dan( ,ei#in( "a(in( sai>,ambin( bole ,eran( dsb #ms, bn ma,anan y( di(oren(>disa#e d( bmb men(andn( i,an> dan( : e#is ,e;a #erasi ,r, Ka;an( #ana @ ,a;an( i=a #ms, Kedelai bn;is ,a;an( ,e;amba @ bn ma,anan y( an=an( ,a;an( mera men(andn( ,a;an( #ana>i=a : +ie dr beras bin9 n,&e s\n bmb e;el>(ado

I II III I* * *I

0$1ml *III 0$1-ml IF 0$22ml F 0$)2ml FI 0$48ml FII 0$!2ml FIII

*II 1$0ml FI*

7ADUAL I.U64TERAPI 0$1ml F* 0$1ml FFII 0$1ml FFIF 0$1ml 0$1-ml F*I 0$1ml FFIII 0$1ml FFF 0$1ml 0$22ml F*II 0$1ml FFI* 0$1ml FFFI 0$1ml 0$)2ml F*III 0$1ml FF* 0$1ml FFFII 0$1ml 0$48ml FIF 0$1ml FF*I 0$1ml FFFIII 0$1ml 0$!2ml FF 0$1ml FF*II 0$1ml FFI* 0$1ml

1$0ml

FFI

0$1ml

FF*III

0$1ml

FFF* 0$1ml

Riniti# Ae"gi ini#is aler(i

 msiman seasonal aller(i; rini#is9 sean=an( #an erenial aller(i; rini#is9 a,iba# ,er=a o;;a#ional aller(i; rini#is9 %C : ile, #ana I?PA idn( (a#al>bn# bersin malo,lsi (i(i aller(i; (ae ml# selal #erb,a a(ar bisa bernafas9aller(i; siners ,li# ,eloa, ma#a ,ei#aman9 edema ,on=n(#iva ma#a

69

70 (a#al @ ,emeraan #ransverse nasal ;rease lia#an #ranversal d idn(9 se,re# idn( =erni m,osa edema basa @ ,ebir
An#iis#amin : "ifenidramin 0- m(>,(>C #id 5+ 003 m(>,(>C #id Kromolin -2 m(>ff #id ?e#iriRin mr 2<- # : 2- m(>dosis mr  6 # : -<10 m(>dosis ora#adin mr 2–- # : 2- m(>dosis mr  6 # : 10 m(>dosis e,sofenadin mr 6<11 # : )0 m(>r bid mr  12 # : 60<180 m(>r bid>qid ARelas#ine mr -–11 # : 1 ff bid mr  12 # : 2 ff bid Psedoefedrin mr 2<6 # : 1- m(>r qid mr 6<12 # : )0 m(>r qid mr  12 # : 60 m(>r qid Ira#roim bromide 0$0)O 2 ff bid>#id Kor#i,os#eroid in#ranasal : l#i;asone  mr  4 # : 1<2 ff +ome#asone mr )<11 # : 1 ff mr  11 # : 2 ff Bdesonide mr  6 # : 1<2 ff e,o#rien an#a(onis : afirl,as# 20 m(>C bid

70

71

71

72

9E.AT4-46!4L4GI

Kadar .b normal 1<)r 1!$1m( 18$2m( 16$1bln 14$0

2<6bln 11$6<24bln 12$0 2<6# 12$6<12# 1)$-

.b neona#s BB  2-00 ( m( 0 1!8 (>dl m( 1 188 (>dl m( ) 1-3 d>(l m( - 12! (>dl m( 8<12 11 (>dl

BB BB? 1-00<2-00 ( M 1-00 ( 168 (>dl 1-6 (>dl 1-) (>dl 148 (>dl 1)2 (>dl 12 (>dl 36 (>dl 82 (>dl 10 (>dl ! (>dl

"5 : Eo>Ba>?#>?(>y>+o : 1<4>0<1>2<->)6<66>22<40>4<8 e,osi#osis ba,#eri9  e,oeni virs9 I ra#io H ?#>?#G?(9  sesis =, 20O AN5 H ?#G?(9Ce,osi#>100  sesis =, M1-00 a#a 8000

Aneia Anemia H enrnan volme B5

7mr 6<2) bln 10).b (>dl )1.# O 24<-3 bln 106 (>dl )2 O 60<8) bln 110 (>dl )) O .ar(a normal ,adar .b :  10 (>dl mr 6<24 bln  11 (>dl mr 2<- #  12 (>dl mr -<12 # Anemia  ./ : M 6 # .b M 11 (O  6 # .b M 12 (O

72

73 IndeC eri#rosi# +5* 80<36 fl P5*>Eri C 109 +5. 2!<)1 ( .b>Eri C 109 +5.5 )2<)6 (>dl .b>P5* C 1009 Σ absol# re#i,losi# ≈ 1<1-O Σ B5  men;ermin,an a,#ifi#as sis#em Eri#rooi#i, s#l s( d# di(na,an > menen#,an anemia def e a#a emoli#i, dan > memer,ira,an reson #d en(oba#an Eri#rosi#osis  B5 mass ↑

73

74 U#ia

5ord Bloo d 2&, ) mo 6 mo< 6 yo !<12 yo

9&(g*dL)

9eatok"it (<)

Reti c'o #it(< ) .ea n

.C 8(I L)

Le'ko#it (WBC*= )

Lo we #t

.ea n

110

1800 0

Ra ng e( >? 11 1) 3< )0

-< 21 6< 18 6< 1-

.

Range

.

"ange

16 8

1)$!< 201

--

4-<6-

-

16 12

1)<20

-0

42<66

1

)6

)1<41

1

12

3-< 1410-<14

)!

))<42

1

!0< !4

1200 0 1200 0 1000 0

1)

11<16

)8

)4<40

1

!6< 80

8000

4< 1) -

14

12<16

42

)!<4!

16

80<

!-00

-< 10

16

14<18

4!

42<-2

Adl # em ale +ale

$ Nelson eC#boo, of Pedia#ri;s$ 1!#

80

75 smo,er\s eri#rosi#osis emo(loblinoa#i d( i(IB5  Anemia defisiensi e ?I ↓ IB5 ↑ feri#in ↓9 Anemia o, infe,si ,roni, ?I ↓ IB5 ↓9 Anemia #alasemia morf ?"+ ele,#roforesis .b .bA2edi(ree9 Anemia emo(lobinoa#i 2$ Anemia ma,rosi#er +5* ↑ +5. ↑ +5.5 N9  Anemia ernisiosa : ;on(eni#al vi# B12 malabsorbsi Anemia me(aloblas#i, Anemia o, malabsor#ion syndrome y a#i (as#re,#omi Anemia defisiensi B 12 vi# 5 Anemia o, E?/ an#i ,onvlsi an#i asam fola# me#aboli# )$ Anemia normo,romi, normosi#er +5* N +5. ↓ +5.5 ↓9 ;e, re#i,  Anemia o, erdaraan Anemia emoli#i, : def %6P" AI.A PN. re#i, ↑ ?I ↑ IB5 N>↓9 Anemia (iRi br, Anemia d ,e(anasan re#i, ↓ le ↑ #ro ↓ or(anome(ali9 Anemia o, ,e(a(alan s#l : anemia alas#i, re#i, ↓9 Anemia o, ,ln endo,rin : io#iroid Anemia d( slenome(ali

T$aa##eia Bdsr bera#nya (C dibeda,an : < alasemia mayor – m#la, memb#,an #ransfsi < alasemia in#ermedia – #d, selal rs #ransfsi < alasemia minor – #d, erl en(oba#an "C : slenome(ali fa;ies monoloid .b ↓ 2<) (O e#i, ↑ ." io,romi, mi,rosi#er

75

76 Pem ele,#roforesis @ ,olom,roma#o(rafi : .bA2 .bE C : < ransfsi anya =, .b M 8 (>dl =, .b M 4 indi,asi +? : rle )<4<-9 diberi,an P5 ) ml>,( ↑ .b 1 (>dl9 s>d .b  10 (>dl =, aler(i E9 < "esferioCamine 2-<-0 m(>,( m 8–12 =am iv>s; -–6 r dlm 1 m( < *i# 5 100<2-0 m(>r  ↑ efe, ,elasi e9 < *i# E 200<400 I7>r < *i# B12 @ B6 1 #ab>r < Asam fola# 2<- m(>r < Ami#ri#ilin 01 m(>,(>r < ?lene,#omi a>i ierslenisme

Aneia Defi#ien#i Be#i .b +5* " EP IB5 erri#in

AKB

al

↓ ↓

↓ ↓

↑ ↑ ↓

N N N N

Inf

↓ N N

↑ ↑ N>↑

Klasifi,asi AKB : 1$ Iron sffi;ien;y 2$ Iron defi;ien;y  ;ad besiM ferri#in ↓9

76

77 )$ Iron defi;ien# ery#rooiesisB5 abN +5* ↓ " ↑ EP ↑9 4$ Iron defi;ien;y anemia  anemia .b ↓9 < "# #=d o, : • Keb#an ↑ < masa er#mban ;ea# aid fisiolo(is9 • In#a,e M < die# renda e malabsorbsi e sre (as#re,#omi9 • e loss – erdaraan sal ;erna>sal ,emi ;a;in(an an,ylosis9 erdaraan lain eis#a,sis l,s dsb9 • Jaran( d bayi M 6 bln o, deo e dari ib9 ,e; d rema#re (emelli ib C AKB "C : .b ↓ inde,s eri#rosi# +5* +5. +5.59 ↓ ." io,romi, mi,rosi#er re#i, ↓ ? I ↓ IB5 ↑ feri#in ↓  EP ↑ B+A a,#ifi#as eri#rooi#i, ↑ C : < "ie# oba# ;a;in( #C emoroid < ?lfas feross 4<6 m(>,(>r #id d; 2<) bln a#a feros fmara#  6<24 bln : )0 m(>r 2- ;;9 2<- # : 4- m(>r !- ;;9 -<10 # : 60 m(>r 12- ;;9  10 # : !- m(>r 1!- ;;9 < *i# 5 100 m(>1- m( e < "ie# seimban(

Aneia ok Infek#i !"onik @ !egana#an < Pem me#abolisme e : ioferemia serm #ransferin ↓ sa#rasi ?I ↓ sideroblas# s#l N>↑ < Pa#o(enesis blm =elas : monosi# @ ma,rofa( memrod,si in#erle,in<1 y( memblo,ade eleasan e ole =ar E? ,e s#l s( #=d ioferemia

Aneia .egao&a#tik C : < Asam fola# - m(>r < *i#amin 5 200 m(>r < *i#amin B12 < J, (a(al  asam fola# 1-–)0 ( im )–- C>m( s>d .b normal

Aneia A%a#tik "C : Pansi#oenia #ana ea#oslenome(ali Kri#eria anemia alas#i, yan( bera#  (ranlosi# M -00>mm) #rombosi# M 20$000>mm re#i,losi# M 10O

77

)

78 s#l ioseller M

2-O

P : < "efe, sel ind, ema#ooe#i, < "efe, lin(,n(an mi,ro smsm #lan( < Proses imnolo(i C : < ransfsi P5>B>5 a>i < ?#eriod anaboli, • #es#os#eron roiona# 1–2 m(>,(>r sl

• #es#os#eron enan#a# 4,(>m( im • o,sime#olon )<- m(>,(>r o • nandrolon de,anoa# 1<2 m(>,(>m( im 8<12 m( < Kor#i,os#eroid  rednison 2 m(>,(>r 4<6m( ↓ fra(ili#as ,ailer9 < %+5? d ,eadaan (a&a#>infe,si bera# mema; eri#rooesis9

< ranslan#asi s#l Aneia 9eoitik !ongenita C : < ransfsi P5 a>i < .ilan(,an>indari en;e#s ,a;an( ,ara infe,si oba# d def %6P" s #erlal din(in d cold paro%ysmal hemoglobinuria 9 < ?lene,#omi a>i ierslenisme

Aneia 9eoitik A'toi'n C : < .indari en;e#s emolisis < ransfsi E a>i < Prednison 2 m(>,(>r s>d .b normal  #a off < ?lene,#omi =, rednison (a(al Imran imnosresif9 =, slene,#omi (a(al

T"an#f'#i Da"a$ ransfsi dara H emindaan dara donor ,e dlm sir,lasi resiien sb( aya en(oba#an ransfsi dara mr #C y( alin( berbaaya s( : #d, erl diberi,an =, #d, #era,sa a>I dC y( #ea# > men(ran(i resi,o imnisasi sebai,nya anya diberi,an ,omonen dara y( ilan( B anya di(na,an sb( #ransfsi en((an#i iovolemia9 a#a eC;an(e #ransfsion

78

79 Jenis ,omonen dara : < ole Blood < Pa;,ed ed 5ells < ased ed 5ells < ed Blood 5ells e;o;y#e ed;ed < roRen<#a&ed
5

5

5

Plasma

Indi,asi Perdaraan rofs  2-O EB* PC ;i#o oerasi d( .b M 8 m(>dl Anemia ,roni, %%K erdaraan ,roni,9 Anemia Alas#i, e,emia allasemia Anemia emoli#i, o, roses imnolo(i9 alassemia PC y( sblnya ada rC #ransfsi non emoli#i, PC y( memb#,an #ransfsi berlan( PC d( an#ibodi ro#ein lasma .emo(lobinria no,#rnal aro,sismal Perdaraan o, #rombosi#oenia M 20000 mm9 Perdaraan o, #rombosi#oa#ia (lanRmann #rombas#enia disro#einemia remia E? Asirin9 e,emia Anemia Alas#i, "emam Berdara "en(e Ne#roenia bera# (ranlosi# M 200 >l9 ebris #in((i >sesis y( (a(al d( an#ibio#i,a ade,a#  48 =am (ranlosi# M -00 >l9 Neona#s M 2 m( d( sesis (ranlosi# M )000 >l9 Anemia Alas#i, d( le,osi# M 2000>ml Penya,i# ,e(anasan lainnya C syo, iovolemia sbl dr #ersedia9 +emerbai,i vol sir,lasi dr lasma lea,a(e d "B"9

79

80 +en((an#i ro# lasma y( ilan( d l,a ba,ar las9 +en((an#i>menamba Σ fa,#or ### y( ilan( mis : fa,# embe,an s#abil : fibrino(en>albmin>(loblinl9 Kore,si def imno(loblin eredi#er C overdosis an#i,oa(lan oral Perdaraan o, def fa;#or embe,an y( belm =elas mis : sirosis d( ema#emesis melena9 ransfsi #,ar "ef an#i#rombin III .aemoilia "ef ro#rombin ,omle,s Imnodefisiensi "ef fa,#or * Pro#ein loos en#eroa#i d bayi .aemoilia A def fa;#or *III9 *on illebrand\s disease "ef fa;#or FIII .iofibrino(enemia A;qired def fa;# *III "I5 dil#ion in massive #ransf9

P

5P

Komonen P5 5 Plasma P PP 5 5ryo

"aya a,ai 12=am =am 6

Penyimanan 2<6°5 2<6°5

2bln 12bln !2=am !2 =am 12bln se(era

4<10°5 <)0°5 20<24°5 20<24°5 <)0°5

"osis #ranfsi n#, ana, Komonen B P5 5 P 5P  *II  IF Alb I(

"osis BB C 6 C .b 1 ml>,(>=am9 BB C ) C ∆ .b 1 ml>,(>=am9 4 ni#>PB 1 ni#>1) ,b ↑ #ro ± -000>mm9 10<20 ml>,(>C 1 ml>,(>=am9 40<-0ni#>,(  20<2- ni#>,(>12 =am 20<)0 ni#>,( 80<100 ni#>,( BB C 0$8 C ∆ alb 1<) (>,(9 1<)ml>,(>C

80

81

#R,y role An (ravis9 : .b ≤ ) (>dl  ) C 2 C BB >12= .b ≤ 4 (>dl  4 C 2 C BB >12= .b ≤ - (>dl  - C 2 C BB >12= .r I 6 ;;>,(>r  r II 8 ;;>,(>r r III 10 ;;>,(>r selan( 12 =am9 Pre : rosemid 1<2 m(>,( iv



Pos#bols : 5a (l; 10O 0-<1 ml>,(>100 ;; dr aa elan

./E B//" B md( ma#eri ml#ian#i(eni, : le,osi# #rombosi# ro#ein lasma Indi,asi : 1$ Perdaraan rofs  2-O EB* EB* H 6-,(9 dlm 24 = (C : iovolemia io,sia .b M 6 (>dl Perdaraan M 2-O d# dia#asi d( emberian ;airan ## =,  )0O d# di(an#i d( ;airan ele,#roli# G P5 2$ PC ;i#o oerasi d( .b M 8 m(>dl "osis : =, #ransfsi diberi,an ber#r#<#r# dlm bbr ari  beri,an 5a (l,onas 10O 1 ;;>100 ;; dara > men;e(a in#o,si,asi ;i#ra#9 PA5KE" E" 5E? B  ;en#rif(e @ sedimen#ed  diambil seba(ian lasmanya  P5 H .;# !0<80O9 le,osi# #rombosi# lasma 1-<2- ml9 an#i,oa(lan 10< 1- ml9 =an : memerbai,i o,si(enasi =arin(an d# #er;aai =, .b  89 Indi,asi : 1$ Anemia ,roni, %%K erdaraan ,roni,9 2$ alassemia Anemia Alas#i, e,emia "osis : ma,in anemis  ma,in sedi,i# Σ dara @ ma,in lamba# Σ #e#esan ± 1 ;;>,(>=am a(ar #d, de;om9  #ar(e# .b 8<10 (>dl An (ravis  #R,y role )<4<-9 : .b ≤ ) (>dl  ) C 2 C BB >12= .b ≤ 4 (>dl  4 C 2 C BB >12= .b ≤ - (>dl  - C 2 C BB >12= Pra,#is : r I 6 ;;>,(  r II 8 ;;>,(  r III 10 ;;>,( selan( 12 =9 re : rosemid 1<2 m(>,( iv os# :5a (l; 10O 0-<1 ml>,(>100 ;;dr bols aa elan .a#i<a#i:=, #=d ↓ .b 1<2 r os# #ransf  A#o Immne .emoly#i; Anemi

81

82 Ken#n(an : < ,emn(,inan overload ;ir;la#ion minimal < rC #ransfsi o, lasma ,omonen minimal < rC #ransfsi o, an#ibodies donor minimal < E? o, volme an#i,oa(lan y( berlebian minimal < menin(,a#,an efisiensi ema,aian dara o, sisa lasma d# diba# ,omonen y( lain E" B//" 5E? E75/5E E"75E" P5  fil#rasi le,osi# @ #rombosi#  Σ le,osi# MM =an : men;e(a rC #ransfsi men(ran(i #ransmisi 5+* men;e(a sensi#isasi .A man le;o;y#e an#i(en9 @ %*." (raf# verss os# disease9 5"o;en-t$awed-degyce"oi;ed RBC B5  dia&e#,an d( (liserol  dibe,,an  di;air,an  di;;i > men(ilan(,an (liserol lasma an#i,oa(lan sisa #rombosi# @ le,osi# Indi,asi : 1$ # > C y( memerl,an #ransfsi an#i(en ma#;ed > men;e(a #erb#,nya an#ibodi bar o, an#ibodi #d eri#rosi#9 2$ PC d( rC aler(i

IA"IAE" B5 B5  diradiasi > mema#i,an limfosi# Indi,asi : C as,a #ranslan#asi smsm #l(>or(an A?.E" E" 5E? P5  di;;i )C d( N? aa > men(ilan(,an an#ibodies  5 le,osi# G #rombosi# #ana lasma rs diberi,an dlm 6 =am s diba# anya d# disiman slm 4 =am d s 4 °59 Indi,asi : emoli#i, o, roses imnolo(i9 alassemia 1$ Anemia 2$ PC y( sblnya ada rC #ransfsi non emoli#i, )$ PC y( memb#,an #ransfsi berlan( 4$ PC d( an#ibodi ro#ein lasma -$ .emo(lobinria no,#rnal aro,sismal Ken#n(an : < emben#,an an#ibodies #d le,osi#>#rombosi# diindar,an

82

d#

83 < rC I(A dr lasma donor #d an#i I(A dr lasma C d# diindar,an < sema allo an#ibodies an#i A an#i B dan ,omlemen #d, ada < ,emn(,inan enla#an .ea#i#is e; #ransfsi minimal < asilnya ;, bai, > y( sblnya ada Cr #ransfsi non emoli#i, dan C y( memb#,an #ransfsi berlan( Ker(ian : o, emba#annya mr roses #erb,a s( ,emn(,inan ,on#aminasi ba,#eri ;, besar ./+B/5E 5/N5ENAE P5  di;;i )C d( N? aa  5 H le,osi# G #rombosi# #ana lasma o, i# rs diberi,an dlm 6 =am s#l diba#9 Indi,asi : 1$ Perdaraan o, #rombosi#oenia M 20000 mm9 2$ Perdaraan o, #rombosi#oa#ia (lanRmann #rombas#enia disro#einemia remia E? Asirin9 )$ e,emia Anemia Alas#i, "emam Berdara "en(e "osis : diberi,an s>d erdaraan beren#i > B M 2C ar(a normal .a#i<a#i : alloimnisasi roses imnolo(i, y( menyebab,an refra,#er #d #ransfsi #rombosi# selan=#nya s( Σ #rombosi# #d, ber#amba9 PAEE I5. PA?+A B ;en#rif(e @ sedimen#asi  PP Indi,asi : 1$ memerbai,i volme sir,lasi dara d C iovolemia @ ioro#einemia 2$ memerbai,i def fa,#or embe,an dara .a#i<a#i : E? amir sama d( res Plasma PA?+A B y( #l disiman9  ;en#rif(e @ sedimen#asi  P5 G Plasma biasa anya md( fa,#or embe,an s#abil : fibrino(en G albmin G (loblin #ana ada y( labil9

83

84 B se(ar>disiman M 6 =am9  ;en#rif(e @ sedimen#asi  P5 G res Plasma fa,#or embe,an # ## =, disiman d s 4°5 sema fa,#or labil a,an rsa, @ m=d Plasma biasa99 Indi,asi : 1$ #C syo, iovolemia sbl dara #ersedia9 2$ memerbai,i volme sir,lasi dara #=d lasma lea,a(e d "B"9 )$ men((an#i ro#ein lasma y( ilan( d l,a ba,ar y( las9

4$ men((an#i

@ menamba Σ fa,#or ### y( ilan( mis: fa,#or embe,an s#abil : fibrino(en>albmin>(loblinl9 -$ ,ore,si def imno(loblin eredi#er 6$ #C overdosis an#i,oa(lan oral "osis : #(# ,linis d 10<1- ml>,(>r s>d 20<40 ml>,(>r .a#i<a#i : d oran( #a d# #=d de;om>overload9 Ken#n(an : < mda didaa# @ d# diberi,an #ana ,omabili#as #es# Ker(ian : resi,o #ransfsi .ea#i#is :os# #ransfsi san(a# besar << resi,o r#i,aria men((i(il febris E?. PA?+A>E?. /EN PA?+A B se(ar>disiman M 6 =am9  ;en#rif(e @ sedimen#asi  P5 G res Plasma  disiman slm 8 =am d s <)0 °5  res roRen Plasma fa,#or embe,an # ## =, disiman d s 4°5 sema fa,#or labil a,an rsa, @ m=d Plasma biasa9 Indi,asi : 1$ Perdaraan o, def fa,#or embe,an y( belm =elas mis : sirosis d( ema#emesis melena9 2$ #,ar )$ ransfsi .aemoilia 4$ "ef an#i#rombin III -$ "ef ro#rombin ,omle,s 6$ "ef fa,#or * !$ Imnodefisiensi 8$ Pro#ein loos en#eroa#i d bayi "osis : #(# ,linis d 20<40 ml>,( serin( di,ombinasi,an d( P5 s( s# B

84

85 .a#i<a#i : rC aler(i men((i(il demam overload resi,o enlaran ea#i#is %AN7/5E > E75/5E 5/N5ENAE  B  ;en#rif(e #ersl9 2$ ebris #in((i >sesis y( (a(al d( an#ibio#i,a ade,a#  48 =am (ranlosi# M -00 >l9 )$ Neona#s M 2 m( d( sesis (ranlosi# M )000 >l9 4$ Anemia Alas#i, d( le,osi# M 2000>ml -$ Penya,i# ,e(anansan lainnya Efe, emberian #ransfsi : ↓ s #b 1<) =am os# #ransfsi

5/PE5IPIAE > A. 5/N5ENAE res Plasma>PP ;en#rif(e @ di;air,an d #em 4 °5  serna#an )0<40 ml9  5ryore;ii#a#e 1-<20 ;;9 H fa;#or *III; -0
85

86 -$ "ef fa;#or FIII "osis : #(# ,linis 40<-0 ni#>,(  20<2- ni#>,( se#ia 12 =am AN7?I P" NE/NA7? Neona#s d# ,eilan(an dara o, : < Perdaraan fe#oma#ernal>fe#ola;en#al < Perdaraan a,iba# amniosin#esis < e#ofe#al #ransfsi d (emelli < Penyli# #ali sa# < Par#s sli# < .emolisis Anemia d neona#s d( .b M 1) (>dl d neona#s bermr M ! ari =(a memb#,an #ransfsi dara rs dila,,an san(a# a#i<a#i o, ba#as ,eamanan semi#9 Keb sedimen#ed B : .b>.b #ar(e# s>d .b ≥ 1- (>dl9 C 2 C BB  maC #ransfsi 10 ;;>,(>r G ;a (l,onas 10O 01 ;;>,( #ia 100 ;; dr Pera#i,an : BB EB* H 8- ml>,(9 mr ,eamilan @ ma#ri#as bayi ?;reenin( : in,oma#ibili#as (ol dara =, dia,ai (ol dr / rs y( #i#er an#idl 168 (>dl 1-6 (>dl m( 1 188 (>dl 1-) (>dl 148 (>dl m( ) 1-3 d>(l 1)2 (>dl 12 (>dl m( 12! (>dl 36 (>dl 82 (>dl m( 8<12 11 (>dl 10 (>dl ! (>dl AN?7?I 7KA =an :

86

87 - menrn,an ,adar bilirbin > men;e(a #o,sisi#as bilirbin - men(,ore,si anemi - memerbai,i sir,lasi – o,si(enasi =arin(an - menelar,an #o,sin y( diasil,an ,man d se#i;emia - memberi>men((an#i fa;#or embe,an @ imno(loblin - men(elar,an eri#rosi# y( dili#i an#ibody - men((an#i d( eroi#rosi# bar y( #d, berea,si d( an#ibodi y(

ada

- men(ilan(,an an#ibodi dlm dara

Indi,asi : 1$ .ierbilirbinemia ,adar bilirbin indire,  20 m(O d( asidosis>ano,sia ar#a M 20 m(O d emoly#i; =andi;e y( bera#>sesis d( def 2$)< "P% ↑ ,adar bilirbin indire, 0$)<1 m(O>=am 2$ .emoly#i; "isease of #e Ne&born .;# M 4-O ↑ ,adar bilirbin  0$6 m(O>=am d  in,oma#ibel ↑ ,adar bilirbin  1$0 m(O>=am d AB/ in,oma#ibel )$ Neona#al alloimne #rombosi#oenia 4$ Anemia bera# d( (a(al =an#n( -$ Kadar .b mbili;s M 14 m(O @ 5oomb\s #es# G 6$ ?evere se#i;emia G s;lerema neona#orm !$ e,emia a,# #d, erl 2C EB* ;, 1C H ar#ial E  d# ↓ le,osi#9 "ara y( dia,ai : - B y( disiman M !2 =am a(ar masi md( 2$)<"P% lb banya= @ ,adar lasma K leb sedi,i#9 - > ."NB  in,oma#ibel dia,ai (ol dara ib @ neona#s d(  <9 y( #d, md( an#i(en - > ."NB AB/ in,oma#ibel dia,ai (ol dara ib lo& #i#er /9 *olme dara : < ransfsi #,ar doble volme 9 H EB* C 2 H BB C 8-9 C 2 ;;  n#, mendaa# .b .9 H  : 2  ,eb#an P5 P9 H . : 0!  ,eb#an P 9 H  – P < ransfsi #,ar d anemia  volme dara H EB* C ∆.b9 : .b donor – .b9 ;;

