BAGIAN FORENSIK DAN FAKULTAS UNIVERSITAS
Lembar Pe!e"a#a D a $e S%!a$&re
KEDOKTERAN MEDIKOLEGAL KEDOKTERAN HASANUDDIN
REFERAT JULI 2016
INTOKSIKASI ALKOHOL
OLEH :
JULIA JOLANET S ADAM VANNY MATASAK ULVIANA HUMAIRAH B
SUPERVISOR : dr. Denny Mathius M.Kes Sp.
DI!A"AKAN DALAM RAN#KA TU#AS KEPANITERAAN KLINIK PADA !A#IAN KEDOKTERAN ORENSIK DAN MEDIKOLE#AL AKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN MAKASSAR $%&'
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)ea+aa mab&) +a me%!!a,' Pa+a a&$(/"% +a/a$ +%$em&)a memar /a+a )(r$e)" "erebr% #ema$(ma "&b+&ra, a)&$ a$a& )r(%)' 1 De/re"% /&"a$ /eraa"a $era+% /a+a )a+ar a,)(#(, ($a) 9:0 m!; ' Pa+a )a+ar :00=600 m!; +a,am +ara# /e+er%$a b%a"a-a me%!!a, +a,am 1=9 am "e$e,a# )(ma "e,ama 10=16 am' 1 Ke,a%a -a! +%$em&)a /a+a )(rba ma$% $%+a) )#a" M&!)% +%$em&)a !ea,a=!ea,a -a! "e"&a% +e!a a"%%)"%a Se,&r&# (r!a me&&))a $a+a /erbe+&!a +ara# ,eb%# e*er ber7ara !e,a/'M&)("a ,amb&! me&&))a $a+a /erbe+&!a )emera#a +a $a+a %,ama"% $a/% )a+a!=)a+a! $%+a) a+a )e,a%a'Or!a=(r!a $erma"&) ($a) +a +ara# berba& a,)(#(,' Pa+a /emer%)"aa #%"$(/a$(,(!%) +a/a$ +%&m/a% e+ema +a /e,ebara /emb&,&# +ara# ($a) +a "e,a/&$ ($a) +e!eera"% be!)a) )er&# /a+a ba!%a /are)%m (r!a +a %,ama"% m&)("a "a,&ra *era''1 Dar% /emer%)"aa /a+a )a"&" )era*&a )r(%) -a! me%!!a, a$&! +a/a$ mem/er,%#a$)a %br("%" %$er"$%$%a, #%/er$r(% "erab&$ ($($ a$&! "e,="e, ra+a! )r(%) /a+a bebera/a $em/a$ !ambara "era$ ,%$a! ($($ a$&! me!#%,a! #%a,%%"a"% e+ema +a 8a")&(,%"a"% "erab&$ ($($ a$&!' S*#e%+er me,a/(r)a m%(/a$% a,)(#(,%) a)&$ +e!a m%(#em(!,(b%&r% -a! +%"ebab)a (,e# e)r("%" $&b&,% !%a, +a )er&"a)a m%()ar+%&m' Pa+a #a$% +%+a/a$)a a+a-a /embe"ara #a$% +e!a me$am(r("%" ,ema) -a! #eba$' 11 Pee$&a )&a,%$a$% +a )&a$%$a$% e$a(, +a,am "/e"%me /("$m(r$em $e,a# mea+% /r("e+&r aa,%$%" -a! re,a$% "e+er#aa +e!a #a"%, -a! m&!)% a)&ra$ $e/a$ +a "/e"%%)' Nam& +e!a mea"%r)a #a"%, /("$m(r$em BA4 3B,((+ a,*(#(,%* 4($e$ Ka+ar A,)(#(, +a,am Dara# +a mear%) )e"%m/&,a -a! bear me!ea% $%!)a$ a$em(r$em +a )ea+aa "e"e(ra! "aa$ mab&) +a +eraa$ )er&"a)a /er%,a)& /a+a "aa$ "aa$ )ema$%a' 2 K(+%"% $&b&# 7a)$& a$ara )ema$%a +a ($(/"% )(+%"% ,%!)