Anda di halaman 1dari 33

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PENYUSUN :
NURUL FATMA DIYANA BINTI AHMAD
030.05.274

PEMBIMBING :
Dr. GATUT SEMIARDJI Sp PD KEMD
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c
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KEPANITERAAN KLINIK ILMU PENYAKIT DALAM


RUMAH SAKIT DR H MARZOEKI MAHDI
FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTI
PERIODE 7 DESEMBER 2009± 13 FEBRUARI 2010
BOGOR

c
LEMBAR PENGESAHAN
c
c
cc 
cc
c

DEMAM BERDARAH DENGUE


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DAFTAR ISI
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BAB I PENDAHULUAN

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c *c c  c c.c c c c  c c*  !c
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BAB II DEMAM BERDARAH DENGUE

Virus Dengue
c c;>c cc  c c; >c   c- c  c
c  c  c c Arthropod Borne Virusc ;( ->c c c  c
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cc c'+*#c
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cc  c c  cc  c cc cc
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c c !ccc- c  c c  c c  c c
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c  c #=:7c c
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c /c c c  c c  c

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cc cc !?#@c

Cara Penularan
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c cAedes aegypti!c+ cAedes albopictuscAedes polynesiensisc c  c
c c c c
c  c - c c  c  c -c c  c
!c + c ( c  c c  c - c  c  c c c
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c  c
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c c  c  c c ;transovanan transmission>c  c c  c
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Epidemiologi
c- c  c c c c c
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c c c c;knokkel koorts>!c c cc
cc
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c c  !c  c c  c c - c  c c (c c c  c
c c c  c c  c !c c 
c  c #=7%c c
- c  c  c c c c  c c  c  c c
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3c  c c  !c  c  c #=9<c c  c  c c   c
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2*c c  c c c  c  c  c c
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c c  c;5>c c c c-c ccc c c c
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;- >c- c  c c cc!c c  c/ c5$c c
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c  c c 
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c !c Incidence ratec c c $$$7c c #$$$$$c  c  c  c #=9<c

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c c - c  c
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- c  c
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Patogenesis
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c c c!?%@c
c c cc; cc >c c  c  cc
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  c ;c secondary heterologous infection>c  c c immune enhancement!c
cc c.c c  c /ccc  ccc
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 c c  c c 8 !c(  c cc c c  cc
c - c c c c c c  c   c  c c
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!c B c c   c  c c - c  c  c  c  c
cc  c  c c  c c!cc
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antibody dependent enhancementc ;('>c   c c cc c c c
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infectionc c  c  c & c #c c   c  c  -c  c #=::!c  c
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c  c c /c - c  c c
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c c cc cc/ c- c c c c
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Secondary heterologous dengue infection
 c- ccccccccccccccccccccccccccccccccccccccccccccccc Anamnestic antibody responsec
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c c c c ccc( c;45c47>c c c  c cEc
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ccccccccc
c c c (c c c c ( c
c c c c c ccc c
Gambar 1. Patogenesis terjadinya syok pada DBD ?%@c
c
 c c  c c - c  c  c *  c  c
-c c  c
c  c c  c c -c
c  c   c  c  c   c  c c ; c %>!c  c c
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c  c  c *  c  c  c  c  c
 c(c; c c>cc c c cc!c cc
c   c  c . c  c 'c ;reticulo endothelial system>c c

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c c  c 
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>c  c c c 2c ;fibrinogen degredation product>c c

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c

c
Secondary heterologous dengue infection
 c- c c c c c Anamnestic antibodyc
c c  c- c  c
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c c c c c c c c c c ( c
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c c c c c c c
& c c c c c c c ccccc cc
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c c c c c ccc  c c c c cccc c
c c ccccccccc2cc
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c
Gambar 2. Patogenesis Perdarahan pada DBD?%@

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Demam Dengue/Demam Berdarah Dengue
c - c  c  c c c c  c c c  c
c *c c  c - c - !c c c c - c
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Bagan 1
Spectrum Klinis Infeksi Virus Dengue?%@

c ccccccccc- c  c
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c c c c c c c c c c cccccc;>c