87

88 ,eb#an P5 H EB* C ∆.;#9 : .;# donor ;; < ransfsi #,ar arsial d olisi#emia  volme ?alin H EB* C BB C ∆.;#9 : .;# ;; Baaya : ari#mia volme overlosd ;ardia; arres# emboli dara #rombosis ;lo##in( ((n ele,#roli# ((n asam basa ((n me#aboli; ((n #ermore(lasi NE5 #rombosi#oenia defisiensi fa,#orembe,an rebond ,adar bilirbin 

a,#or y( d# menyebab,an ,e(a(alan emos#a#i, os# #ransfsi dara : ∗ %(n y( sd ada sblnya enya,i# rimer9 ∗ Keilan(an fa;#or embe,an la#ele# @ inibi#or ∗ %(n sin#esa o, syo, d ear @ smsm #l( ∗ Pen(en;eran fa;#or
88

89

89

90

DIC

Kri#eria "I5 : "I5 =, s,o r 0 rombosi# "P>"<"imer P ibrino(en

≥ 5) 1

2

)

 100$000 -0$000 <100$000 M -0$000 M-00 -00<1000 100 M)d#, 4<6d#, 6d#, 100 M100

"C : < Perdaraan rofs ada infe,si sesis syo, ,ombsio < ." : #rombosi#oenia brr ;ell fra(men#osi# < B  P  AP    fibrino(en ↓ < "P ↑ " < A III -0 7>,(  12- 7>,( dri #id )<- r < .earin =, #romboemboli9 -0<100 7>,( iv  10<17>,(>r dri qid 5 dier#aan,an s>d 1-–2CN ITP "C : #rombosi# M -0000>m) (ian# la#ele# me(a,ariosi#9 B  C : < .indari a,#ivi#as berlebi < Prednison mlai do 2<4 m(>,(>r o>iv ! r evalasi #ia ! r #a do&n s>d 4 m( =, reson M  imnosresan Imran®9 Perdaraan eba# : +e#ilrednisolon 8<12 m(>,( iv a#a "eCame#ason 0-<1 m( >,( o>iv bersama d( I*I% a#a #ransfsi 5 < I*I% dosis inisial 06< 08 (>,( 1C  dilan( =, #rombosi# M )0000>m) !2 = s#l infs er#ama r ,e<)9 Perdaraan eba# : 08 (>,( 1<2C bersama,(>2<8 m( < Imnosresan : 1$ ARa#iorin 2 m(>,(>r o #id 6<8 m( 2$ ?i,losorin )<8 m(>,( BB>ari o #id )$ ?i,lofosfamid 2<2$- m(>,(>r o a(i ari 6<12 m( 4$ *in;ris#in 2 m(>m 2 -$ An#i<"9 an#ibodi10<2- µ(>,(>r 2<- r dri )0 mn# dlm -0;; Na5l 03O

90

91 6$ INγ ) C 106 ni# sb,#an )C>m( slm 4 m( < ransfsi =, #ro M-000>m ) a#a manifes#asi erdaraan eba# < ?lene,#omi =, #d, membai, dlm 1<2 # ?#d 1 2

rombosi# -0000<1-0000 20000

) 4

 M 20000 10000

%C

C

#ida,ada #ida,ada

< reven#if

erdaraan erdaraanm,osa minor

+? I*I%>,or#i,os#eroid

IP a,# 80O membai, son#an dlm 6 bln 10O m=d ,roni, 60O slene,#omi9 IPa,# IP,ronis 7mr 2<6# de&asa Jenis ,elamin 1:1 1:) ♂:♀9 i&aya#infe,si G80O Jaran( A&al (C A,# Kronis )

rombosi#

M 20000>mm

Eosinofil @ limfosi#osis I(A ama(C Pro(nosis

?erin( Normal 2<6m( 80O son#an

enda Blans>d#an semb rombosi# nai, #rn

./+E/?A?I? Kas,ade ,oa(lasi : I II III I* * *I *II *III IF

40000< 80000>mm) Jaran(

a,#or ibrino(en Pro#rombin isse #rombolas#in 5al;im Pro ;al;elerin>labile fa;#or Pro ;onver#in>s#able fa;#or An#i emoili; fa;#or 5ris#mas fa;#or

91

92 F FI FII FIII

?#ar# Pro&er fa;#or rombolas#in an#e;eden# .a(eman>5on#a;# fa;#or ibrin s#abiliRier fa;#or

In#erre#asi . : P ↑ PP ↑ PP N

P N P ↑ PN

 ↑

Afibrino(enemia "I5 efe, earin

 N Py a#i def vi# K efe, ,marin "ef  FII FI IF *III efe, earin "ef  FII "efFIII "efvi#K

Eri#rosi#

N

P P ?P rombosi# a,# y( #((

↑ ↑ N N II *II IF F

Pya#i ?el#ar(e#

↑ ↑ N>↑ N III**II IF F

92

"I5 ?el #ar(e# sel brr sferosi#

↑ ↑ ↑ ↓ I II * *III FIII

93

9eofiia .emofilia A : defe, fa,#or *III A.9 .emofilia B : defe, fa,#or IF .emofilia 5 : defe, fa,#or FI .emofilia A : B : 5 H -<8 : 1 : =aran( "C : PP ↑ AP N ?P ↓ B N fibrino(en N

.emofilia *on illebrand\s "efisiensi*i#K

B N

↑ N

PP

↑ ↑ ↑

AP N N

↑

9E.45ILIA A "C :  *III M 1 O  emofilia bera#  *III 1<-O  emofilia sedan(  *III -<2-O  emofilia rin(an C : Pen(oba#an dasar< 
Kadar *III "osis *III>12 =

Eis#a,sis ema#ria

40<-0O

1-<2- 7>,( s>d (C Ө

?on#an dlm sendi>o#o#9

)0<-0O

20<2- 7>,( 2<) r

E,s#ra,si 1 (i(i

20<)0O

10<1- 7>,( 1 r

E,s#ra,si 1 (i(i

40<-0O

20<2- 7>,( ) r

60<80O

)0<40 7>,( -
.ema#om di #ema# berbaayaQ /erasi besar erdrn in#ernal

100<1-0O

-0,(QQQ

93

C elen(,a Prednison 2 m(>,(>r 2r  1 m(>,(>r )r Prednison 2 m(>,(>r Imobilisasi Kmr an#ise#i, Pera&a#an (i(i rofila,#i, EA5A100 m(>,( bb>r qid ! rQQ isio#C ?,rinin( inibi#or assay $*III #ia 12

94 #rama ,eala

=a+ .man A. ;on; dosis ?i,lofosfamid iv Pasien den(an #in((i roleC a#a oral inibi#or $*III fa,#or II *III lasmaeresis IF F9 A. sai > babi Q re#roaryn(eal dasar ml# leer ma#a #elin(a daera y( mda mene,an saraf QQ eri,sa rin sebelm men((na,an EA5A e,( in#erval 8<12 =am 1 ;; lasma H 06<0! 7 *III9 < ransfsi dara > lasma se(ar =, efe, reara# A. ,ran( memas,an < Kor#i,os#eroid  d# men(ran(i ,eb fa,#or *III ber,a# efe, ↑ resis#ensi ,aliler dan ↓ rea,si radan( bermanfaa# d ema#ria < C rofila,sis : A. 20<40 7>,(>#ia 48 = memer#aan,an fa,#or *III 1O s( erdaraan son#an #erindar,an < C ,omli,asi : reabili#asi fisi, men#al sosial < Inibi#or  *III < "e#e,si ,arier @ dia(nosis rena#al

9E.45ILIA B C : < ransfsi reara# PP?B #dd ro#rombin>II ro;onver#in>*III fa;#or>F dan 5ris#mas fa;#or>IF9 ProleC 480 7 dlm 7 dlm 20;;9 d( a#o ,an dos is s# *III dosis

?#ar )0;;9 Konyne -00

rofila,sis 10 7>,(

2C>m(

8!DB 1$ *K"B dini 2$ *K"B ,lasi, )$ *K"B lamba# < AP5" ac&uired prothrombin comple% deficiency9 < ?e;ondary ro#rombin ;omleC P59 defi;ien;y *K"B dini 7mr

M 24 =am

*K"B ,lasi, 1
94

*K"B lamba# ?P5" AP5"9 2 m(<6 bln ?e(ala

95

Penyebab @ fa,# resi,o

/ba# slm ,eamilan

re,ensi

M -O d ,elomo, resi,o #in((i

o,asi erdara an

Pen;e(a an

d )<- r9

d 2<8 m(9

In#a,e *i# K inade,a#

In#a,e *i# K inade,a#

001<1O #(# ola

ma,an bayi9 7mbili,s ?efal idn( ema#om #ema# mbili,s sn#i,an in#ra,ranial be,as  in#raabdl sir,msisi in#ra#ora,al in#ra,ranial en(en#i *i# K an oba# rofila,sis enyebab

sia /bs#r,s i bilier malabsorb si

10>100$000 ,elairan In#ra,ranial )0< 60O9 ,li# idn( #ema# sn#i,an mbili,s %I 7% in#ra#ora,al *i# K rofila,sis

*i#amin K dierl,an n#, : < sin#esis ro,oa(lan fa,#or II *II IF dan F ,omle,s ro#rombin9 < sin#esis ro#ein 5 @ ? y( bereran sb( an#i,oa(lan - ,onversi fa,#or embe,an #ida, a,#if m=d a,#if

"C : B  PP  P   N 7?% 5 s;an>+I C : < *i#amin K1 1<2 m(>r im slm 1<) r < ransfsi P 10<1- ml>,( Le'keia

1$ e,emia 3!O9 A,# < A 8)O9 < e,emiaA,# imfobla#i, 1 – blas# ,e;il omo(en d( si#olasma sedi,i# 2 – blas# besar e#ero(en d( si#olasma bervariasi ) – blas# besar omo(en d( si#olasma basofili, @ berva,olisasi < e,emia +ieloblas#i, AK# – A+>AN 1!O9 +0 – le,emia mielosi#i, diferensiasi minimal +1 – le,emia mielosi#i, #ana ma#rai

95

96 +2 – le,emia mielosi#i, d( ma#rasi +) – le,emia romielosi#i, ier(ranlar +- – le,emia monosi#i, a,# +6 – eri#role,emia +! – le,emia me(a,ariosi#i, a,# 2$ e,emia Kroni, )O9 < e,emia +ielo(eni, Kroni, 5+9 ALL

%C : 1$ A,iba# ,e(a(alan smsm #lan( memrod,si dara < Anemia  lema ;ea# lela ;a# nafs ma,an M sesa, naf < e,oenia>ne#renia  anas K7 ↓ < rombosi#oenia  e#e,ie rra e,imosa ema#om erdaraan (si sal ;erna sal ,en;in( o#a, 2$ A,iba# enyebaran>infil#rasi ,e or(an lain < ?is#em limfoid  ea#oslenome(ali limfadenoa#i K%B9 < ??P  nyeri ,eala mal mn#a ,e=an( ,oma < Nyeri #lan( emben(,a,an "C : "  anemia ,elainan =mla @ i#n( =enis le,osi# #rombosi#oenia ."  normo,rom normosi#er sel blas# abnormal G B+A ierseller sel blas# abN 2-Ole,emia ,on(eni#al 80O9 analisa 5? 5F C : < ?or#if  ,omli,asi #ransfsi AB n#risi KIE si,olo(is < Kra#if  si#os#a#i,a>,emo#erai ro#o,ol K A 20009 : 1$ ase ind,si 6 m(9  remisi ,omli# 2$ ase in#ensifi,asi>,onsolidasi  rofila,sis ??P )$ ase rma#an>lan=#an 2 #9 a,#or ro(nosis : sia M 1$- # a#a  10 # ana, la,il #rombosi# M -0000>l or(anome(ali massa medias#inm A #ie 2 ) ,elainan ??P (iRi br, ,romosom diloidi #ida, men;aai remisi emisi ,omli# : ,elan < (C – B+A : sellari#as dbN sel blas# M -O sel berin#i " : .b  12 (>dl #ana #ransfsi9 le,osi#  )000>l

96

97 i#n( =enis normal d( (ranlosi#  2000>l #rombosi#  1-0000>l sel blas# < analisa 5? normal KC : 1$ .ierle,osi#osis  le,osi# ≥ 100000>l A,iba# : erdaraan>#rombosis o#a, le,os#asis ar sindrom #mor lisis  ((n sir,lasi asidosis me#aboli, oli(ri anri C : < .idrasi "-N? )000 ml>m>24 =am J, rod rine M 2 ml>,(>= : +ani#ol 0- m(>,( slm 1- mn#  rosemid 1<2 m(>,( < Al,alinisasi rin : NaBi, 84O )-<4- mEq>m>24 =am < Alorinol )00<600 m(>m>24 =am #id < .indari #ransfsi ?"+ S < ranfsi 5 =, #rombosi# M 20000>mmh 2$ ?indrom #mor lisis  o, de(radasi>ao#osis flminan sel blas#>sel #mor Gf(s (in=al #d, ade,a#  ier,alemia ierfosfa#emia io,alsemia ierrisemia #=d s;r son#an>os# sios#a#i,a9 %C : < le#ar(i mal mn#a ,e=an( sasme #e#ani ,esadaran ↓ < oli(ria anria =, as ra#  10<1- m(>dl9  %%A )$ e,emia ??P  o, enyebaran ema#o(enos N *II III I* *I9 "C : analisa 5? ≥ - sel blas#>mmh %C : sa,i# ,eala mal mn#a iri#abel ail edema>IK ↑ C : +F i# radiasi ;ranial 4$ Ia#ro(eni, E? si#os#a#i,a9 a$ Anemia  o, rod eri#rosi# M desa,an sel le,emia di s#l alasia se,nder o, ,emo#C erdaraan C : #ransfsi ?"+ e;ombinan# .man Ery#eooie#in b$ Perdaraan  o, fa;#or emb dr #rombosi#oeni>a#i ro#ein ,oa(lasi "I59 C : #ransfsi 5 P n#, "I59 ;$ Infe,si  imno,omromais %C : demam  )8c5 ne#roenia M -00>mmh fo;s infe,si ml# ar ,li# erianal9 "C :#ersembnyi ,l#r dara>rine C : AB 5efo#aCim 100<200 m(>,(>r iv #id 5ef#aRidim -0 m(>,(>r iv bid osfomisin 100<200 m(>,(>r iv dri an#i=amr an#ivirs ?i#os#a#i,a : < A  +#C "eCa *5 "N 
97

98 < ?yara# ,emo#C : le,osi#  2000>l ne#rofil absol#  1000>l #rombosi#  10000>l #ida, ada infe,si B+P : #ida, ada mielosresi Sya"at B.P 3 .b  10 m(>dl le  2000>l AN5  -00>l#ro  20000>

Pro#o,ol K. : fase ind,si ,onsolidasi reind,si9 lan=#an < Kri#eria A . : le  -0000>l massa medias#inm le,emia o#a, < PB mm9H jB ;m9 C BB ,(9L : )600 < ?ebelm mas, si#os#a#i,a  E5%   ? ro#

%ase i&!ksi ('! 0-6 # * +,) 012)4-6 +F i# "eCa o *5 iv "N iv 
G G

B+P

G

G G G

G G G

G G G

G G

G G

G

G G

ase ,onsolidasi m( !<119 ! 8 3 101 1 +F i# G G G 
G G G

G

G G G

G

G G G

G

ase lan=#an I m( 18<6- < dimlai =, le  2000 #ro  1000009 1! 13 2- 2! 23 )) 41 4) 43 -1 -! -3 +F i# G G G G G G *5 iv G G G G G G "eCa o G G G G G G

98

99 6<+P o +#C o

G G

G G

G G

G G

G G

G G

ase lan=#an II m( 6-<11)9 +F i# *5 "eCaivo 6<+P o +#C o B+P

6G

6!

G G

!) G

!-

G G G G

81 G

8)

G G G G

83 G

31

G G G G

3! G

33 10- 10! 11 G

G G G G

G G G G

G G G

+E./EFAE vial - m( -0 m( #ab 2$- m(9 < "osis +F i#  M 1 # : 6 m(>C 1 # : 8 m(>C 2 # : 10 m(>C  ) # : 12 m(>C < "osis +F o  20 m(>m < ?yara# :  normal < E? : miolosresi orol #rombosi# ≥ !-000>l ?; normal ?%/ M 4C normal 7 : . 6$-<8$0 =, . rine M 6$1 r sblmny al,alinisasi d( NaBi, 1 (>m>C o qid a#a 0$- (>m iv9 < ?aa# ." +F  infs "-N? min 2-00 ml>m>24 =am9 al,alinisasi rine #ers ;e, . rine>6=9 < 5ara emberian : k )0 mn# sblm ms, +F  an#ieme#i, ondansen#ron dosis sesai mr9 k 1>- dosis +F dien;er,an d( -0 ;; P dri dlm )0 mn# 100 ##s>mn#9 k ?#l abis beri ;i#roform fa;#or res;e iv5>e;ovorin vial -0 m(9 k 4>- dosis +F dien;er,an d( 4-0 ;; P dri dlm 12 =am )8 ##s>mn#9 k 1 =am s#l abis e;ovorin #ia 6 =am  ari beri,#nya bid s>d 10C k in#a,e ;airan #o#al min 2-00 ml>m>24 = k er#aan,an  rine ± !$0 k eri,sa  ,adar +F dlm dara < /ndansen#ron 5edan#ron ofran #ab 4 m( 8 m( am 4 m( 8 m(9 < "osis /ndan;en#ron iv  ) # : 0$1- m(>,(>C dlm -0 ;; P dri 1-mn#

99

100 < "osis /ndan;en#ron o



)<10 # : 4 m( #id 11 # : 8 m( #id

M 0$) m 0$)<0$6 m 0$6<1 m 1 m

: 1 m( #id : 2 m( #id : ) m( #id : 4 m( #id

e;ovorin 5a es;volin vial -0 m( #ab 1- m(9 < "osis e;ovorin   1 # : - m(>C 2<- # : 10 m(>C  6 # : 1- m(>C "EFA+E.A?/NE #ab 0$- m(9 < "osis "eCa m(>m>r9  r<1 r<2 r<) r<4 k e,osi# M 20000 : 6 6 6 6 k e,osi# 20000<-0000 : 2 ) 4 k e,osi# -0000<10000 : 1 2 ) 4 k e,osi#  100000 : 0$1 2 4 *IN5I?IN /n;ovin vial 1 m( 2 m(9 < "osis *5 iv  1$- m(>m>C < 5ara emberian :

r<6 6 6 6

k *5 dien;er,an d( 10 ;; P iv bols elan k .indar,an e,s#ravasasi < E? : nero#o,si, neroa#i erifer mo#ori, @ sensori,9 ,ons#iasi iles arali#i, re#ensi ;airan "A7N/7BI5IN vial 20 m(9 < "osis "N iv  )0 m(>m < ?yara# : E5% normal < 5ara emberian : k "N dien;er,an d( 100 ;; "-N? dri dlm 1<2 =am -0 ##s mi,ro>mn#9 k ?#l abis soel d( P -00 ;; 20 ##s>mn#9 < E? : ,ardiomioa#i miolosresi mal mn#a aloesia m < ?yara# :  normal < 5ara emberian : k sblm mlai dila,,an s,in #es# dl k enase dien;er,an d( 2-0 ;; P dri dlm 4 =am 60 ##s>mn#9 k s#l abis soel d( P -00 ;; 20 ##s>mn#9 < E? : rC iersensi#if ((n emb dara an,rea#i#is a,# ea#o#o,si, enrnan albmin @ lioro#ein 6<+E5AP/P7IN #ab -0 m(9

100

101 < "osis 6<+P o  -0 m(>m < E? : mielosresi ((n f(s ear m;osi#is 5AABINE AleCan vial 100 m( -00 m(9 < "osis AleCan i#  M 1 # : 1- m(>C 1 # : 20 m(>C 2 # : 2- m(>C  ) # : )0 m(>C < E? : mielosresi mal mn#a mial(ia nyeri #lan( @ sendi nyeri dada

"/F/7BI5IN Adriamy;in vial 10 m( -0 m(9 < ?yara# : E5% normal < E? : ,ardiomioa#i miolosresi mal mn#a aloesia < KI : severe 5. ;ardiome(ali myelosresan < 5ara emberian k Adriamy;in dien;er,an d( 2-0 ;; P a#a "-N? dri 4 =am 20 ##s>mn#9 k s#l abis soel d( P 2-0 ;; 20 ##s>mn#9 55/P./?P.A+I"E Neosar vial 200 m( 1000 m( #ab -0 m(9 < 5ara emberian : k 1 r sblmnya  idrasi d( "-N? 1 ,eb ;airan>24 = k 4 =am sblmnya  infs 2-0 ;; "-N? 20 ##s>mn# k )0 mn# sblmnya  an#ieme#i, /ndan;en#ron - m(>m k 1>) dosis 5y;lo dien;er,an d( 2-0 ;; "-N? dri 20 ##s>mn# k 2>) dosis 5y;lo dien;er,an d( -00 ;; "-N? dri 20 ##s>mn# k saa# mas, 5y;lo  +esna 7romi#eCan am 200 m( 400 m(9 > ro#o,si, an#ido#e !-0 m(>m iv :  dosis iv bols   dosis dri 24 =   dosis dri 12 = k s#l abis soel d( P -00 ;; 20 ##s>mn#9 k idrasi di#ers,an s>d 24 =am beri,#nya k eri,sa 7 n#, ;e, ema#ria

*INBA?IN < 5ara emberian : k *inblas#in dien;er,an d( 200 ;; P a#a "-N? dri 20 ##s>mn#9

5I?PAIN vial 10 m( -0 m(9 < ?yara# : E5%  normal < 5ara emberian : k 5isla#in dien;er,an d( 1000 ;; P a#a "-N? dri 20 ##s>mn#9

101

102 k /ba# #ida, bole #er,ena ;aaya

C nyeri ,an,er 1$ Anal(esi, non oioid A;e#aminoen 10<1- m( o qid Ibrofen 10 m(>,( o #id

2$ Anal(esi, oioid 5odein Pe#idine +orine

0$-<1 m(>,( o qid 1<1$- m(>,( o qid < 0$!- m(>,( iv #ia 2 =am 0$) m(>,( o qid < 0$1 m(>,( iv>s; < 0$0) m(>,( dri

)$ %ol a=van An#ideresan An#i,onvlsan

?eda#ive .ino#i,

Ami#ri#yline 5arbamaReine Peny#oin 5lonaReam "iaReam +idaRolam

An#iis#amin Psi,os#imlan An#ieme#i,

"ienydramine "eC#roame#amine /ndansen#ron

102

0$2<0$- m(>,(>r 2 m(>,( o bid 2 m(>,( o bid 0$01 m(>,( o bid 0$0-<0$1m(>,(oqid 0$0-m(>iv-mn#sbl #inda,an 0$-<1 m(>,( qid 0$1<0$2 m(>,( bid - m(>m>C #id

103

103

104

69L N.  ,e(anasan rimer =ar limfoid y( bersifa# ada# ## ♂ !<10 #9 %C : masa in#raabdominal in#ra#ora,al G efsi lera9 medias#inal nyeri disfa(i sesa, naas emben(,a,an daera leer @ m,a o, obs#r,si vena ,ava serior limfadenoa#i leer sra,lavi,lar a,siler di a#as diafra(ma9 embesaran lima @ a#i  infil#rasi s#l A9 "C : "   5? asam ra# ". 7?% abdomen biosi K%B B+A C : ,emo#erai d( ro#o,ol 5/+P < fase ind,si  ?i,lofosfamid 12 (>miv r 19 *in,ris#in 2 m(>m iv r )<10<18<269 +e#o#re,sa# )00 m(>m iv r 129 +e#o#re,sa# 62- m(>m i# r 4<)0<)49 Prednison 60 m(>m o r ) s>d )0 #a off s>d r 409 < fase rma#an  ?i,lofosfamid 10 (>m iv m( 0<4<8<12<16<209 *in,ris#in 1- m(>m iv m( 0<2<4<6<8<10<12<14<16<189 +e#o#re,sa# )00 m(>m iv m( 2<6<10<14<189 <209 +e#o#re,sa# 62- m(>m i# m( 4<8<12<16<209 Prednison 60 m(>m o slm - r m( 0<4<8<12<16< 209

Wi# T'o" ilms #mor H nefroblas#oma  ,e(anasan embrional (in=al me#anefros ?indrom A% H #mor ilms aniridia malformasi (eni#al + Klasifi,asi is#oa#olo(i ilms #mor : risi,o renda favorable9 risi,o sedan( risi,o #in((i nfavorable9

mor #b#s di dlm =ar (in=al #ana menembs ,asl  d# direse,si d( len(,a mor menembs ,asl @ melas mas, ,e dlm =ar ?#d II (in=al @ se,i#ar (in=al  ms d# direse,si d( len(,a ?#d III mor menyebar ,e ron((a abdomen mor menyebar s;r ema#o(en ,e ron((a ?#d I* abdomen ar<ar o#a, @ #lan( "C : "   Al, fosfa#ase ".↑ *+A dbN o #ora,s I*P 7?%>5 ?;an abdomen %C : ema#ri . anemia BB ↓ I?K demam malaise C : oerasi ,emo#erai radio#erai  modali#as #(# s#d @ is#oa#olo(i ?#d I

104

105 ?#d S ?#d I ?#d III

avorable

/erasi ?i#os#a#i,a "a;#inomisin *59 /erasi ?i#os#a#i,a "a;#inomisin *5 "N9 adiasi abdomen /erasi ?i#os#a#i,a "a;#inomisin *5 "oCorbisin9 adiasi abdomen @ ar

7nfavorable

?i#os#a#i,a "a;#inomisin *5 g9

?#d I* ?#d II ?#d III ?#d I*

105

106

106

107

107

108 I65E!SI @ PE6:A!IT TR4PIS

Jadal imnisasi : mr va,sin lr 1 B P " 5 . P I +

*

2

PPI < di&a=ib,an 5% 1C .e B 1 2 olio 0 P ama, Non PPI < dian=r,an ib 5* nflenRa + ifoid .e A

blan 4 - 6

)

3 12 1- 18 2

)

#an - 6 10

) 1

2 1

) 2

4 )

4

-

1 1 1

2 2

) )

2 4 4 1C># 1 1C>) # 2C in#erval 6<12 bl

arisela

Q ?a#(as Imnisasi I"AI 2006 Ke#eran(an : B5% .e B

"P Polio 5ama, .ib ++ P5*

0<2 bln  ) bln



+#C dl9

Ib .BsA( g  M12 = G .BI(9 Ib .BsA( G  M12 = G .BI(9 Ib .BsA( <  M! r  6 m( "&P>"#aP a#a ,ombo d( .e B>.ib 12 #  BIA?

0$0- ml bayi9>0$1 ml ana,9 in#ra,#an 0$- ml im .B*aC En(eriC B EvaC B Baye B .BI(9 0$- ml im InfanriC ria;el ri#anriC .B InfanriC .ib e#ra;# .ib

?aa# bayi dilan(,an 2 (## o J, bayi dir&#  2 bln  IP* ImovaC Polio 6#BIA? 0$-mls, 0$- ml im 2bln A;# .ib .iberiC PedvaC .ib 0$- ml s, 12 bln =, ;ama, <9 ++
108

2

1C

109 InflenRa

M 8 # 2C in#erval 4 m(

ifoid

 2 # dilan( #ia ) #

*aCi(ri yim *i yeriC im *ivo#if o al# day .avriC AvaCim 0$- ml s, *arilriC /,avaC

.e A

 2 # )C in#erval 0<1<6 bln 10<12 # *arisela  1) # 2C in#erval 4<8 m( ?is#em imn : 1$ Inna#e  fisi, : ,li# 1 s# barrier9 bio,imia : lisosim m,s silia asam lambn( 2$ Ada#ive  moral AB media#ed9 :limfosi# B  sel lasma seller ;ell media#ed9 :limfosi#   5"8 – ; 5"4 – 1 2

Infek#i 8i"'# Deng'e "" A 30>"B" A 319 Kri#eria ./ 133! : Klinis < "emam mendada, #in((i #ana sebab =elas #ers#ana erdaraan9 < .ea#ome(ali abora#orim < #rombosi#oenia M 100000>mm P5* ↑  20O "B" (r I :  G ro M 100000 P5* ↑ 20O "B" (r II : erdaraan son#an ro M 100000 P5* ↑ 20O "B" (r III : ,e(a(alan sir,lasi " ↓ #e, nadi M 20 mm.( N ↑ 5 ↓  ↑ (elisa a,ral din(in diresis M9 "B" (r I* : syo, " ## N ##b ,esadaran ↓9 Plasma lea,a(e  efsi lera asi#es ioalbmin "C : " asan PB ≥ 1-O9 .I I(%>I(+ an#i den(e r -9 o #oraC 7?% abd

"B" (r III>I* : >N?>"->"-A 10<20ml>,(><1 =am

↓

ollo&  : P5* *?

