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c c c c PENYUSUN : NURUL FATMA DIYANA BINTI AHMAD 030.05.274

PEMBIMBING : Dr. GATUT SEMIARDJI Sp PD KEMD c c c

c KEPANITERAAN KLINIK ILMU PENYAKIT DALAM RUMAH SAKIT DR H MARZOEKI MAHDI FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTI PERIODE 7 DESEMBER 2009± 13 FEBRUARI 2010 BOGOR

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c 


c c  c 
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c cc
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c c /c c c
c  c c c %*5c  c 

c c
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c c cc c c  c c 
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c c c c  c c  c 
c c 
c*c c cc

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c
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c c /c  c c
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c  c .c ' c c 

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c c!c 7!c &c' c 
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c 

c cc c 
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c 

c IgM/IgG Dengue Blot, Dengue aapid IgM/IgG, IgM Elisa, IgG Elisa.?#@c c Diagnosis Banding ?5@ !c  c / c 
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c c  c 
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c c  !c ( c 
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cc c
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c c 
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c .c ;4>!c  c 4c c 
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c c 
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c c
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c c
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c  !c  c 4c  c 
c
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c

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c 


c c
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c 
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c * c
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c 
c c
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c 0'c c 
c c 

c 
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c.c

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c c 
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c c
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c c 
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c c c c c  c 
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c !c  c  c 
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c
c c


c !?#@c c Penatalaksanaanc 
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c !c  c  c c  c 
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c  c c 
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c  c c 
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c c 
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c  c c 
c .c c 
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.
c 
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c  c c
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c c ;
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c c 
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c c  c 

c c 

c 
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c 
/ !c ( c 


c  c c 
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c 
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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  cc cc
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c


c c c
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c cc c
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c c c c 
c c  c 
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c 
c c 

c /c  c 
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c  c c 
c c 
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c  c  c  !c 
c c  c /c c 
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c c
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cc c 
c c 
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c
c 
c 
c 
c c ;
c c 
c >c
c !c?#@c c 1. Demam Dengue 
c c c
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c
c 
c  c Pc c c
cc
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cc
cc 
c  c 
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c c 
  c L5=A4c  c 

c 
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c 
c c 

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c.c c

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c c c ccc cc c  c c
c 
c
c%c!c Pc cc  c c c
cc
c-

!c c  c 
c c c c c  c c 
c  c 

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c
c 
c 
c c  
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c %c c 

c c !c  c c 
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c 
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ccc c c c
c
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ccc
ccc c c  c c c 
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c  c  c 
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c 
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c c c c c 
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c c 
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c

c c  c 

c 
c  c 
/c
cc

c  /c

c
cc!c

cccc c



c c0c#!c c
cc c
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ccc%* 5c c  c 
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c  c c %c ; c 
c >!c?#@c c 2. Demam Berdarah Dengue Ketentuan Umum 

c ccc8 8c c
c c  c c 
c 

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c c 

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c  c c c 
!c& c c 8cccc
cc
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c 
c 

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c  c c 


c 
.c c 
c c c c c c ;the time of defervescence>cc 
c
c/ c
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c 
c  
-c c 
c
c


c c cc
!cc  c

c c

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c cc c 
c c 
c c
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cc cc c
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c!c 
c  c ccL#$$!$$$8M ccc c#*%c 8  c;*c c c#$c  >c
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c
c
c c

c
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c %$Cc c
c 
.
c 


c  c c 
c  c c 

c .!c 0c 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  c cL7$!$$$8M !c
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c c
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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
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c
c
c ccccc
c
cc

c c .c -
c c 
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!c (
c  * c 
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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?6@c

c

Tabel 1 Dosis Parasetamol Menurut Kelompok Umur ,c;>c L#c #*5c 6*9c :*#%c F#%c


 c;c c

>c c;>c 
c;#c cHc7$$c>c 9$c #8
c cc c
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c c
cc
c c!c"
ccc  c  c c cc
cccc
c

c  !c 
c 
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c c 7$c  8

c  c 6*9c c 
!c 

c


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c .c c<$*#$$c  8c

c  c %6c

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
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c c /c 
c 
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 c c c c 
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c c   c /c c c c c c  c c c 
c 5*7c 
c
!c 

c  c 
c
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c 

c  c c 
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/c  c 

c .c c 
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.c  c c 
c 
c .c -
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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 c c 
c c c  c 
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c 
c  c 