Demam Dengue
&
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c c c/ cc;#*%c>c c cc c c 
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c  c  c /!c  c  c / c  c  c
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c  c  c   c c c  c  c ; >!c  c
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c  .c  c c  c c  c c    c  c
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Demam Berdarah Dengue (DBD)


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c!c?%@c
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palpable c %*6c .c c /c . c .c !c   c  c c  c
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Derajat Ic c c 
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Derajat IIc c 
cc c cc c c c c c !c
Derajat IIIc  c  c  c  c  c .c c  c c  c
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Derajat IVc c c;profound shock>c c c c  c cc c c
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Laboratorium
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c c   c  c  .c  c  c c c  c
!c  c  c c c c cc   c c c
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c 3cc Nc c  c !cc cc 
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c !c( c   c cc
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Sindrom Syok Dengue (SSD)


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cc*:!cc  * c c c c c c
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c  c c c *   ccc  c c.* cc
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c
Definisi kasus DD/DBD
(!c.c0 c
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c c  c  c c  c  c c  c c  c c
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c c O#!%<$c c  c
c c  c c  c c  c c c c  c c c c
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%!c „onfirmedc c;c >c c cc   c c  c
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Diagnosis Serologis
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cc c c   c
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c
c  c c IgM/IgG Dengue Blot, Dengue aapid IgM/IgG, IgM Elisa, IgG
Elisa.?#@c
c
Diagnosis Banding ?5@
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c c c c  c .c  c c c .  c
c c  !c ( c c c
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c  cc c cc !c
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cc c
c  c c c  c c /c  !c  c *c c
c c  c   c c c  c c  c c c .c
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c  c  c c c c c  c  c c c
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c c c c !?#@c
c
Penatalaksanaanc
 c  c c  !c  c  c c  c  c
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c c
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c c c  c
 c  c c  c /c c  c /c
!cc c c c c c  c/c!c, c c
/c c  c c c  c c c /c c  c c
  c c  c .c   c c   c c c c c c
c  c  !c c c c  c c  c c /c  c
 c  c c  c  c c c  c  c c !c c
c c 
 c c  c  c  !c c c  c / c  c
 c  cc c  c / c c c   c c  c !c
 .c  c c 8c c c cc c  c c
c c  c c c c c c   c   c ;c c c >c
c !c?#@c
c
1. Demam Dengue
c c c  c
 c  c  c /!c  c c c c

c
Pc c c cc !c
Pc B cc ccc  c  c  !c
Pc , c   c   c 
 c L5=A4c 
c  c  !c
( 8  c  c 
c ; >c  c c c   c
c c c !c
Pc 
c c.c c  cc c
c cc  c cc
 c 
c c c  c c%c!c
Pc c  c
 c c cccc- !c
c
 c c c c   c   c  c  c  c  c  !c
 c c  c c  c  -c  c  c c c 
 c
 c %c c  c   c   !c  c c   c  c c  c c  c
  ccc c c cc !c  ccc
 cc  c
  c  c  c c c 
 c  c  c  c  c  c  c / c
 c  c ;>!c  c  c c 
 c  c c c c

 c !c B c c  c c  c  c c c  c c c  c  c
c c c c  c  c  c  c c  c c c
 c  c  c  c c c c  c  c  c  c
/cc cc  /ccc c!cc  cc c