↓ Bai, P5* ↓ K7 s#abil

 !ml>,(>=am

↓ ida, bai, P5*↑ Nadi ;ea# @ lema " ↓ s @ d menyemi#9 Prodrine ↓

109

110 ↓

↓

-ml>,(>=am

Bai, P5* ↓ .b ↓

↓ )ml>,(>=am

↓

ida,bai, P5* #e#a

"ara

diara,an semb

↑

 ↓

↓

24<48=am =am

↓

Plasma

10 ml>,(>1 =am d#dilan( sesai ,eb

10 ml>,(>1

↔ d# dilan(

)C>r Kore,si (as dara @ ele,#roli# /ba# ino#roi, Ps( : ,a#e#er 5*

"B" (r I
"->"-A !ml>,(>=am

↓ ↓

ollo&  : P5* *?

↓

Bai, ida, bai, ds# ds# Ensefaloa#i den(e : < %an#i ;airan d( N?:"- 1:) < "eCame#ason 0- m(>,(>C #ia 8 =am KI : %I bleedin(9 < *i# K )<10 m( iv ) r < Per#imban(,an : neomisin la,#losa ,ore,si asidosis @ ele,#roli# #ransfsi Indi,asi #ransfsi : erdaraan  em,(9 ,oa(lasi ,onsm#if #rombosi# M -0000 5 4 ni#>mH10<20 ml>,(9 "I5 ;ryore;ii#a#e 1 ni#>- ,(BB9

110

111

111

112

112

113

Dea Tifoid A 019 %C : anas  ! r ladder s#e ## malam r %I



obs#iasi diare mal mn#a ,embn( ea#ome(ali slenome(ali lida ,o#or #ei ieremi

??P  delirim aa#is somnolen soor ,oma "  le,oeni eosinofilia anemia %all ;l#  dr m( I9 #in=a m( II9 rin m( III9 s#l m( I*9 idal  #i#er /  1>200 m( II9 EI?A P5 #yi do# KC : nemoni ensefaloa#i syo, iles erforasi melena i,#ers mio,ardi#is /+A I?K ((n s#a#s men#al C : Kloramfeni,ol -0 m(>,(>r #id o>iv 14 r Ko#rimo,saRol 8 m(>,(>r bid o 14 r Amo,sisilin 100m(>,(>r #id o 21 r Amisilin 200m(>,(>r #id iv 21 r 5ef#iraCon -0<80 m(>,(>r bid im -,(>r bidloroqinolin o 10 r AR#reonam ARi#romi;in +"9 .offman #C : "eCame#ason ) m(>,( iv dri )0 mn#  1 m(>,( qid iv !C9 Imm : a,#if –  2 # dilan( #ia ) #9

Difte"i A )69 "C : KN I>II>III>,man lain>,on#a, ?;i;, #es# E5% C : < isolasi ,e#a# s>d bia,an ne(a#if )C ber#r#<#r# < is#iraa# 2 m( die# @ ;airan ade,a#

113

114 < A"?

 dif#eri idn( ma#a ,li# rin(an9 : 20000 7I im dif#eri #onsil sedan(9 : 40000 7I iv dri dif#eri larin( bera#9 :100000 7I iv dri A"? diberi,an dri dlm 200 ml "-O slm 4<8 = J, s,in #es# G  Bedres,a #i#rasi #ia 1- mn#9 00- ;; A"? G 1 ;; P s; 01 ;; A"? G 1 ;; P s; 01 ;; A"? s;>im 02 ;; A"? s;>im 0- ;; A"? s;>im 2 ;; A"? s;>im 4 ;; A"? s;>im sisanya diberi,an sema a#a ber#aa 4 ;;>1- m#9 J, sedomembran #e#a G dlm 24 = os# A"?  b,an dif#eri S < AB  PP -0000<100000 I7>,(>r bid im 10 r =, aler(i : Eri#romisin -0 m(>,(>r o #id 10 r KC : obs#r,si =ln nafas mio,ardioa#i #o,si, m( 2 a#a m( 69 ,elman ala#m molle m( )9 aralisis o#o# ma#a m( -
Ca%ak B 0$-39

%C : +asa in,basi 10<12 r Infe,sis a&al s#d rodromal s>d r ,e<4 ram ?#d rodromal 2<4 r  ;oryRa ;on=n;#ivi#is ;o( ,oli, so# ?#d ersi>e,san#em -<6 r  ram ma,lo<alar ?#d ,onvalesens 1<2 m(  ieri(men#asi @ des,amasi "C : " I(+ an#i morbili C : sor#if  an#iire#i, e,se,#oran ;airan @ n#risi ade,a# vi#amin A 100000<200000 7I im 2 r  1-00<-000 I7 o indi,asi +?  ierire,sia deidrasi ,e=an( in#a,e sli# ,C imm : a,#if PPI 3 bln ++ mr 12<1<- bln9 KC : diare deidrasi bron,onemonia /+A ensefali#is maln#risi rea,#ifasi B ??PE Ek#antea Ak't B 039 12)4-6

114

115 ++ ++

5ama, bela E,san#ema sbi#m Infe,si en#erovirs Infe,si adenovirs "emam s,arla#ina +onon,les infe,siosa Ersi oba#

+ ±

± ± ±

+

± ± +++ + ± ± ++ + + ++ ± ± +

+ + +

Ke# : 1 ,on=n(#ivi#is 2 rini#is ) nyeri #elan 4 enan#em - le,os#osis 6 #es lab sesifi, Pa"otiti# E%ideika B 26$39 %C : +asa in,basi 14<21 r "emam anore,sia sa,i# ,eala mn#a nyeri o#o# disfa(ia #risms C : sor#if @ sim#oma#is 8a"i#ea B 01$39 %C : +asa in,basi 11<20 r Infe,sis 1<2 r sbl ram s>d -<6 r s#l ram vesi,oblosa C : A;y;lovir 20 m(>,(>C qid - r o Imm – a,#if :  10 #9 asif : *I% 12- 7>10 ,( M !2 =am os# eCosre9

Pe"t'#i# %C : +asa in,basi !<14 r ?#d ,a#aralis 1<2 m(



fl li,e ba#, mlm r ile, anore,sia

demam ?#d sasmodi, 2<4 m(  &ooin( ;o( m,a mera s>d sianosis ba#, dia,irir mn#a d( s#m ,en#al ?#d ,onvalesens 2 m(  nafs ma,an membai, C : Eri#romisin -0 m(>,(>r o qid a#a rovamisin

Tetan'# A )-9

115

116 AC : < Ke,a,an o#o#  #risms riss sardoni;s ois#o#ons o#o# er# se,eras aan ,e=an( mm ran(san( son#an s#a#s eile#i,s9 < ,a #s,>a#a #lan( #erb,a l,a bernana o#i#is media rlen#a ,aries (i(i (i(i#an bina#an( < Imnisasi "> beraa ,ali @ ,aan yan( #era,ir9 < Kaan mlai (e=ala ,lini, er#ama in;ba#ion eriod -< 14 r9 < ?elan( &a,# an#ara #risms>sasme lo,al den(an ,e=an( yan( er#ama eriod of onse#9 <e#ans neona#orm  siaa enolon( ersalinan #ema# ersalinan ala# emo#on( #ali sa# ;ara era&a#an #ali sa# aa,a ib sda diimnisasi  mlai ,aan bayi #ida, bisa mene#e, in;ba#ion eriod9 beraa lama selan( &a,# an#ara #ida, daa# mene#e, den(an ,e=an( yan( er#ama eriod of onse#9 %C :< e#ans rin(an  #risms ≥ 2 ;m ,a, ,d, ois#o#ons #ana ,e=an( ran(san( <e#ans sedan(  #risms M 1 ;m9 ,a, #imbl ,e=an( ran(san( #ana ,e=an( son#an #a,inea disfa(ia rin(an <e#ans bera#  #risms bera# o#o# sas#is ,a, #imbl ,e=an( son#an #a,inea #a,i,ardia anei; selldisfa(ia bera# a,#ifi#as o#onom ↑ <e#ans #erminal  ((n o#onom ier#ensi bera# G #a,i,ardia io#ensi bera# G bradi,ardia "" : menin(i#is>menin(oensefali#is>ensefali#is  ,esadaran analisis 5? #e#ani  ,aroedal sasme io5a in#o,si,asi s#ri,nin rabies  sli# menelan idrofobia ri&aya# (i(i#an bina#an( #risms o, inf lo,al mas#oidi#is /+P eri#onsiler abses9 asime#ris KC : sesis bron,onemonia asirasi lendir>ma,anan>minman (an((an ernafasan o, ,e,a,an o#o# larin(  ano,sia  9 (an((an sir,lasi o, en(ar #o,sin d saraf o#onom9 deidrasi @ (an((an ele,#roli# o, ieremi @ ierirosis9 ,e,a,an o#o# sin;#er @ o#o# olos lain a#a #lan( an=an(>fra,#r ,omresi #lan( bela,an( C : < Eliminasi ,man "ebridemen#  e,slorasi @ ra&a# l,a ;o (i(i>.>beda9 AB  PP -0000<100000 7I>,(>C im bid 10<14 r s,in #es#9 a#a

116

117 Amisilin 1-0 m(>,(>r iv qid =, aler(i : Eri#romisin -0 m(>,(>r o qid in,omisin 10 m(>,(>r im +e#ronidaRol 1- m(>,(>=  !- m(>,(>C qid < Ne#ralisasi #o,sin An#isera : A? -000<10000 7I s,in #es#9 a#a .I% -00<)000 7I o,soid : "P>"> < An#i,onvlsan:"iaReam am 10 m(>2 ml m>bols #ia 2 =9 dosis a&al 01<0) m(>,(>C -<10 m(9 iv elan dosis rma#an : < neona#s 30<120 m(>24= maC 20m(>,(>r9 < ana, 180<240 m(>24 = maC 40 m(>,(>r9 e#ans rin(an 08 ml>= e#ans sedan( 12 ml>= e#ans bera# 16 ml>= dosis dier#n,an )<- r  ↓ 20O #ia ) r  (an#i o 8 m(>,(>r 6<8 dosis -$ ?or#if < Pera&a#an in#ensif ran(an ,ss y( #enan(9 < Per#aan,an =alan nafas ,> #ra,eos#omi < /2 bron,ial #oile# << I*" ,> PN Pirido,sin vi# s>d B69 d# s( sonde lambn(

5U4  -0$19 "emam d ana, # re,#al  )8°5 a#a # aCiler  )!$8°59  over# fo;s o;;l# fo;sn,no&n ori(in ?BI 10O9 : menin(i#is sesis inf #l( @ sendi I?K nemoni en#eri#is "C : mr 0<28 r  &or,  sesis " 7  5? ; d>>f 5F9 mr 1<) bln  ## I?K d( ,man (ram ne( mr 2<)6 bln  ; dr =, #  )3 °5 mr  ) # Predi,#or ba,#eremia #ersembnyi : ?

:

e,osi# : AN5 : C : AB emiri,  Amo,sisilin -0<100 m(>,(>r 5ef#ria,son -0,(>r

117

)3<)3)3-<40 40<40 40 1-000  20000  10000

M 2O 2<)O )<4O 4<-O )<-O 8<10O 8<10O

118 C.8 %C : 10O BB d( I7% i,#ers ea#od rra nemonia le#ar(i ier>io#oni ,ln ;on(eni#al lain mi,rosefali ;oriore#ini#is #li neral sensori, PJB a#resia bilier abnormali#as ms,los,ele#al ernia in(inalis9 P : #ransmisi ver#i,al ib  bayi #ransla;en#al9 "C : rine @ saliva d bayi M ) m( I(%>I(+ an#i 5+*  osi#if =, I(+ an#i 5+* G9 saa# lair a,#if =, I(% an#i 5+* ↑ dibandin(,an #i#er ib lan( d 1<)<6 bln an#i(enemia 5+*  d# > mo #C ?%/  )00 I7 bilirbin dire,  )0 m(>dl #rombosi#oenia 2000<12-$000>mm) m( 19 5 s;an ,eala : le,omalasia eriven#ri,ler a#rofi ,or#i,al embesaran ven#ri,el ni#eral>bila#eral efsi sbdral erdaraan o#a, ,alsifi,asi in#ra,ranial C : %an;y;lovir 6 m(>,(>C iv dri 1 = bid 6 m(

.aa"ia %C : demam relasin(>;on#ine9 men((i(il anemia i,#ers ea#oasan malaria < Plasmodim fal;iarm  malaria #roi,ana demam #a, =elas9 < Plasmodim vivaC  malaria #er#iana demam #ia 48 =9 < Plasmodim ovale  malaria ovale demam #ia 48 =9 < Plasmodim malariae  malaria ,ar#ana demam #ia !2 =9 +alaria bera# : < ierarasi#emia  -O eri#rosi# diin((ai arasi#9 < malaria serebral d( ,esadaran ↓ Blan#yre ;oma s;ore M )9 < anemia bera# .b M - (>dl9 < erdaraan a#a "I5 < i,#ers bilirbin serm  -0 mmol>l9

< io(li,emia ,d( o, #C ,inin9 < (a(al (in=al ?K  ) (>dl @ diresis M 400 ml>24 =9 < ierire,sia < edema ar < syo, "C : ." #e#es #ebal @ #iis #ia 6 = slm ) r ber#r#<#r# .P<2 < ". C : P$ fal;iarm

118

119 p Ar#esna# 4 m(>,(>C G Amodia,in 10 m( basa>,(>C o ) r G Prima,in 0!- m( basa>,(>C o r<) p Kina )0 m(>,(>r #id G e#rasi,lin -0 m(>,(>r qid KI : M 12 #9 a#a "o,sisi,lin 2 m(>,(>r bid KI : M 8 #9 G Prima,in 0!- m( basa>,(>C o KI : M 1 #9 r<1  Kina G e#ra>"o,sisi,lin r<2 s>d ! < an#imalaria > P$ al;iarm resis#en ,loro,in p Kinin slfa# 10 m(>,(>C o #id ! r  bayi : 10 m(>mr,(>r qid ! r < an#imalaria > P$ vivaC>ovale p Kloro,in slfa# 2- m(>,( o ) r r<1 s>d ) : 10 – 10 < - m(>,(9 G Prima,in 02- m(>,(>r o 14 r < an#imalaria > P$ vivaC>ovale resis#en ,loro,in < Kina diidro,lorid )0 m( (rm>,(>r iv dri 4 = dlm "->P #id ! r G Prima,in 02- m(>,(>r o 14 r < an#imalaria > P$ vivaC>ovale relas Kloro,in slfa# 10 m(>,(>C o 1C>m( 8<12 m( G Prima,in 0!- m(>,(>C o 14 r 1C>m( 8<12 m( < re(imen al#erna#if p Kinin slfa# o> Kinin diidro,lorid iv G p Pirime#amin slfado,sin fansidar9 o < rofila,sis relas p Prima,in fosfa# o  +alaria vivaC>ovale : 02- m(>,( -<14 r  +alaria fal;iarm : 0-<0!- m( basa>,( r<1 #C < rofila,sis daera endemis 2 m( re – dran#e – 8 m( os#9 p Kloro,in basa - m(>,(>m( p Pirime#amin slfado,sin fansidar9 0-<0!- m(>,(>m( p ?lfado,sin 10<1- m(>,(>m( mr  6 bl9

9I8 BI.A : enlaran ver#i,al 14<40O  (C AI"? mr 1 # 2)O mr 4 # 40O %C : BB inf sal nafas berlan( P5P sesis moniliasis 7/ ea#oslenome(ali ensefaloa#i KI : A?I imnisasi B5% "C : "  ?el  5"4 M2-00<)-00>ml P5 .I* "NA mr M48= – 14 r < 1<2<)<6<12<18 bln  =, G ,onfirmasi d( P5 .I* NA ≥100000>ml9 I(% an#i .I* mr 18 bln EI?AI(A an#i .I* .I* ne( : BI.A 6<8 m( ≠ A?I 6 m(  .I* "NA>NA < 7mr 18 bln>3<12 bln ≠ A?I 6 m(  Ab .I* –

119

120 "C resm#if : min 1 (C – P5P ,andidiasis esofa(s #oColasmosis KEP bera# min 2 (C – ,andidiasis oral nemonia bera# sesis ib .I* G 5"4 M20O %C ,linis : ?#adim 1 – Asim#oma#i, P% limfadenoa#i 1 ;m @ 2 lo,asi ?#adim 2 – .ea#ome(ali slenomea(li derma#i#is aro#i#is I?PA sinsi#is /+A berlan( ,andidiasis oral ≥2C>bln an(lar ;eili#is %E .* ?#adim ) – Anemi .b M89 ne#roeni AN5 10009 #rombosi#oeni M10000009 mene#a ≥ )0 r +enin(i#is ba,#erial nemoni IP sesis Kandidiasis orofarin( mene#a 2 bln d bayi 6 bln s#oma#i#is .?* berlan( 2 eisode># esofa(i#is .?* onse# M1 # /. "emam 1 bln diare berlan(>,roni,>ersis#en ≥14 r .ea#i#is mio,ardi#is ,ardiomioa#i nefroa#i Bron,i#is nemoni#is varisela disemina#a eres Ros#er ≥2 eisode>1 derma#om ?#adim 4 – KEP bera# P5P inf ba,#erial berlan( inf .?* ,ronis Kandidiasis esofa(s mi,osis las B e,s#ralmner Inf #oCo>5+* onse# mr 1 bln sar,oma ,aosi

?#a#s imnosresi berdasar =mla @ ersen#asi sel  5"4 :

≤11 bln 12<)- bln )6<-3 bln ≥60 bln Asim#oma#i, )-O )0O 2-O -00 in(an )0<)-O 2-<)0O 20<2-O )-0<433 ?edan( 2-<23O 20<24O 1-<13O 200<)43 bera# M2-O M20O M1-O M200 5"4 M1-00 M!-0 M)!M200 Kri#eria imnodefisiensi 5 M4000 M)000 M2-00 M2000 AI"? : (C ,linis s#d 4>imnosresi ,a#e(ori ) Indi,asi A* d ana, : "C inf .I* G 2 #es virolo(i G d( I(% an#i .I* G 18 Ka#e(ori1 Ka#e(ori2 Ka#e(ori) Ka#e(ori4

bln9 %C ,linis ,a#e(ori Ad4>AB5 G )5 G N*P>E* e(imen lini 2 : 2 NI G 1 PI  ddI G AB5>A G P*>?^*>N* 1 NI G 1 NN#i G 1 PI  ddI G E*>N*P G P*>?^*>N*

120

121 A* < NI : idovdin A "* e#rovir9 ?#avdin d49 Aba;avir AB amivdin )5 Eivir9 "idanosin ddI9 < NNI : Neviraine N*P *iramne9 EfavirenR E* ?s#iva9 < PI : oinavir P*9 ?aqinavir ?^*9 Nelfinavir N* *ira;e#9 i#onavir * Novir9 5a# : syara# A  .b ≥!- m(>dl syara# E*  mr ≥) # BB  10 ,( #C /A ifamisin Indi,asi A : ?#d 1 @ 2  #(# 5"4>5 ?#d )  mr M1 # : sema d# A* mr ≥1 # : A* =, ada B IP /. #romboeni 5"4 renda ?#d 4  sema d# A* C : < P+5 : +P 4 m(>,(>r se=a, mr 4<6 m( s>d s#a#s < /IP P5P9 IN. - m(>,(>r selama 6 blan =, ,on#a, B G /IP B9 < A* : idvdin 2 m(>,(>C qid 6 m( dan>a#a Nevirain 2 m(>,( o M12=9 +o A : 5"4  .b<e #ia bln9  evalasi s#l #C 6 bln : resonsif>(a(al E? A : mal mn#a nyeri er# diare nyeri ,eala demam ba#, sesa, lela ;a# ram (a#al  "" d( /I>II? II? Immne e;ons#i##ion Inflamma#ory ?yndrome9 H inflamasi lo,al y( berb d( /I s#l #C A* o, ↑ 5"4 > ;e(a II? : /A 2<8 m(  A*9 C /I : P5P – +P 1-<20 m(>,(>r qid 21 r mr  2 bln9 IP – Prednison 1<2 m(>,(>r 14<21 r  #a off Kandidosis oral – Nys#a#in 400000<6000007 -C>r !<14 r Kandidosis esofa(s – l,onaRol )<6 m(>,( 1C>r 14<21 r Kandidemia – Amfo#erisin B 0- m(>,(>r iv 14 r  l,onaRol 21 r oColasmosis – Pirime#amin,(>C bid 14<21 r *arisela – A;y;lovir 10 m(>,(>C #id ! r .eres Ros#er – A;y;lovir 20 m(>,(>C qid ! r

!ARDI4L4GI

P7B

121

122 "C :  #ora,s E5% E;o 5a# Non siano#i, : <  #o  sn#  *?" 20O9 P"A -<10O9 A?" 10O9 < obs#r,si =#( ,anan  P? 8O9 < obs#r,si =#( ,iri  A? -O9 ,oar#asio Ao 6O9 +? ?iano#i, : <  #o  sn#  / 10O9 %A -O9 "/* 1O9

8SD

"C : *?" erimembranos 80O9 < o#le# inle# #rabe,lar Konflens  anerisma se#m membranasea *?" ms,lar 20O9 – os#erior #rabe,lar infndiblar *?" dobly ;ommi#ed sbar#erial -O9  rolas ,a# aor#a *?" ,;l  )0<40O men# son#an sia 6 bln *?" sd(>bsr  ((l =#( 6<8 m( s#enosis infndiblar 6<12 bln %C : *?" defe, ,e;il d( resis#ensi vas,lar ar normal < d asim#oma#i, < bisin( olosis#oli, #rill <  #ora,s E5% dbN *?" defe, sedan( d( resis#ensi vas,lar ar bervariasi < md lela ba#, sesa, nafas BB sli# nai, < bisin( ansis#oli, i;s )<4 sl ? < ,ardiome(ali .*Ki>Ka ;ons lmonal rominen B*P ↑ *?" defe, besar d( resis#ensi vas,lar ar rin(an s>d sedan( < ba#, sesa, nafas BB sli# nai, < #a,i,ardi #a,ine ea#ome(ali < bisin( ansis#oli, i;s )<4 sl ? bisin( mididas#oli, ae,s < ,ardiome(ali .*Ki>Ka>.AKi ;ons lmonal rominen B*P ↑ *?" defe, besar d( resis#ensi vas,lar ar bera#>. lmonal sindrom Eisenmen(er9

< sesa, nafas s>d sianosis BB sli# nai, < #d ((l =#( : #a,i,ardi #a,ine ea#ome(ali < bisin( ansis#oli, lema < ,ardiome(ali .*Ka mrni B*P ↑ C : < ,onserva#if *?" ,e;il9 < rofila,sis ?BE < ((l =#( : ino#roi, di(i#alisasi9 G dire#i, < o alia#if : lmonary ar#ery bindin( PAB9 < o ,ore,#if : #rans;a#e#er ;losre mbrella devi;e amla#Rer erimembranos ven#ri;lar se#al defe;# o;;lder AP+*/9 amla#Rer ms;lar ven#ri;lar se#al defe;# o;;lder A+*/9

122

123

Indi,asi o : *?" besar G ((l =#( G   PAB 6<12 bln  ,ore,si #o#al 4<6 # *?" sedan(  rle of 10 KI o : (a(al =#( endo,arsi#is sindrom Eisenmen(er

PDA "C : P"A ,e;il M ) mm P"A besar  - mm %C : < d asim#oma#i, ,on#iny i;s 1<2 sl ? 24Ka>.AKi ;ons lmonal rominen B*P ↑ < A" .*Ka .A,a C: < Indome#asin sblm sia 10 r ## rema#r9 sia M 48 = : 02 m(>,( o>iv  01 m(>,( 2C selan( 12 =9 

sia sia M ! ! r r :: 02 02 m(>,( m(>,( o>iv o>iv  02 02-m(>,( m(>,(2C2Cselan( selan(12 12=9=9 Ibrofen 10 m(>,( 1C>r o ) r +o : B7N M 20 m(>dl ?5 M 16 m(>dl E5% erdaraan syo, NE5 < rofila,sis ?BE < er#n,an P5*  4-O < ((l =#( : ino#roi, di(i#alisasi9 G dire#i, < o ,ore,#if : #rans;a#e#er ;losre < mbrella ;oil amla#Rer d;#al o;lder – A"/9 ;oil (ian#r;o P"A M ) mm9 li(asi P"A M 12 mm sblm sia ?" a#a 6 bln s#l semb dr ?BE9 KC : (a(al =#( nemonia ?BE . bera#

ASD "C : A?" se,ndm -0
123

124 < ba#, ali#asi sesa, nafas BB sli# nai, < vassore ;ardiaqe dada asime#ris9 bisin( sis#oli, i;s 2<) sl ?  #o sn# : bisin( middias#oli, < 5F  ,ardiome(ali .AKa>.*Ka B*P ↑ < A?" se,ndm : A" BBB rs\d *19 A* blo, < A?" rimm : A" < A*?" : A" P in#  C : < ,onserva#if A?" ,e;il9 < rofila,sis ?BE < ((l =#( : ino#roi, di(i#alisasi9 G dire#i, < o alia#if : lmonary ar#ery bandin( PAB9 < o ,ore,#if : #rans;a#e#er ;losre A?" se,ndm9 ;lamsell devi;e amla#Rer se#al defe;# o;;lder A?/9 oen ear# A?" rimm9 Indi,asi o : A?" besar G ((l =#( G   6<12 bln A?" ,e;il  #nda s>d -<8 # KI o : sindrom Eisenmen(er

PS "C : P? valvlar – obs#r,si ada ,a# P? sbvalvlar – obs#r,si sebelm ,a# P? sravalvlar < obs#r,si di a#as ,a# P? infndiblar %C : < d asim#oma#i, < ,li, ro#osis#oli, i;s 2<) sl ? < A" .*Ka s#rain q di *1  inversi di *)<* 49 C : < ,onserva#if P? rin(an9 < er;#anes #rans;a#e#er baloon valvlolas#y PB*9 AS "C : A? valvlar !1O9 – obs#r,si ada ,a# A? sbvalvlar 2)O9 – obs#r,si sebelm ,a# A? sravalvlar 6O9 < obs#r,si di a#as ,a# %C : < d asim#oma#i, abd sin,o < #rill fossa =(laris bisin( sis#oli,>,li, ro#osis#oli, < " len(an ,a>,i @ #n(,ai berbeda A? sravalvlar9

124

125 < &a=a elfin dai #in((i menon=ol lia# ei,an#s ba#an( idn( #d, #mb0 bibir a#as men((an#n( anomali (i(i mandibla ,e;il s#rabisms sara ,asar9 < E5%  .*Ki s#rain ? deresi di *-<*6 #ana  inversi9 C : < ,onserva#if A? rin(an9 < ((l =#( : ino#roi, di(i#alisasi9 G dire#i, < #ran;a#e#er baloon baloon aor#i; valvlolas#y < BA*9 < o ,ore,#if : ,omisro#omi "era=a# s#enosis I < in(an II < ?edan( III < Bera#

e,*,a M -0 mm.( -0<100 mm.(  100 mm.(

e, *,a e, e, *,i e, A? sis#emi, Ao 20<)0 mm .(  )0O9 M 20 mm .( )0<-0 mm.(  -0O9 20<-0 mm.( -0<60 mm.(  !-O9 M -0 mm.(

P?