&!a 3"&#& +a )e,embaba +a "%a$ "/e"%me +%)&m/&,)a &$&) aa,%"%" a+a,a# a)$(r -a! /e$%! &$&) +%/er$%mba!)a'Da,am bebera/a )(+%"% a,)(#(, m&!)% +%#a"%,)a "e$e,a# )ema$%a (,e# a)$%8%$a" m%)r(ba +a erme$a"% !,&)("a -a! mer&/a)a ma"a,a# -a! -a$a %)a ma-a$ $e,a# me!a,am% +e)(m/("%"%' D%&"%
a,)(#(, /("$m(r$em
+ar% /er&$ )e $em/a$ /&"a$ /e!amb%,a "am/e, +ara#
mer&/a)a a)$(r r&m%$ ,a% %)a "e"e(ra! me%!!a, $a) ,ama "e$e,a# /er%(+e m%&m bera$' Pera7a$a +%/er,&)a &$&) mema"$%)a ba#7a "/e"%me b%(,(!% $%+a) $er)($am%a"% +e!a e$a(, a$a& /e,ar&$ a"%! ,a%-a "e,ama /era7a$a &$&) me-e,ama$)a %7a a$a& "e#&b&!a +e!a /emer%)"aa ,&ar $&b&# a$a& %)a "am/e, +ara# &$&) aa,%"%" a,)(#(, +%amb%, "ebe,&m me,a)&)a ($(/"% ,e!)a/': Bebera/a /ra)$%"% (re"%) me!a!!a/ ba#7a +ara# +ar% b%,%) a$&! &$&# "e"&a% &$&) aa,%"%" $()"%)(,(!% e$a(, "e+a!)a -a! ,a% me-ara)a me!!&a)a 8ea /er%er &$&) /e!amb%,a "am/e, "eba%)-a 8ea em(ra,%" "e$e,a# 8%"&a,%"a"% +a ,%$a"=),em /r()"%ma,' : BA4 -a! +%/er,&)a &$&) me-ebab)a )ema$%a "er%! me%mb&,)a /er$a-aa $erb&)a +a ba-a) $er!a$&! /a+a &"%a "e"e(ra! /e!a,ama m%&m +a +eraa$ /er)emba!a $(,era"%' Ke*e/a$a m%&m ber/era +a,am $()"%"%$a" a,)(#(, "e/er$% #a,-a e%" m%&ma -a! +%)("&m"% a/a)a# b%r 3:; 8?8 a$a& ,%&(r 390; 8?8 +a )#&"&"-a "e$%a/ ma")%! +ar% ra"a a,)(#(, +e!a meamba#)a !&,a a$a& /era"a b&a#' Ba-a) /e!em&+% mab&) $e,a# +%$a!)a/ +e!a )("e$ra"% +ara#=e$a(, ,eb%# +ar% 900 m!?100 m, +a bebera/a $e,a# me,eb%#% :00 m! ? 100 m,'
:
Tam/a)-a ma"&) a)a, &$&) me!a"&m"%)a ba#7a BA4 "aa$ a&$(/"% a)a #am/%r "e,a,& ,eb%# re+a# +ar% BA4 ma)"%m&m -a! +%*a/a% "e,ama /e"$a m%&m )area me$ab(,%"me e$a(, ber,a!"&! "am/a% "aa$ )ema$%a' Se,ama "e$e,a# /e!#e$%a m%&m "am/a% ma$% BA4 +a/a$ me&r& $er!a$&! /a+a )e*e/a$a e,%m%a"% a,)(#(, +ar% +ara# -a! /a+a /em%&m bera$ b%"a me,eb%#% 20 a$a& 50 m! ?100 m, /er am 30'02 a$a& 0'05 !; /er # +a,am $()"%)(,(!% /("$m(r$em BA4 )&ra! +ar% 10 m! ? 100 m, 301 m! ? mL #ar&" +%,a/(r)a "eba!a% e!a$%': H&b&!a )&a$%$a$% a$ara )("e$ra"% &r%e +a a,)(#(, 3UA4 +a BA4 $e,a# +%/e,aar% "e*ara e)"$e"%'Se,a% )($e a%r -a! ,eb%# $%!!% +a,am &r% 3@@=100; +%ba+%!)a +e!a +ara# 3>0; )&r8a )("e$ra"%=7a)$& ber!e"er +a,am 7a)$&'Ja+% +e!a me!#%$&! ra"%( UA4 ? BA4 me,e!)a/%