c
c c0c#!c ccc c c c c  c  c%*
5c c  c  c c  -!c  c c c  c c %c ; c
c >!c?#@c
c
2. Demam Berdarah Dengue
Ketentuan Umum
  c c cc8 8c cc c  c c
c   c  c c   c  c  c c  c
!c& c c 8ccc c cc  c c
c  c c  c  !c c   c  c  c
 c  c c  c .c c c c  c c   c   c ;the time of
defervescence>cc  cc/ c
 c c c c   c
 -c c c c c c c c!cc
 c c c c/ c
 c c cc c  c c
c c!c2cc c  c c
 c ccc!c
  c
 c ccL#$$!$$$8M c c c c#*%c 8  c;*c
 c c#$c  >c
 c  ccc c  c
 c  c
  !c c c %$Cc  c  c .c  c  c c
 c  c  c  c .!c 0 c c c  c c c
 c .c / c c - c  c c  c  c c c c
!c c   c  c  c c c c c  c  c
c  c
 c cL7$!$$$8M !c.c  cc c 
cc cc c
/c c  c  c c  c c 4c c  c  c /c c c  c c
 c c c(!c?6@c
c
Fase Demam
 c  c c c  c   c c  c c c
c c  c  c  c .c  c  c .c  !c (  c
.c c c c  c cc c c c c cc cc
  c c .c -c  c  c  !c (c  * c
 cc c c /cc c c  c c c
 c  !c  c  c  c  c  c c  c
cc c  c#!c?6@c

c
Tabel 1
Dosis Parasetamol Menurut Kelompok Umur
, c; >c  c;c c >c
c;>c  c;#c cHc7$$c>c
L#c 9$c #8<c
#*5c 9$*#%7c #8<*#86c
6*9c #%7*%7$c #86*#8%c
:*#%c %7$*7$$c #8%*#c
F#%c 7$$*#$$$c #*%c
c
c c c c  c c c c c ccc
c !c"c cc 
c  c
c cccc c  cc
 c  !c c  c  c  c 7$c  8 c  c 6*9c
c !c  c
 c  c c c c  c .c  c<$*#$$c  8c c  c %6c

c  !c c c c  c cc  c  c c  c  !c
 c
 c
c c cc  c- c c !c?6@ c
c  c /c c  c 
 c c c  c 
 !c  c
c   c / c c  c c   c   c  c  c c c 5*7c c !c
c  c c  c  c c   c c  c
 c /c  c  c .c  c  c 
c  .c  c
c  c   c .c -!c c  c  c
 c   c

c  c c c c c  !c c  c c  c
 c  c 
c c c c c   c  c   !c  c c c
c  c  c c   c c  c  c  c
/   c c  c!c?#@c
, c cc c c ccc c  c c
 c !c c cc ccHc5cQc c !?#@c
c
Penggantian Volume Plasma
cc c  c c cc
 c cc  c
  c ;c * c c c c >c c c  c   c c
- c cc !c)   c cc.c c  c c

c c *!c   c .c / c  c  c %*5c
c c
 c c cc c  cc;c5$*9$c>!cc  c%6*%<c

c  c  c   c  c c  c - c  c c c
 c
- c !c c - c .c  c   c  c  c .  c

c
 .c  !c .c  c - c c   c   c
 c .c  c
 c7*<C!?#@c
4c -c  c   c ;#>c  c  c  c  c  c  c
c c c  c  c  c  c c  c  c 
 c
 cc .c
 c!c ;%>c + c c .  c c
 cc  !c"  c.cc  c c c 
c  c c
 c   c 
c .c  c 7Cc c  c  c +4 c $67C!c  c
 c c  c c  c:69Cc#*%c 8 c-c  c *
!c?#@c
(  c c c %$Cc c  c c c
c .c c
 c  c c c  !c 3 c cc .c c  c c
.c  c  c c ccc c c.c cIc c9Cc;7c
c<C>ccc c  c%c  /c!c?#@c

Tabel 2
Kebutuhan Cairan pada Dehidrasi Sedang (defisit cairan 5-8%)c
c  c) c c c "  c.c
;>c  8c c  ccc
L:c %%$c
:*##c #97c
#%*#<c #5%c
F#<c <<c
c
 c
c c - c .c c  c c c  c c c
 c c c 
c  c  c c  c c 
c !c
 cc  c   c .c  c c c  c   c  cc  c
c!c  c.c c c  c c  c5c  !c?#@c

