Kasus Ketosis

7/24/2019 Kasus Ketosis

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BAB I

LAPORAN KASUS

I. IDENTITAS PASIEN

Nama : Tn. JL

Nomor CM : 01 01 48 75

Usia : 40 tahn

A!amat : J!. "ar#a $#. T. No %C& Ja'arta S(!atan

P('(r)aan : T'an# *)('

P(n+i+i'an : SMA

A#ama : Is!am

Stats P(rni'ahan : M(ni'ah

Mas' ,mah Sa'it : S(!asa& 5 Janari -01%

II. ANAMNESIS

Di!a''an s(ara atoanamn(sis +(n#an Pasi(n /a+a hari amis 7 Janari -01% /a+a /'!

11.00 "I.

1. (!han tama : (n#'a' /a+a tan#an 'iri s()a' - min## SM,S.

-. (!han tam2ahan : L(mas 36. ,PS : *S m(n#(!h'an 2(n#'a' /a+a tan#an 'iri s()a' - min##

SM,S. Pa+a aa!na !(n#an +irasa'an m(m(rah& !a! tim2! 2(n)o!an s(/(rti 2is! an#

'(m+ian /(ah m(m2(nt' !'a. Darah 3& nanah 3. N(ri 3. *S m(n#(!h'an

!(mas s(!ama 1 min## t(ra'hir& *S m(n#(!h'an (/at has 3 +an s(rin# A 3

t(rtama /a+a ma!am hari 9 6 t(ta/i /asi(n ti+a' (/at !a/ar 3;. L'a +irasa'an ti+a'

'n)n# m(m2ai' +a!am - min## ini. (rat 2a+an ti+a' +irasa'an m(nrn 3;. Ma!

3 mntah 3 +(mam 3;. *S m(nan#'a! riaat trama /a+a tan#an 'iri.

1


2/41

4. ,PD : *S m(nan#'a! /(rnah m(n#a!ami '(!han +an /(na'it an#

sama s(2(!mna. ,iaat DM +an


3/41

Tan+a ita!

o TD : 160=70 mm


4/41

Ins/('si : rata& i't(ri' 3;& (@!or(s(nsi 2(rma'na 3;& s/i+(r

na? 3;& /(rna/asan a2+ominothora'a!

As'!tasi : U 6=m(nit& ?(nos hm/ 3;& Art(ria!

rit 3;

P(r'si : Tim/ani 4 'a+ran& shi@tin# +!!n(ss 3;

Pa!/asi : s/(!& N(ri t('an 3;& n(ri !(/as 3;& h(/ar

+an !i(n& ti+a' t(ra2a m(m2(sar& 2a!!ott(m(nt #in)a! 3;&

n+!asi 3;

o E'str(mitas atas : sim(tris& /ro/orsiona!& +(@ormitas 3;& o(+(m 3; s(!!itis

3 /a+a mans sinistra 3m(rah& o(+(m& NT 3F

o E'str(mitas 2aah : sim(tris& /ro/orsiona!& +(@ormitas 3;& o(+(m 3;

I. PEME,ISAAN PENUNJAN$

A. La2oratorim

5 Janari -01%

J(nis P(m(ri'saan


5/41

7 Janari -01%

J(nis P(m(ri'saan


6/41

8 Janari -01%

M(ta2o!ism( ar2ohi+rat

$DS 0%.00 177 m#=+! 110

$DS 11.00 -50 m#=+! 110

$DS 1%.00 -71 m#=+! 110

H Janari -01%

J(nis P(m(ri'saan


7/41

$DS 0%.00 1-H m#=+! 110

$DS 11.00 110 m#=+! 110

$DS 1%.00 141 m#=+! 110

1- Janari -01%

J(nis P(m(ri'saan


8/41

L('osit 7.-00 =GL 6800;10%00

Eritrosit 4&8 Jta=GL 4.4;5.H


9/41

an#io/ati. Dimana a'i2at +ari 'om/!i'asi t(rs(2t ?as'!arisasi /a+a t2h t(rtama !'a

m(n#a!ami '(rsa'an& s(hin##a /ros(s /(n(m2han !'a an# m(m2th'an

?as'!arisasi an# 2ai' nt' /ros(s in@!amasi +an /ro!i@(rasi m(n)a+i t(r#an##. Pasi(n

m(n#(!h'an !'a an# aa!na m(r/a'an #(!(m2n# 2(sar an# '(m+ian /(ah +an

m(m2(nt' !'a +an '!it s('(!i!in#na m(rah 2(r2atan# t(#as.


10/41

a. Non;m(+i'a m(ntosa: /(n#atran +i(t DM& (+'asi /asi(n m(n#(nai ara

/(n#(n+a!ian #!'osa +arah s(/(rti /(n#atran ma'an +an 2(ro!ahra#a.2. M(+i'am(ntosa:

i. Dri/ ins!in +(n#an +osis /(m2(rian

Jam ,I Unit=

Jam

$DS Jam ,I ,I 3Cor(tion

Dos(

$DS

; 150 0%.00 ; -00

0&5 IU 150;-00 5 IU -01;-50

1 IU -01;600 1-.00 10 IU -51;600

1&5 IU 601;400 15 IU 601; 650

- IU 400;450 18.00 -0 IU 651

6 IU 400 Etra -4.0

0

ii. P(m2(rian C! nt' m(n#hin+ari t(r)a+ina h/o'a!(mia 'ar(na/(m2(rian ins!in. P(m2(rian +i!a''an +(n#an +osis -0;60

mE=L.

3. Dia2(t(s M(!!its Ti/( IIPasi(n m(n#(!h !(mas s(!rh t2h s()a' 2(2(ra/a hari SM,S. L(mas /a+a /asi(n

+i'ar(na'an #an##an /(m2(nt'an (n(r#i s(2a#ai a'i2at +ari a+ana #an##an

m(ta2o!ism( #!'osa /a+a /(n+(rita Dia2(t(s M(!its. Pasi(n m(n#(!h'an a+ana !'a

an# ti+a' 'n)n# s(m2h /a+a t(!a/a' tan#an 'anan.


11/41

osmoti' intra +an ('stra s(!!(r& s(hin##a s(!;s(! m(n)a+i +(hi+rasi a'i2atna /asi(n

m(rasa (/at has.


12/41

,(nana t(ra/i an# +i!a''an s(ara m(+i'am(ntosa a+a!ah 'or('si

(!('tro!it an# 2isa +i!a''an +(n#an /(m2(rian S, 61 ta2 m(n#in#at

'('ran#an 'a!im an# masih t(r#o!on# rin#an ait 6&0;6&5 mmo!=+!