%(rma"% -a! ber!&a $e$a! "$a$&" /e-era/a a,)(#(, /a+a "aa$ )ema$%a' Meem&)a ra"%( )&ra! +ar% a$a& me+e)a$% "a$& me&&))a /e-era/a a,)(#(, -a! be,&m )(m/,%$ /a+a "em&a *a%ra $&b&# /a+a "aa$ )ema$%a -a! me&&))a bar& "aa me!)("&m"% m%&ma bera,)(#(, +a bebera/a a,)(#(, $er$e,a m&!)% $e$a/ $%+a) $er"era/ +% /er&$ "e+a!)a meem&)a ra"%( 12: a$a& ,eb%# me&&))a /e-era/a +a +%"$r%b&"% e$a(, $e,a# )(m/,%$ /a+a "aa$ )ema$%a': Ur%e a+a,a# "/e"%me -a! ber!&a &$&) aa,%"%" e$a(, )area $er&$ama $er+%r% a$a" a%r +a r%"%)( m%)r(ba a$a& ra!% me-era! )a+&! )em%# "e$e,a# )ema$%a $am/a)-a )&ra! +%ba+%!)a +e!a r%"%)( $er)($am%a"%-a "/e"%me +ara#' Se,a% %$& &r%e -a! +%#a"%,)a (,e# (ra! -a! "e#a$ $%+a) me!a+&! "e&m,a# be"ar !,&)("a me")%/& %% a+a,a# )e$erba$a"a &$ama %)a a,mar#&m me+er%$a +%abe$e" +a !,%)("&r%a' : G,&)("a mer&/a)a "&b"$ra$ &$&) "%$e"%" e$a(, /("$ m(r$em +a,am +ara# +a &r%'Meem&)a UA4 $%!!% +a,am "/e"%me +ar% +%abe$e" +a )("e$ra"% e!a$% +a,am +ara# b%a"a-a berar$% ba#7a e$a(, +%/r(+&)"% +a,am &r% "e$e,a# )ema$%a m%"a,-a +e!a erme$a"% ra!% !,&)("a' III' ASPEK MEDIKOLEGAL
&. Peranan IKM da(a0 Kasus,Kasus Penya(ah*unaan A()-h-(
Pe-a,a#!&aa a,)(#(, mer&/a)a /e-ebab a$a& /a,%! $%+a) "eba!a% a)$(r /e*e$&" +ar% )e*e,a)aa /emb&&#a b&&# +%r% "er$a /e,ba!a% $%+a) /%+aa ,a%-a De!a +em%)%a /emer%)"aa a,)(#(, +a,am "e$%a/ $%+a) /%+aa /er,& +%,a)&)a ba%) /emer%)"aa $er#a+a/ +%r% )(rba ma&/& $er#a+a/ /e,a)& )ea#a$a +e!a $&&a memb&a$ e,a" +a $era! )a"&" -a! ber"a!)&$a' 1 Pe*a+& a,)(#(, "er%! mea+% )(rba )e*e,a)aa "e/er$% )e*e,e)aa ,a,& ,%$a" a$&# +a $e!!e,am "e,a% %$& mere)a +a/a$ /&,a mea+% /e,a)& )ea#a$a a$a& "eba!a% )(rba +ar% )ea#a$a' 1@ Da,am )a%$a-a +e!a )e*e,a)aa ,a,& ,%$a" +%ba-a) e!ara +%b&a$ U+a!=&+a! -a! me!a$&r "am/a% "ea&# maa )a+ar a,)(#(, -a! ma"%#