Tabel 3
Kebutuhan Cairan Rumatan
c  c;>c "  c.c; >c
#$c #$$ccc c
#$*%$c #$$$cIc7$cQcc; cc#$c>c
F%$c #7$$cIc%$cQcc; cc%$c>c
c
 c  c c  c6$ccc.c c  c#7$$I;%$Q%$>cH#=$$c
 !c "  c .c  c  c %6c
!c B c c  c c  c

c
c ; c  c 
 c  c .c  c c   c   >c c - c .c
c c  c c.c c c cc c  c
c  c  c !c c - c c   c c  c  c
 c  c c  c  c !c  c  c c c
 cc cc
 c  c.c- c  cc  c
- !c (  c  c c  c .c  c  c c   c  c  c
c c?#@ c
c c /c cc  c  c 
c * cc c c
8 c c c  c c   c c  c c c  c
c ;%$c  c  >c  c c c c   c c  c
c  c  c c c  c  c /   c  c  c .c
-!?#@c
c

Jenis Cairan (rekomendasi WHO)c


  c
Pc 0 cc c; 0>c
Pc 0 ccc; (>c
Pc 0 cc c;&2>c
Pc c7Cc  c  cc c;78 0>c
Pc c7Cc  c  ccc;78 (>c
Pc c7Cc  c#8%c  cc c;78#8%0&2>c
c
;4c, c cc  c  c 0c c (c c  c
 cc c >c
c
  c
Pc c6$c
Pc  c
Pc ( c

3. Sindrom Syok Dengue


c  c  c /!c 4c c   c  c c
cc  c  c c c- c !cccc.c
 cc c c  c  c  cc  c6<c
!c c cc

c
c c c   c c c  c L%$c c c c c .c   c
 c %$c  8c 8
c c 5$c c  c c c   c 
 c #$c
 8 !?#@c

Penggantian Volume Plasma Segera


 c / c .c -c  c c c F%$c  8c !c c
 c .c  c  c 5$c !c  c c c c  c  c  c
.c c c c  c c  c#$c8c 8
c  c c c c c
.c  c  c.c  !c(  cc  c cc c9$cc
c .c   c c c #$c  8c 8
c  c  c  c  c c
 c  c c c.c  c; c6$c c >c#$c 8c 8
!c c
 c  c   c c   c 5$c  8c !c c  c   c#7$$c
 8c c c  c cc !c c c.c c
  c c   c c c c  c  c c   c  c  c

 c  Dc c 
c  c  c c !c (  c  c
ccFcc c c c  c - c . c ;#$c  8 8
>c c
 cc5$c 8 8%6c
!c c c c cc c  c
c c c c c c!?#@c
c
Pemeriksaan Hematokrit untuk Memantau Penggantian Volume Plasma
 c.c cc  c/   c c- c c c c c
c  !cc.cc   c
 c#$c  8c 8
c c c
 c  c c  c  c c 
 c  c %6*6<c
!c c
43cc c  c ccc ccc c 
c !c?#@c
4c -c c c  c c c  c   c  c
c   !c "  c 8 8c 8
c  c  c  c  c /c  c
 c  !c  c  c .c  c  c  c c  c 6<c
c c
!c (  c .c c  c c
 c c   c  c c 
 c
 c  c c - c ;  c c   c  c c  c
 c .c  >c c c   c - c c  c  c
 c c  c
 !c   c c  c c   c  c c
c
c  c  c  c c   c  c   !c + c c  c
c c  c  c .  c  c - c c  c  c 
 c c
  !?#@c

c
Koreksi Gangguan Metabolik dan Elektrolit
c c  c   c c c c  8c c
 c c c c  c   c  c   c c  c  c !c (  c
 c c cc . c
 c cc c c 
 c
 c !c?#@c
 c  c   c c .c  c  c .c c
  cc c c c  cc c c cc
 cc
 ccc c  !?#@c
c
Pemberian Oksigen
c c %c c c c  c   c  c  c  c c !c