!oa"kta#io Ao"ta (Steno#i# I#t$'# Ao"ta) "C : ie difs is#ms aor#ae #ie red,#al>infan#il9 – diser#ai *?" A?" a#a ,elainan ,a# mi#ral>aor#a ie dis,re# #ie osd,#al>adl#9 < enyemi#an d

sambn(an an# d,#s ar#erioss d( aor#a a#a d aor#a abd %C : < d asim#oma#i, < =, d,#s men# 2<10 r9  ((l =#( ,iri asidosis io(li,emi < nyeri ,eala>dada ,ladi,asio in#ermi#en nyeri s# ,e=an( d #n(,ai s#l berola ra(a9 < nadi femoralis ,e;il>#a, #eraba " len(an  #n(,ai < bisin( sis#oli, #ie e=e,si>fsiform di sd# s,ala < E5%  .*Ki>Ka C : < P%E1 n# memer#n,an P"A < ((l =#( : ino#roi, di(i#alisasi9 G dire#i, < balloon an(iolas#y < ,ore,si #o#al ;ardiolmonary byass9  6<1- #

T45 "C : ?#enosis lmonal valvlar infndiblar9 ro(resif *?" besar defe,  ∅ aor#a9 /verridin( aor#a d se#m ven#ri,el9 .*Ka %C : sianosis disne deffor# ((n #mb sqa##in(

125

126 sell 6<18 bln9 : sianosis ;a# ,ssmal ,e=an( ,sdrn ;lbin( fin(er ier#rofi (in(iva v =(laris menon=ol bisin( sis#oli, Z s#enosis lmonalis @ *?" ea#ome(ali ea#o=(lar refl,s dada bld(in( 5F  boo# sae ar,s aor#a rominen B*P ↓ E5%  A" .*Ka #ransisi ^? di *1 s9 @ *2 r?9 "  .b 1! (>dl .;# -0<80O anemia io,romi, rela#if

↓

"era=a# / :III < ,b>C s;>im in= Nabi; 84O 1 meq>,( iv bols aa elan Proanolol 0-<1 m(>,(>C qid o < #C AKB  e fmara# ) m(>,(>r a; o < lebo#omi a>i .b  18 m(>dl .;#  !0O9  ∆ .;#>.;# #ar(e#9 C BB C !0 ;; < o alia#if dera=a# III @ I*9 : blalo;, #assi( sn# B?9 < o ,ore,#if : ,ore,si #o#al – *?" ;losre G rese,si infndib rle of 109 KC : (a(al =an#n( bron,onemoni abses o#a,

TGA "C : d<%A ;omle#e %A9 l<%A ;on(eni#ally ;orre;#ed %A9  ,linis dbN %C : sianosis ((l =#( ,on(es#if asidosis 5F  e(( saed .*Ka>.AKa B*P ↑ *?" G P?  B*P ↓9 E5%  A" .*Ka>.AKa C : < P%E1 n# memer#n,an P"A P%E1 00-<01 µ(>,(>mn# iv  rma#an 0$01<002- µ(>,(>mn# iv E? : ane sor# +*9 io#ensi demam iri#abel ,e=an( flsin( diare E5% abN < ((l =#( : ino#roi, di(i#alisasi9 G dire#i, < o alia#if : balloon a#rial se#os#omy BA?9 blalo;, #assi( sn# B?9 lmonary ar#ery bindin( PAB9 < o ,ore,#if : ar#erial>a#rial s&i;#  2<) m( bi;aval lmonary sn# B5P?9 #o#al ;avolmonary ;onne;#ion 5P59

126

127 D4R8 "C : *?" sbaor#i, 60.AKa ;ons lm  B*P ↑ < E5%  A" .*Ka>.AKa *?" sbaor#i, d( P? infndiblar  / < sianosis bera# < 5F  .*Ka B*P ↓ < E5%  A" .*Ka *?" sblmoni, anomali asi(
P?

< sianosis ((l =#( < 5F  .*Ka ;ons lm  B*P ↑ < E5%  A" .*Ka C : < P? bera#  P%E1 n# memer#n,an P"A < ((l =#(  lmonary ar#ery bindin( PAB9 < o alia#if : blalo;, #assi( sn# B?9 < o ,ore,#if : ar#erial>a#rial s&i;#  2<) bln bi;aval lmonary sn# B5P?9 #o#al ;avolmonary ;onne;#ion 5P59 eC#ra;ardia; ;ondi# on#an9 A8 BL4! C : J, . 40<60C>mn# emodinami, s#abil  observasi J, . M 40C>mn#  ?A 001 m(>,(>C #ia1- mn# s>d . 60  a;e ma,er =, (a(al =, berasil  Alen#  am dlm -00 ;; dri s>d =, *>*  re;ardial #mb . 80<120

127

128 S8T "C : . 180<)00 C>m# d( ^? ,omle,s normal C : < +anver va(al massa(e sins ,aro#i,s s#imlasi naso(as#ri,9 < Adenosine -0 µ(>,( iv bols  dosis ↑ #ia 2 m# s>d 2-0 µ(>,( < ?yn;roniRed "5 so;, 0-<2 =ole>,( < "i(i#alisasi ;ea# KI : P9  rma#an )<6 bln < enilefrin 10 m( dlm 200 ;; ;airan dri ;ea# < Proanolol a#a *eraamil < Amiodaron - m(>,( dri slm 10 m# d# dilan( )C9  10 m(>,(>r iv ;on#inos dri>o bid -<10 r  -,(  2<- m(>,(

Gaga 7ant'ng "C : " ?E B%A  #ora,s E5%$ e;o Kls I Kls II Kls III Kls I*

#d, ada emba#asan a,#ifi#as fisi, ,elelaan disne ali#asi d a,#ifi#as fisi, biasa  (C #imbl d a,#ifi#as fisi, sedan( 





(C #imbl d saa# is#iraa#

E#io : < PJB : saa# lair  ylolas#i; lef# ear# syndrome  bera# P. bera# A* fis#el besar m( 1  %A P"A besar d rema#r AP*" m( 1<4  A? bera# P? bera# ,oar,#asio aor#a m( 4<6   #o  sn# m( 6<20  *?" besar P"A besar < +io,ardi#is "A PJ ,ardiomioa#i

<%(n me#aboli, io,sia asidosis io(li,emi io5a9 < Anemia bera# . a,# BP" overload sesis dll %C : < ,elelaan anore,sia iri#abel edema ,erin(a# din(in < #a,i,ardi irama (allo ron,i basa basal ,ardiome(ali < (a(al =an#n( ,anan ,on(es#i dara di sir,lasi sis#emi,9  #a,ine #e, v =(lar ↑ ea#ome(ali edema asi#es < (a(al =an#n( ,iri ,iri ,on(es#i di ar9  ba#, ,ronis serin( bersin dysne deffor# or#onoe &eeRin( C : < Bed res# #o#al osisi  dd,  ± minal 2<) m(>,(>C o>im #id9 < /,si(enasi ade,a# < A#asi fa,#or enyebab @ en;e#s < "ie# P% G res#ri,si ;airan !0<80O

128

129 < Ino#roi, : "i(oCin r 1 di(i#alisasi iv>o



.r 2

r!'ata) "osis #o#al

"osis rma#an

Prema#r M 28 r

10<20 µ(>,( 1-<)0 µ(>,(

- µ(>,( 8 µ(>,(

M  2 2# #

)0<-0 µ(>,( 2-<40 µ(>,(

10<1- µ(>,( 8<10 µ(>,(

"i(i#alisasi a&al Z  dosis #o#al iv !-O dosis o9



8=Z

dosis #o#al  8 = Z  dosis #o#al 12 = Z dosis rma#an 2 r +o : ?E E5%  a&as : in# P  ari#mia S KI : A* blo, #o#al #amonade =#( ,ardiomioa#i ier#roi, "oamin -<1- µ(>,(>m# iv dri "ob#amin 2<8 µ(>,(>m# iv dri < "ire#i, : rosemid 1<2 m(>,(>C iv 2<) r  2<- m(>,(>r #id o ?ironola,#on 2<- m(>,(>r #id o < *asodila#orEnalaril : 5a#oril 01<0m(>,(>C 008 m(>,(>C bid o#id o +o : balans ;airan BB

"efinisi Preload beban dias#oli,9

• ?e#ara den(an isi dias#oli; a,ir • n(si dari alir bali, dan ,elen#ran ven#ri,el • • • •

yan( menen#,an #e,anan isi dan #e,anan a#rim ,iri dan ,anan$ "era=a# re(an(an mio,ard ada saa# a,an ,on#ra,si sys#ole9a#a selama rela,sasi se#ara den(an volme ada saa# a,ir dias#ole$ Pere(an(an serab# mio,ardim ber(an#n( ada volme dara yan( mere(an(,an ven#ri,el ada a,ir dias#oli;$ Penin(,a#an aliran bali, vena menin(,a#,an volme a,ir dias#oli; ven#ri,el yan( ,emdian memer,a# ere(an(an serab# mio,ardim$ .,m ran, ?#arlin( : Ber#ambanya volme a,ir dias#ole samai

129

130 #i#i, o#imal a,an menin(,a#,an ;ra =an#n( sema#ae=e,si9 dies#imasi,an seba(ai #e,anan aor#a$ • Penin(,a#an af#erload a,an menin(,a#,an beban yan( diadai mio,ard sein((a menrn,an volme se,n; dan ;ra =an#n($ ?as#roasmoro?$ +adiyono B$ B, A=ar Kardiolo(i Ana,$ 1334 erdaa# ) me,anisme seba(ai aya n#, memer#aan,an fn(si =an#n( seba(ai oma dara yai#: 1$ Penin(,a#an reload 2$ Penin(,a#an ,a#e,olamin n#, menin(,a#,an ,o#ra,#ili#as mio,ardim )$ .ier#rofi o#o# =an#n($ +asin(sis#emi, #a,ayas b$

;$ d$ e$

,a&asa,i9 Beban volme reload menin(,a#9 Pira ,iri<,anan re(r(i#asi ,a#b ar#eriovenos fis#la anemia (an((an (iRi bera#9 amonade =an#n( /bs#r,si en(isian ven#ri,el ,arena s#enosis mi#ral #ri;sid Anerisma ven#ri,el

130

131 f$ "ysner(y ven#ri,el ($ es#ri,si endo,ardial a#a mio,ardial 2$ Penrnan ,on#ra,#ili#as =an#n( )$ %an((an irama =an#n( Pada (a(al =an#n( ,on(es#if #er=adi ,e#ida,maman en(oson(an selr dara di dalam ran( =an#n( sein((a selal #erdaa# sisa se#ia a,ir sys#ole yan( menamba volme ada se#ia a,ir sis#oli,$ Kondisi ini menimbl,an enin(,a#an re(an(an ada dindin( ran( =an#n($ ?mber : /n#oseno eddy$ a#ala,sana %a(al Jan#n( ada ana,$ 5on#inin( Ed;a#ion IKA , 7nair$ ?rabaya: 200) 4&at-o&at: G o Ino#roi,

6aao&at "i(i#alis di(oCin

"oamin

"ob#amin

A5E inibi#or

Ka#oril

.ekani#e +enamba ,e,a#an

dan ,e;ea#an ,on#ra,si ven#ri,el Pre;rsor ,a#e,olamin

+enamba ,on#ra,#ili# as =an#n( #ana menin(,a#, an fre,ensi =an#n( +enrn,an rod,si aldos#eron *asodila#asi ar#eri →

131

Do#i#o&at Efek# Neona#es : %I:na Prema#r 20 U(>,( mn#a

A#erm U(>,( Bayi 40)0 U(>,( Ana, 20<)0 U(>,( +a,simm 1m( 2<- U(>,(>men: menin(,a#,an aliran dara (in=al 10<20 U(>,(>men :efe, ino#roi, 2<10 U(>,(>meni#

01<0m(>,(>dosis ?e#ia 12<24 =am

*isal

Efe, l (in=al

Ba#, an(ioe

132

"ire#i,

rosemid dire#i; ,a#9

An#a(oni s Aldos#ero n

?ironola,# on

menrn,an af#erload$ +enin(,a#, an dieresis →menrn, an af#erload$ Ansa .elen as;endens men(amb a# reabsorbsi Na>K>5l9 +en(amba # aldos#eron se;ara ,ome#i#if

1 m(>,(>dosis iv9 2<- m(>,(>ari oral9

1<2 m(>,(>ari P/9

%an(( ,esei ;airan ele,#r Aler(i /#o#o .ier, %yne;

Dea Re'a Ak't

"C : " diff ;on# E" 5P A?/ 54 5) ANA   #ora,s E5%$ e;o ,l#r asan #en((oro, ?#re#o,o,s β emoli#i,s (r A9 %C : Kri#eria Jones 13449  revisi A.A 13329 : Kri#eria mayor Kri#eria minor Kardi#is Klinis : demam Poliar#ri#is ar#al(ia Korea ?ydenam ri&aya# PJ Eri#ema E5% : P in# meman=an( mar(ina#m ab : le,osi#>E">5P Nodl sb,#an ↑ anemi B,#i inf ?%A : A?/ ↑> ,l#r asan #en((oro, ⊕  ri&aya# demam s,arla#ina < i(ly robable  2 ,ri#eria mayor a#a 1 ,ri#eria mayor G 2 ,ri#eria minor b,#i inf ?%A : A?/ ↑ a#a ,l#r ⊕

132

133 < dob#fl dC

2 ,ri#eria mayor a#a 1 ,ri#eria mayor G 2 ,ri#eria minor #d, ada b,#i inf ?%A < eC;e#ion  anya #d ,orea a#a ,ardi#is indolen sa=a Kardi#is : demam ba#, sesa, nyeri dada 1 dari 4 ,ri#eria : < bisin( or(ani, bar Z insfisiensi ,a# mi#ral aor#a9 < eri,ardi#is #a,i>bradi,ardi fri;#ion rb e,s#rasis#ole P in#  s>d A* blo,9  ,ardi#is rin(an < ,ardiome(ali  ,ardi#is sedan( < (a(al =an#n( ,on(es#if (allo9  ,ardi#is bera# Poliar#ri#is mi(rans : #anda radan( d sendi besar Korea ?ydenam : d ana, ♀ 8<12 # Eri#ema mar(ina#m : #d, (a#al anya d ,ass bera# Nodl sb,#an : #d, nyeri mobil Kri#eria ./ 200)9 : Ka#e(ori dia(nos#i, Kri#eria "A seran(an er#ama 2 mayor a#a 1 mayor "A seran(an re,ren #ana G 2 minor d( b,#i inf ?%A PJ "A seran(an re,ren d( PJ 2 minor d( b,#i inf ?%A Korea ?ydenam #d, erl ,ri#eria lain> b,#i inf ?%A PJ +?>+I ± A9 C : ase a,# < Bed res# #o#al s>d E" dbN9 < AB : BenRan#in enisilin % 600000<1200000 7 im 1C 

Penisilin * 4C12-< 2-0 obid m( o 10 10 r r Eri#romisin 40 m(>,(>r < Prednison 1<2 m(>,(>r qid  #a off 2 m( mlai di#C d( < ?alisila# 100 m(>,(> qid 2 m(



!- m(>,(>r qid 4

m(  60 m(>,(>r qid +o : (as#ri#is . B9 < "i(i#alis mo ,e#a# E5%  KI : A* blo, S9 < "ire#i,a ± Kalim

133

134 < "ie# KP% ira barin(

1<2 m(

Kardi#is rin(an 2<) m(

A,#ivi#as dlm rm

1<2 m(

2<) m(

4<6 m(

2<) bln

A,#ivi#as lar rm

2 m(

2<4 m(

1<) bln

2<) bln

A,#ivi#as en Prednison ?alisila#

6<10 m( 6<10 m( < < 1<2 m( )<4 m(

)<6 bln < 6<8 m(

 6 bln 2<6 m( 2<4 bln

Ar#ri#is

Kardi#is Kardi#is sedan( bera# 4<6 m( 2<4 bln

Pen;e(aan 2nd  semr id d C d( ,ardi#is>PJ>res#i - # s>d sia 21 #9 d C #ana ,ardi#is < AB : BenRan#in enisilin % 600000<1200000 7 im #ia 28 r Penisilin * 4C12-< 2-0 o m( 10 r Eri#romisin -0 m(>,( BB>r o 10 r KC : PJ < +I  ?1 lema ?2 sli##in( bisin( ansis#oli, .*Ki +?  bisin( resis#oli,Ki AI  bisin( middias#oli, ae,s #rill i;s ) sl ? .*Ki %a(al =#( ?BE #romboemboli

Endoka"diti# Infektif AC : demam sesa, nyeri dada nyeri sendi malaise ,erin(a# malam BB ↓ (C nerolo(is ri&aya# PJB>PJ #inda,an invasif P : demam #a,i,ardi e#e,ie slin#er emorra(e o#\s so# /sler nodes Jane&ay lesion slenome(ali ;lbbin( fin(er (lomerlonefri#is ar#ri#is abses mio,ard ((l =#(

"C : " diff ;on# E" 5P A?/ 54 5) ANA   #ora,s E5%$ e;o ,l#r dara 2C d( in#erval 12 =am9 %C : Kri#eria ",e : Kri#eria mayor Kl#r ⊕ E5%>e;o ⊕

Kri#eria minor a,#or redisosisi ⊕ "emam  )8°5 enomena vas,lar : emboli ar#eri infar, ar anerisma mi,o#i, sb;on=n(#ival bleedin( I5. slin#er emorra(e Jane&ay lesion

134

135 enomena imnolo(is : (lomerlonefri#is ar#ri#is o#\s so# /sler nodes B,#i inf ⊕ mi,robiolo(i>serolo(i9 E5%>e;o ⊕ ve(e#asi>abses in#ra,ardia,9 < EI : ,ri#eria a#olo(i  b,#i inf ⊕ E5%>e;o ⊕ ,ri#eria ,linis  2 ,ri#eria mayor a#a 1 ,ri#eria mayor G ) ,ri#eria minor a#a - ,ri#eria minor < robable EI : #eman men(ara ,e EI # #d, memeni ,ri#eria defini#if < b,an EI : manifes#asi endo,ardi#is ilan( s#l #C AB  4 r

C : < AB : BenRan#in enisilin % 200000 7>,(>r qid im 4<6 m( 5ef#riaCon 100 m(>,(>r iv G %en#amisin ) m(>,(>r im *an,omisin 40 m(>,(>r iv G %en#amisin ) m(>,(>r im Eri#romisin 40 m(>,(>r #id o 10 r Profila,sis  1 = re o : Amo,sisilin -0 m(>,( o 5efadroCil>5efaleCin -0 m(>,( o ARi#romisin>Klari#romisin 1- m(>,( o a#a )0 mn# re o : Amisilin -0 m(>,( iv 5efaRolin 2- m(>,( 1v Klindamisin 20 m(>,(>iv o ,o#or %I>7%9 : )0 mn# re o : *an,omisin 20 m(>,( iv G %en#amisin 1- m(>,( im < / > men(a#asi ve(e#asi>abses @ insfisiensi ,a# KC : ((l =#( embolisasi anerisma mi,o#i, (C nerolo(is

Profila,sis endo,ardi#is len#a esi,o #in((i Ka# =#( ba#an

esi,o sedan( PJB

esi,o renda A?" se,ndm

i&aya# EI PJB siano#i, ?n# sis#emi,<ar

PJ i&aya# "A #ana PJB Kardiomioa#i Prolas ,a# mi#ral ier#roi, #ana + Prolas ,a# mi#ral d( +

1$ / mayor  1 = re o : Penisilin % -00000<1000000 7 im 6 = os# o : Penisilin * 800000 7 im 2<) r9 a#a Penisilin * 1200000 7 o bid 2<) r9 =, aler(i :

135

136 2 = re o : Eri#romisin 2-0<-00 m( o 6 = os# o : Eri#romisin 12-<2-0 m( o 2<)<r9 o ,o#or %I>7%9 : G ?#re#omisin -0 m(>,(>r im 2$ / minor )$ Prosedr (i(i



e,s#ra,si s,elin( imlan# dll

Persiaan #inda,an ;a#>o :  #ora,s E5% " diff ;on# .;# E" 5P .   %"A .bsA( B%A ,ss PJB?9 A?/ ,ss PJ9 Konsl %i(i @ . > oen ear#9 Nilai normal EK% ana, 7mr . P in# maC M!0 0<1 bln !0<160 0<1 # 0$16 1<12 bln8 0<140 1
!1<30 0$1-0$16-

30<110 110<1)0 1)0 0$14- 0$1)- 0$120$1-- 0$14- 0$1)-

1<-# 80<120 !<1)# 6<10 # !0<100 14<1! # 11<1-# --<30 de&asa

0$1! 0$18 0$13

0$16 0$1! 0$18

0$18 0$13 0$20

A" *er#i,al

110  ^? aCis !- s>d 110 0d 1<) # 180 ?emiver#i,al 4- s>d !- !<28 r 0 s>d )<- # 180 In#ermedia#e1- s>d 4- 1<) bln 20 s>d -<8 # 120 ?emioriRon#<1- s>d 1- )<6 bln 40 s>d 8<12 # A"

0<1bln 1<6 bln 6<12bln

0$10$16 0$1!

0$14 0$10$16

%el  10 s>d 100

bayi 48= M2mm I II *69 0 s>d 120 abN: !mm di <20 s>d 100 lead eC# 10mm <)0 s>d 30

100 di lead 6<12 20 s>d 12<16 # <20 s>d 100 re;ord bln 120 %elmaC %el?maC asio>? *1 *2 *- *6 *1 *2 *- * *1 *2 *6 6 2- )0 )0 21 20 )- )0 1 0$-<13 0$)<) 0$1
M<)0

136

137 1<)# )<8 # 8<12 # 12<16 # de&asa

18 18 16 16 14

228 22 13 21

)6 )6 )6 )) ))

24 24 24 22 21

2! )0 26 24 2)

)4 )8 )8 48 )6

16 14 1! 16

6 4 1 )

0$-<2 0$1<2 0$1-<1 0$1<1 0<1

0$)<1$0$0-<1$0$1<1$2 0$1<1$2 0$1<2$-

A.

%el P 2$- mm II *4 *19

A.

%el P bifasi, M 0$10 *4 *19

*.

A" a#a N di *4 *1 ? di *1 ?N di *6 1-<10
*.

B*.

^?

)
?#enosis Plmonal bera# A#resia Plmonal A#resia ri;sid Penya,i# ,a# mi#ral obs#r,si ven#ri,el ,iri enya,i# mio,ard ven#ri,el ,iri

?#enosis Plmonal . Plmonal / %A

?#enosis Aor#a e(r(i#asi Aor#a Koar#a,sio Aor#a ? di *1>*2 G  di *->*6  )0<40 mm *?" ?edan( P"A ^?  01 di *-*6 a#a  da#ar di *-$*6 e(r(i#asi +i#ral  inversi di *-*6 BBB . sis#emi, Kardiomioa#i dila#a#if @ obs#r,#if  ? dlm di *) *4 G?-0 mm *. @  bifid di *4 a#a 8mm di *1 *. G  inversi di *-*6 Kri#eria *. G *. .ier#rofi ven#ri,el BBB ier,alemi +eman=an(  0$08 io#iroid di(i#alisasi

+emba;a E5% : Irama II =(9 – aCis I av9 – ier#rofi *1<*69

137

138

138

139

139

140

RESPIR4L4GI

A#a

Berdasar dera=a# enya,i#nya  asma eisodi, =aran( asma eisodi, serin( asma ersis#en Berdasar,an dera=a# seran(annya  seran(an asma rin(an seran(an asma sedan( seran(an asma bera# "C : < " E" "5 ?E B%A E*1 < o oraC E5% C : < /2 G neblisasi β2 a(onis *en#olin>Bri;asma9 1<)C #ia 20\  neblisasi ,e<) G an#i,oliner(i, A#roven#9 a#a Adrenalin 1:1000 001 ml>,(>C s; 1<)C #ia 20\ < Neblisasi #ia 1<2 =am  4<6 =am < Aminofilin bols  dri < ?#eroid iv #ia 6<8 =am < A#asi deidrasi ;airan 1 C ,eb rma#an9 < A#asi asidosis ((n ,eseimban(an ele,#roli# < "ie# B?IK < E>5>" ,> +o : *? dis#ress nafas Pa"aete" A#a A#a A#a !ini#0 E%i#odik E%i#odik Pe"#i#ten ke&'t'$an 7a"ang Se"ing o&at0 dan faa %a"' re,ensi M1C > 1C> ?erin( seran(an blan blan 2$ ama seran(an

M 1 min((

 1 min((

140

141 In#ensi#as seran(an

Biasanya rin(an

Biasanya sedan(

4$ "i an#ara seran(an

ana (e=ala

?erin( (e=ala

-$ idr a,#ivi#as

ida, #er(an((

?erin( #er(an((

Biasanya bera#

6$ Pemeri,saan fisis di lar seran(an

PE > E*I  80 O

%e=ala sian( dan malam

!$ /ba# en(endali an#i inflamasi9 8$ 7=i faal ar di lar seran(an9 3$ *ariabili#as faal ar bila ada seran(an9

ida, erl

+n(,in #er(an(( di#em,an ,elainan9 Perl

Pereda

dan

eofilin Aminofilin ?alb#amol erb#alin Ia#roim Adrenalin

ada

.amir sean=an( #an ida, ada remisi

?an(a# #er(an((

PE > E*1 60 – 80 O *ariabili#as  1- O

*ariabili#as  )0 O

)<6 m(>,(  2-<- m(>,(>C #id 4,( iv slm 20 m#  0-<1 m(>,(>= dri 01<01- m(>,(>C #id 4<6 µ(>,( iv slm 10 m# 2-<- m( neb qid 002 ml>,(>C9 00!- m(>,(>C #id -<10 m( nebl qid M 6 # : 8<20 ##s  6 ##s : 4<10 ##s 01<0) m(>,(>C s;

?#eroid : .idro,or#ison ?ol;or#ef9 Prednison Pea;or#9 Prednisolon

4<10 m(>,(>C iv qid 0-<2 m(>,(>r #id 0-<2 m(>,(>r #id  1C a(i

141

142 ?olmedrol9 "eCame#ason /radeCon9 Kon#rol : Kromolin

r 0-<1 m(>,(>C #id

Nedo,romil

2 ml neb bid 800 U(>ff +"I bid 1!- m(>ff +"I bid

afirl,as#

20 m(>C bid

142



1 m(>,(>r

143

143

144

144

145

145

146 Sind"oa C"o'%

?indroma ;ro H ba#, sara ara s#ridor insira#oir o, obs#r,si salran naas a#as>larin( 5ro  Ei(lo#i#is a,# arin(i#is>larin(o#ra,eo
A?+A B/NKI/II? ier rea,#ivi#as virs bron,s 7mr 2# 6bln<2# ?esa, berlan( ya #ida, /nse# sesa, a,# insidios I?PA a#as G>< selalG A#oi,elar(a serin( =aran( Aler(ilain serin( #d,ada eson bron,odila#or ;ea# lamba# Eosinofil menin(,a# normal Penyebab

esira#ory "is#ress Assessmen# Ins#rmen# "AI9 0 eeRin( :
< < <

e#ra,si :
< < <

?K/ 2

1

)

a,ir   seba(ian sema sema ≤ 2 dr 4 ≥ ) dr 4 la ar la ar rin(an rin(an rin(an

sedan( sedan( sedan(

4 sema sema

bera# bera# bera# o#al

?,or  1-  dis#res nafas bera# M )  dis#res nafas rin(an C : < /2 G neblisasi β2 a(onis #ia 4<6 =am

146

?,or ma,si mal 4 2 2

) ) ) 1!