III. *LL*" UP

7 Janari -01%

S N(ri +an 2(n#'a' /a+a tan#an 'iri& /sin# 3

* TD: 1-0=80

N : 80

,,: -0

S :6%&5

Mata: CA ;=; SI ;=;

Jantn#: SI=II r(# m; #;

P!mo: SN = ,h;=; "h;=;

A2+: S/(!& U 4& NT;

E's: o(+(m +an m(rah /a+a mans 'iri&

?(r2an+ r(m2(s +arah +an nanah

A (tosis DM& s(!!itis mans sinistra

P C(@o/(raBon(=s!2atam -1

M(troni+aBo!( 6500

A/i+ra 65i

Thora+osi -1

S, 61

Crma 61

Ntri@!am 61

Sim?astatin 110 m#

8 Janari -01%

S N(ri +an 2(n#'a' /a+a tan#an 'iri& /sin# 3

* TD: 160=80

N : 84

,,: -0

S :6%&7

Mata: CA ;=; SI ;=;


P!mo: SN = ,h;=; "h;=;

A2+: S/(!& U 6& NT;


?(r2an+ r(m2(s +arah +an nanah


P M(troni+aBo!( 6500

A/i+ra 65i

Thora+osi -1

C(@tri!o/

S, 61

Crma 61

Ntri@!am 61

Sim?astatin 110 m#

12


13/41

C(@o/(raBon(=s!2atam -1

H Janari -01%

S N(ri +an 2(n#'a' /a+a tan#an 'iri& t(rasa 2(r+(nt

* TD: 1-0=80

N : 7%

,,: -0

S :6%&5

Mata: CA ;=; SI ;=;


P!mo: SN = ,h;=; "h;=;

A2+: S/(!& U 4& NT;

E's: 5mans 'iri& ?(r2an+ r(m2(s +arah

+an nanah



M(troni+aBo!( 6500

A/i+ra 65i

Thora+osi -1

M(ti!o2a!amin -1

S, 61

Crma 61

Ntri@!am 61

Sim?astatin 110 m#

11 Janari -01%

S N(ri +an 2(n#'a' /a+a tan#an 'iri&

* TD: 110=70

N : H%

,,: 18

S :6%&%

Mata: CA ;=; SI ;=;


P!mo: SN = ,h;=; "h;=;

A2+: S/(!& U 6& NT;


+an nanah



M(troni+aBo!( 6500

A/i+ra 65i

Thora+osi -1

Pro D(2ri+(m(nt

S, 61

Crma 61

Ntri@!am 61

Sim?astatin 110 m#

1- Janari -01%

S N(ri +an 2(n#'a' /a+a tan#an +an si' 'iri& ma! & mntah - isi ma'anan&

+(mam ;

13


14/41

* TD: 160=H0

N : 80

,,: 18

S :6%&8

Mata: CA ;=; SI ;=;


P!mo: SN = ,h;=; "h;=;

A2+: S/(!& U 6& NT;

E's: 5 mans 'iri& ?(r2an+ r(m2(s +arah

+an nanah



M(troni+aBo!( 6500

A/i+ra 65i

Thora+osi -1

Pro D(2ri+(m(nt

S, 61

Crma 61

Ntri@!am 61

Sim?astatin 110 m#

16 Janari -01%

S N(ri +an 2(n#'a' /a+a tan#an +an si' 'iri & ma! & mntah - isi ma'anan&

+(mam ;

* TD: 1-0=80

N : 80

,,: 18

S :6%&8

Mata: CA ;=; SI ;=;


P!mo: SN = ,h;=; "h;=;

A2+: S/(!& U 4& NT;


+an nanah



M(troni+aBo!( 6500

A/i+ra 65i

Thora+osi -1

Transamin -1

M(o2a!amin -1

Pro D(2ri+(m(nt

S, 61

Crma 61

Ntri@!am 61

Sim?astatin 110 m#

14 Janari -01%

S N(ri +an 2(n#'a' /a+a tan#an 'iri & ma! ;& mntah ;& +(mam ;

14


15/41

* TD: 1-0=80

N : 80

,,: -0

S :6%&8

Mata: CA ;=; SI ;=;


P!mo: SN = ,h;=; "h;=;

A2+: S/(!& U 6& NT;

E's: 5 mans 'iri& ?(r2an+ r(m2(s +arah

+an nanah



M(troni+aBo!( 6500

A/i+ra 65i

Thora+osi -1

Transamin -1

M(o2a!amin -1

Pro D(2ri+(m(nt

S, 61

Crma 61

Ntri@!am 61

Sim?astatin 110 m#

15 Janari -01%

S N(ri +an 2(n#'a' /a+a tan#an 'iri & ma! ;& mntah ;& +(mam ;

* TD: 160=80

N : 7%

,,: 18

S :6%&8

Mata: CA ;=; SI ;=;


P!mo: SN = ,h;=; "h;=;

A2+: S/(!& U 6& NT;


?(r2an+ r(m2(s +arah ; +an nanah ;



M(troni+aBo!( 6500

A/i+ra 65i

Thora+osi -1

Transamin -1

M(o2a!amin -1

Post D(2ri+(m(nt hari '(;1

S, 61

Crma 61

Ntri@!am 61

Sim?astatin 110 m#

3. P,*$N*SIS

15


16/41

AD ITAM : a+ 2onam

AD SANATI*NAM : +2ia a+ 2onam

AD UN$SI*NAM : +2ia a+ 2onam

BAB II

TINJAUAN PUSTAKA

DIABETES MELLITUS

A. DEFINISI

M(nrt American Diabetes Association 3ADA tahn -010& Dia2(t(s m(!its

m(r/a'an sat '(!om/o' /(na'it m(ta2o!i' +(n#an 'ara't(risti' hi/(r#!i'(mia an# t(r)a+i

'ar(na '(!ainan s('r(si ins!in& '(r)a ins!in& ata '(+a;+ana.

B. EPIDEMIOLOGI

"or!+


17/41

2aha m(r('a m(n+(rita +ia2(t(s& +an hana 60 +ari /(n+(rita m(!a''an /(m(ri'saan

s(ara t(ratr.

La/oran +ari hasi! /(ni!itian +i 2(r2a#ai +a(rah +i In+on(sia an# +i!a''an /a+a +('a+(

1H80;an m(nn)''an s(2aran /r(?a!(nsi DM ti/( - antara 0&8 +i Tanah Tora)a& sam/ai %&1

an# +i+a/at'an +i Mana+o.


18/41

Dia2(t(s m(!its ti/( - ata Non-insuline Dependent Diabetic Mellitus 3NIDDM

m(r/a'an sat '(!ainan an# h(t(ro#(ni' +(n#an 'ara't(r tama hi/(r#!i'(mi' 'roni'.