c  c c c  c c c  c c  c
 cc c
 cc c  c cc!?#@c
c
Transfusi Darah
c c c.*.c c   c cccc
 c  c c c 
c ;prolonged shock>!c  c  c c
 c  c  c c  c c !c   c  c  c
 c  c c ;internal haemorrhage>c   c c !c
  c c ; c c 7$Cc 
 c 6$C>c c  c  c /   c
 c  c .c c .  c  c  c  c  !c  c
cc  c  cc cc.  c c c c
c c c c  c  !c  c c c  c  c  c
 c  c c c c c  c !c c c 
 c  c c
c c   c  c c c c  c !c
c  c c / c   c  c / c  c c
fibrinogen degradation productsc  c c  c c c  c  c

 c c c c !c c  c  c
c  c
!?#@ c
c
Monitoring
 c- c c cc c c c - c.c c  c
 c c !c * cc c c cc  c

c
Pc + cc cc c c c .cc#7*5$cc c  c
ccc c!c
Pc  cc c cc6*9c
c cc c cc  !c
Pc cc c c c cc
c.c
 c c
c  c cc.cc  c c.  !c
Pc "  c c c  !c
 c  c c c  c c c /c c - c
- c  c * c  c c !c (  c  c  c .  c #c
 88 c c
 c.c c  c  c  c c c-  c
c c  c c c c  
c   c #c 8 c c
 !c  c
 c  c  c  c c c c  c   !c
c  c  cc  c.  c c  cc  c cc
c cc c c c  !c?#@c
c  c c / c c c c  c   c c  c
c 8 c c c c  c  c  c / c c  c
 c5c c ?%@c
#!c  c cc c c cc c 
cc c c 
c
ccc c!c; c%c c5>c
%!c  c  c  c  c  c  c 
c c c c  c
!c; c6>c
5!c  c c cc  c c c 
cc c3!c; c7>c
c

c
Bagan 2. Tatalaksana kasus tersangka DBD?%@
c c c
c c Tersangka
Tersangka DBDc
DBD
c c c c c cc  c
c c c c c  c cL:cc
c c c c c  c cc cc cc
c c c c c  c 8  c
c
Ada kedaruratanc c c Tidak ada kedaruratanc
c  cc c c c ccccccc
cJ c
c  c c c
c 
cc c c Uji torniquet (+)c ccccccccccUji torniquet (-)c
c  c  c c ;  c0 >c cccccccccc;  c0 >c
c  c c
c c c
c cccccccccc"  c c cccccccc"  c cccccccccRawat Jalan
c c cL#$$!$$$8M c c cccccccccccF#$$!$$$8M c ccccccccc c
c c c c c c c c ccccccccc ccc
 c c c c c c c cccccccccc c c
 c
;0c c567>c
c c cccRawat Inap
( c c5>c
c c c c c cccccccccRawat Jalan + c c cRc
 c c#7c 8c
 c cc
c c c c ccccccccc c c c  cc c
c c c c ccccccccc cccc c cc*5c
c c c c cccccccccc c  c
c c c c cccccccccc cc cc
c c c c ccccccccc c
c
c c c c cccccccccc  cc c
c c c c cccccccccc  c c cc
c c c c ccccccccc c c8c
c c c c ccccccccc cc c ( cc
c c c c ccccccccc (c c
c
c c c c ccccccccc0 cc cRccc
c c c c ccccccccc c  c
c
c c c c Segera bawa ke rumah sakit

c
Bagan 3. Tatalaksana kasus DBD derajat I dan II
tanpa peningkatan hematokrit?%@

cc 
cc ccccc
c 
cc ccccc
c c c c c c c &
 c c
c c c c c c c c%*:cc
c c c c c c c ,
cJ c;I>c c
c c c c c c c  cc
c c c c c c c 0  cc
c c c c c c c c cc
c c c c c c c  c;>c
c