147 < ?#eroid iv #ia 6<8 =am < AB se,#rm las < E>5>" ,>

B"onkiti# Ak't %C : ba#, ile, )<4 r didali I?PA K7 bai,

An#ifl :

Para;e#amol Efedrin "+P 5+ "ifenidramin ?i#eriRin ora#adin Psedoefedrin

10<1- m(>,(>C qid 0-<1 m(>,(>C #id )C #id M- #9 !-<1- m(>C #id - #9 003m(>,(>r#id 0- m(>,(>C #id 2<- # : 2- m(>r  6 # : -<10 m(>r 2<- # : 2- m(>r  6 # : -<10 m(>r 2<- # : 1- m(>r qid 6<12 # : )0 m(>r qid  12 # : 60 m(>r qid

B"onko%ne'onia "C : < " E" 7 B%A < o oraC < ,onsl eab +edi, C : 1$ es#ri,si ;airan 60<80O ,eb rma#an 2$ /2 nasal 2<4 lm>mas,er 6<8 lm )$ ?emen#ara asa 4$ 5es# fisio#C Neb>s;#ion ber,ala - AB an#i =amr ,> AB : PP G Kloram>Ami G 5loCa>Eri#ro G Kloram ) bln<- #n9 PP G %en#a>5loCa G %en#a M ) bln9 PP>Eri#ro>Ko#rim  - #9

5efroCim>5efo#aCim>5ef#riaCon>5ef#aRidim

147

148 +eroenem G Amino(li,osida 6$ A#asi asidosis G K? : "eCame#ason 01<02 m(>,(>C +o : *? dis#ress nafas o oraC lan( s#l 2 m( #C ?is#em ?,orin( Pernafasan 0 ?ianosis A,#ifi#as o#o#
< < Bai, Normal M10 !0<100

1 d( G/

2

ran(an ?edan( 2

G d( i/ 2 40O Nya#a

?edan( Jele, "eresi>(elisa Koma 10<40 40  !0 d( / 2 ran(an  !0 i/ 2 40O9 40<66

?,or 0<4  #ida, ada baaya -<6  an;aman (a(al nafas  !  (a(al nafas Kri#eria(a(alnafas:

Klinis ?ara nafas ↓ e#ra,si ⊕ ?ianosis ?a/2 M 40O9 ons o#o# ↓ Kesadaran ↓

ab Pa5/2  -0 mm.( Pa/2 M -0 mm.(

Edea %'on' C : < Posisi  dd, < /2 4<6 lm < rosemid 1<2 m(>,( iv G di(i#alisasi ;ea# < +orfin 01 m(>,( s; elan < Plebo#omi ± -00 ;; TBC "C B5 ana, Konsenss Nasional 20009 1$ 5ri(a B : < ,on#a, era# d( C B5 d( BA G < #d rea,si ;ea# B5% < #d (C mm 2$ %e=ala B : < (C mm  BB ↓ s>d (a(al #mb anore,sia demam lama ,erin(a# malam ba#,  ) m(

148

149 embesaran K%B < (C sesifi,  B milier +enin(i#is )<6 bln9 B #lan( @ sendi ) #9 B (in=al B ,li# - #9 )$ +#C #es# 10mm =, B5% s;ar <  1-mm =, B5% s;ar G9 4$ ea,si ;ea# B5% eri#ema @ indrasi -mm dlm )ara#ra,eal9 6$ Pemeri,saan mi,robiolo(i>serolo(i BA9 !$ Pemeri,saan a#olo(i 8$ eson #d /A dlm 2 bln ?,or B : Parame#er 0 Kon#a, d,=elas + #C #es# Ne(a#if

1

) BAG9 Posi#if Klinis (iRi br, BB>B M 30O a#a BB>BM !0O BB>7 M 80O BB>7 M 60O

?# (iRi "emam #ana sebab =elas

 2 min((  ) min((

Ba#, Pembesaran K%B ;oli aCila in(inal Pemben(,a,an l## #l(>sendi an((l falan(  o #ora,s

2 BA#d,=elas

 1 ;m Σ 1 #d, nyeri Ada

N>#d, =elas

%ambaran ?(es#if B

"C : < " E"   < o oraC < +an#oC #es# BA serial )C < ?,or B ≥ 6 < P biosi ,> C : < /A : 2 .>4. B sim#oma#i, limfadeni#is endobron,ial9 2 .E?>10. B milier menin(i#is #lan( serosi#is9

IsoniaRid

- 4<69 m(>,(>r maC )00 m(>r9

149

150 ifamisin PiraRinamid E#amb#ol ?#re#omisin

10 8<129 m(>,(>r maC 600 m(>r9 2- 20<)09 m(>,(>r maC 2- (>r9 20 1-<2-9 m(>,(>r maC 2- (>r9 1- 12<289 m(>,(>r maC !-0 m(< 1 (>r9

< *i# B6 10 m(>r < Prednison 1<2 m(>,(>r 1<) bln #a off +o : " 

GASTR4E6TER4L4GI

150

151

Dia"e

"iare H BAB ;air  )C>24=  "iare a,# M )<- r9 "iare ber,ean=an(an !<14 r9 "iare ,roni,  14 r9 DIARE A!UT E#io : en#eral infe,si in#o,si,asi9 aren#eral I?PA I?K /+A dll9 "C : < " 7  ?E %"A B%A < Kl#r feses "5 =, bera, dara9 ,l#r rine Kri#eria dC : "eidrasi in(an

"efisi#;airan ≤ - O BB 2- ml>,(

?edan(

6<3O BB

Bera#

??P somnolens soor ,oma9 ≥ 10O BB 100 ml>,( (C (C res>5*? Kssmal syo,9

!- ml>,(

%C as oli(ria #r(or ↓ 77B ;e,n( ma#a ;o&on(

C : 1$ eidrasi 2$ *i# A -0000<200000 I7 im  1-00<-000 I7 o G *i# B; 5 E )$ AB : Ko#rim>Nalidi; a;id si(ella9 Neomy;in>5olis#in E ;oli9 +e#ro amoeba9 Eri#ro ;amyloba;#er9 e#ra ,ole 4$ Probio#i, 2C1 sa;e# -$ A?I>PA?I dien;er,an 60O  ,> +>+>+5 E5"9 "ie#in#a,e
KEB77.AN 5AIAN

JENI? A

5AA PE+B

G )0 ml>,(>1 =am 10 ##s>,(>m#9

>N?

iv dlm 1 =am

151

152

Plan B

Plan A

?edan( 6<3O

G !0 ml>,(>) =am ##s>,(>m#9

>N?> .?"

iv>i(>o dlm ) =am

in(an ≤ -O

G -0 ml>,(>) =am )<4 ##s>,(>m#9

.?" /rali#

o>i(>iv dlm ) =am

Non deidr

G 10<20 ml>,( #ia ,ali diare

/rali# 5

Po

7n#, neona#s M ) bln9 : Plan 5 : )0 ml>,(>2 =am d( ;airan neona#s Plan B : !0 ml>,(>6 =am d( ;airan neona#s 7n#, diare d( y enyer#a : Plan 5 : )0 ml>,(>2 =am d( ;airan  "arro& Plan B : !0 ml>,(>6 =am d( ;airan  "arro& 7n#, deidrasi ierna#remi : Plan B : !0 G1009 ml>,( G 2 r on (oin( losses H ± )20 ml>,(>4 2<) ##s>,(>m#9 ;airan  "arro& 7n#, maln#risi bera#  reidrasi d( esomal o>s I*" an =i,a ada indi,asi : diare>mn#a>deidrasi syo, le#ar(is KC : %(n ,eseimban(an ;airan ele,#roli# asam basa In#oleransi K. @ lema, diare ber,ean=an(an diare ,roni, DIARE BER!EPA67A6GA6 E#io : infe,si sindr malabsorbsi in#oleransi en#eroa#i 5+P?E9 "C : < " 7  ?E %"A B%A < Kl#r feses "5 =, bera, dara9 ,l#r rine < . 5lini#es# ?dan III osial>floa#in( #es# * de Kramer

< Eliminasi<rofo,asi 5+P?E KC : diare in#ra,#abel DIARE !R46I! E#io : infe,si sindroma os#en#eri#is "C : < " 7  ?E %"A B%A < Kl#r feses "5 =, bera, dara9 ,l#r rine < . 5lini#es# ?dan III osial>floa#in( #es# * de Kramer < o oraC B/ Ba inloo biosi ss serial < Eliminasi<rofo,asi 5+P?E KC : sesis 

152

153

DIARE PD !EP a,#or
,edelai Perbedaan (e=ala ,linis deidrasi dan syo, sesis ada KEP bera# : %e=ala "iare .as .io#ermi +a#a;o&on( "eny# nadi A,ral Prod,si rin ?#a#s men#al .io(li,emi±

"eidrasi sedan( a a,sminm ida, a Ka# .an(a# Ada %elisa re&el

±

"eidrasi bera# a +alasminm ida, a ema "in(in ida, ada e#ar(i ,oma

±

±

153

Imendin( ?yo, syo, sesis a>#ida, a>#ida, ida, ida, a>#ida, a>#ida, ida, ida, ema ema "in(in "in(in Ada ida, ad Aa#is e#ar(i

154

/eebab &iare

*olme #in=a Pasa /smolari#as #in=a Na #in=a mEq>l9 K #in=a mEq>l9

/smo#i, M -00 "iare s#o 400

?e,re#ori,  -00 "iare mene#a 280

)0

100

)0

40

!o%o#i#i Rata-"ata Eekt"oit0 o* 6a

!

C

9C4=-

!oe"a "e&asa Bali#a Dia"e non koe"a Bali#a La"'tan o"ait

140 101

1) 2!

104 32

44 )2

-6

2-

--

14

30

20

80

)0Q

4"ait +11+

!-

20

6-

10

A##it"at ?1 *L

154

G'ko#a

111 !-

155

Komosisi orali# ./ > 7NI5E  2002 Kandn(an

Jmla (>l

Ion

Konsen#rasi mmol>l

Na#rim ,lorida

26

Na#irm

!-

rina#rim si#ra# diidra#

23

?i#ra#

10

Kalim ;lorida

10

Kalim 5lorida

20 6-

%l,osa anidros9

1)-

%l,osa

!-

Q Na#rim bi,arbona# 2- ( – bi,arbona# )0 mmol> ! ;ara en;e(aan diare  yai# : ? + =  2  

Pemberian A?I e,s,lsif blan er#ama dan dilan=#,an samai sia 26 #an Pemberian ma,anan endamin( A?I yan( #ea# =enis #ea# &a,# dan bersi Pen((naan air bersi n#, ,ebersian @ n#, minm 5;i #an(an Pen((naan =amban Pemban(an #in=a bayi yan( aman Imnisasi ;ama,

.'nta$ "C : < " 7 <   ?E B%A < B/ 7?% I*P 5>+I C : < A#asi y rimer < An#ieme#i, sim#oma#i,  +e#o,loramid 01<02 m(>,(>C #id "omeridon 0) m(>,(>C #id /ndasen#ron 4 m(>8 = slm - r

155

156 ?ma#ri#an 01<12 m(>,(>r ?ime#idin -<10 m(>,(>C #id ani#idin 1<2 m(>,(>C bid

Pe"da"a$an Sa'"an Ce"na 1$ Perdaraan sal serna ba( a#as  ema#emesis < %as#ri#is @ dodeni#is < *arises esofa(s < ?indroma +allory eiss 2$ Perdaraan re,#al  ema#o;eRia < isra ani oli ro;#i#is aler(i < Infe,si : diare ;oli#is < +e;,el\s diver#i,lm < 5ron\s disease )$ Perdaraan sal ;erna masif < *arises esofa(s < 7l,s e#i,m

< +e;,el\s diver#i,lm < A*+ 4$ Nyeri er# < Peri#oni#is NE5 < .eno; ?;onlein Prra < In#ssesi

156

157 9EPAT4L4GI

9e%atiti# 8i"'# Ak't

"C : " 7 Bili ">I ?%/>P Alb>%lob %"A . I(+ an#i .A* G  .eA .bsA( G  I(+ an#i .B; G  .e B a,#  .e B ,ronis I(+ an#i .B; < An#i .5* G  .e 5 An#i ."* G  .e " I(+ le#osira ,l#r rine 7?% ear @ sal bilier ,l#r daraP M1  roses a,# 1  roses ,ronis C : 1$ ?or#if : emba#asan a,#ivi#as die# KP KI oba# ea#o#o,si, 2$ +edi,amen#osa : < 7rsedeo,si,oli,asid 7"5A9 10<20 m(>,(>r bid < An#iviral : in#erferon lamivdin ribavirin < Prednison ,ss .A* ,oles#a#i,9 < Koles#iramin 02-<0- (>,(>r 6C>r < As rsodeo,si,oli, 7rdafal,9

!oe#ta#i# Koles#asis  Bili " ≥ 2 m(>dl 20O dr bili 9 Koles#asis ?%/>P %% Bili C In#raea#al GGG G GGG medi,amen#osa E,s#raea#al G GGGG GG oera#if

"C : < " ." 7 bilirbin robilin9  s#er,obilin9 < ?%/>P bili "> γ% PP>AP Alb>%lob Koles#>% < %"P B7N>?; < 7?% abdomen asa @ os# feedin(9 5 s;an +I s,in#i(rafi "A < .BsA( I(+ an#i .Bs I(+>I(% an#i 5+*>/5. C : < ?s +5 1)0<1-0O ,eb normal9 *i# A -000<2-000 I7 1C *i# " 00-<02 µ(>,(>r

157

158 *i# E 2-<200 I7>,(>r *i# K1 2-<- m( selan( seari +ineral : 5a P +n n ?e e < As rsodeo,si,oli, 7rdafal,9 10<20 m(>,(>r bid enobarbi#al - m(>,(>r bid Koles#iramin ^es#ran9 02-<0- (>,(>r 6C>r "ifenidramin -<10 m(>,(>r ifamisin : 10 m(>,(>r +o : i,#ers besarnya a#i lima asi#es vena ,ola#eral "A - asa )<4 =am sblmnya - me#o,loramid 04 m(>,( <1 =am sblmnya - diaReam iv - sonde nasal  la,ms - dara 100 ;;  mirin( ,anan 1-<)0 mn# smbl dir# - B/>floros,oi - +(?o4 2-O - asirasi s#l )0 mn#  #es bilirbin - emeri,saan #ia 4 =am s>d )C

Gaga 9ati Klasifi,asi (a(al a#i : In#ervali i,#ers < ensefaloa#i

.iera,# A,# ?ba,#

Edema o#a,

Pro(nosis

M!r

?erin(

?edan(

8<28r )<12m(

?erin( ?erin(

Jele, Jele,

Penyebab .A*.*B P;# NonA>B>5 NonA>B>5

%radasi ,oma ea#i,m : %radasi Kesadaran Ke=i&aan %C nerolo(i %(n EE% 0 Normal Normal d,ada d,ada %(n #es ?b<,linis Normal Normal d, ada si,ome#ri, 1 %(nola a remor %elomban( #idr Bin(n( Ara,sia ) fase - .R9

158

159 %elisa

A(i#asi Iri#abel

2

e#ar(i esons lamba#

"isorien#asi &a,# Kela,an #a, #\,on#rol

)

?omnolen

"isorien#asi #ema# A(resif

4

Koma

ida,ada

In,ordinasi d, bs nlis As#eri,sis flain( #remor9 "isar#ria A#a,sia efle,s ↓ As#eri,sis Ke,a,an o#o# Babins,y G efle,s ↑

%elomban( ) fase - .R9

%elomban( ) fase - .R9

"eserebrasi

"C : bilirbin  4 m(>dl />P io(li,emia al, fosfa#ase N> ↑ . 

A,#ifi#as (el del#a> lamba#

↑ !0<100C alb N>↓

B7N>?; ↑  ea#orenal syndrome Asidosis me#ab>al,alosis res  ea#olmonary syndrome .io Na>K io P/4 N.) @ la,#a# ↑ EE% 7?% ear doler9 5 s;an>+I abd 5 s;an ,eala C : < *i# K P fa,# ,oa(lan B < Enema la;#lose 1-0 ml dlm -00 ml air #id < a;#lose 1 ml>,(>C o #id < Neomi;in 2- m(>,(>C o #id < lma;enil =, ,e=an( KI diaReam9 < +ani#ol 0-<1 (>,( iv  02-<0- (>,(>C iv qid =, edema o#a, < "ie# K5P5 < inda,an ,ss: #ransfsi #,ar dialisis eri#onial #ranslan a#i %a(al a#i flminan  ensefaloa#i o, ne,rosis sel a#i las %C (a(al a#i flminan : ,esadaran ↓ erdaraan bili dire,  4 m(>dl />P  1000 I7> P  ) ,oles#asis  )0 r

9i%e"ten#i Po"ta

159

160 . or#al  #e, aliran dara or#al  10<12 mm.( N 4<8 mm.(9 %C : ema#emesis melena ensefaloa#i asi#es ea#o< slenome(ali i,#ers elebaran vena dindin( er# @ ;a# medsa "C : "  . alb serolo(i ea#i#is def alfa<1 an#i#risin B/ 7?% "oler 5 s;an 5,omonen dara9 < Kore,si ,oa(loa#i : vi# K #ransfsi 5 @ P9 < ?#erilisasi ss : Neomisin 4 (>r o < ese#or .2 blo,er : ani#idin 1<2 m(>,(>C iv bid < /;#reo#ide>?oma#os#a#in 1<10 µ(>,( dlm -0<100 ;; P dri s>d 12= ?#l erdran beren#i < *asoresin 0002<000- 7>,(>mn# dlm "-O dri slm 20<40 mn# rma#an d( dosis y( sama #ia =am < ?,lero#erai endos,oi, erai reven#if erdaraan varises esofa(s < β,(>C o bid < "ire#i, : ?ironola,#on - m(>,( )<- r < rans=(lar in#raea#i; or#osys#emi; sn# IP??9 < ?lene,#omi < "evas,larisasi < ranslan#asi a#i



A#cite#  ?#a(e 1  #erde#e,si d( emeri,saan fisi, y( s(# #eli#i  ?#a(e 2  mda di,e#ai d( emeri,saan fisi, biasa  

Σ

;airan ?#a(e )min  d# dilia# #ana emeri,saan fisi, ## abdomen #d, #e(an( ?#a(e 4  asi#es erma(na

P : e, idros#a#i, ↑  sirosis o,lsi v ea#i,a sindrom Bdd<5iari9 obs#r,si v ;ava inf eri,ardi#is ,ons#ri,#if y =#( ,on(es#if e, ,oloid osmo#i, ↓  y a#i s#d lan=# d( ((n sin#esis ro#ein sindrom nefro#i, maln#risi ro#ein
160

161 Permeabili#as ,ailer eri#oneal ↑  eri#oni#is B ?BP mali(nansi Kebo;oran ;airan di ;avm eri#oneal Analisis ;airan asi#es : < Perbedaan ,adar albmin sermdl  . or#al  transudative ascites9 : sirosis ea#i#is al, (a(al =an#n( (a(al a#i flminan #rombosis v or#a ?AA% M 11 (>dl  b,an . or#al  e%udative ascites9 : # eri#onim asi#es an,reas asi#es bilier B5 eri#onim sindrom Nefro#i, obs#r,si ss < Kadar amilase  ↑ d asi#es an,reas < Kadar #ri(liserida  ↑ d asi#es bilier < e,osi#  )-0  infe,si P+N  ba,#erial +N  viral>B>=amr9 < Eri#rosi#  -0000  mali(nansi B>=amr < . M !  infe,si ba,#eri < Pen(e;a#an (ram ,l#r si#olo(i C : < "ire#i, : ?ironola,#on 1<) m(>,(>r G rosemid 1<2 m(>,(>C qid < es#ri,si ;airan die# renda (aram 0- (>r < Para;en#esis -0 ;;>,(  Albmin 10 ( iv #ia 1 l# ;airan asi#es < Peri#oneovenos sn# e*een>"enver l#rafil#rasi e,s#ra,ororal9

T'o" 9ati mor a#i d ana, =ina, (anas : rimer>me#as#ase ea#oblas#oma 6-O M ) #9 ea#oseller ;a M 13 #9

"C : "  +I serolo(i ea#i#is AP o #ora,s B/ 7?% "oler 5 s;an Biosi a#i Klasifi,asi #mor : < ?#d I : #mor d# dian(,a# len(,a d( embedaan < ?#d II : #mor d# dian(,a# d( embedaan # ms ada sisa < ?#d III : #mor #d, d# dian(,a# s;r len(,a d( embedaan #d enyebaran d ,elen=ar (e#a benin( dise,i#arnya

161

162 < ?#d I* : #mor #l menyebar ,e or(an #b lain < elas : #mor mn;l la(i s#l en(oba#an bai, di a#i>or(an lain C berdasar,an =enis @ s#adim #mor : < .ea#oblas#oma s#d I @ II  en(an(,a#an #mor G ,emo#erai 4 seri 5isla#in *in;ris#ine lorora;il9 < .ea#oseller ;a s#d I @ II



en(an(,a#an #mor G ,emo#erai 5isla#in dan>a#a "oCorbi;in9 < .ea#oblas#oma s#d III @ I*  bbr al#erna#if #C : ⋅ ,emo#C > men(ran(i , #mor G en(an(,a#an #mor G ,emo#C ⋅ embedaan me#as#ase #mor ar ⋅ ,emo#C ⋅ radio#C G embedaan ⋅ in=e,si si#os#a#i,a l(s ,e emb dr a#i ⋅ ,emo#C @ ,emoembolisasi ⋅ #ranslan#asi a#i < .ea#oseller ;a s#d III @ I*  ,emo#C 5isla#in d( vin;ris#in >loro< ra;il>"oCorbi;in9 G en(an(,a#an #mor sebanya, mn(,in < elas  #C lan( berdasar,an en(oba#an sebelmnya

162

163

163

164

164

165

165

166

6E5R4L4GI

Infek#i Sa'"an !ei$ I?K a#as  re#ri#is sis#i#is I?K ba&a  re#eri#is ieli#is ielonefri#is a,#>,roni, E#io : E ;oli 8-O9 ro#es mirabilis sedomonas en#eroba;#ers#afilo,o,s ares ,lebsiela ;i#roba;#er in#ermedis dll E ;oli memi; reson si#o,in sel roei#el bli s( #=d : < ↑ se,resi I<6  demam ↑ fa;#or inflamasi9 < ↑ se,resi I<8  reson imn sesifi, ne#rofil9 men(eliminasi Bli meleas,an rese#or an#iadesin n#, men(sir ba,#eri y bersaa menemel d dd( bli an .arsfall (ly;oro#ein se;re#ory I(A9 +e,anisme er#aanan #b : aliran ,emi dr (in=al<re#errC imnolo(i Pa#o(enesis : as;endin( ## ♀9>ema#o(en bayi9 Predisosisi : < Kln ana#omi : refl,s vesi,o<re#ral dli,asi (in=al @ re#er sindroma Prne Belly s#asis ,emi o, obs#r,si>resid d diver#i,lm bli re#ero,el nids < %(n f(s : nero(eni; bladder ninibi#ed bladder infreqen# voidin( obs#iasi < /bs#r,si : benda asin( ba# ,a#e#era9 s#asis %C : 0<1 bln  7/  anore,sia mn#a diare ,e=an( sesis 1 bln – 2 #  idem ,oli, mi,si rine ba>b\&arna lema 2<6 #  disri fre,ensi in,on#inensia ola,isri r(ensi enresis

6<18 #  demam nyeri>,ememn( daera in((an( "C : 7rinalisis

166

167 7=i ;ari, le,osi# es#erase =i ;ari, ni#ri# =i dis#i;, =i red,si  B/ I*P +57 7?% s;in#i(rafi (in=al Konse i#n( ,oloni ,man : < Piria H le,osi#  -<10>lb 400C9 a#a 10>mmh non sesifi,>roses inflamasi < Ba,#eriria berma,naH le,osi#10-57>ml sim#oma#is >asim#oma#is In#erre#asi bia,an ,man %lass9 : < +id s#ream rine  1C10- 57>ml 80O inf9 )C10- 57>ml 3-O inf9 < Ka#e#er  10- 57>ml 3-O inf9 104<10- 57>ml -0O inf9 10)<104 57>ml lan(9 M10) 57>ml ≠ inf9 < ?ra bi, as  , (ram <>G 10) 57>ml 33O inf9 +enen#,an lo,asi I?K eeves9 : < (s  bia,an dr ,a#e#er re#er>,d( ,emi s#eril bladder &aso# #e;niqe9>NAB (in=al < d, l(s  5P  )0 (>ml E" )0>1= AB ;oa#ed ba;#eri rine sedimen# G I*P>+57 renal s;arin( ;ali;es bln#in( refl,s9 ". isoenRyme #ie III I* dlm rine KC : refl,s vesi,o<re#er   : voidin( ;ys#ore#ro(ray nefroa#i ier#ensi %%K C : 1$ ?or#if : a#asi demam mn#a deidrasi y(iene erinem sim#oma#i,  enaRoiridin 10 m(>,(>r 2$ Eradi,asi infe,si AB : ?+F>+P ni#rofran#oin asam iemida# sefalosorin amino(li,osid !<10 r )$ Pen;e(aan reinfe,si : a#asi fa,#or redisosisi BAK #ia 2<) = minm ;, indari iri#asi rofila,sis AB 1>) dosis mlm r 6 bln9 Ko#rimo,saRol 4<8 m(+P>,r>r bid Ami>amo,silin -0<100 m(>,(>r #id ?efale,sin -0<100 m(>,(>r #id Asam nalidi,sa# 2-<-0 m(>,(>r #id Asam iemida# 1-<20 m(>,(>r bid

167

168 Ni#rofran#oin %en#amisin

)<- m(>,(>r #id -,(>r im #id

4$ Kore,si ,elainan ana#omis  ;o Beda

Sind"oa 6ef"otik E#io : rimer

?N ;on(eni#al ?N idioa#i, : +5"  %N se,nder  me#aboli; infe,si #o,sin aler(i %C : sembab "C : 7  ro#eiria  -0 m(>,(>r Z 40 m(>m>= ,an#i#a#if : Esba; ' (>l>r ,ali#a#if : =i rebs Z sean(in  ± 10 m(>dl9 G ±)0 m(>dl9 GG ± 100 m(>dl9 GGG  ± )00 m(>dl9 GGGG ± 1000 m(>dl9 ema#ria ± "  ioalbminemia M 2- (>dl ier,oles#erolemnia  200 m(>dl  dbN   ydro#oraC Biosi  ind : mr M 2 #> 6 # #d, remisi d( rednison relas serin( . ema#ria  ↓ KC : infe,si anemia ioNa io5a %%A diare ea#ome(ali nyeri abd anore,sia asi#es efsi l ((n ,oa(lasi ((n er#mban E? s#eroid s#res C : 

1$ Perbai,an K7 : #ira barin( #o#al res#ri,si ;airan ± dire#i, ↑ albmin ,> #ransfsi lasma>albmin9 a#asi infe,si @ ,omli,asi die# KP % 2$ Prednison : diberi,an s=, 14 r s#l dC #e(a, =, dlm 14 r #=dremisi son#an  #d, erl rednison

∗ ?N sr(n I < Ind,si : Prednison 60 m(>m>r 2 m(>,(>r9 #id 4 m( < ma#an : Prednison 40 m(>m>48 =am a(i al# day 4 m( ∗ ?N relas #d, sr(  ,amb M 2C dlm 6 bln a#a  4C dlm 1 # < Ind,si : Prednison 60 m(>m>r 2 m(>,(>r9 #id ) m(