M(s'i/n /o!a /(arisanna 2(!m )(!as& @a'tor #(n(ti' +i'ata'an m(mi!i'i /(ranan an#

/(ntin# +a!am mn!na DM ti/( - ini. a'tor #(n(ti' ini a'an 2(rint(ra'si +(n#an @a'tor;

@a'tor !in#'n#an s(/(rti #aa hi+/& +i(t& r(n+ahna a'ti@itas @isi'& o2(sitas +an tin##ina 'a+ar

asam !(ma' 2(2as. Pato@isio!o#i DM ti/( - t(r+iri atas 6 m('anism(& ait:

1. ,(sist(nsi ins!in /a+a )arin#an /(ri@(r.

-. D(@(' s('r(si ins!in.

6. $an##an r(#!asi /ro+'si #!'osa o!(h h(/ar.

1. Resistensi terh!" ins#$in

,(sist(nsi t(rha+a/ ins!in t(r)a+i +is(2a2'an o!(h /(nrnan '(mam/an hormon

ins!in nt' 2('(r)a s(ara (@('ti@ /a+a )arin#an;)arin#an tar#(t /(ri@(r 3t(rtama /a+a otot +an

hati& ini san#at m(no!o' /a+a DM ti/( -. ,(sist(nsi t(rha+a/ ins!in ini m(r/a'an ha! an#

r(!ati@. Unt' m(na/ai 'a+ar #!'osa +arah an# norma! +i2th'an 'a+ar ins!in /!asma an#

!(2ih tin##i. Pa+a oran# +(n#an DM ti/( -& t(r)a+i /(nrnan /a+a /(n##naan ma'simm

ins!in& ait !(2ih r(n+ah 60 O %0 +ari/a+a oran# norma!. ,(sist(nsi t(rha+a/ '(r)a ins!in

m(n(2a2'an t(r)a+ina #an##an /(n##naan ins!in o!(h )arin#an;)arin#an an# s(nsiti@ +an

m(nin#'at'an /(n#(!aran #!'osa hati. (+a (@(' ini m(m2(ri'an 'ontri2si t(r)a+ina

hi/(r#!i'(mi /a+a +ia2(t(s. P(nin#'atan /(n#(!aran #!'osa hati +i#am2ar'an +(n#an

/(nin#'atan P$ 3Fasting Plasma Glukose ata 'a+ar #!a /asa 3SN. Pa+a otot t(r)a+i

#an##an /a+a /(n##naan #!'osa s(ara non o'si+ati@ 3/(m2(nt'an #!i'o#(n +ari/a+a

m(ta2o!ism( #!'osa s(ara o'si+ati@ m(!a!i #!i'o!isis. P(n##naan #!'osa /a+a )arin#an an#

in+(/(n+(n t(rha+a/ ins!in ti+a' m(nrn /a+a DM ti/( -.

M('anism( mo!('!ar t(r)a+ina r(sist(nsi ins!in t(!ah +i'(tahi. L(?(! 'a+ar r(s(/tor

ins!in +an a'ti@itas tirosin 'inas( /a+a )arin#an otot m(nrn& ha! ini m(r/a'an +(@(' s('n+(r

/a+a hi/(rins!in(mia 2'an +(@(' /rim(r. *!(h 'ar(na it& +(@(' /a+a /ost r(s(/tor +i+#a

m(m/nai /(ranan an# +ominan t(rha+a/ t(r)a+ina r(sist(nsi ins!in. Po!imor@i' +ari I,S;1

3Insulin Receptor Substrat mn#'in 2(rh2n#an +(n#an into!(ransi #!'osa. Po!imor@i' +ari

2(rmaam;maam mo!('! /ost r(s(/tor +i+#a 2(r'om2inasi +a!am m(n(2a2'an '(a+aan

r(sist(nsi ins!in.

18


19/41

S('aran# ini& /ato#(n(sis t(r)a+ina r(sist(nsi ins!in t(r@o's /a+a +(@(' PI;6 'inas(

3Phosphatidyl Inocytol an# m(n(2a2'an t(r)a+ina r(+'tasi trans!o'asi +ari $LUT;4

3Glukose ransporter '( m(m2ran /!asma nt' m(n#an#'t ins!in.


20/41

m(ta2o!i' nt' m(!(/as'an #ran!;#ran! 2(risi ins!in. (mam/an trans/or #!'osa /a+a

DM ti/( II san#at m(nrn& s(hin##a 'ontro! s('r(si ins!in 2(r#(s(r +ari #!'o'inas( '( sist(m

trans/or #!'osa. D(@(' ini +a/at +i/(r2ai'i o!(h s!@oni!r(a.

(!ainan an# 'has /a+a DM ti/( - a+a!ah '(ti+a'mam/an s(! 2(ta m(nin#'at'an

s('r(si ins!in +a!am a't 10 m(nit s(t(!ah /(m2(rian #!'osa ora! +an !am2atna /(!(/asan

ins!in @as( a't.


21/41

Dia#nosis DM +it(#a''an atas +asar /(m(ri'saan 'a+ar #!'osa +arah. Dia#nosis

ti+a' +a/at +it(#a''an atas +asar a+ana #!'osria. $na /(n(ntan +ia#nosis DM&

/(m(ri'saan #!'osa +arah an# +ian)r'an a+a!ah /(m(ri'saan #!'osa s(ara (nBimati'

+(n#an 2ahan +arah /!asma ?(na. P(n##naan 2ahan +arah th 3!hole blood& ?(na&

ata/n 'a/i!(r t(ta/ +a/at +i/(r#na'an +(n#an m(m/(rhati'an an#'a; an#'a 'rit(ria

+ia#nosti' an# 2(r2(+a s(sai /(m2a'an o!(h "


22/41

1. T$T: Dia#nosis T$T +it(#a''an 2i!a s(t(!ah /(m(ri'saan TT$*+i+a/at'an #!'osa

/!asma - )am s(t(!ah 2(2an antara 140 O1HH m#=+L 37&8;11&0 mmo!=L.

-. $DPT: Dia#nosis $DPT +it(#a''an 2i!a s(t(!ah /(m(ri'saan #!'osa /!asma /asa

+i+a/at'an antara 100 O 1-5 m#=+L 35&%O %&H mmo!=L +an /(m(ri'saan TT$* #!a

+arah - )am 140 m#=+L.