c 

c 
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c 
c  
c / c c
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!c?#@c ,c
cc c c c

cc c 
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c 
c !c c
c
c ccHc5cQc c !?#@c c Penggantian Volume Plasma c

c c  c


c cc
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c
c c ;
c *
c 
c c 
c >c c c 
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c - 
c cc !c) c
c
c.cc 
c
c  c c
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c .c / c c c %*5c c 
c 
c cccc
c
c;
c5$*9$c
>!c

c  c%6*%
c
c c 
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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 c  c7*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
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c
c c
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cc  c:69Cc#*%c 8

c-
c  c
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!c?#@c (  c
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c %$Ccc
c c c
c .c c 
c c c
c  !c 3 
c cc .c c 
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c .cc
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ccc
cc.ccIc
c9Cc;7c cc

c

c c
c%c  /c!c?#@c

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

 c
c c - 
c .c c 
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c c c c
c  c 
c 
c
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c
c
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!c  cc 
c 
c .c 
c
c
c  c 
 c cc c c!c
c.cc c 
c c
c5c
!c?#@c

Tabel 3 Kebutuhan Cairan Rumatan
c  c;>c #$c #$*%$c F%$c

" c.c; >c #$$c
cc c #$$$cIc7$cQcc; cc#$c>c #7$$cIc%$cQcc; cc%$c>c c

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c  c6$ccc.cc  c#7$$I;%$Q%$>cH#=$$c  !c " c .c c 
c %6c !c B
c 
c 


c c  c c

c ;


c  c 
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c .
c  c c c >c c - 
c .c 
cc 
c
c
.
c c
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c c 
c  c 
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c c 
c 

c 

c  c 

c 
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!c 


c  c

c 
c 
c
c

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- c
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c  c -
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c c c 
c
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cc /c c

c  c  c  c * ccc
c


8
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 c

Jenis Cairan (rekomendasi WHO)c   c Pc 0c
c c; 0>c Pc 0c
c
c; (>c Pc 0cc c;&2>c Pc 
c7Cc  c c
c c;78 0>c Pc 
c7Cc  c c
c
c;78 (>c Pc 
c7Cc  c#8%c cc c;78#8%0&2>c c ;4c,c
cc 
c c 0cc (c c 
c

cc
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>c c   c Pc 
c6$c Pc  c Pc ( c

3. Sindrom Syok Dengue c 
c 
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/!c 4c 
c   c 
 c c cc
cc

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c- 
c !c
ccc.
c 
 c
c c
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c  c6

c 
c c 
c c 
c  c L%$c c c 

c
c .c   c 
c %$c  8c  8

8 c 
c 5$c 
c  c c 
c c 
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!?#@c

Penggantian Volume Plasma Segera 
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c c 
c c F%$c  8c

!c 

c


c 
.
c c  c 5$c 
!c  c c
c
c  c
c 
c .c
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c
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8 c  c c c
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c

.c  c  c.c  !c(  cc
c c
c

c9$c
c
c .c   c
c 

c #$c  8c

8 c  c  c  c 
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c  c c
c.c  c;
c6$cc >c#$c 8c c 

c   c c 

c 5$c  8c

8 !c c

!c c 

c   c#7$$c

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c c 
c cc
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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 c c 
!c (  c  c 
c
cFcc c
c c  c - 
c 
. c ;#$c  8  cc5$c 8

8 >c c

8%6c !c

c
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cc c


c
c
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!?#@c c Pemeriksaan Hematokrit untuk Memantau Penggantian Volume Plasma 

c.cc
c 
c/ c c- c
c
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c!c

c.c

c c
  c#$c  8c

8 c c
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c 
c c 
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c %6*6
8 c c
c 
c  c /c 
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c c 

c 6c c c 

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-
c
c  c

c c c  c !c 
c 
c  c c 
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c  c 
 c 
c 
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c 
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c c  c 
c .c  c - c c 
c  c 
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c 
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Koreksi Gangguan Metabolik dan Elektrolit 
c c  c 
  c 
c 

c 
c  8c c  c c c c  c

 c c 
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c  c  c
!c (  c  c c 
cc 
.c
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c c 
c 
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c
!c?#@c  c c   c 
c .c  c 
c 
.
c c  c
c c
cc  cc
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c cc  cc
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c
c c 
 !?#@c c Pemberian Oksigen 
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  c  cc
 c
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c  c c
c
!?#@c c Transfusi Darah 