168

169 < ma#an : Prednison 40 m(>m>48 =am a(i al# day 4 m(

∗ ?N relas serin(  ,amb ≥ 2C dlm 6 bln a#a ≥ 4C dlm 1 # < Ind,si : Prednison 60 m(>m>r 2 m(>,(>r9 #id ) m( < ma#an : Prednison 60 m(>m>48 =am a(i al# day 4 m(  40 m(>m>48 =am 1 m(  )0 m(>m>48 =am 1 m(  20 m(>m>48 =am 1 m(  10 m(>m>48 =am 6 m(  s#o ?aa# fase rma#an diberi,an ?i,lofosfamid 2<) m(>,(>r o a(i ari 8<12 m( KI: le,osi# M)000>mmh9 ∗ ?N? < +e#ilrednisolon )0 m(>,(>iv bols  2 m(>,( o : al#erna#e day A"9 2 m(  #ia m( 8 m(  al# &ee, 8 m( #ia bln 3 bln  al#erna#e mo 6 bln < Prednison )0 m(>m>r 1 bln  al# day - bln =, ro#eiria #d, m\bai, s#l 2 m(>rasio ro#ein:,rea#in 2 d m( ,e<10 #C di#amba d( : < ?i,lofosfamid 2<2$- m(>,(>r o a(i ari 6<12 m( < ?i,losorin 1-0<200 m(>m>r o bid -<6 m(>,(>r9 < ARa#iorin 2 m(>,(>r #id 6<8 m( an#ime#aboli#9 < evamisol 2$- m(>r al# day imnos#imlan9 )$ Kore,si ioalbminemia : a H 08 C BB C ∆ Alb 1 (>,(>C9  aC1009>20 H -a ;; Alb 20O maC 1(>,(>r Alb 20O m 4<6= 1<2 = dran#e @ os# #ranfsi : rosemid 1<2 m(>,( iv 4$ "ire#i, : rosemid 1<2 m(>,(>r ?ironola,#on 2 m(>,(>r emisi elas elas serin( ensonsif
Pro#einria <>sean(in M 4>m>=9 slm ) r Pro#einria G2 40>m>=9 slm ) r Kamb  2C dlm 6 bln> 4C dlm 12 blm emisi anya d( #C s#eroid Kamb 2C slm #a off K?>14 r os# K?

esis#en
%a(al remisi s#l ind,si Prednison 4 m( emisi s#l ind,si Prednison 4 m( esis#en
G6APS Proses radan( sra#if>rC imnolo(is d (lomerli #d inf ### E#io : rimer  nefroa#i I(A se,nder  os# inf e,s#ra renal : ?#re#o,o,s V em (r A #ie 12412182-43--60 8<14 r : (C ,linis9

169



170 imnolo(is : sifilis in#o,si,asi Pb #rombosis v$

renalis y ,ola(en ?E .?P IP rra anafila,#oid9 Pa#o(enesis : , ?#re y( nefri#o(en  roses a#oimn , ?#re @ membr basal mem ,omonen A( y( sama ,omle,s A(d sembab anasar,a

malaise sa,i# ,eala mn#a demam anore,sia ema#ria oli(ria s>d anria . "  3-O mnr# mr9 ensefaloa#i  ,e=an( ,oma "C : 7  vol ↓ BJ ↑ ema#ria (ross9 ro#eiria "  B7N  2- mEq>l ?;  1$- mEq>l fase a,#9 E" ↑ .b ↓ Alb ↓ ;

,omlemen (lob 1 9 M -0 m( 4 m(9 A?/  10005) sa#Vodd ier t (lob ## I(% an#i "NAd ensefaloa#i . re#inoa#i . %%A  remia ierK ierP/4 anemi (C overload  de;om ;ordis dema ar C : #d, ada #C sesifi, 1$ ira barin( #o#al  +? 1<2 m( n#, ;e(a ,omli,asi9 2$ AB  PP 600000 7I im 10 r fa;e o# inf ?#re9 )$ .ema#ria  KarbaRo,rom Adona A59 - m( iv bols 4$ ?or#if  Inf "-O res#ri,si !-O =, #d "5 A/9 dire#i, an#i. A5E inibi#or di(i#alis doamine dialysis -$ "ie# lna, KP% 9i%e"ten#i Krisis .ier#ensi H " sis#  180 mm.( @ dias#  120 mm.( a#a ↑ " G (C ensefaloa#i ,e=an( de;om ;ordis viss ↓

170

171 1$ Nifediin 01 ml>,( sl #ia 1-<)0 m#  evalasi maC 1 m(>,(>r9 =, "d M 100 mm.( s#abil : lan( #ia 4 =am =, "d  100 mm.( : G 5a#oril 0) m(>,(>C o #id =, ## #\s#abil : G Proanolol - m(>,(>r #id

2$ 5lonidin 0002 m(>,( dlm 100 ml "-O dri 12 ##s>m# slm )0\  nai, 6 ##s>m# #ia )0\  maC )6 ##s>m# )$ rosemid 1<2 m(>,(>r 4$ "ie# % Jenis +anse# Neona#s Bayi Ana, "e&asa en(anbesar Paa

ebar ,are# ;m9 2$-<4$0 4$0<6$0 !$-<3$0 11$-<1) 14$0<1-$0 18$0<13$0

Pan=an( ,are# ;m9 -$0<3$0 11$-<18$0 1!$0<13$0 22$0<23$0 )0$-<))$0 )6$0<)8$0

a= il#rasi %lomerls  .ay;o;,
Kons#an#a 02! 0)! 040-0-0!0 %ml>men>1!)m 208 13  466-2 60146 6!-6!)8!2 3)!140

171

172 1<2#an 33118! 2<-#an 126-240 -<1-#an 116!202 Si#teik L'%'# E"iteato#'# %C : Kri#eria AA 1382 4 dr 119 : < Eri#ema malar b##erfly a9 < s dis;oid < o#osensi#if < 7lserasi m,o,#an oral < Pleri#is>eri,ardi#is < Nefri#is ro#einria 0- (>r9 < Nerolo(is ,onvlsi si,osis9 < Ar#ri#is non erosif < .ema#olo(is an emoli#i, le,o>limfo>#romboeni9 < Imnolo(is sel E Ab an#i "NA9 < ANA #es# G Kri#eria is#oa#olo(i ./ : %r I %lomerls dbN ,linis rin(an rinalisis dbN>M  dbN %r II %N mesan(ial rinalisis M  dbN %r III %N rolifera#if fo,al %r I* %N rolifera#if difs  %NA>?N d( .>%%K %r * %N membranosa  ?N ,ronis .  M %r *I %lomerlos,eloris  %% KC : C : < Ind,si : m( 0<20 < ?i,lofosfamid !-0 m(>m iv #ia 4 m( 6C9 < Prednison 1 m(>,(>r 4 m(  0$!- m(>,(>r 4 m( 0$- m(>,(>r 4 m(  dosis arian ↓ - m(>4 m( a#a < +e#ilrednisolon 1 ( iv r 0<1<2<14<1-<16<42<4)<44 < ARa#iorin 2 m(>,(>r < Prednison 20 m(>r < ma#an : m( 21<104 < ?i,lofosfamid !-0 m(>m iv #ia ) bln 6C9 < Prednison dosis arian ↓ - m(>4 m(  10 m(>r

a#a

172



173 < ARa#iorin 2 m(>,(>r < Prednison 1- m(>r 4m( < ARa#iorin 2 m(>,(>r < Prednison 10 m(>,(

10m(>r

m( 10-<108

Gaga Gina Ak't %%A H % ↓ -<1- ml>mn#>1$!)m9 aRo#emia oli(ria>anria o## rine M 1 ml>,(>= a#a 240 ml>m>r9 Pa#o(enesis : ermeabili#as ,ailer (lomerls↓ ba;,)600 % H ,CB9>5r , B 0$)) 5r M2 # 0$4<0$- m(>d 0<18 bln 0$42<8 # 0$-<0$! m(>d 2<1) # 0$-3<18 # 0$6<0$3 m(>d 1) # 0$-!<r 0$!
KC : C : 9enoc$ Sc$onein P'"%'"a C : 1$ Prednison < Ind,si : Prednison 1<2 m(>,(>r o #id 4 m( < ma#an : Prednison 1<2 m(>,(>48 =am a(i al# day 2$ AA 1<4 m(>,(>r 8
Indi,asi "ialisis 1$ 2$ )$ 4$ -$

Kadar rem dara 200 m(O .ier,alemia  !$- mEq> ?erm bi,arbonas M 12 mEq> Ada (e=ala overidrasi : edema ar de,omensasi =an#n( ier#ensi yan( #ida, #era#asi den(an oba#< oba#an Perbr,an den(an (e=ala remia bera# erdaraan ,esadaran menrn

173

174 6$

Kera;nan a#a ,elebian dosis oba#  salisila# (li,ol e#ilen ierfosfa#emia io,alsemia ierri,emia io>ierna#remia inborn of me#abolism 9

174

175

6EUR4PEDIATRI

!eang Dea

K" H ,e=an( o, ↑ s # re;#al )8c59 o, roses e,s#ra,ranial K"? vs K"K  ,e=an(  1- mn# #ie ,e=an( fo,al #=d 2C dlm 24= "C : < " E" 7 %"A B%A ?E B7N>?5  < P ,> mr M 18 bln9 < EE% 10 r os# ,e=an( K"K mr  6 #9 C : < A,( iv a#a 04<06 m(>,( re;#al < An#iire#i,  ,omres basa # )3c5 air an(a# # )8c air biasa9 < C ,asal < Profila,sis In#ermi#en>rma#an : K"? : P;# 10<1- m(>,(>C qid a#a Ibrofen -<10 m(>,(>C #id G "iaReam 01<0$) m(>,(>C o K"K :m(>,(>r enobarbi#al )<4 2 m(>,(>r a#a a#a Asammr *alroa# bid s>d # bebas#id ,e=an( 6 #910<20 +o : *? ,e=an(

Stat'# E%ie%tik'#

?#a#s Eile#i,s H ,e=an(  )0 mn# "C : < " E" 7 ,l#r %"A B%A ?E B7N>?5  < P EE% 5 ?;an ,eala < o oraC E5%

175

176 C : 1$ An#i,onvlsan : < "iaReam 0)<0- m(>,( iv a#a 04<06 m(>,( re;#al < oraReam 0$01<0$1 m(>,(>C iv < eni#oin 1-<20 m(>,( iv dien;er,an d( P  )<8 m(>,(>r bid < enobarbi#al 10<1- m(>,( iv slm 20 m#  ),(>r bid < +idaRolam 02 m(>,( iv elan  2<4 m(>,(>= dri refra,#er9 < "iaReam 001<004 m(>,(>min dri refra,#er9 2$ ?or#if : < A,( bols dien;er,an d( aqades aa9 < iamin 2- m(>C iv ana, M 18 bln : Pirido,sin 100<200 m( iv9 < "eCame#ason 0- m(>,(>C iv < Posisi semirone @ asan( N% < C ,asal +o : *? ,e=an(

.E6I6GITIS In#erre#asi analisa 5? es

Normal

e,anan P arna Jmla sel Jenis sel Pro#ein %l,osa

N Jerni 0<+N -<40 m(>dl 40<80 m(>dl

+enin(i#is Ba,#erial

↑ Ker  1000>ml P+N

↑ N>↓

+enin(i#is *irs N Jerni M 100>ml +N N>↑ N

+enin(i#is B5 N>↑ Fan#o,rom Bervariasi +N

↑ ↓

C : +enin(i#is ba,#erial < 5efalosorin (en ,e ) a#a < Ami 1-0<200 m(>,(>r iv qid @ Kloramfeni,ol -0,(>r iv qid 10<14 r < "eCame#ason 0-<1 m(>,( iv  0- m(>,(>r iv #id ) r )0\ sbl AB +enin(i#is #ber,losa < IsoniaRid 10<20 m(>,(>r o 1 # < ifamisin 10<1- m(>,(>r o 1 #n < ?#re#omisin 20<40 m(>,(>r im ) bln An#i,e=an( :

176

177 <"iaReam 02<0- m(>,(>C iv a#a 04<06 m(>,(>C s  <eni#oin - m(>,(>r iv>o #id a#a enobarbi#al -,(>r ,(>C o a#a Ibrofen -<10 m(>,(>C o #id

E6SE5ALITIS C : .?*1<2  Asi,lovir 10 m(>,(>8= dri1 =am 10 r9

ABSES 4TA!

?#d abses o#a, : 1$ serebri#is dini ari ,e 1<)9 2$ serebri#is lamba# ari ,e 4<39 )$ emben#,an ,asl dini ari ,e 10<149 4$ emben#,an ,asl lamba# s#l ari ,e 149 C : < 5efo#a,sim 200m(<)00m(>,(>r 4C dlm 6 m( a#a 200 m(>,(>r 100 m(>,(>r ,( GivKlorameni,ol  !- m(>,(>C iv>o qid ! rqid < +ani#ol 0-<1 m(>,( iv dlm )0 –60 m#  02-<0- m(>,(>C iv qid < "e,same#ason 0- m(>,( iv  0- m(>,(>r #id a#a +e#ilrednisolon 1 – 2 m(>,( iv  0- m(>,(>C qid #a off r ,e< -9 KC : erniasi n,al>#onsiler o, ↑ IK ven#ri,li#is o, abses e;a

Edea 4tak %C IK ↑ : < refle,s o;lo;eali; abnormal ne;, s#iffness

< os#re abnormal : de;or#i;a#e>de;erebra#e < resons il abnormal : la#eralisasi aniso,or9 ail edema < ola nafas abnormal : ierven#ilasi – 5eynes ?#o,es – ane < 5sin( #riad : N lamba# " ↑ ola nafas abnormal C : < .ead  )0° < es#ri,si ;airan 60O ,eb rma#an < .ierven#ilasi < ela#if io#ermia < A;e#aRolamid 10<2- m(>,(>r o #id

177

178 < +ani#ol 20O 0-<1 (>,( iv 10<)0\



02-<- (>,( iv #ia 4<6 =am

< rosemid 0-<1 m(>,(>C o #id < "eCame#ason 0- m(>,(  01<02 m(>,(>C qid ) r 9id"o#efa'# P : (an((an absorsi obs#r,si dan>a#a rod,si 5? y( berlebian C : < A;e#aRolamid 2- m(>,(>r o #id < rosemid 1 m(>,(>r o #id < Beda : E*" *P sn# *P

E%ie%#i Eilesi H ,e=an(  2C ber,ala9 son#an #ana rovo,asi #ana eriode demam dlm 24 =am9 Klasifi,asi eilesi I5E?9 : 1$ Ke=an( arsial lo,alfo,al9 < simel < ,omle,s 2$ Ke=an( (eneral

absens << mio,loni, < a#oni, < #oni,<,loni, C : < Ke=an( (eneral absens

: *PA P+ PB P. < Ke=an( (eneral mio,loni, : B" *PA P+ P. < Ke=an( (eneral a#oni, : B" P+ < Ke=an( (eneral #oni,<,loni, : 5B PB P. P+ < Ke=an( arsial simel>,omle,s : 5B PB P. *PA P+ > 5B+ – 5arbamaRein -<10 m(>,(>r bid  1-<20 m(>,(>r bid PB – enobarbi#al 2<6 m(>,(>r bid dosis ↑ #ia 2 m(9 P. – eni#oin 4<8 m(>,(>r bid *PA – Asam valroa# 10<1- m(>,(>r bid dosis #ia m(9 P+ – oirama# 0$-<1 m(>,(>r dosis ↑ #ia 2↑m(9

G'iain Ba""e Synd"oe %illain
178

179 Kri#eria Asbrry 1$ Pro(ressive &ea,ness in bo# arms and le(s$ 2$ ArefleCia$ )$ ea#res s#ron(ly sor#in( dia(nosis$ 4$ Pro(ression of sym#oms over days  #o 4 &ee,s$ -$ ela#ive symme#ry of sym#oms$ 6$ +ild sensory sym#oms or si(ns$ !$ 5ranial nerve involvemen# ese;ially bila#eral dile(ia$ 8$ e;overy be(innin( #&o #o for &ee,s af#er ro(ression ;eases$ 3$ A#onomi; dysfn;#ion$ 10$ Absen;e of fever a# onse#$ C : 1$ I*I% 04 (>,(>r - r 2$ Plasmaaresis 4<-C dlm !<10 r )$ "eCame#ason 0- m(>,(>r #id 4$ eabili#asi medi, -$ +* =, menyeran( o#o# nafas9 S.A ie I – Infan#il a,# erni(<.offman disease9 (C #imbl sbl sia 6 bln 3-O ,ass d sia ) bln9 io#oni floy infan#9 disf(s blbar sli# men(isa menelan bernafas9 ri&aya# sianosis ber,ean=an(an d &,# lair ie II – Infan#il ,roni,  #erserin( (C #imbl d sia 6<18 bln mo#ori; delay #remor =ari<=ari fasi,lasi9  sedoier#roi m$ (as#ro,nemis deformi#as ms,olos,ele#al (a(al nafas ie III – Jvenil ,roni, K(elber(<elander syndrome9  l( rin(an (C #imbl s#l sia 18 bln ,elemaan o#o# ↑ 5? N E+%>N5* N

Be# Pa#y

179

180 Bells alsy H ,elman N *II erifer nila#eral y( bersifa# a,# C : < Prednison 1 m(>,(>r o ! r < A;y;lovir 20 m(>,(>r o < a&a# ma#a

y#i; ;o;,#ail BB enobarbi#al "ifenidrami n ar(a;#il

M-,( -<10,( 10,( - m( 10 m( 10 m( 1 m( 1 m( 2 m( 1 m( 1 m( 2 m(

Kri#eria +B/ : < eson E<*<+ #ida, ada < efle,s ba#an( o#a, refle,s il ,ornea o;lo;eali; o;loves#ibl refle,s mn#a9 ne(a#if << Anea 10#sb meni# Ke#i(a al mene#a  12 =am d ana, ,e;il !2 =am9 < Konfirmasi : EE% isoele,#ri, ar#erio(rafi s#a(nan

180

181

6UTRISI @ PE6:A!IT .ETAB4LI!

Pola dasar ma,anan bayi @ ana, 0<6 bln 6<8 bln A?I>PA?I E,s,lsif Air ba 1C Ba Bbrss 1C Nasi #im 1C sarin( Nasi #im Nasi lna, Infan# formla #dd :

3<12 bln  12 bln /ndemand 1C 1C 1C 1C

)C )C

∗ ?#ar#in( formla a&al9 < Ada#ed formla  s(# miri ,omosisi A?I > sia 0<4 bln < 5omle#e formla  Ra# (iRi s(# len(,a > sia 0<6 bln ∗ ollo&  formla lan=#an9  ro# lb #in((i > 6 bln<) #

Kandn(an ss a# %iRi A?I er 100 ml9 ema, (9 )0<-Pro#ein (9 11<14 Karboidra# 66
Ada#ed ormla )4<)64 1-<16 !2
5omle#e ormla 1)2<)6 1!6<24 !)2<36 -1
PA?I )2 )1 44 61

Enfamil AG +ead Jonson9 ?26 ye#9 N#rilon Primi N#ri;ia9 +orina(a B+ +orina(a9 Nan Nes#le9 ?imila Advan;e Abbo##9 *i#ala; ?ari .sada9 Bebela;1 yem

181

182 Bimbi 5i#ra P ama9 a;#o(en1 Nes#le9 N#rilon A>Ne& 5amelo N#ri;ia9 5omle#e ?%+1 ?ari .sada9 Bebela;2 *i#ala;2 5il+il N#rima Enfaro N#rilon ollo& on follo&on a;#o(en2 ?%+2 Nan2 Promil Nena#al N#ri;ia9 Pre Nan Nes#le9 Enfala; P +ead Prema#r Jonson9 ?%+ BB A 110 Nes#le9 Bebela;  yemf9 N )) ree la;#ose / fa# malabsor#ion +5 Pro#ein Nan .A Nes#le9 N#rami(en +ead Joson9 Enfamil .A idrolisa# +ead Jonson9 N#rilon .A N#ri;ia9l ?emi Alfare Nes#le9 Pre(es#imil +ead Jonson9 Pe#i Jnior elemen#er N#ri;ia9 Pro;al 5il Kid Enfa(ro& N#rima Kid ?s#a(en Jnior Kss risian la( 12) "an;o& Bali#a Ande; 1G Pediasre %ai  1 # Advan;e

Asan ,alori n#, ana, sesai BB ≤ 10 ,( 100 ,al>,( 10<20 ,( 1000 G -0 ,al>,( dia#as 10 ,( 20,( dia#as 20 ,( Asan ,alori n#, ana, sesai BB BB 1-0 ,;al>,(>r 2-<) (>,(>r 0<1 # 120 ,;al>,(>r 2<2- (>,(>r 2<1) # 100 ,;al>,(>r 1-<2 (>,(>r Asan ,alori n#, ana, sesai "A 0<1 # 100<120 ,;al>,(>r 1<) # 100 ,;al>,(>r 4<6 # 30 ,;al>,(>r !<3 # 80 ,;al>,(>r 10<12 #  60,(>r P -0<60 ,;al>,(>r 12<18 #  -0<60 ,;al>,(>r P 40<-0 ,;al>,(>r

182

183

Keb#an ,alori @ ro#ein Kondisi ,ri#is *en#ilasi me,ani, C (ro&# ormon 5ombs#io>#rama Asan ro#ein Pro# > ;ombs  20O

d ana, sa,i# 2-<)0 ,al>,(>r 20<2- ,al>,(>r 1-<20 ,al>,(>r 40<4- ,al>,(>r 1-<2- (>,(>r 2<) (>,(>r

Komosisi smber ener(i dalam n#risi Karboidra# 40<60O ?esai BB )4 ,,al>( Pro#ein 20<-0O 1<) (>,(>r 4 ,,al>( ema, !<1-O 1<)(>,(>r 3,,al>( abel "A n#, mr B C BB ideal BB B Kal Pro# 5airan 6,( 60;m 108 22 140<160 3,( !1;m 38 112-<141),( 30;m 102 1) 11-<1220,( 112;m 30 12 30<110 28,( 1)2;m !0 10 !0<81-!;m -10 !0<8♂ 4-,( 11<14 # ♀ 46,( 1-!;m 4! 10 !0<81!6;m 408 -0<60 ♂ 66,( 1-<18 # ♀ --,( 16);m 40 08 -0<60 Q ,alori ,,al>,(9 ro#ein (>,(9 ;airan ml>,(9 Keb#an ,alori>ro#ein H "A n#, mr B ei(#
abel BEE ,,al>r9 !ari<10blan B+ BB ♂>♀ )-,( 202 40,( 228

mr 11<)6blan )<16#an B+ B+ BB BB ♂ ♀ ♂ ♀ 30,( -28 -03 1-,( 8-3 !33 3-,( -4! -28 20,( 3-) 838

183

184 4-,( -0,( --,( 60,( 6-,( !0,(

2-2 2!) )0))2 )-8 )84

-4! -66 -86 60624 646

2-,( )0,( )-,( 40,( 4-,( -0,(

1048 11)3 12)1 1)21418 1-12

336 1032 1130 1283 1)8! 1486

!410 682 6680,( ,( 4)! 1)0 1)-,( ,( !01 684 8-,( 46) 140,( !20 !0) 30,( 430 14-,( !)3 !22 3-,( -14 1-0,( !-8 !41 100,( -40 1--,( !!8 !60 10-,( -66 160,( !3! !82 110,( -3) 16-,( 816 802 abel fa,#or s#ress Kondisi ,linis a,#or s#res ma#an #ana 10<12

-60,( ,( 6-,( !0,( !-,(

1606 1633 1!3) 1886 1380

1-84 1680 1!!8 18!4 13!)

s#res9 "emam Bedaele,#if Bedamayor %a(al=an#n( ?esis rama>;idera ,eala mb,e=ar

100,( 10-,( 110,( 11-,( 120,( 12-,(

-66 -86 60624 64) 662

12O #ia ↑ 1°5 11<1) 12<14 12-<114<11-<1! 1-<20

Pada rinsinya asien den(an berba(ai s#a#s (iRi ,eb#an n#risinya ber#=an n#, men;aai BB ideal dii#n( d( rms : Keb#an ,alori>ro#ein H "AQ sesai 7mr BQQ C BB idealQQQ Q"A  lia# #abel QQ7mr B  dilo# d ,rva lia# P-0
184

185 H 1062-<12)2- ,,al ] 11-0 ,,al>r PC sa,i# bera# #ai masi bisa eroral>en#eral i#n(annya sama ,eb#an ,alori berdasar "A sesai mr B J, #d, bisa eroral a#a anya bisa aren#eral ma,a dii#n( berdasar ,eb#an ener(i basal a#a BEE di#amba,an fa,#or s#res .ars diin(a# selama ,ondisi s#res me#aboli, emberian n#risi #ida, bole berlebian -0r ,eb#an ro#ein 1<) (>,(9 ] 8 (>r ,eb#an ;airan 11-<12- ml>,( ] 360 ml>r diberi,an !0<80O dl a#a  800 ml>r9 #erba(i dlm : < aminofsin -O H 8>- C 100 H 160 ml>r  8 ( C 4 ,,al H )2 ,,al < de,s#rose 12-O H 800 < 160 H 640 ml>r  640 C 12- C )4 H 2!0 ,  %I H O de,s#rose C ,e; #e#esan ml>=am9 > BB ,( C 69 H 12- C 26!9 > 8 C 69 H 63- ren#an( N : 6<8 m(>,(>mn#9 #o#al ,alori yan( diberi,an )2 G 2!0 H )02 ,,al 6-O B+9 se;ara ber#aa emberian ;airan dan asan ro#ein dinai,,an d ari ,e<- daa# di#amba,an asan lema, 1<) (>,(9 ] 8 (>r d( rin;ian sbb : H 8>20 C 100 H 40 ml>r  8 ( C 3 ,,al H !2 ,,al < iveli 20O < aminofsin -O H 16>- C 100 H 240 ml>r  16 ( C 4 H 64 ,,al < de,s#rose 12-O H 860 < 280 H -80 ml>r  -80 C 12- C )4 H 246  %I H 12- C 2429 > 8 C 69 H 6) m(>,(>mn# #o#al ,alori yan( diberi,an !2 G 64 G 246- H )82- 826O B+9 Pada (iRi ,ran(>br, sa,i# bera# y( #ida, bisa en#eral a#o,an sesai ,eb#an ;airan n#, ana, Pada (iRi lebi>obesi#as ,eb#an ,alori dii#n( d(

BB ,ore,si H BB ideal G BB a,#al – BB ideal9 C 02-L Bila diren;ana,an PN dalam &a,# lama  14 ari9 saa,an s( vena sen#ral saya bisa dinai,,an ber#aa samai 30<3-O B+ B+ =(a bisa dii#n( den(an rms ?;ofield>./ 016! BB G 1-1!4 B – 61!6 ,,al9  asilnya biasanya sedi,i# lebi #in((i dari #abel ?#andard die# ?7

185

186 B B? ? B.

4-0(r 4-0(r 4-0(r -00(r

600,;al 300,;al 1000,;al 1200,;al

"ie# biasa : Kls I Kls II Kls III "ie# lna, : Kls I Kls II Kls III "ie#KPbiasa "ie#KPlna, "ie# sonde : KP

BK Nim KP B?I K

K;al 1831!14 16)) 1803 1!26 1-4! 188) 1!08 862

800(r 1-00,;al 300(r 1200,;al 300(r 1300,;al 300 (r 800 ,;al

Pro# m, K. 63 !) 240 -8 -8 240 -8 60 218 63 !) 213 62 6! 218 -! -136 66) 261 664 220 )4 -0 !1

im 336 48 "ie#;air:KP !326 Bbr#en( 6)) 23 Bbr ss !-0 26 imsarin( 3!6 )2 "ie# renda sera# #ifs9 1-42 -1 "ie# renda ro#ein 20( 1428 21 )0( 1!)8 )1 40( 188)3 "ie#rendalema, 16)8 -0 +odis;o  4-! 2) +odis;o I -88 24 +odis;o II -42 22 +odis;o III !46 18

Indi,asi Komosisi

Panen#eral +alabsorsi +5 de,s#rin

41 23 20 24 16 43 )0 )) 441)0 246

Pro#en ?a,i# bera# Bb, ,edelai

186

142 108 -2 !8 1!8 228 2!2 ))6 )64 2-3 -3 -3 60 68

Neomn Imnodefisien +5 de,s#rin

187 ,asein s,ro
mal#ode,s#rin s,rosa vi#amin

200 ,,al 6$12 ( 21$81 ( 10$28 ( 200 ml 40 (9

212 ,,al 10 ( 2!$! ( -$8 200 ml -2 (9

Ener(i Pro#ein K. ema, #ia

olide,s#rosa fr,#osa ,asein ar(inin (l#amin minya, =a(n( minya, i,an Ω<) #arin ,arni#in mineral 200 ,,al 12$- ( 2-$01 ( -$!3 ( 200 ml 48 (9