Kriteri Di)n'sis DM

Ge+$ &$si& DM

,

G$#&'s "$s- se&t# / 200 -)!L 111 --'$L4

$!'osa /!asma s(a't m(r/a'an hasi! /(m(ri'saan s(saat/a+a sat hari tan/am(m/(rhati'an a't ma'an t(ra'hir

Ata

Ge+$ &$si& DM

,

K!r )$#&'s "$s- "#s /125 -)!L 6.0 --'$L4

Pasa +iarti'an /asi(n ta' m(n+a/at 'a!ori tam2ahan s(+i'itna 8)am

Ata

a+ar #!a /!asma - )am /a+a TT$* 9-00 m#=+L 311&1 mmo!=L TT$* an#+i!a''an +(n#an stan+ar "


23/41

7. S(!ama /ros(s /(m(ri'saan& s2)(' an# +i/(ri'sa t(ta/ istirahat +an ti+a'

m(ro'o'

Pe-eri&sn "en;rin)

P(m(ri'saan /(narin# +i!a''an /a+a m(r('a an# m(m/nai risi'o DM

namn ti+a' m(nn)''an a+ana #()a!a DM. P(m(ri'saan /(narin# 2(rt)an nt'

m(n(m'an /asi(n +(n#an DM& T$T& ma/n $DPT& s(hin##a +a/at +itan#ani !(2ih

+ini s(ara t(/at. Pasi(n +(n#an T$T +an $DPT )#a +is(2t s(2a#ai into!(ransi #!'osa&

m(r/a'an taha/an s(m(ntara m(n) DM. (+a '(a+aan t(rs(2t )#a m(r/a'an @a'tor

risi'o nt' t(r)a+ina DM +an /(na'it 'ar+io?as'!ar +i'(m+ian hari.

P(m(ri'saan /(narin# +a/at +i!a''an m(!a!i /(m(ri'saan 'a+ar #!'osa +arah

s(a't ata 'a+ar #!'osa +arah /asa. P(m(ri'saan /(narin# nt' t)an /(n)arin#an

masa! 3massscreening ti+a' +ian)r'an m(n#in#at 2iaa an# maha!& an# /a+a mmna

ti+a' +ii'ti +(n#an r(nana tin+a' !an)t 2a#i m(r('a an# +i'(t(m'an a+ana

'(!ainan. P(m(ri'saan /(narin# +ian)r'an +i'(r)a'an /a+a saat /(m(ri'saan nt'

/(na'it !ain atageneral check-up.

a+ar #!'osa +arah s(a't +an #!'osa +arah /asa s(2a#ai /ato'an /(narin# +a/at

+i!ihat /a+a ta2(! 6.

Unt' '(!om/o' risi'o tin##i an# ti+a' m(nn)''an '(!ainan hasi!& +i!a''an

!an#an tia/ tahn. a#i m(r('a an# 2(rsia 45 tahn tan/a @a'tor risi'o !ain& /(m(ri'saan

/(narin# +a/at +i!a''an s(tia/ 6 tahn.

23


24/41

B)n 1. Ln)&h


25/41

Dia2(t(s ti/( - mmna t(r)a+i /a+a saat /o!a #aa hi+/ +an/(ri!a' t(!ah t(r2(nt'

+(n#an ma/an. P(m2(r+aaan/(nan+an# +ia2(t(s m(m(r!'an /artisi/asi a'ti@ /asi(n&

'(!ar#a +an masara'at. Tim '(s(hatan m(n+am/in#i /asi(n +a!am m(n) /(r2ahan

/(ri!a' s(hat. Unt' m(na/ai '(2(rhasi!an /(r2ahan /(ri!a'& +i2th'an (+'asi an#

'om/r(h(nsi +an /aa /(nin#'atan moti?asi.

24 Ter"i N#trisi Me!is

- T(ra/i Ntrisi M(+is 3TNM m(r/a'an 2a#ian +ari/(nata!a'sanaan +ia2(t(s s(ara

tota!. ni '(2(rhasi!an TNM a+a!ah '(t(r!i2atan s(ara m(n(!rh +ari an##ota

tim 3+o't(r& ah!i #iBi& /(t#as '(s(hatan an# !ain s(rta /asi(n +an '(!ar#ana.

- Prinsi/ /(n#atran ma'an /a+a /(nan+an# +ia2(t(s ham/ir sama +(n#an an)ran

ma'an nt' masara'at mmait ma'anan an# s(im2an# +an s(sai +(n#an

'(2than 'a!ori +an Bat #iBi masin#;masin# in+i?i+. Pa+a /(nan+an# +ia2(t(s

/(r! +it('an'an /(ntin#na '(t(ratran ma'an +a!am ha! )a+a! ma'an& )(nis& +an

)m!ah ma'anan& t(rtama /a+a m(r('a an# m(n##na'an o2at /(nrn #!'osa

+arah ata ins!in.

. K'-"'sisi -&nn ;n) !in+#r&n

Kr*'hi!r t

-ar2ohi+rat an# +ian)r'an s(2(sar 45;%5 tota! as/an (n(r#i.

- P(m2atasan 'ar2ohi+rat tota! 160 #=hari ti+a' +ian)r'an

- Ma'anan hars m(n#an+n# 'ar2ohi+rat t(rtama an# 2(rs(rat tin##i.

- S'rosa ti+a' 2o!(h !(2ih +ari 5 tota! as/an (n(r#i.

- P(manis a!t(rnati@ +a/at +i#na'an s(2a#ai /(n##anti #!a& asa! ti+a' m(!(2ihi

2atas aman 'onsmsi harian 3Accepted DailyIntake

- Ma'an ti#a 'a!i s(hari nt' m(n+istri2si'an as/an 'ar2ohi+rat +a!am s(hari.

a!a +i/(r!'an +a/at +i2(ri'an ma'anan s(!in#an 2ah ata ma'anan !ain

s(2a#ai 2a#ian +ari '(2than 'a!ori s(hari.

Le - &

- As/an !(ma' +ian)r'an s('itar -0;-5 '(2than 'a!ori. Ti+a' +i/(r'(nan'an

m(!(2ihi 60 tota! as/an (n(r#i.

- L(ma' )(nh 7 '(2than 'a!ori

25


26/41

- L(ma' ti+a' )(nh #an+a 10 & s(!(2ihna +ari !(ma' ti+a')(nh tn##a!.

- ahan ma'anan an# /(r! +i2atasi a+a!ah an# 2ana' m(n#an+n# !(ma' )(nh

+an !(ma' trans antara !ain: +a#in#2(r!(ma' +an ss /(nh 3!hole milk.

- An)ran 'onsmsi 'o!(st(ro! -00 m#=hari.

Pr'tei n

- Di2th'an s(2(sar 10 O -0 tota! as/an (n(r#i.

- Sm2(r /rot(in an# 2ai' a+a!ah sea0ood 3i'an& +an#& mi& +!!& +a#in# tan/a

!(ma'& aam tan/a '!it& /ro+' ss r(n+ah !(ma'& 'aan#;'aan#an& tah& +an

t(m/(.

- Pa+a /asi(n +(n#an n(@ro/ati /(r! /(nrnan as/an /rot(in m(n)a+i 0&8

#=# /(rhari ata 10 +ari '(2than (n(r#i +an %5 h(n+a'na 2(rni!ai

2io!o#i' tin##i.

