Nutrisi

Keb cairan 30-35 cc/kgBB/24jam

Kenaikan suhu 1 derajat ditambah 12% total cairan
Keb kalori 25-30 kkal/kgBB/24jam (rule of tumb)

KH 50-60% total kalori, per oral 4 kkal/gr, iv 3,4 kkal/gr

Protein 15-20%, keb harian sehat 0,8-1 gr/kg/day, stres 1-2
Lemak 20-30%, 1 gr/kgBB/day. Tidak dpt diberikan sbg sumber kalori tunggal krn tidak punya
protein sparing efek

Malnutrisi
Ringan penurunan BB<10%
Sedang 10-20%, alb<3,2
Berat >20%, alb<2,5
BB normal : TB-100
Ideal : BB normal-10%

NE
Sedini mungkin. Sakit kritis dan pasca major surgery 24-36jam
Post laparatomy dng reseksi 2-3 jam post op
Multiple trauma <6jam post masuk ICU
Burn <8jam
Digestiv major surgery 12jam post op
Op lower GIT 4jam post op
Bedah jantung dng dukungan inotropik 30jam post op

NPE
Monitor: GDS, BS, elektrolit, fungsi ginjal dan hati, TG dan kolesterol
BB, nitrogen balance, plasma protein
Dextros: kec infus tidak boleh >5 mg/kgBB/menit
As amino: konsen bervariasi antara 5-15%
Nitrogen:protein / 6,25
Lewat vena perifer:
Osm < 700 max 900
Pasca bedah dan trauma dng status gizi awal normal : mulai hari ke 3
Status gizi awal jelek : mulai 24-48jam
Respon metabolik thd trauma :
1. Ebb phase : 24 jam
Ada syok hipovolemi, tjd penurunan CO, BP, suhu, MR
2. Flow phase
Peningkatan katekolamin, glukokortikoid, glukagon, sitokin, lipid mediator, fase akut prod
protein
Gut feeding d10 20cc/jam (192 kkal)
Hari ke 2 50% BEE

Dextrose 6 gr/kgBB/hr
GDS dipertahankan <200gr, dibagi rata 24jam. Start low go slow
Dextrose 5% osm 277 cal 85
Osm plasma 290 ± 5
Vena perifer bisa menerima s/d max 900 mOsm
Makin hipertonis mudah thrombophlebitis, thromboemboli
Dextrose murni
Hari 1 : Ringer D5 1000 cc + D5 1500 cc : 500 kcal
Hari 2-3 : Ringer D5 1000 cc + D10 1500 cc : 800 kcal
Hari 4 dst : + D20 1000 cc : 1000 kcal
Dextrose + AA via vena perifer
Hari 1 : Ringer D5 1000 cc + D5 1500 cc : 500 kcal
Hari 2-3 : AA 2.5% + KH 1000 cc + D10 1500 cc : 900 kcal + 25 gr AA
Hari 4 dst : + D20 1000 cc : 1100 kcal + 25 gr AA
Protein
0.5 g/kg/day (sehat)
1-1.5 g/kg/day (critically ill)
Harris-Benedict
Male : 66 + (13.7 x BB) + (5 x TB) - (6.8 x age)
Female :655 + (9.6 x BB) + (1.8 x TB) - (4.7 x age)
Stres factor :
1-1.25 for mild starvation
1.25-1.5 moderat-severe
1.5-1.75 severe

Aminofusin 5% AA 300 kkal

Clinimix 410 kkal
Aminofluid 210 kkal
Kabiven 983 kkal
As amino 34 gr, nitrogen 5.4 gr, glukosa 97 gr, lemak 51 gr.

Snack 150 kkal

Bubur saring 1500 kkal

Early parenteral
K 60%
L 40%
Rule of tumb 30 kkal/kgBB
Dosis awal sama2 50%,setelah itu baru 60:40%
Baru kemudian ditambah protein 0,8-1,5 gr/kgBB