Pasien masih dapat minum Pasien tidak dapat minum


c c c#*%c 8c c c c c c c
( c#c ccc7cc
"c Dcc ccc
 c
c c  c c
 c  cF5= 4c c c c c c c+4 c$=Cc
 c
c c c- c c c c7Cc;#5>c
 c c  c c c c c c c c c  c
c c c c c c c cc cc9c
c c
c c c c c c c c9*#%c
c
c
Monitor gejala klinis dan laboratorium
c cc
 cccc
, c  ccc c c c cc c c c  c
(/c c
cc cc9*#%c
c
c
c c c c c c c  cc 0c
Perbaikan klinis dan laboratoris (c  c c c6>c
c
c
Pulang ;c c>c
Pc  c c c%6c
ccc
Pc + cc c
Pc .c cc c
Pc c  c
Pc cc ccc
Pc "  c cF7$!$$$8M c
Pc  c 
c cc;   c c c  c c >c
c

c
Bagan 4. Tatalaksana kasus DBD derajat II dengan peningkatan
hematokrit >20%?%@

 c 
cc cc cccF%$Cc
c 
cc cc cccF%$Cc
c c c c Cairan awal
08 (8+4 c$=Cc c 078+4 c$=CI7c
c c c c c cccc9*:c 8 8
c
c c c c c- 8+ ccRc cc9c
c
c
c
 c c c c c c c  c c c
c  c c c c c c c c & c
c + c c c c c c c c cc
c ! c  c c c c c c 2! cc
c  c.  c  c- c  c c cc8c
c ;#%c 8 8
>c cc c c c ! cL%$cc
c c  c c c c c c c  cL8 c c
c ;%Qc>c
c
c
c  c c c c c c c c
c c c c c c c #$*#7c 8 8
c
c c c  c
7c 8 8
c c c c c c '- c#%*%6c
c
c
c c c c c c c  c- c c  c
c
 c
 cc
c c c c c c cc cccccccc  c c ccccc
5c 8 8
c c c cc
c c c c c c ! cLc%$cc
32cc c%6*6<c
c
(  c c- 8c  c c   cc c  c cc
 c.  cc c c %$*5$c 8 c cccccc#$c 8 c
c c c c c c c c ccc c c c(c
c c c c c c c c ccc*ccc  cc
c c c c c c  c ccc*c cc
c
c
c
c
c
c
c
c
c
c

c
Bagan 5. Tatalaksana kasus DBD derajat III dan IV
(Sindrom Syok Dengue/SSD) c?%@
c
 c 
ccRc3c
c 
ccRc3c
c c
c
1.c Oksigenasi (berikan O 2 2-4 liter/menit
2.c Penggantian volume plasma segerac;.c  c>
c 8+4 c$=Cc
c %$ 8 c.c;  c  c5$c>c
c
c
c Evaluasi 30 menit, apakah syok teratasi ?
 c c- cc#$cc
c 4c  .c.c c c.c-c
c
Syok teratasi Syok tidak teratasi
 c c c c c  c  c
c + c c c c c c + c  8 c c
c c cF%$cc c c c cL%$cc
c  cc8c c c c8c
c 'cc c c c  c c c   c
c  c.  c#c 8 8
c c 'c c
c c c c c c c c c c c
c
Cairan dan tetesan disesuaikan 1. Lanjutkan cairan
#$c 8 8
 #7*%$c 8 8
c
Evaluasi ketat
c  c- c c c c c 2. Tambahkan koloid/plasmac
c  c c c c c cccc822
 c c c c c ccccc
c  c cc c c c 3. Koreksi asidosisccccc
c c c c c c c cccc'- c#c
c