Ntri# -

- An)ran as/an natrim nt' /(nan+an# +ia2(t(s sama +(n#an an)ran nt'

masara'at mm ait ti+a' !(2ih +ari 6000 m# ata sama +(n#an %;7 #ram

31 s(n+o' t(h #aram +a/r.

- M(r('a an# hi/(rt(nsi& /(m2atasan natrim sam/ai -400 m# #aram +a/r.

-Sm2(r natrim antara !ain a+a!ah #aram +a/r& ?(tsin& so+a& +an2ahan /(n#a(ts(/(rti natrim 2(nBoat +an natrim nitrit.

Ser t

- S(/(rti ha!na masara'at mm /(nan+an# +ia2(t(s +ian)r'an m(n#onsmsi

'/ s(rat +ari 'aan#;'aan#an& 2ah& +an saran s(rta sm2(r 'ar2ohi+rat

an# tin##i s(rat& 'ar(na m(n#an+n# ?itamin& min(ra!& s(rat& +an 2ahan !ain

an# 2ai' nt' '(s(hatan.

- An)ran 'onsmsi s(rat a+a!ah > -5 #=hari.

Pe - ni s $ternti=e

- P(manis +i'(!om/o''an m(n)a+i /(manis 2(r'a!ori +an /(manis ta' 2(r'a!ori.

T(rmas' /(manis 2(r'a!ori a+a!ah #!a a!'oho! +an @r'tosa.

- $!a a!'oho! antara !ain isomalt/ lactitol/ maltitol/ mannitol/sorbitol+an1ylitol.

- r'tosa ti+a' +ian)r'an +i#na'an /a+a /(nan+an# +ia2(t(s 'ar(na (@('

26


27/41

sam/in# /a+a !(ma' +arah.

- P(manis ta' 2(r'a!ori an# masih +a/at +i#na'an antara !ain as/artam& sa'arin&

a(s!@am( /otassim& s'ra!os(& +an n(otam(.

- P(manis aman +i#na'an s(/an)an# ti+a' m(!(2ihi 2atas aman 3Accepted

Daily Intake = ADI

*. Ke*#t#hn &$'ri

A+a 2(2(ra/a ara nt' m(n(nt'an )m!ah 'a!ori an# +i2th'an /(nan+an#

+ia2(t(s. Di antarana a+a!ah +(n#an m(m/(rhitn#'an '(2than 'a!ori 2asa! an#

2(sarna -5;60 'a!ori='# i+(a!&+itam2ah ata +i'ran#i 2(r#antn# /a+a 2(2(ra/a

@a'tor s(/(rti: )(nis '(!amin& mr& a'ti?itas& 2(rat 2a+an& +!!.

P(rhitn#an 2(rat 2a+an I+(a! 3I +(n#an rms roa an# +imo+i@i'asi

a+a!ah s22:

- (rat 2a+an i+(a! H0 3T +a!am m ; 100 1 '#.

- a#i /ria +(n#an tin##i 2a+an +i 2aah 1%0 m +an anita +i2aah 150 m&

rms +imo+i@i'asi m(n)a+i :

(rat 2a+an i+(a! 3I 3T +a!am m ; 100 1 '#. Norma! : i+(a!

> 10

rs : I ; 10

$(m' : I 10

P(rhitn#an 2(rat 2a+an i+(a! m(nrt In+('s Massa T2h 3IMT. In+('s massa

t2h +a/at +ihitn# +(n#an rms:

IMT 3'#= T3m-

!as i@ i'as i I M T

ran# 18&5

Norma! 18&5;--&H

L(2ih 9 -6&0

D(n#an risi'o -6&0;-4&H

*2(s I -5&0;-H&H

*2(s II 60

a'tor;@a'tor an# m(n(nt'an '(2than 'a!ori antara !ain :

27


28/41

- J(nis (!amin

(2than 'a!ori /a+a anita !(2ih '(i! +ari/a+a /ria. (2than 'a!ori anita

s(2(sar -5 'a!='# +an nt' /ria s(2(sar 60 'a!= '# .

- Umr

Unt' /asi(n sia +i atas 40 tahn& '(2than 'a!ori +i'ran#i 5 nt' +('a+( antara

40 +an 5H tahn& +i'ran#i 10 nt' +('a+( antara %0 +an %H tahn +an +i'ran#i

-0& +i atas sia 70 tahn.

- A'ti?itas isi' ata P('(r)aan

o (2than 'a!ori +a/at +itam2ah s(sai +(n#an int(nsitas a'ti?itas @isi'.

o P(nam2ahan s()m!ah 10 +ari '(2than 2asa! +i2(ri'an /a+a '(+aaan

istirahat& -0 /a+a /asi(n +(n#an a'ti?itas rin#an& 60 +(n#an a'ti?itas

s(+an#& +an 50 +(n#an a'ti?itas san#at 2(rat.

- (rat a+an

o i!a '(#(m'an +i'ran#i s('itar -0;60 t(r#antn# '(/a+a tin#'at

'(#(m'an

o i!a 'rs +itam2ah s('itar -0;60 s(sai +(n#an '(2than nt'

m(nin#'at'an .

o Unt' t)an /(nrnan 2(rat 2a+an )m!ah 'a!ori an# +i2(ri'an /a!in#

s(+i'it 1000;1-00 ''a! /(rhari nt' anita +an 1-00;1%00 ''a! /(rhari nt'

/ria.

Ma'anan s()m!ah 'a!ori t(rhitn# +(n#an 'om/osisi t(rs(2t +i atas +i2a#i

+a!am 6 /orsi 2(sar nt' ma'an /a#i 3-0& sian# 360& +an sor( 3-5& s(rta

-;6 /orsi ma'anan rin#an 310;15 +i antarana. Unt' m(nin#'at'an

'(/athan /asi(n& s()ah mn#'in /(r2ahan +i!a''an s(sai +(n#an '(2iasaan.

Unt' /(nan+an# +ia2(t(s an# m(n#i+a/ /(na'it !ain& /o!a /(n#atran ma'an

+is(sai'an +(n#an/(na'it /(n(rtana.

34 Ltihn +s-ni

(#iatan )asmani s(hari;hari +an !atihan )asmani s(ara t(ratr 36;4 'a!i s(min## s(!ama

'ran# !(2ih 60 m(nit& m(r/a'an sa!ah sat /i!ar +a!am /(n#(!o!aan DM ti/( -.

(#iatan s(hari;hari s(/(rti2(r)a!an 'a'i '( /asar& m(n##na'an tan##a& 2(r'(2n hars

t(ta/ +i!a''an 3!ihat ta2(! 4. Latihan )asmani s(!ain nt' m(n)a#a '(2#aran )#a +a/at

28


29/41

m(nrn'an 2(rat 2a+an +an m(m/(r2ai'i s(nsiti?itas ins!in& s(hin##a a'an

m(m/(r2ai'i '(n+a!i #!'osa +arah. Latihan )asmani an# +ian)r'an 2(r/a !atihan

)asmani an#2(rsi@at a(ro2i' s(/(rti )a!an 'a'i& 2(rs(/(+a santai& .ogging& +an2(r(nan#.