+%/er)ea)a /a+a "e$%a/ /e!em&+%' 1@ D% %!!r%" )a+ar a,)(#(, +a,am +ara# -a! $%+a) +%/er)ea)a a+a,a# "ebe"ar >0 m! /er 100 m, +% amer%)a "er%)a$ >0=1:= m! /er 100 m, "7e+%a +a (r7e!%a :0 m! /er 100 m, "e+a!)a +% Jerma T%m&r +a 4.e*#(",(8a)%a #a-a "ebe"ar 50 m! /er 100 m, +ara#' 1@ Ber+a"ar)a #a"%, /e-e,%+%)a -a! +%,a)&)a (,e# Baa- +% /eara "%!= "%! +%+a/a$ #a"%, ba#7a )ea#a$a -a! +%,a)&)a (,e# /ara /e*a+& a,)(#(, #a-a,a# )ea#a$a -a! ber)&a,%$a" re+a# "e/er$% "e/er$% /er)("aa /eram/()a a$a /emb&&#a +e!a )a$a ,a% +%)a$e!(r%)a "eba!a% )ea#a$a )(8e"%(a, 3*(8e"%(a, "$ree$ *r%me'1@
$. Pasa(,Pasa( 5 Hu)u0 6an* !erhu1un*an den*an Penya(ah*unaan A()-h-(
S&mber /era$&ra -a! +%)e,&ar)a (,e# /emer%$a# -a! me!a$&r $e$a! m%&ma )era" $e,a# +%"eb&$)a +%m&)a -a%$& Ke/&$&"a Me$er% Ke"e#a$a N(m(r 2>2?MENKES?SK?II?1@@> $e$a! S$a+ar M&$& Pr(+&)"% M%&ma Bera,)(#(,' Ya! +%ma)"&+ m%&ma )era" +a,am /a"a, 31 a-a$ 1 a+a,a# m%&ma -a! me!a+&! e$a(, -a! +% /r("e" +ar% ba#a #a"%, /er$a%a -a! me!a+&! )arb(#%+ra$ +e!a *ara erme$a"% +a +e"$%,a"% a$a& erme$a"% $a/a +e"$%,a"% ba%) +e!a *ara member%)a /er,a)&a $er,eb%# +a#&,& a$a& $%+a) meamba#)a ba#a ,a% a$a& $%+a) ma&/& -a! +%/r("e" +e!a *ara me*am/&r )("e$ra$ +e!a e$#a(, a$a& +e!a *ara /e!e*era m%&ma me!a+&! e$#a(,' 20 Ha,=#a, /()() -a! +%a$&r +a,am /era$&ra Me$er% Ke"e#a$a $er"eb&$ "e*ara !ar%" be"ar $e$a! /e!!(,(!a m%&ma )era" a+a,a# "eba!a% ber%)&$ C 1: a M%&ma )era" !(,(!aA M%&ma )era" +e!a )a+ar e$a(, 342H:OH 1; 3Sa$&Per"e "am/a% +e!a :; 3L%ma Per"e< m%"a,-a C B%r B%$a! Gree Sa+ A!)er B%r er( He%e)e' M%&ma )era" !(,(!a b M%&ma )era" !(,(!a B M&ma )era" +e!a )a+ar e$a(, 342H:OH ,eb%# +ar%:; 3L%ma Per"e "am/a% +e!a 20; 3D&a P&,&# Per"e< m%"a,-a C A!!&r Ma,a!a A!!&r K(,e"(m #%")- Dr&m A!!&r Ora! T&a'
* M%&ma )era" !(,(!a 4 M%&ma )era" +e!a )a+ar e$a(, 342H:OH ,eb%# +ar%20; 3D&a P&,&# Per"e "am/a% +e!a ::; 3L%ma P&,&# L%ma Per"e< m%"a,-a C Jee8er J#(- (,)er Me"%( M(&"e M* D(a,+ 3bra+- S*($*# Bra+-' *% yang dimaksud adalah volume/volume pada suhu 200 .