Stabil dalam 24 jam


c7c 8 8
c c c c Syok belum teratasi
c  c  c%Qc c Syok teratasi
c c c c c c  c cc8c
c
c5c 8 8
c c c  c cc
c c c c c c #$c 8 c c   c%$c 8 c
c c c c c c c  c c
 cc c  c6<c
c c   c
 ccc

c
Pemberantasan Demam Berdarah Dengue
c c  c  c  c c c c c c  
!c
c c   c c c  c  c  c -c
 c cc c- !c?5@c
c
cc
#!c c c c c
c c  8c  c c /c c  c 8 c  c
.ccccc!c c c   c c.c
/c
 c c /c c  c c  c c  c c c

cc   !c?5@c
%!c  c-c
c  c   c  c  c   c   c c
 c c  c c !c   c c  c
.c c  c c   c c  c c  c c  c
 c cc  c c/ c cccc c c- c
c c  c  !c " c c   c c c  c c
  c cccc c cc !c?5@c
c c cc c  c 
cc 8c  c
.c  c  * c c 5c c  c   c  c c
c
!ccc 
c  c c c-c c c
  cc  c  c  c+c.c c cc c c
c  c  c c
c  cAe. aegypti!c c +c   c  c
c  8/.c c c  c c c .c  c  * c
 c  c   c c (c  c  c c  c  c c
c   c c c  c 
 c c  c c c  c -c
c c c  c  c .8c c c c c  c
 c   c cc c  c cc  cc  c c
c c c  cc!c?5@c
c c  c  c %c  c c  c  c  c c  c
 c c c c  c c   c / c !c c   c c
 c c cc c c c  c c6Cc; c>c
 c c c c65<c 8!c?5@c
cc

c
5!c  c cc c- c
c  c c   c c  c  c / c c
c  c
 c  c c  c  c c
c c c  c
8 8c c  c 8/!c  c c  c   c
 c c.c  c !c?5@c
c  c  c   c  c /c c c c  c  c
 
c  c 8 8c  c   c   c c  c c
c cc !c?5@cc
c '- c c  c c  c.cc*
c c c .c  c  c  c c
 c   c  c  !c 
 c c c   c  c
 c c cc!c?5@c
c
c 
c
c c 
cc   c  cc  cc   c
 cc  cc c  c  c 
c c !c
c  c  c cc cc cc
c c c
c c c  c c  c  c  c c
 c 8 c cc c c c c c
c!c c c  c 8c
c c  cc c c
 ccc !c?5@c
c  c  c  c c  c  c  c
  c c  c   c  c c  !c  c
 c cc  cc c  c c !c?5@c
c

c
BAB III KESIMPULAN

c c  c c c  c  c  cccc   c
 c- c  c cc c ccc 8 cc cc
c c  c  c  c c c !c  c
 c 
 c  c  c c  c c c ;c
>c  c   c .c c c  !c  c 
c  c   c
c  c  cc  c c
8!c
c , c  c .  c   c / c 
c  c
 c.  cc
 c c c ccc
c  c   c 5Cc c c  c  c c
 c  !c c  c  c  c c  c c
-!c
c c c  c c  c  c   c  c c
 c c /c  c  c  c c  !c  c
c  c  c c  c  c c c
 8  c c c-c c c  cc!c

c
DAFTAR PUSTAKAc
c
#>c  c ! !c 
c c !c Tatalaksana Demam Berdarah Dengue di
Indonesiac c c  c  !c c "  c
 c c  c c c 0 !. ' c 5!c "!c
%$$6!c
%>c   c !c Demam Berdarah Dengue.  c(
c  cc !c"  c!c
' c 3!c  c  c c   c c  c 2 c  c
,-c !c"c" c%$$9!c !c#:5#*7!c
5>c  c !c Demam Berdarah Dengue.c   c  c  
c c
c  !c Sc  c c c  !c "c (  c
%$$%!c
6>c (c S!c!!cDemam Berdarah Dengue, Diagnosis, ?engobatan, ?encegahan, dan
?engendalian. ) c cB!c' c%!c"!c#==<!c
7>c & c !"!c Dengue and Dengue Hemorrhagic Fever!c  c 4 c"  c 0!c
 c c 88///!  . !!-8.  !.T H#7$<9$#!c
c c%$$=c c%=!c
9>c & c "c 4 c &&!c Dengue/Dengue Hemorrhagic Fever: The Emergence of a
Global Health ?roblem.c + c 4c c . c c
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