Latihan )asmani s(2ai'na +is(sai'an +(n#an mr +an stats '(s(#aran )asmani. Unt'

m(r('a an# r(!ati?( s(hat& int(nsitas !atihan )asmani 2isa +itin#'at'an& s(m(ntara an#

s+ah m(n+a/at 'om/!i'asi DM +a/at +i'ran#i.


30/41

+(n#an (/at s(t(!ah /(m2(rian s(ara ora! +an +i('s'r(si s(ara (/at m(!a!i hati. *2at

ini +a/at m(n#atasi hi/(r#!i'(mia postprandial.

2. Penin)&t Sensiti=its Terh!" Ins#$in

Ti?'$i!in!i' n

TiaBo!i+in+ion 3/io#!itaBon 2(ri'atan /a+a Pero1isome Proli0erator Acti2ated Receptor

Gamma 3PPA,;#& sat r(s(/tor inti +i s(! otot +an s(! !(ma'.$o!on#an ini m(m/nai

(@(' m(nrn'an r(sist(nsi ins!in +(n#an m(nin#'at'an )m!ah /rot(in /(n#an#'t

#!'osa& s(hin##a m(nin#'at'an am2i!an #!'osa +i /(ri@(r. TiaBo!i+in+ion

+i'ontrain+i'asi'an/a+a /asi(n +(n#an #a#a! )antn# '(!as I;I 'ar(na +a/at m(m/(r2(rat

(+(ma=r(t(nsi airan +an )#a /a+a #an##an @aa! hati. Pa+a /asi(n an# m(n##na'an

tiaBo!i+in+ion /(r! +i!a''an /(mantaan @aa! hati s(ara2(r'a!a.

3. Pen)h-*t )$#&'ne')enesis

M et%'r - i n

*2at ini m(m/nai (@(' tama m(n#ran#i /ro+'si #!'osa hati 3#!'on(o#(n(sis& +i

sam/in# )#a m(m/(r2ai'i am2i!an #!'osa /(ri@(r. T(rtama +i/a'ai /a+a /(nan+an#

+ia2(t(s #(m'. M(t@ormin +i'ontrain+i'asi'an /a+a /asi(n +(n#an #an##an @n#si #in)a!

3s(rm 'r(atinin 1&5 m#=+L +an hati& s(rta/asi(n;/asi(n +(n#an '((n+(rn#an hi/o's(mia

3misa!na /(na'it s(r(2ro;?as'!ar& s(/sis& r(n)atan& #a#a! )antn#. M(t@ormin +a/at

m(m2(ri'an (@(' sam/in# ma!. Unt' m(n#ran#i '(!han t(rs(2t +a/at +i2(ri'an /a+a

saat ata s(s+ah ma'an. S(!ain it hars +i/(rhati'an 2aha /(m2(rian m(t@ormin s(ara

titrasi /a+a aa!/(n##naan a'an m(m+ah'an +o't(r nt' m(manta (@(' sam/in# o2at

t(rs(2t.

9. Pen)h-*t G$#&'si!se A$% 2A>r*'se4

*2at ini 2('(r)a +(n#an m(n#ran#i a2sor/si #!'osa +i ss ha!s& s(hin##a m(m/nai

(@(' m(nrn'an 'a+ar #!'osa +arah s(s+ah ma'an. Aar2os( ti+a' m(nim2!'an (@('

sam/in# hi/o#!i'(mia. E@(' sam/in# an# /a!in# s(rin# +it(m'an ia!ah '(m2n# +an@!at!(ns.

@. DPP


31/41

+an s('a!i#s s(2a#ai /(n#ham2at s('r(si #!'a#on. Namn +(mi'ian& s(ara (/at $LP;1

+i2ah o!(h (nBim dipeptidylpeptidase-3 3DPP;4& m(n)a+i m(ta2o!it G4P-$-%5/6'+-

amide an# ti+a' a'ti@.

S('r(si $LP;1 m(nrn /a+a DM ti/( -& s(hin##a /aa an# +it)'an nt' m(nin#'at'an

$LP;1 2(nt' a'ti@ m(r/a'an ha! rasiona! +a!am /(n#o2atan DM ti/( -. P(nin#'atan

'ons(ntrasi $LP;1 +a/at +ia/ai +(n#an /(m2(rian o2at an# m(n#ham2at 'in(r)a (nBim

DPP;4 3/(n#ham2at DPP;4& ata m(m2(ri'an hormon as!i ata ana!o#na 3ana!o#

inr(tin$LP;1 a#onis.

(r2a#ai o2at an# mas' #o!on#an DPP;4 inhi2itor& mam/ m(n#ham2at '(r)a DPP;4

s(hin##a $LP;1 t(ta/ +a!am 'ons(ntrasi an# tin##i +a!am 2(nt' a'ti@ +an mam/

m(ran#san# /(n#!(/asan ins!in s(rta m(n#ham2at /(n#!(/asan #!'a#on.

Cr Pe-*erin O(O ter!iri !ri:

- *


32/41

- Str(s 2(rat 3in@('si sist(mi'& o/(rasi 2(sar& IMA& stro'(

- (hami!an +(n#an DM=+ia2(t(s m(!its #(stasiona! an# ti+a' t(r'(n+a!i +(n#an

/(r(nanaan ma'an

- $an##an @n#si #in)a! ata hati an# 2(rat

- ontrain+i'asi +an ata a!(r#i t(rha+a/ *. Ter"i K'-*insi

P(m2(rian *


33/41

'(n+a!i #!'osa +arah an# 2ai' +(n#an +osis ins!in an# '/ '(i!. Dosis aa!

ins!in '(r)a m(n(n#ah a+a!ah %;10 nit an# +i2(ri'an s('itar )am --.00& '(m+ian

+i!a''an (?a!asi +osis t(rs(2t +(n#an m(ni!ai 'a+ar #!'osa +arah /asa '((so'an

harina. i!a +(n#an ara s(/(rti +i atas 'a+ar #!'osa +arah s(/an)an# hari masih ti+a'

t(r'(n+a!i& ma'a *


34/41

B)n 2. A$)'rit-

"en)e$'$n DM ti"e 2 tn" !iserti !e&'-"enssi

B)n 3. A$)'rit-

"en)e$'$n DM ti"e 2 tn" !iserti !e&'-"enssi

3. Pe-nt#n Ben! Ket'n

P(mantaan 2(n+a '(ton +a!am +arah ma/n +a!am rin '/ /(ntin# t(rtama /a+a

/(nan+an# DM ti/( - an# t(r'(n+a!i 2r' 3'a+ar #!'osa +arah 600 m#=+L.