c c c.*.cc  c c
c
cc 
c  c c c

 c ;prolonged shock>!c 

c c c 
c  c 
 c 
c 
 c c !c   c  c c 

c 
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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 
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c c
c  cc
c
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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 
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c c 

 c 
 c c 
c c 
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!c 

c 
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c /c   c  c /c  c c fibrinogen degradation productsc c 
c  c 
c c c 


c 
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c c !c 

c 
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c c 

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

c

Pc + c
c c
c c

cc .c
c#7*5$c
cc
c 
ccc c
!c Pc  c
cc 
cc6*9c c
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c  !c Pc 
c
cc
c c
c

c
c.c  c c 

cc

cc.cc 
c c
.!c Pc " c c

c 
!c  c 
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c /c 
c - 
c -
c 
c
*
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c
c !c (  c 
c
c .c #c  88

c
c  c.c c

c
c 
c
c c-
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c c

c 
c 
c c 
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 c #c 8

c c


!c 
c  c 
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c 
c c  !c 
c  c 
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c
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.c ccc
c c

c
c cc

c c
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c  c c / c 
c c c
c 
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c c 8 c
c 
c c 
c 
c  c / c c  c  c5c c?%@c #!c  cc
c c
ccc c
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c c
!c; c%c c5>c %!c  c c  c 
c c  c
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c 
c  c 
!c; c6>c 5!c  cc cc

c
c c
 cc c3!c; c7>c c

c

Bagan 2. Tatalaksana kasus tersangka DBD?%@ c c

c

Tersangka Tersangka DBDc DBD

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

cL:cc  c 
c
c cc cc  c
8
c

c

c

Tidak ada kedaruratanc

c Ada kedaruratanc c c c c c c

 cc c c c
c

c 
cc c c 
 c
c c c c
c c

c cccccccccc" c c c c cL#$$!$$$8M c c c c c c c  c c c c 
c ;0c c567>c

c

cccccc
c cJ
c

Uji torniquet (+)c ; 
c0


>c

ccccccccccUji torniquet (-)c cccccccccc; 
c0


>c

cccccccc" c cccccccccRawat Jalan cccccccccccF#$$!$$$8M c ccccccccc
 c c c c ccccccccc ccc c c c cccccccccc
c c

c

c

cccRawat Inap ( c c5>c

c

c

c

c

c c c c c c c c c c c c c c

c c c c c

c c c c c

c c c c c

cccccccccRawat Jalan c c#7c 
8c ccccccccc
 c c c ccccccccc cccc c cccccccccc
cc ccccccccc
c cc cc ccccccccc c

c c c c c

c c c c c

c c c c c

ccccccccc
cccc ccccccccc
c  c  c cc ccccccccc
c
c8c ccccccccc cc
c ( cc ccccccccc (cc

c c

c c

c c

ccccccccc0 cc cRccc ccccccccc cc

c

c

c

Segera bawa ke rumah sakit

c

c c

c

+ c c cRc

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

c c c c c c c

c c c c c c c

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

Pasien masih dapat minum Pasien tidak dapat minum
cc c#*%c 
8c c c 
cc
c

c (c#c
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c "
cDccc
cc c c cc c  ccF5= 4c
c
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c
c c- c c c
c7Cc;#5>c 
c
c  c c c c c 

cc
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  cc
cc ,c 
c
cc c c c cc cc cc (/c
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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 cc
c Pc +cc
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.c cc
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c  c Pc cc

cc
c Pc " c cF7$!$$$8M c Pc  c  c 
c
c; 
 c
c
c
cc >c c

c

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

c

c

c

Cairan awal 08 (8+4 c$=Ccc 078+4 c$=CI7c c c cccc9*:c 8 8 c c c- 8+ ccRc cc9c 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 + cc c c c c c c 
c
c c 
! c  c c c c c c 2
! cc c 
c.c  c- c
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c8c c ;#%c 8 8 >c c
c c c c 
! cL%$cc c cc 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 
c

c c c c c c c 
c
c ccccccccc c ccccc 5c 8 8 c c c cc c c c c c c 
! cLc%$cc 32cc

c%6*6
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$c
>c c c c Evaluasi 30 menit, apakah syok teratasi ? c c- cc#$c
c c 4c  .
c.c
c

c.c-
c c Syok teratasi 
 c
 c c c c + c
 cc c c c 
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