Jenis ma,anan biasa – lna, – sarin( – ;air9 KEP anas #in((i y ,roni, re<os# o ;ombs#io /besi#as "iare In#oleransi %(n %I Kons#iasi IB? Pre,oma ,oma .ea#i#is bera# %(n ear .ea#i#is rin(an ase enyemban "e;om ;ordis %(n =#( (s =an#n( ↓ ." demam rema 55 M 13 ml>mn# B7N  60 m(>dl ?5 4<6 m(>dl %(n (in=al 55 20<)0 ml>mn# B7N 40<60 m(>dl ?5 2<4 m(>dl ?indroma nefro#i, "iabe#es+eli#s

"ie# KP "ie#renda,alori "ie# renda sera# "ie#rendala,#osa "ie# #in((i sera# "ie# .a#i 1 ro# 0$- (>,(9 "ie# .a#i 2 ro# 1 (>,(9 "ie# .a#i ) ro# 2 (>,(9 "ie# .a#i 4 ro# ) (>,(9 "ie# 5* 1 P #ana (aram9 "ie# 5* 2 5P% 0$2 (>r9 "ie# 5* ) "ie# P #ana (aram

"ie# P% "ie# P% "ie#B1K.:P:60:20:209

ormla KEP ?s s,im (9 ?s fll;ream (9


187

188 ?s sai se(ar )00 880 ml9 %la (9 100 100 100 !0 !0 !-0 -0 !en( beras (9 ))22-0 en( sereal (9 )en( ,edelai (9 1-0 +inya, ml9 )0 20 20 2)0 )0 -0 60 +ar(arin (9 -0 arele,#r>minml9 20 20 20 20 20 )0 Air s>d ml9 1000 1000 1000 1000 1000 1000 1000 1000 1000 1 Ener(i,,al>100ml9 !!!80 100 100 100 100 1)- 1 Pro#ein (>100 ml9 0$3 0$3 1$1 )$- 2$3 2$3 )$- )$- )$) ema, (>100 ml9 4 4$-

?ema baan dia#as dimasa, selama 4B BB ANAK AKI< B BB ANAK AKI ;m PE+P7AN med ?"lo ?" 9 med ?"lo ?" & & )$1 0$) 0$6 43 )$) 0$4 0$) )$) 0$4 0$- -0 )$4 0$4 0$4 )$- 0$4 0$- -1 )$- 0$4 0$)$! 0$- 0$- -2 )$! 0$4 0$)$3 0$- 0$6 -) )$3 0$- 0$4$1 0$- 0$6 -4 4$1 0$- 0$4$) 0$- 0$- -- 4$) 0$- 0$4$6 0$6 0$6 -6 4$- 0$- 0$4$8 0$6 0$6 -! 4$8 0$6 0$6 -$1 0$6 0$6 -8 -$0 0$6 0$6 -$4 0$! 0$! -3 -$) 0$6 0$6 -$! 0$! 0$! 60 -$- 0$6 0$6 -$3 0$! 0$! 61 -$8 0$6 0$6 6$2 0$! 0$! 62 6$1 0$! 0$! 6$- 0$! 0$! 6) 6$4 0$! 0$! 6$8 0$! 0$! 64 6$! 0$! 0$! !$1 0$! 0$! 6- !$0 0$8 0$8 !$4 0$! 0$! 66 !$) 0$8 0$8 !$! 0$8 0$8 6! !$- 0$8 0$8 8$0 0$8 0$8 68 !$8 0$8 0$8 8$) 0$8 0$8 63 8$1 0$8 0$8 8$- 0$8 0$8 !0 8$4 0$8 0$8 8$8 0$8 0$8 !1 8$6 0$8 0$8

BB ANAK AKI< B BB ANAK PE+P7AN AKI ;m9 med? "lo&? " med ?"lo& ?" 1-$2 1-$1-$8 16$0 16$) 16$6 16$3 1!$1 1!$4 1!$! 18$0 18$) 18$! 13$0 13$) 13$6 20$0 20$) 20$! 21$1 21$4 21$8 22$2

1$) 1$4 1$) 1$4 1$4 1$1$1$1$1$1$1$1$6 1$6 1$6 1$6 1$! 1$! 1$8 1$8 1$8 1$8 1$8

188

1$1$1$6 1$1$1$1$1$8 1$! 1$! 1$! 1$8 1$! 1$8 1$3 2$0 2$0 2$1 2$1 2$1 2$) 2$4 2$4

38 33 100 101 102 10) 104 10106 10! 108 103 110 111 112 11) 114 11116 11! 118 113 120

14$3 1-$1 1-$4 1-$6 1-$3 16$2 16$16$! 1!$0 1!$) 1!$6 1!$3 18$2 18$6 18$3 13$2 13$13$3 20$) 20$6 21$0 21$4 21$8

1$4 1$6 1$4 1$) 1$4 1$1$1$4 1$1$1$1$1$6 1$! 1$! 1$! 1$6 1$! 1$! 1$8 1$8 1$8 1$8

1$6 1$6 1$6 1$! 1$! 1$! 1$! 1$8 1$3 1$3 1$3 1$3 2$0 2$0 2$0 2$1 2$2 2$2 2$2 2$4 2$4 2$2$6

189 3$1 3$) 3$6 3$8 10$0 10$) 10$10$! 10$3 11$1 11$) 11$11$! 12$1 12$) 12$6 12$8 1)$0 1)$) 1)$1)$! 14$0 14$2 14$14$! 1-$0

0$8 0$8 0$8 0$3 0$8 0$3 0$3 0$3 0$3 0$3 0$3 0$3 0$3 1$1 1$1 1$1 1$1 1$1 1$2 1$2 1$2 1$2 1$2 1$) 1$) 1$)

0$8 0$8 0$8 0$3 0$8 0$3 0$3 0$3 0$3 0$3 0$3 0$3 0$3 1$1$1$4 1$1$1$4 1$1$1$4 1$1$4 1$1$-

!2 !) !4 !!6 !! !8 !3 80 81 82 8) 84 886 8! 88 83 30 31 32 3) 34 336 3!

8$3 3$1 3$4 3$6 3$8 10$0 10$2 10$4 10$6 10$8 11$0 11$2 11$4 11$8 12$0 12$) 12$12$! 12$3 1)$2 1)$4 1)$6 1)$3 14$1 14$) 14$6

0$3 0$8 0$3 0$3 0$3 0$3 0$3 0$3 0$3 0$3 0$3 0$3 0$3 1$0 1$0 1$1 1$1 1$1 1$1 1$2 1$2 1$2 1$) 1$2 1$2 1$)

0$3 0$8 0$3 0$3 0$3 0$3 0$3 0$3 0$3 0$3 0$3 0$3 0$3 1$4 1$4 1$4 1$4 1$4 1$1$4 1$1$1$1$1$6 1$6

22$6 2)$0 2)$4 2)$3 24$) 24$8 2-$2 2-$! 26$2 26$8 2!$) 2!$8 28$4 23$0 23$6 )0$2 )0$3 )1$6 )2$) ))$0 ))$! )4$)-$2 )6$1 )6$3

1$3 1$3 1$3 2$0 2$0 2$0 2$0 2$1 2$1 2$) 2$) 2$) 2$4 2$2$6 2$! 2$8 )$0 )$1 )$2 )$) )$)$6 )$3 4$1

2$2$6 2$8 2$8 2$3 )$0 )$2 )$) )$)$)$! )$3 4$0 4$2 4$) 4$4$6 4$8 4$3 -$1 -$4 -$-$8 -$3 6$1

121 122 12) 124 12126 12! 128 123 1)0 1)1 1)2 1)) 1)4 1)1)6 1)! 1)8 1)3 140 141 142 14) 144 14-

22$2 22$! 2)$1 2)$6 24$1 24$6 2-$1 2-$! 26$2 26$8 2!$4 28$0 28$! 23$4 )0$1 )0$8 )1$-

1$3 2$0 2$0 2$0 2$1 2$2 2$2 2$4 2$4 2$2$6 2$6 2$8 2$3 )$1 )$2 )$)

2$! 2$8 )$0 )$1 )$2 )$4 )$)$! )$3 4$1 4$4 4$6 4$3 -$1 -$4 -$! 6$1

abel an#roome#ri 7 BB ANAK AKI< 7?I BB ANAK AKI Abl PE+P7AN med ?"lo ?" n9 med ?"lo ?" & & )$) 0$40 0$-0 0 )$2 0$-0 0$40 4$) 0$!0 0$!0 1 4$0 0$60 0$-0 -$) 0$30 0$80 2 4$! 0$!0 0$!0 6$0 1$00 0$30 ) -$4 0$!0 0$80 6$! 1$00 0$30 4 6$0 0$!0 0$30 !$) 1$00 0$30 - 6$! 0$30 0$80 !$8 0$30 1$00 6 !$2 0$30 0$30 8$) 0$30 1$00 ! !$! 0$30 1$00 8$8 1$00 1$00 8 8$2 1$00 0$30 3$2 1$00 1$00 3 8$6 1$00 1$00 3$- 0$30 1$10 10 8$3 1$00 1$00 3$3 1$00 1$00 11 3$2 1$00 1$00 10$21 $10 1$10 12 3$- 1$00 1$10

BB ANAK AKI< 7?IA BB ANAK PE+P7A AKI #9 med ?"lo&? " med ?"lo& ?" 14$6 1-$2 1-$! 16$2 16$! 1!$2 1!$! 18$2 18$! 13$2 13$! 20$2 20$!

189

1$60 1$!0 1$80 1$8 1$30 2$00 2$00 2$10 2$10 2$20 2$)0 2$)0 2$)0

1$-0 1$80 1$30 2$00 2$00 2$10 2$20 2$)0 2$40 2$-0 2$60 2$80 2$30

) ) ) ) 4 4 4 4 - - - 6

1)$3 14$6 1-$1 1-$16$0 16$4 16$8 1!$2 1!$! 18$1 18$6 13$2 13$-

1$40 1$-0 1$60 1$!0 1$!0 1$80 1$80 1$80 2$00 2$00 2$10 2$10 2$20

1$60 2$10 2$10 2$20 2$)0 2$-0 2$60 2$!0 2$!0 2$30 )$00 )$20 )$40

190 10$4 1$00 10$!1 $10 10$3 1$10 11$11 $10 11$) 1$20 11$-1 $20 11$! 1$20 11$8 1$20 12$0 1$20 12$2 1$)0 12$4 1$)0 12$6 1$)0 12$8 1$40 1)$0 1$40 1)$1 1$40 1)$) 1$40 1)$- 1$40 1)$! 1$-0 1)$8 1$40 14$0 1$-0 4$2 1$-0 14$1 1$60 14$- 1$-0 14$6 1$60

1$10 1$10 1$10 1$20 1$20 1$20 1$20 1$)0 1$)0 1$)0 1$)0 1$)0 1$)0 1$)0 1$40 1$)0 1$)0 1$)0 1$40 1$40 1$40 1$40 1$-0 1$-0

1) 14 116 1! 18 13 20 21 22 2) 24 226 2! 28 23 )0 )1 )2 )) )4 ))6

3$8 1$10 10$01 $10 10$2 1$10 10$41 $10 10$6 1$10 10$81 $10 11$0 1$20 11$2 1$20 11$4 1$20 11$- 1$20 11$! 1$20 11$3 1$20 12$1 1$)0 12$) 1$)0 12$4 1$)0 12$6 1$)0 12$8 1$)0 12$3 1$)0 1)$1 1$)0 1)$) 1$40 1)$4 1$)0 1)$6 1$40 1)$8 1$40 1)$3 1$40

1$10 1$00 1$10 1$10 1$10 1$20 1$20 1$20 1$20 1$)0 1$)0 1$)0 1$)0 1$)0 1$40 1$40 1$40 1$-0 1$-0 1$-0 1$60 1$60 1$60 1$60

21$! 22$3 24$0 2-$) 26$! 28$1 23$! )1$4 ))$) )-$) )!$)3$8 42$) 4-$0 4!$8 -0$8 -)$8 -6$! -3$62$1 64$4 66$) 6!$8 68$3

2$40 2$!0 2$80 )$10 )$-0 )$80 4$20 4$60 -$10 -$60 6$10 6$-0 6$30 !$)0 !$60 8$00 8$20 8$40 8$-0 8$!0 8$80 8$30 8$30 3$00

)$)0 )$60 4$20 4$!0 -$20 -$30 6$60 !$)0 8$00 8$!0 3$40 10$00 10$60 11$10 11$60 11$30 12$20 12$-0 12$!0 12$30 1)$20 1)$-0 1)$!0 14$00

6 ! ! 8 8 3 3 10 10 11 11 12 12 1) 1) 14 14 11- 16 16 1! 1! 18

20$6 21$8 2)$) 24$8 26$6 28$)0$)2$4 )4$! )!$0 )3$2 41$4 )$8 46$0 4 8$) -0$) - 2$1 -)$! - -$0 --$3 -6$4 -6$! -6$! -6$6

2$-0 2$!0 )$10 )$40 )$30 4$40 4$30 -$)0 -$80 6$)0 6$60 !$00 !$)0 !$!0 !$30 8$00 8$10 8$20 8$20 8$00 !$80 !$!0 !$40 !$20

)$!0 4$20 4$!0 -$40 6$10 6$80 !$-0 8$40 3$10 3$!0 10$4 10$3 11$4 11$! 11$3 12$1 12$2 12$) 12$) 12$) 12$4 12$4 12$4 12$4

abel an#roome#ri 7 B ANAK AKI< 7?I B ANAK AKI Ab PE+P7AN med ?"lo ?" ln9 med ?"lo ?" &  &  -0$- 2$) 2$) 0 43$3 2$2 2$1 -4$6 2$- 2$4 1 -)$- 2$) 2$) -8$1 2$6 2$6 2 -6$8 2$4 2$4 61$1 2$6 2$6 ) -3$- 2$4 2$6)$! 2$! 2$! 4 62$0 2$6 2$6-$3 2$! 2$! - 64$1 2$6 2$6 6!$8 2$! 2$! 6 6-$3 2$6 2$! 63$- 2$! 2$! ! 6!$6 2$! 2$6 !1$0 2$! 2$6 8 63$1 2$! 2$! !2$) 2$6 2$! 3 !0$4 2$! 2$8 !)$6 2$6 2$! 10 !1$8 2$8 2$! !4$3 2$! 2$6 11 !)$1 2$8 2$8 !6$1 2$! 2$! 12 !4$) 2$8 2$8

190

B ANAK AKI< 7?IA B AN AKI #9 PE+P7 med ?"lo& ?" med ?"lo  34$3 )$8 )$8 ) 3)$3 )$! 3!$0 )$3 4$0 ) 36$0 )$8 33$1 4$1 4$0 ) 3!$3 )$3 101$0 4$1 4$2 ) 33$8 4$0 102$3 4$2 4$) 4 101$6 4$0 104$8 4$4 4$) 4 10)$4 4$1 106$6 4$- 4$4 4 10-$1 4$2 108$) 4$6 4$- 4 106$! 4$) 103$3 4$6 4$6 - 108$4 4$4 111$- 4$6 4$! - 110$0 4$6 11)$1 4$! 4$! - 111$6 4$! 114$6 4$8 4$8 - 11)$1 4$8 116$1 4$3 4$3 6 114$6 4$3

191 !!$2 !8$) !3$4 80$4 81$4 82$4 8)$)

2$! 2$! 2$8 2$3 2$3 )$0 )$1

2$8 2$8 2$3 )$0 )$0 )$0 )$1

1) 14 116 1! 18 13

!-$!6$! !!$8 !8$3 !3$3 80$3 81$3

2$3 )$0 )$0 )$0 )$0 )$0 )$1

2$3 2$3 2$3 2$3 )$0 )$1 )$1

113$0 121$! 124$4 12!$0 123$6 1)2$2 1)4$8

-$0 -$1 -$) -$4 -$-$! -$3

4$3 -$1 -$) -$) -$-$6 -$3

6 ! ! 8 8 3 3

11!$6 120$6 12)$126$4 123$) 1)2$2 1)-$2

-$2 -$-$8 6$0 6$) 6$6$!

84$2 8-$1 86$0 86$8 8!$6 88$83$2 30$0 30$8 31$6 32$) 3)$0

)$1 )$2 )$) )$) )$) )$4 )$4 )$4 )$4 )$)$4 )$4

)$2 )$) )$) )$4 )$4 )$)$)$4 )$4 )$4 )$4 )$-

20 21 22 2) 24 226 2! 28 23 )0 )1

82$3 8)$8 84$! 8-$6 86$8!$) 88$2 83$0 83$8 30$6 31$) 32$1

)$2 )$2 )$2 )$2 )$) )$) )$4 )$4 )$4 )$4 )$4 )$-

)$1 )$2 )$2 )$) )$) )$) )$) )$) )$) )$) )$4 )$4

1)!$140$) 14)$) 146$4 143$! 1-)$0 1-6$1-3$3 16)$1 166$2 163$0 1!1$-

6$1 6$4 6$! !$1 !$6 !$3 8$) 8$6 8$8$4 8$1 !$!

6$1 6$4 6$! !$1 !$8$0 8$2 8$8$6 8$4 8$1 !$6

10 141$1)8$) 10 11 144$8 11 148$2 12 1-1$12 1-4$6 1) 1-!$1 1) 1-3$0 14 160$4 14 161$2 1- 161$8 1- 162$1

6$8 6$3 !$0 6$3 6$8 6$8 6$6 6$6 6$! 6$! 6$8 6$!

3)$! 34$3-$0 3-$8 36$-

)$4 )$)$)$)$-

)$)$4 )$4 )$)$6

)2 )) )4 ))6

32$8 3)$34$2 34$3 3-$6

)$)$)$)$)$6

)$)$)$)$)$-

1!)$1!-$2 1!6$2 1!6$! 1!6$8

!$1 6$3 6$6$6$6

!$2 16 162$! 162$4 6$6$! 6$8 16 6$6 1! 16)$1 6$4 6$- 1! 16)$4 6$1 6$6 18 16)$! 6$0

Penilaian s#a#s (iRi IndeC Nilai ;#mr ≥ P 3BB>B 3P BB>B -PM B>mr MPK>mr M P - a#a  P 3-

Indi,a#or /besi#as /besi#as %iRi br, ?or#s#a#re %(n er,emban(an

Klasifi,asi s#a#s (iRi : B+I H BB>B BB H BB>B<1009 ?#a#s %iRi B+I BB>BBI %iRibr, M13 M!0O %iRi,ran( 13<20 !0<80O %iRibai, 20<280<110O

191

192 %iRilebi /besrin(an /bes sedan( /besbera# /besmorbid

26<2! 28<)0 )1<))6<40 40

110<120O 120<1)-O 1)-<1-0O 1-0<200O 200O

Ba, an#roome#ri ./ N5.? 7 %iRi bai, normal &ei(#9 %iRi ,ran( nder &ei(#9 %iRi br, severe nder &ie(#9 in((i #all9 Normal normal ei(#9 B>7 Pende,s#n#ed9 ?(# ende, severe s#n#ed9 ?(#(em,obese9 %em,fa#9 BB>B Normalnormal9 Krs&as#ed9 ?(# ,rssevere &as#ed9

Amban(Ba#as G)?" G2?" s>d G)?" <2?" s>d G2?" <)?" s>d <2?" M <)?" G2?"  <2?" s>d G2?" <)?"s>d<2?" M <2?" G)?" G2?"s>dG)?" <2?"s>dG2?" <)?"s>d<2?" M<)?"

In#erre#asi s#a#s (iRi berdasar,an indeC an#roome#ri BB>7 N  M

B>7 N  M

BB>B N N N

Kondisiana, %iRibai,era&a,ansedan( %iRibai,era&a,an=an(,n( %iRibai,ende,erna,ran((iRi

N M M N  

 N  M N M

M M M   

%iRi,ran(era&a,an=an(,n( %iRi,ran(era&a,ansedan( %iRibr,era&a,an=an(,n( %iRilebiende,erna,ran((iRi %iRilebiera&a,ansedan( %iRilebiende,mn(,inobesi#as

BB>B : maln#risi a,# BB>7 : maln#risi B>7 : maln#risi ,ronis !EP

192

193 Klasifi,asi KEP ell;ome rs#9 BBI Edema +arasms M60O G +arasms<,&arsio,or 60
Klasifi,asi KEP +; aren9 %C Nilai Albmin Pro#ein Nilai Edema ) 1 M )$2! "erma#osis 2 1<1$43 )$2-<)$33 6 EdemaGderma#osis 6 1$-<1$33 4<4$!Perbaanramb# 1 2<2$43 4$!-<-$43 4 .ea#ome(ali 1 2$-<2$33 -$-<6$24 ) ?,or 0<)  +arasms )<)$43 6$2-<6$33 2 )$-<)$33 !
Kasiikasi 'a!trisi ata! K!ra eri /rotei (K/) H : KEP?edan( BB>B B>7 Edema

<2 s>d <) ?" d <) ?" 
Klasifi,asi +EP I"AI9 BB>7 in(an ?edan( Bera#

KEPBera#

!0<80O 60
B>7 8-<30O M8-O

M <) ?" 
BB>B 80<30O !0<80O M!0O

Beberaa al yan( erl dera#i,an ada ana, +EP bera# :

193

194 • 5endern( io(li,emia o, ;adan(an (li,o(en #erba#as @ • • • • •

(an((an fn(si a#i dlm (l,oneo(enesis  ana, #ida, bole diasa,an "efisiensi mi,ron#rein asam fola# e n +( vi# A9 "elesi K Na @ 5a e#ensi ;airan @ rendanya ,aasi#as =an#n( @ sir,lasi s( ana, KEP s(# sensi#if enambaan Na  d# men;e#s,an iervolemia dema#d ar (a(al =an#n( @ suddent death A#rofi m,osa ss als @ insfisiensi an,reas  diare d# membera# d( emberian ma,anan +da infe,si o, erbaan flora normal ss @ sis#em imni#as #d, be,er=a o#imal

%C : < K&asior,or  edema ma#a say ramb# #iis ,emeraan s# ramb# =a(n( mda di;ab# @ ron#o, ;en(en(>e&el>aa#is ea#ome(ali io#rofi o#o# ;raRy avmen# derma#osis < +arasms  s(# ,rs #ama, #lan( #erbn(,s ,li# &a=a s# or# ;en(en( @ re&el ,li# ,eri# =ar lema, sb,#an #iis < +arasms ,&asior,or  (C ;amran "C : AC – analisa die# #mb ,emban( enya,i# yd dideri#a ab – .b Albmin serm ferri#in An#ro : BB>7 B>7 A>7 BB>B A>B

a#ala,sana +EP bera# (iRi br,9

1$ /risi &asar ?#abilisasi

.io(li,emia .io#ermia "eidrasi Ele,#roli# Infe,si P+ mb ,e=ar +i,ron#rien

ransis i r 1<2 r 2
194

eabili#asi m( ,e )
C C

195 ?#imlasi inda, lan=#

C

C

C C

<an(,a I : mene#a,an ilian =enis ma,anan "ie# ada# ,alori !0,,al>100( 10O ,alori dari ro#ein9 ml>,(BB>r selama ! ari



diberi,an 200

Per#imban(,an fa,#or : mr ,ebiasaan ma,an sebelm dan selama sa,i# ,emaman en;ernaan ana, a;an : A?I ars #e#a diberi,an s>d 2 #9 <an(,a II : menen#,an ben#, ma,anan  ilian die# ;air ioosmolar renda la,#osa dan renda sera# "ie# renda la,#osa smber ro#ein : ss sai d( la,#osa M)!(>,(BB>r9 "ie# renda #en( bebas la,#osa smber ro#ein : #elr ayam i,an9 <an(,a III : fre,ensi ma,an  orsi ma,anan ,e;il seserin( mn(,in Jadal =enis =mla P+  re,omendasi ./ : formla starter 
r 1<2 r )<4 r -
: !->+odis;o  12 C 40<110 ;;>r : !->+odis;o  8 C 60<160 ;;>r : !->+odis;o  6 C 30<220 ;;>r : 100>+odis;o I>II 4 C 30<220 ;;>r : 1)->+odis;o III ) C 30<1!- ;;>r G ma,anan lma#>lna, ) C 1 rs G sari ba>ba ) C 1 rs

Keb (iRi menr# fase P+ Ener(i Pro#ein ?#abil 80<100 ,,al>,(>r 1<1- (>,(>r ransisi 100<1-0 ,,al>,(>r 2<) (>,(>r eab

1-0<200 ,,al>,(>r 4<6 (>,(>r

5airan 100<1)0 ml>,(>r 1-0 ml>,(>r 1-0<200 ml>,(>r

?lemen : +l#ivi#amin A<5r - r9 +( 04<14 meq>,(>r n 2 m(>,(>r 5 02 m(>,(>r e ) m(>,(>r a#a ?lfas feross 10 m(>,(>r +o ↑ BB :  10 (>,(>r bai,9 -<10 (>,(>r ;,9

195

196 M - (>,(>r ,ran(9 2$ C enya,i# enyer#a a$ "ef vi# A : M 6 bln -0$000 I7 im 6<12 bln 100$000 I7 im  2-00 I7>r o  1 # 200$000 I7 im  -000 I7>r o =, sim#oma#i, : r 2 @ 14>sblm K? dilan( emberian im "ef vi# 5 : -0<)00 m(>r b$ Inves#asi arasi#  +ebendasol 100 m( bid ) r ;$ "iare  PA?I + +e#ronidaRol !- m(>,(>C #id ! r d$ B @ .I*  &or,  B e$ "erma#osis  ,omres PK n Ralf )$ C ,e(a&a#an a$ ?yo, < "->P 1:1 a#a "- 1- ml>,( 1 =am  evalasi < J, membai, H syo, o, deidrasi : lan( reidrasi slm 1 =am  esomal o 10 ml>,(>=am slm 10 =am  !- o < J, #\membai, H syo, se#i, : beri ;airan rma#an 4 ml>,(>=am G #ransfsi lasma 10 ml>,( dlm ) =am  !- o b$ Anemia (ravis ransfsi =, .b M 4 a#a #d dis#ress nafas>de;om ;ordis alb M 1- (>dl #C ade,a# dlm 2 m( #a, ada ,ema=an : B>P5>Plasma 10 ml>,( ba(i 2 dlm ) =am selan( 12 =am a#a sesai rle of ei#R9 remed rosemid 1 m(>,( iv mo rC #ransfsi ;$ .io(li,emia "10O - ml>,( bols a#a -0 ml o>s a#a "- 1- ;;>,( 1 = d$ "eidrasi

esomal reydra#ion sol#ion for maln#ri#ion9: < /? s#andar ./ - sa;e# < %la asir -0 ( < ar ele,#roli#>K5l 4( < Air q$s 2 li#er

4&e#ita# /besi#as  BB  120O IB I+  P 3- #ri;es s,in fold #i;,ness  P 8rimer o, fa,#or e,so(en 30O se,nder o, fa,#or endo(en 10O defe, (ene#i, ((n ormonal9

196

197 C : <

↓ asan ener(i  mr 2bn s>d IB

die# seimban( renda ,alori red,si,eb )0O9 K. -0<60Olema, 20<)0Olema =enM 10O9 ro#ein 1-<20O ,oles#erol M )00 m(>r < modifi,asi (aya id  ↑ a,#ifi#as fisi, < #C die# in#ensif  > C d( BB  140O IB a#a I+  P 3! die# 600<800 vi# ,,al>r G ro#Ge&ani (>,( G slemen @ mineral minm 1-<2 1- l>r 12IB r9 < #C beda  > C d( BB  200O IB

Gaga t'&'$

 H BB>7 dan BB>B MP- enyiman(an ara er#mbnan 2 (aris ,rva dlm )<6 bln ↓ BB 2?" dlm )<6 bln sia M)#9