P(m(ri'saan 2(n+a '(ton )#a +i/(r!'an /a+a /(nan+an# +ia2(t(s an# s(+an#

hami!. T(s 2(n+a '(ton rin m(n#'r 'a+ar as(toas(tat& s(m(ntara 2(n+a '(ton an#

/(ntin# a+a!ah asam 2(ta hi+ro'si2tirat. Saat ini t(!ah +a/at +i!a''an /(m(ri'saan

'a+ar asam2(tahi+ro'si2tirat +a!am +arah s(ara !an#sn# +(n#an m(n##na'an stri/

34


35/41

'hss. a+ar asam 2(ta hi+ro'si2tirat +arah 0&% mmo!=L +ian##a/ norma!& +i atas

1&0 mmo!=L +is(2t '(tosis +an m(!(2ihi 6&0 mmo!=L in+i'asi a+ana AD. P(n#'ran

'a+ar #!'osa +arah +an 2(n+a '(ton s(ara man+iri& +a/at m(n(#ah t(r)a+ina

/(n!it a't +ia2(t(s& 'hssna AD.

F. KOMPLIKASI

S(ara #aris 2(sar& 'om/!i'asi DM ti/( - +a/at +i2(+a'an m(n)a+i 'om/!i'asi a't +an

'roni'.

Ket'si!'sis Di*eti& KAD4

AD m(r/a'an sat sin+roma an# t(r+iri +ari trias: hi/(r#!i'(mia& '(tosis& +an ai+(mia.

A+a 2(2(ra/a @a'tor /(n(ts t(r)a+ina AD& antara !ain:

1. DM ti/( 1 an# ta' t(r+ia#nosa

-. P(ma'aian ins!in an# ti+a' a+('at& 'ar(na anor('sia& mntah& ata '(ta'tan a'an

hi/o#!i'(mia.

6. In@('si

4. P(na'it a't& s(/(rti trama& /an'r(atitis& CA& mio'ar+ in@ar'.

5. P(n#o2atan& s(/(rti st(roi+& /(ritami+in& +an /(ritonia! +ia!isis.

35

PJ

Sto'(

P(na'it /m2!h

+arah t(/i

om/!i'asi

DM

$an#. Er('si

$astro/ar(sis

(!ainan '!it

,(tino/ati

N(@ro/ati

N(ro/ati

Mi'ro

Ma'ro

as'!ar

roni'

(to Asi+osis Dia2(ti


36/41

%. $an##an (n+o'rin& s(/(rti hi/(rtiroi+& @(oromositoma.

Pato@isio!o#i AD

Pa+a +asarna /ato@isio!o#i AD a+a!ah #an##an '(s(im2an#an hormona!. AD 2iasana

t(r)a+i /a+a DM ti/( I.

A+a 6 @a'tor an# 2(r/(ran s(hin##a tim2! AD& ait:

1. D(@isi(nsi ins!in.

P(ma'aian ins!in +a!am )m!ah an# 'ran# a+('at ata +(@isi(nsi ins!in

m(nim2!'an +ir(sis osmoti'& an# s(!an)tna a'an t(r)a+i +(hi+rasi +an #an##an

'(s(im2an#an (!('tro!it. D(@isi(nsi ins!in m(nim2!'an #!'on(o#(n(sis +an

#!i'o#(o!isis& +isam/in# it )#a t(r)a+i !i/o!isis +an /(m2(nt'a asam !(ma' 2(2as

3A.

D(@isi(nsi ins!in m(n(2a2'an /(nrnan /(ma'aian #!'osa /(ri@(r& s(hin##a

m(nam2ah hi/(r#!i'(mia& +(hi+rasi s(rta /(nrnan a!iran +arah. Asam !(ma' 2(2as

a'an m(n(2a2'an '(to#(n(sis '(ton(mia& s(!an)tna '(toria +an #an##an (!('tro!it.

D('om/(nsasi m(ta2o!i' ini a'an m(n(2a2'an asi+osis.7

-. P(nin#'atan hormon 'ontra ins!in.

T(!ah t(r2'ti 2aha /a+a AD +i+a/at'an /(nin#'atan )m!ah hormon 'ontra ins!in

3counter regulatory hormones s(/(rti& #!'a#on& 'at('o!amin& 'ortiso!& +an hormon

/(rtm2han. P(ma'aian st(roi+ /a+a 'ass;'ass t(rt(nt& t(rmas' /a+a /(raatan

DM #(stasi +a/at m(mi t(r)a+ina AD. E@(' hormon;hormon ini a+a!ah m(nam2ah

/ro+'si #!a& s(rta m(nam2ah 'ata2o!ism( t2h 3'(s(im2an#an nitro#(n n(#ati@.

S(!ain m(n#ham2at /(n#am2i!an #!'osa o!(h otot& )#a m(ran#san# #!'on(o#(n(sis&

#!i'o#(no!isis +an !i/o!isis.

6. D(hi+rasi.

Dir(sis osmoti' a'i2at hi/(r#!i'(mia a'an m(nim2!'an +(hi+rasi& 'a+an#;'a+an# o!(h

'ar(na #an##an #astroint(stina!. ,(hi+rasi an# a+('at san#at /(ntin# /a+a AD&

s(!ain m(n#ran#i hi/(r#!i'(mi& )#a m(m/(r2ai'i '(tosis.

36


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Pent$&snn KAD

37


38/41

KETOSIS DIABETES MELLITUS

Da!am 'on+isi m(ta2o!i' +(n#an !a) o'si+asi asam !(ma' an# tin##i& hati

m(n#hasi!'an 2ana' as(to as(tat +an 2;hi+ro'si2tirat. (m+ian as(toas(tat m(n#a!ami

38


39/41

+('ar2o'si!asi s/ontan nt' m(n#hasi!'an as(ton. (ti#a Bat ini +is(2t s(2a#ai 2(n+a '(ton.

a+an '(ton 2(r@n#si s(2a#ai 2ahan 2a'ar 2a#i )arin#an ('strah(/ati' s(/(rti otot.