Ke/&$&"a
Me$er%
Ke"e#a$a
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$e$a!S$a+ar M&$& Pr(+&)"% M%&ma Bera,)(#(,'D%+a,am Ke/&$&"a me$er% )e"e#a$a %% &!a me!a$&r me!ea% ma"a,a# /e-a,a#!&aa "$a+ar%"a"% +a ,abe,%"a"% -a! $er"ebar +a,ambab V $e$a! "a)"% /a"a, 12 -a! b&-% /a"a,-aC Pa"a, 12 Ke/&$&"a Me$er% Ke"e#a$a N(m(r 2>2?MENKES?SK?II?1@@> C 19 31 Bara!"%a/a +e!a "e!aa mem/r(+&)"% +a a$a& me!e+ar)a m%&ma bera,)(#(#(, -a! $%+a) meme&#% "$a+ar m&$& "eba!a%maa +%ma)"&+ /a"a, 5 +%/%+aa "e"&a% +e!a &+a!= &+a! (m(r 25 $a#& 1@@2 $e$a! )e"e#a$a +a a$a& &+a!= &+a! (m(r $a#& 1@@6 $e$a! /a!a' 32 Bara!"%a/a +e!a "e!aa me!e+ar)a m%&ma bera,)(#(, -a! +%)ema" $a/a me*a$&m)a $a+a a$a& ,abe, "eba!a%maa +%ma)"&+ /a"a, 6 +%/%+aa "e"&a% +e!a &+a!=&+a! (m(r 25 $a#& 1@@2 $e$a! )e"e#a$a +a a$a& &+a!=&+a! (m(r $a#& 1@@6 $e$a! /a!a'
IV' KASUS=KASUS YANG BERKAITAN DENGAN PENYALAHGUNAAN ALKOHOL 3-nt-h Kasus &
Se(ra! /r%a 6> $a#& +e!a r%7a-a$ /e-a,a#!&aa e$a(, )r(%" +%$em&)a $e7a" +% )amar ma+% +e!a +ara# -a! $er*%/ra$ -a! +%$em&% +% /a)a%a-a ,a$a% +a +a,am ember )e*%, +% )a)%-a' 3Gambar 1 Pa+a ($(/"% %a+%$em&)a mem%,%)% "%r("%" m%*r((+&,ar +a me-ebar /er&ba#a ,ema) #a$% 3Gambar 2 Gambar 5' Dara# bera"a, +ar% 8ar%"e" e"(a!&" 3Gambar 9' Gambar 1. Pasien yang ditemukan tewas di kamar mandi
Gambar 2. Sirosis Micronodular
Gambar 3. Sirosis Micronodular
Gambar 4. Varises Esofagus
3-nt-h Kasus $
Se(ra! 7a%$a :2 $a#& +e!a r%7a-a$ /e-a,a#!&aa a,)(#(, +%$em&)a $e7a" +% )amar m($e,-a' Pa+a ($(/"% a+a /er&ba#a ,ema) +%&"e /a+a #a$% ber"ama="ama +e!a #%a,% Ma,,(r- +a,am #e/a$("%$ +a %,ama"% a)&$ -a! )("%"$e +e!a #e/a$%$%" a,)(#(,%)' K("e$ra"%
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3-nt-h Kasus /
Se(ra! 7a%$a 5> $a#& +e!a r%7a-a$ /e-a,a#!&aa e$a(, )r(%" +%$em&)a $e7a" +% r&ma#-a' D%a $e,a# me!e,&# "a)%$ /er&$ +%"er$a% +e!a m&a, +a m&$a# $e$a/% $%+a) me*ar% /er#a$%a me+%" &$&) %%' Pa+a ($(/"% a+a /er+ara#a re$r(/er%$(ea, 3Gambar : -a! $%mb&, "eba!a% a)%ba$ +ar% #em(ra!%) /a)rea$%$%" a)&$ 3Gambar 6'
Gambar . !etro"eritoneal Gambar 2. #emoragik akut #emorr$a e ankreatitis
DAFTAR PUSTAKA
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Dr&!" a+ "(*%e$- 12$# e+'
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