197

198

TU.BU9 !E.BA6G @ PEDIATRI-S4SIAL

%/BI 

%ro&# moni#orin( < /ral reydra#ion < Breas# feedin( – ImmniR#ion – ood slemen#a#ion – amily lannin( – emale ed;a#ion 

+iles#one er,emban(an ana, : 4<6 m( #ersenym son#an bersara 1<2 m( ,mdn 12<16 m( mene(a,,an ,eala menole ,e ara sara #en(,ra sendiri meme(an( benda y( dile#a,,an di #an(annya )<6 bln men(an(,a# ,eala dlm osisi #en(,ra merai benda y( dide,a#,an adanya -<3 bln meminda,an benda dr sa# #an(an ,e #an(an lainnya dd, d( ban#an ,eda #an(annya ,e dean d# ma,an bis;i# sendiri 3<10 bln menn=, d( =ar i #eln=, meme(an( benda d( ib =ari @ #eln=, bersara da'da'meran(,a, berdiri d( bere(an(an 12<18 bln berdiri>ber=alan #ana ban#an men(;a,an ,a#a< ,a#a #n((al abel s,rinin( ,e#erlamba#an er,emban(an : 7mr +o#ori, ,asar +o#ori, als ?osialisasi +en(an(,a# an(an ?enym ) bln ,eala #erb,a son#an

198

Bi;ara 5ooin( #er#a&a

199

18 bln

"d, #ana e(an(an Berdiri bere(an(an Ber=alan di#n#n Nai, #an((a diban#

24 bln

Berlari

6 bln 3 bln 12 bln

+eminda,an benda +en(ambil d( =ari +eleas,an benda +a,an d( sendo, ?sn 6 balo, mainan

?,a – #ida, s,a

Babblin(

5il, ba

Imi#asi sara

"a#an( =, dian((il +en(i,#i mimi, Bermain

"enver II 136!<13309 : 1$ Personal sosial 2$ Ada#if mo#ori, als ) $Baasa 4$ +o#ori, ,asar G es Perila,

1<2 ,a#a  8 ,a#a 2<) ,alima#

12-#(asG-#es

In#erre#asi : Advan;ed  P > #(as di sbl ,anan (aris mr Normal  P>> d P2- #(as di (aris mr 5a#ion  > d P!-<30 > #(as di (aris mr "elayed  > > #(as di sbl ,iri (aris mr No oor#ni#y  N/ > #(as di sbl ,iri>d (aris mr Kesimlan : Normal  #d, ada "elay maC 1 5a#ion s,rinin( lan( ) bln9 ?se;#  ≥1 "elay a#a ≥2 5a#ion s,rinin( lan( 1<2 m(9 7n#es#able  ≥1 efsal s,rinin( lan( 1<2 m(9

Reta"da#i .enta

+ H f(s in#ele,#al di b& ra#a((n erila, min 2 area : ,o(ni#if in#erersonal ,emaman bermasyara,a# ,emaman a,ademi, @ fn(sional9 #imbl M18 # %C : ,e#erlamba#an er,emban(an baasa (an((an (era,an mo#ori, als

199

200 @ ada#asi ((n erila, Klasifi,asi : < + a#olo(is : ((n men#al bera# I^ M209 idio#>imbisil I^ 20<4-9 < + fisiolo(is : sb,l#ral>familial>i,iran lema I 4-
Pa#i Ce"e&"a

5P H ,elainan (era,an>si,a #b y( #ida, ro(resif o, ,ersa,an o#a, ada eriode er#mban o#a, sia M) #9 %C : (an((an (era,an>si,a #b ,e#erlamba#an er,emban(an mo#ori, @ baasa ((n viss (era,an bola ma#a s#rabisms nis#a(ms9 ,e#lian ie : < 5P diel(ia sas#i,  ,ersa,an #r ,or#i,osinalis -0O9 < 5P emile(i,  ,ersa,an #r ,or#i,osinalis nila#eral )0O9 < 5P ,adrila(i sas#i,>dile(i ,omle,s  diser#ai ,oreoa#e#osis < 5P ,oreoa#e#oid  ,ersa,an sis#em iramidal < 5P a#a,sia  ,ersa,an serebelm

200

201

201

202 Nelas %$ Pedia#ri;s 1368T4:106

202

203

203

204

204

205

205

206

206

207

207

208

208

209

209

210

210

211

211

212

212

213

213

214

214

215

215

216

216

217 E6D4!RI64L4GI "IABEE? +EI7? "asar"C: (l,osa dara dan ada #ida,nya (e=ala$ %"A normal →,ailer M126 m(>dl ! mmol>9$ %l,osria sa=a #ida, sesifi, n#, "+ "ia(nosis "+ memeni sala sa# ,ri#eria seba(ai beri,# : 1$ Kadar (l,osa dara asa  !0 mmol>  126 m(>dl9$ Pasa adala #ana asan ,alori minimal selama 8 =am$ 2$ "i#em,an (e=ala ,linis oliria olidisia olifa(ia bera# badan yan( menrn dan ,adar (l,osa dara se&a,#  200 m(>dl 111 mmol>9$ )$ Pada enderi#a yan( asim#oma#is di#em,an ,adar (l,osa dara se&a,# $ 200 m(>dl a#a ,adar (l,osa asa lebi #in((i dari normal den(an #es #oleransi (l,osa ada lebi dari sa# ,ali emeri,saan$

?e,resi inslin Pemeri,saan lain : Β ;ell a#o an#ibody %A" I5A IAA IA2

217

218 a$ Inslin Jenis inslin

A&i#an =am9

Ker=a ;ea# raid a;#in(9 asar#a# (llisisin lisro9

01-<0)-

Pn;a, ,er=a =am9 1<)

Ker=a ende, re(lar>solble9

0-<1

2<4

-<8

4<10 4<12 6<1-

8<16 12<24 18<24

Ker=a +enen(a ?emilen#e 1<2 NP. 2<4 I?len#e#ye )<4 Inslin basal %lar(ine 2<4 "e#emir 1<2 Ker=a an=an( 7l#ralen#e#ye 4<8 Inslin ;amran 5ea# 0menen(a Pende, 0menen(a

ama ,er=a =am9 )<-

ida,ada 6<12

24Q 20<24

12<24

20<)0

218

1<12

16<24

1<12

16<24

219 Inslin 0-<1 I7>,(bb>r 7mr #9 "osis inslin -M 6<3 10<12 12

I7 -M -<10 10<20 20 

Pe G an dosis inslin #ia ↑ %"A -0 m(>dl 027 01 1-<2

5ara emberian inslin : 1$ 5ara ,onvensional

 inslin ,er=a menen(a in#ermedia#e a;#in(9 minimal 2 C>r sbl ma,an a(i dan ma,an malam>#idr malam9

 inslin ,er=a ende, sor# a;#in(9 > ;ea# raid a;#in(9 2 > ) C seari sbl ma,an a(i ma,an malam ma,an sian( a#a ,e sian( Z %"A 2$ 5ara in#ensif lebi lebi menyerai se,resi inslin fisiolo(is$  inslin basal memer#aan,an ,adar inslin basal dan mene,an roses liolisis$  inslin ,er=a ende, a#a ,er=a ;ea# sebelm ma,an #ama a#a ,e #er(an#n( asil ,adar (la dara$ b$ "ie# : 0<12 # H X1000 G sia #an9 C 100 YH,al>ari 2$ 12 #anH2000 ,al>m2 $ )$ Komosisi :,arboidra# -0<--O lema, )0<)-O  =en M 10O9 dan ro#ein 10<1-O sera# 2 (r>100 ,al ,oles#erol M )00m(>ari n#, rema=a a#a de&asa Pemba(ian : 20 O ma,an a(i 10O sna;, a(i 2-O ma,an sian( 10O sna;, sore 2-O ma,an malam 10O sna;, malam ;$ /la ra(a d$ Ed,asi 1$

219

220 e$

Kon#rol +e#aboli,

ar(e# me#aboli, Prerandial Pos#randial 7rine red,si .bA1;

Bai, se,ali M120 m(>d M140 <

Bai, M140 m(>d M200 <

M!O

!
?edan( M180 m(>d M240
Kran( 180 m($d 240 G 10O

Indi,a#or ,on#rol me#aboli, yan( br,  oliri dan olidisi  eneresis dan no,#oria  (an((an en(lia#an  enrnan bera# badan a#a (a(al enambaan bera# badan  (a(al #mb  ber#as #erlamba#  infe,si ,li#  enrnan res#asi di se,ola enin(,a#an ,adar .bA15 dan enin(,a#an ,adar lema, dara$ Komli,asi a$,omli,asi a,# : io(li,emia ier(li,emia ,e#oasidosis diabe#i,m b$,omli,asi =an(,a an=an( : re#inoa#i nefroa#i neroa#i dan enya,i# ,ardiovas,ler.

220

221

!ET4ASID4SIS DIABETI!U. ?e;ara bio,imia dia(nosis KA" daa# di#e(a,,an bila #erdaa#: • ier(li,emia bila ,adar (la dara  11mmol> 1mmol> H 18m(>d9 • . dara M !)

• bi,arbona# M 1-mmol> +enr# dera=a# asidosisnya:  rin(an  . !2-9  sedan( . !19  bera# . M !1 bi,arbona# M - mmol>9 abel dia(nosis KA"
G> 3

221

222 Poliria olidisi BB↓  +al mn#a nyeri er#  Kesadaran menrn %C deidrasi #r(or↓#a,i,ardi io#ensi s>d syo,9 ierven#ilasi ,smal9 nafas ase#on$ E#iolo(i : Infe,si s#ress #rama C inslin #ida, ade,a# !o"ek#i : inda,an yan( ars dila,,an adala: • essi#asi yan( dierl,an • +enyia,an emeri,saan<emeri,saan dasar • +emlai moni#orin( ,lini, se;ara re(ler • +emlai reidrasi • Penilaian en((an#ian Na • Penilaian en((an#ian K • +emlai emberian inslin • +en(a#r ,eb#an inslin sein((a #er;aai asil yan( diin(in,an$ a Re#'#ita#i #anda<#anda ren=a#an  io#ensi erfsi erifer yan( menrn oli(ria9 ressi#asi 0$3O ?alin 10<20 ml>,(BB 1<2=am$ "aa# dilan( bila #anda<#anda ren=a#an masi ada PC #ida, sadar : sonde lambn( ;e(a asirasi isi lambn($ b$ Pee"ik#aan Da#a" Pemeri,saan labora#orim yan( erl disia,an: • %la dara • Ele,#roli# dara dan osmolali#as serm • Analisa %as "ara • "ara len(,a • B7N serm Krea#inin ;a#a#an:serm ,rea#inin ↑,>,e#on G9 • 7rinalisis dan ,e#on dalam rine (all urine until negative) • Kl#r dara bila ada indi,asi • F < fo#o #ora,s bila ada indi,asi • 'hroat swab bila ada indi,asi 

;$

4&#e"Fa#i !inik 1+oni#orin( ,e#a# yan( erl dila,,an:

222

223 • Nadi ernafasan dan #e,anan dara #ia =am • nerolo(is > =am #anda ,emn(,inan edema o#a,: a$ b$ ;$ d$

• • • • •

?a,i# ,eala Bradi,ardi +n#a #ers meners Perbaan s#a#s nerolo(is  (elisa iri#abel men(an#, yan( san(a# in,on#inensia rin9 a#a #erdaa# #anda<#anda a#olo(is seer#i reson il yan( =ele, a#a ,elman syaraf ;ranial e$ Penin(,a#an #e,anan dara enrnan sa#rasi o,si(en %la dara #ia =am ada saa# emberian inslin Pen(,ran balans ;airan yan( ;erma#  ,ala erl asan( ,a#e#er rine ada asien bera# mera,an ,earsan9 ? #b #ia 2 < 4 =am Pemeri,saan ,e#on dalam rine samai ne(a#i EK% n#, memban# melia# adanya ier,alemia a#a io,alemia

;airan adala esensial$ Bila oliria masi #ers • balans berlan(sn( mn(,in balans ;airan masi ne(a#i dan ,i#a belm berasil mereidrasi enderi#a den(an bai,$ Penderi#a ars asa samai ,eadaan s#abil$ d Re$id"a#i Per#ama ,ali er,ira,an dera=a# deidrasi enderi#a:1) o -O #r(or menrn m,osa ml# ,erin( #a,i,ardia #a,inea9 o 10O  ma#a ;o&on(bn<bn ;e,n( #r(or menrn lebi bera#9 o  10O ren=a#an nadi #a, #eraba a#a san(a# lema io#ensi oli(ria9 %na,an ;airan N? 03O o Jmla ;airan H defisi#Grma#an g48 =am9 o Per,iraan defisi# :O deidrasiC10CBera# badan ,(9 H $$$ml o Per,iraan ;airan rma#an>r H 1-00 ml>m2 > .olliday se(ar o as erm,aan #b m29 : o o#al reidrasi dalam 48 =am bila ierna#remia ;ore;#ed9 reidrasi dierlamba# bisa samai !2 =am o -0<60O ;airan T 12 Jam I o

223

224 ?isa : )6 =am II o %"A M 2-0 (an#i "-O  saline e$ Penggantian 6a 12310 corrected Na daa# dieri#n(,an den(an rms: 16 (l,osa < 1009 5orre;#ed Na H Na G  (l,osa dalam m(>d9 100 o

Na: 1 mmol> H 1 mEq>d Jadi #amba,an 16 mmol> a#a 16 mEq>d Na n#, se#ia 100 m(>d (l,osa dia#as 100 m(>d f

Penggantian ! 1$ dimlai se#ela ressi#asi den(an ;airan 2$ bersamaan dimlainya emberian inslin$ )$ di;ri(ai (a(al (in=al =an(an beri,an samai ada asil ele,#roli# dan ,a#e#er rine diasan($ 4$ +laila dosis K5l - mmol>,(BB>ari en(,ran K 2 < 4 =am beri,#nya selan=#nya >4 =am9$ Beberaa e(an(an ra,#is: o K5l !- O H 1 mmol H 1 ml o Biasanya #ida, lebi dari )0 < 40 mmol K5l diberi,an dalam se#ia 1000 ml ;airan reidrasi$ o Ke;ea#an emberian K5l 0- mmol>K(BB>=am$ ($

6at"i' Bika"&onat 163

=aran( dierl,an #erai Nabi; anya ada enderi#a yan( san(a# bera# ,eadaanya$ Indi,asi emberian Nabi,: • Penderi#a den(an ren=a#an bera#

• Penderi#a asidosis bera# .M 63 dan>a#a .5/ 1$ 2$

M - mmol>9 +o =an#n(→io,alemia ,>,ore,si asidosis #erlal ;ea#$ Nabi, memerbera# ierna#remia dan memerbr, en(ar asidosis ada ??P$

224

)

225 )$

4$

Bila Nabi, diberi,an ;, den(an dosis 1<2mmol>,( dan n#, emberian beri,#nya ars dilia# #erlebi dal reson #erai sebelmnya$ Pemberian #ia ,ali se;ara in#ravenos selama 60 meni#$1 $

In#'in in#ravenos den(an inslin m $anya &oe$ ?or# A;#in(>e(lar A;#raid .mlin 9$ ?e#ela ressi#asi selesai sedan(,an reidrasi ser#a en((an#ian K5l dalam roses #erai inslin daa# dimlai den(an en(ama#an ,linis dan labora#oris yan( ,e#a#$ lar#an inslin den(an ,e,a#an 10? Unit*$ 5ara: ar#an inslin diba# den(an menamba,an 1 7ni# I ,e dalam 10 ml Normal ?aline$ Bila den(an syrin(e m yan( men((na,an syrin(e>si# 20 ml ma,a dib#,an 2 7ni# I n#, se#ia 20 ml Normal ?aline$ ?edan(,an bila den(an #e#esan infs biasa: -0 7ni# I n#,

se#ia -00 ml Normal ?alin$ $a"'# te"%i#a$ dari ;airan reidrasi →syrin(e m>asan( 2 infs$ inslin mda dena#rasi < inslin dan ala#,(BB>=am$ enrnan %"A !- < 100 m(>d er =am$ %"A ber,isar an#ara 30 < 180 m(>d$ Bila C masi infs se#ela 24 =am<"-O in 04- > 022- ?aline$ 4edea 4tak

Biasanya #er=adi dalamberi,an 24 =am +anni#ol er#ama 1en(oba#an$ Bila ra(,(BB den(an I* dri ;ea#$ Bila mn(,in ba# 5 s;an o#a,$ Tanda-tanda Ba$aya #anda<#anda ba&a enan(anan enderi#a men=adi lebi sli#$ • "eidrasi bera# dan ren=a#an$ • Asidosis bera# G serm K renda →K #o#al san(a# ,ran($

225

226 • • • •

.ierna#remia →ierosmoler yan( membr,$ .iona#remia iaemia bera# Penrnanan ,esadaran saa# #erai→oedema o#a,$

!a%an .in' da%at Di'ai

,eadaan enderi#a s#abil se;ara me#aboli, yai#: • Kadar (la dara M 2-0 m(>d • .  !)0 • .5/)  1- mmol> 5airan renda ,alori air #i9 daa# diberi,an n#, di;oba aa,a enderi#a sda daa# diberi er oral$

Pengat'"an In#'in I8 d"i% %ada #aat .akan 1$ san(a# ber(na memer#aan,an inslin 2$

)$

I*

dri

s>d

sda daa# ma,an sedi,i#nya 1 ,ali$ ma,anan ,e;il sna;,9 ,e;ea#an inslin dri 2 C sebelmnya dimlai saa# ma,an dier#aan,an samai 1>2 =am s#l selesai lal ,embali ,e dosis sebelmnya$ ma,an besar brea,fas#ln;dinner9 ,e;ea#an inslin diberi,an 2 C =mla sebelmnya dimlai saa# ma,an dan dier#aan,an samai 1 =am se#ela ma,an$ ?e#ela i# ,embali,an inslin ,e dosis sebelmnya$

!a%an In#'in I8 D"i% Di$entikan ,esadaran enderi#a bai,  se;ara me#aboli, ,eadaan s#abil

bila enderi#a sda daa# ma,an sedi,i#nya sa# ,ali$ ?aa# #erbai, ada saa# sebelm ma,an$ Inslin sb,#an ars diberi,an )0 meni# sbl ma,an dimlai$ ?edan(,an inslin I* dri dier#aan,an selama ma,an samai 30 meni# se#ela inslin sb,#an diberi,an$ a,# ar inslin I* anya 4- meni# ole ,arena i# adala en#in( n#, memberi,an inslin sb,#an sebelm men(en#i,an inslin I* dri$

226

227 Patofi#ioogi !AD-S99

.IP/I/I" A(ar ?;ore : Geaakini# .erniambili;alis Kromosom#ida,ada&ani#a9 P;a#din(inio#ermi

Sko"

2 1 1

ie &a=a,asedema#os +a,ro(losi .io#oni I,#erslebi)ari Kli#,asardan,erin( on#anela os#erior #erb,a  ) ;m Kons#iasi ,( )BB  1 Keamilan40m((

227

2 1 1 1 1 1 2 1

228 o#al 1"C : #es fn(si #iroid→ Primer ?. ↑ 4↓ ?e,nder ?. ↓ 4 ↓ ?,in#i(rafi #iroid Bone a(e BEA " anemia normo,rom normosi#erier,oles#erol9 ar(e# : o 4 di a#as  nilai normal o mb ,e=ar o Kema=an develomen#al qo#ien# C: 7sia "osis #iro,sin m(>,(>r9 0<)bln 10<1)<6 bln 8<12 6<12 bln 6<8 1<#n 4<6 6<12 #n )< #nm(( s#l C mlai 2<4 +o : 4 ?. 12 2<4 dan 2 m(( #ia erb dosis Kon#rol #ia bln s>d sia 2 # ) blan s>d - # ds# #ia 6<12 bl Bone a(e #ia 1# s>d er#mban beren#i PERAWA!A6 PE6DE! ?or# ?#a#re : *ariasi normal Primer>ins#rinsi,: ,> ,elainan d sel>s#r,#r (ro&# ala#e ?e,nder>e,s#ernal:,> ,elainan di lar (ro&# ala#e Idioa#i,$ %C : b M P) a#a M <2 ?" Ke;ea#an #mb M P 2Pra,iraan #in((i d&s M #ar(e# ei(# 7mr #lan( #erlamba# ar(e# ei(# : b aya G ib9>2 Po#ensial (ebe#i; ei(# : mid aren#al ei(#  8- ;m "C: " E" +#C Alb  ?E B%A → s,rinin( eny sis#emi,

228

229 ?. 4 ?. . analisa ,romosom Bone a(e =i rovo,asi %.>I%
ereman 8 # > la,i
229

230

230

231

231

232

in(,a# ma#ri#as aydara

 

+ 1: Praber#as + 2: +enon=ol seer#i b,i# ,e;il areola melebar

232

233   

+ ): Paydara dan areola membesar #ana daa# diisa,an ben#,nya masin(
in(,a# ma#ri#as ramb# bis  P 1: Praber#as  P 2: =aran( i(men sedi,i# lrs> sedi,i# i,al anya ada labia E9 >an(,al enis G9  P ): lebi i#am i,al menyebar ,e mons bis  P 4: #ebal seer#i ben#, de&asa #ai belm menyebar ,e medial aa  P -: ben#, de&asa berben#, se(i#i(a  E9  menyebar ,e medial aa

in(,a# ma#ri#as %eni#al

233

234

" " ""

% 2: 1: diame#er Praber#as % #es#es  2$- ;m ,li# s,ro#m meniis dan ber&arna mera mda " % ): enis membesar dan meman=an( s,ro#m membesar " % 4: enis lebi membesar s,ro#m ber&arna lebi (ela " % -: ben#, de&asa

234

235 5AILURE T4 T9RI8E 5ri#eria dia(nosis : 1$ %ro&# belo& a se;ial er;en#ile on #e (ro&# ;ar# : >A >. M - er;en#ile$ 2$ Poor (ro&# felo;i#y • "e;reased (ro&# felo;i#y &ere &ei(# dros 2 ma=or er;en#iles over ) – 6 mon#s • "e;rease of  2 ?" over a ) – 6 mon# eriod$

235

236

236

237

237

238

9i%e"&ii"'&ineia fi#ioogi# #er=adi ada amir sema neona#s$ Prod,si bilirbin menin(,a# ,arena sia sel dara mera yan( lebi ende,T defisiensi ,on=(asi ,arena defisiensi 7% menrn,an ,lirensT dan rendanya =mla ba,#eri dalam ss diser#ai menin(,a#nya idrolisis bilirbin dire, menin(,a#,an sir,lasi en#eroea#i,$ Kadar bilirbin daa# menin(,a# in((a 18 m(>dl ada sia )<4 ari dan menrn ada ari<ari selan=#nya$2) B"ea#tfeeding a'ndice #er=adi ada seerenam bayi yan( mendaa# A?I ada min(( er#ama$ Pemberian A?I

menin(,a#,an sir,lasi en#eroea#i, bilirbina#a ada,alori beberaa bayi yan( ,ran( in#a,e A?I dan deidrasi yan( ,ran($ Penin(,a#an sir,lasi en#eroea#i, =(a daa# disebab,an ber,ran(nya ba,#eri in#es#inal yan( men(ba bilirbin men=adi me#aboli# yan( #ida, diresorbsi$2) B"ea#t ik a'ndice dibeda,an dari breas#feedin( =andi;e$ Kondisi ini #er=adi se#ela -
238

239 dalam A?I menyebab,an nai,nya de,on=(asi dan reabsorbsi bilirbin$ 9i%e"&ii"'&ineia %atoogi# didia(nosis aabila • Jandi;e mn;l ada 24 =am er#ama se#ela min(( er#ama a#a mene#a lebi dari 2 min(( • o#al serm bilirbin ?B9 menin(,a#  - m(>d>ari bilirbin serm #o#al  123 m(>d ada bayi • Konsen#rasi ;, blan dan 1- m(>dl a#a lebi ada bayi ,ran( bln • Konsen#rasi bilirbin dire, 1-<2 m(>dl a#a lebi • Klinis i,#ers mene#a 1 min(( ada bayi ;, blan dan 2 min(( ada bayi ,ran( blan diser#ai roses emolisis

• • Neona#s yan( menn=,,an #anda>(e=ala enya,i# bera# • diser#ai BB M 2000 (ram (es#asi M )6 m(( asfi,sia io,sia sindrom (an((an nafas Penyebab ierbilirbinemia indire, a#olo(is #erserin( adala: • Pemben#,an bilirbin menin(,a#2) 1$ Isoimmne
Kliren menrnada 7% menrn,an ,on=(asi bilirbin •"efe, eredi#er sein((a men(ran(i ,liren bilirbin ea#i, dan level ?B menin(,a#$ Kelainan ini meli#i 5ri(ler
239

240 (an((an mo#ili#as in#es#inal yan( disebab,an fa,#or fn(sional man obs#r,si ana#omi$ 13 2)

o#o#erai diindi,asi,an edoman dari AAP: • ba(i bayi den(an risi,o renda masa (es#asi  )8 min(( dan #ana fa,#or risi,o9 fo#o#erai di,er=a,an ada ,ondisi: o sia 24 =am : 12 m(>d 20- mi,romol>9 o sia 48 =am: 1- m(>d 2-! mi,romol>9 o sia !2 =am : 18 m(>d )08 mi,romol>9 • ba(i bayi den(an risi,o sedan( masa (es#asi  )8 min(( den(an fa,#or risi,o a#a masa (es#asi )- in((a )! 6>! min(( #ana fa,#or risi,o9 fo#o#erai di,er=a,an ada ,ondisi o

sia sia 24 48 =am =am :: 10 1) m(>d m(>d 1!1 222 mi,romol>9 mi,romol>9 o sia !2 =am: 1- m(>d 2-! mi,romol>9 ba(i bayi den(an risi,o #in((i masa (es#asi )- in((a )! 6>! min(( den(an fa,#or risi,o9 fo#o#erai dimlai ada ,ondisi ?B seba(ai beri,#: o sia 24 =am: 8 m(>d 1)! mi,romol>9 o sia 48 =am : 11 m(>d 188 mi,romol>9 o sia !2 =am : 1)$- m(>d 2)1 mi,romol>9 o

•

240

241

ransfsi #,ar ada ,ondisi ierbilirbinemia beri,# ini: • Bayi ,nin( #andaGABE le#ar(is io#onia refle, men(isa =ele, a#a high*pithced cry9den(an ,adar bilirbin serm #o#al beraan$ • Bayi den(an ,adar bilirbin serm #o#al lebi dari amban( ba#as yan( dire,omendasi,an AAP Amban( ?B Zsia n#, #ransfsi #,ar berdasar,an fa,#or risi,o: • ba(i bayi den(an risi,o renda masa (es#asi  )8 min(( dan #ana fa,#or risi,o9 o 7sia 24 =am: 13 m(>d )2- mi,romol>9 o 7sia 48 =am : 22 m(>d )!6 mi,romol>9 o 7sia !2 =am : 24 m(>d 410 mi,romol>9 o

7siabayi lebi dari !2risi,o : 2-sedan( m(>d 428 mi,romol>9 • ba(i den(an masa (es#asi  )8 min(( den(an fa,#or risi,o a#a masa (es#asi )- in((a )! 6>! min(( #ana fa,#or risi,o9 o 7sia 24 =am : 16$- m(>d 282 mi,romol>9 o 7sia 48 =am : 13 m(>d )2- mi,romol>9 o 7sia  !2 =am: 21 m(>d )-3 mi,romol>9 • ba(i bayi den(an risi,o #in((i masa (es#asi )- in((a )! 6>! min(( den(an fa,#or risi,o9 o sia 24 =am: 1- m(>d 2-! mi,romol>9 o sia 48 =am : 1! m(>d 231 mi,romol>9 o

7sia  !2 =am: 18$- m(>d )16 mi,romol>9

241

242

%ambar )$ Pedoman #ransfsi #,ar ada bayi den(an masa (es#asi  )- min((

242

Pocket Book Koas PPDS Anak Pediatri

Recommend Documents