Pa+a '(a+aan /asa ata '(!a/aran )#a /a+a '(a+aan +imana t(r)a+i /(nin#'atan 'a+ar

asam !(ma' +a!am +arah& misa!na /a+a +iit tin##i !(ma'& '(#iatan )asmani an# 2(rat tan/a +i

s(rtai inta'( < an# '/& /ro+'si '(ton;'(ton a'an m(nin#'at& ha! an# sama t(r)a+i /a+a

'(a+aan +ia2(t(s m(!!its. i!a 2(n+a;2(n+a '(ton +a!am +arah 'a+arna m(nin#'at m(!(2ihi 1

m# +is(2t '(ton(mia. P(nin#'atan 'a+ar 2(n+a;2(n+a '(ton +a!am +arah ini /a+a '(a+aan

norma! a'an +iim2an#i +(n#an 2(rtam2ahna /ros(s o'si+asi s(naa;s(naa t(rs(2t o!(h

)arin#an ('strah(/ati'.

i!a /ro+'si s(ma'in 2(rtam2ah sam/ai 'a+ar +i+a!am +arah m(na/ai 70m#& ma'a

'a/asitas o'si+asi /a+a )arin#an ('strah(/ati' ti+a' +a/at +itin#'at'an !a#i& s(hin##a

/(nin#'atan !(2ih !an)t /ro+'si s(naa t(rs(2t a'an san#at m(nin#'at'an 'a+ar +i +a!am

+arah. Pa+a '(a+aan norma! '(ton;'(ton s(!ain +i o'si+asi o!(h otot& ota'& s(rta otot )antn#&

s(2a#ian '(i! an# )m!ahna ti+a' m(!(2ihi 1 m# +i('s'r(si'an m(!a!i rin /(r -4 )am.

Am2an# #in)a! nt' ('s'r(si 2(n+a;2(n+a '(ton 2i!a 'a+ar +a!am +arah +i2aah 70m# ti+a'

m(m/(n#arhi )m!ah ('s'r(sina& t(ta/i 2i!a !(2ih +ari 70m#& ma'a ('s'r(si !(at #in)a!

a'an san#at m(nin#'at& 'ar(na am2an# #in)a! +i!am/ai.

P(nin#'atan ('s'r(si 2(n+a;2(n+a '(ton !(at #in)a! 2(rsama rin( ini +i s(2t

'(tonria. (a+aan +imana '(ton(mia +i2ar(n#i +(n#an t(r)a+ina '(tonri +is(2t ET*SIS.

*!(h 'ar(na s(naa;s(naa t(rs(2t 2(rsi@at asam ma'a a'an 2(ra'i2at t(r)a+ina asi+osis

m(ta2o!i'& o!(h 'ar(na a+an#an a!'a!i +itrn'an& '(a+aan ini +is(2t '(toasi+osis& an# +a/at

2(ra'i2at @ata!.

Pa+a DM an# ta' t(r'(n+a!i'an& '(tosis +a/at t(r)a+i san#at 2(rat& 'ar(na /a+a DM

+isam/in# /ro+'si 2(n+a;2(n+a '(ton m(nin#'at +(n#an (/at& 'a/asitas )arin#an ('stra

h(/ati nt' m(n#o'si+asi 2(n+a;2(n+a t(rs(2t ma!ah 2(r'ran#& o!(h s(2a2 /(n#arh +ari

hormon( ins!in. Pa+a 'ass;'ass +(mi'ian s(rin# 'a!i +a/at t(rim 2a as(ton 'ar(na

'a+arna an# tin##i +a!am +arah.

(tosis s(ara mm +a/at t(r)a+i /a+a - '(a+aan '!inis a'ni DM +an '(!a/aran.

a'tor;@a'tor an# m(nin#'at'an t(r)a+ina '(tosis :

1. ('ran#an < +(n#an a'i2at mo2i!isasi A s(hin##a A m(nin#'at +a!am sir'!asi&

+(n#an s(n+irina as(ti! oA a'an m(nin#'at )#a.

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40/41

-. Pa+a '(a+aan '(!a/aran /(rs(+ian #!i'o#(n t(r/a'ai ha2is& hin##a o'si+asi #!'osa a'an

m(nrn& nt' !on an# a'an +i#na'an a+a!ah !(ma'& s(hin##a sint(sis asam

!(ma' m(nrn.

6. P(n#arh ins!in an# m(n('an /ros(s '(to#(n(sis& +an m(ma /ros(s o'si+asi 2(n+a

'(ton /a+a )arin#an ('strah(/ati'. Pa+a '(a+aan '(!a/aran ata DM 'a+ar ins!in +a!am

t2h m(nrn& hin##a /ros(s '(to#(n(sis m(nin#'at& o'si+asi 2(n+a;2(n+a '(ton

m(nrn.4. S(ma @ator an# m(n#ham2at si'!s TCC a'an m(nin#'at'an '(to#(n(sis& 'ar(na

'a/asitas nt' m(n#o'si+asi s(ara m(n(!rh as(ti! oA m(nrn.

(tosis /a+a '(!a/aran sama +(n#an '(a+aan DM. Pa+a DM t(r)a+i #!'osria an# t(rs

m(n(rs& hin##a #!'osa hi!an# t(rham2r. Pa+a '(!a/aran tim2!na '(tosis s(mata;mata o!(h

s(2a2 /ro+'si 2(n+a;2(n+a '(ton an# 2(r!(2ihan& t(r)a+ina '(tosis m(m(r!'an a't !ama

+an ti+a' a'an m(n(2a2'an '(toasi+osis an# s(ris& ha! ini 2(r2(+a +(n#an DM& '(tosis /a+a

DM t(r)a+i s(ara /ro#r(si@ an# a'hirna t(r)a+i '(toasi+osis an# h(2at. P(r2(+aan ini

mn#'in +is(2a2'an - ha! :

1. P(n#arh ins!in t(rha+a/ o'si+asi 2(n+a '(ton ('strah(/ati' an# /a+a '(!a/aran ha! ini

ti+a' m(n#ran#i #an##an an# 2(rarti.

-. Pa+a DM 2iasana #!'on(o#(n(sis /ros(sna !(2ih h(2at +ari/a+a '(!a/aran +(n#an

+(mi'ian a'an m(n##an## /ros(s TCC.

DATA, PUSTAA

40


41/41

1. Dann( P. "(st(r2(r#& D*. Dia2(ti (toai+osis. E?a!ation an+ Tr(atm(nt. Am(rian

ami! Phsiian. o!m( 87& Nm2(r 5: 667;4%.-. PE,ENI. ons(nss P(n#(!o!aan +an /(n(#ahan +ia2(t(s m(!its ti/( - +i In+on(sia.

-00%. P(n#rs (sar P(r'm/!an En+o'rino!o#i In+on(sia. Ja'arta. -00%

6. "as/a+)i S. om/!i'asi roni' Dia2(t(s : M('anis( T(r)a+ina& Dia#nosis& +an Strat(#iP(n#(!o!aan. ' A)ar I!m P(na'it Da!am. E+isi III. D(/art(m(n I!m Pana'it Da!am

UI -00% ha!. 1H-04. $sta?ani ,. Dia#nosis +an !asi@i'asi Dia2(t(s M(!its. ' A)ar I!m P(na'it Da!am.

E+isi III. D(/art(m(n I!m Pana'it Da!am UI -00% ha!. 1876

5. Lin M& isho/ $& (nito;

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