Update Malaria 2012

7/21/2019 Update Malaria 2012

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Dr. Paul Harijanto, SpPD-KPTI,Dr. Paul Harijanto, SpPD-KPTI,FINASIMFINASIM

RSU Bethesa !MIM To"ohonRSU Bethesa !MIM To"ohon


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MORTALITY

0.1% case fatality rate providedprompt and eective treatment

Ineective, delayed

severemalaria

evere malaria, mortality 1! " #0 %

$ntreated severe malaria, almostalays fatal


3/114

TR&ATM&'T O()&*TI+&

$ncomplicated malaria *-re infection revent pro/ression severe disease revent moridity associated it treatment

fail-re Red-ced transmission revent te emer/ence 2 spread resistance

antimalarial

evere Malaria revent deat revention recr-descence Avoidence of minor adverse eects


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asien malaria.. Men//i/il, erselim-t len/3ap


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Gejala MalariaGejala Malaria

Karakteristik : Demam periodik, Anemia, SplenomegaliKarakteristik : Demam periodik, Anemia, Splenomegali 4emam periodi3 5 6 Trias Malaria 6 74emam periodi3 5 6 Trias Malaria 6 7

Dingin/ menggigil ( 15 - 60 menit )Dingin/ menggigil ( 15 - 60 menit )

Panas ( 1 - 2 jam )Panas ( 1 - 2 jam )

BerkeringatBerkeringat

Periode bebas demam 12jam(P.F), 6(P.!),Periode bebas demam 12jam(P.F), 6(P.!),

"2(P.#), 2$(P.%)"2(P.#), 2$(P.%)

a3it 3epalaa3it 3epala8e9ala /astro:intestinal m-al 2 m-nta,8e9ala /astro:intestinal m-al 2 m-nta,

nyeri epi/astri-mnyeri epi/astri-m

'on:spesi;3 diarea, at-3'on:spesi;3 diarea, at-3


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7/114

==

4I>$I 1.8e9ala demam 2 diare 5 8e9ala non:

3lasi3 ? 7#.lasmodi-m +iva@ Rin/ , sat- -lanseel-mnya viva@ pos. 5 Relaps ? B Re:cr-densi ? B Re:infe3si ? 7

C. Dasil Laoratori-m Tromositopenia5 E1.000B mmC7. erin/ didia/nose 4en/-e5 Apa 44 nya 7

E. en/oatan Malaria seel-mnya den/an *F F # tB1E ari. 5 Apa pen/oatan

yan/ enar ? 7


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enyea Tromositopeniaenyea Tromositopenia

4efects of te marro4efects of te marro

eG-estration d-e to splenome/alyeG-estration d-e to splenome/aly

Accelerated destr-ction Accelerated destr-ction Infections 5 den/-e, malaria, typoid,Infections 5 den/-e, malaria, typoid,

/ram ne/ 7/ram ne/ 7

4r-/s4r-/s

A-toimm-neA-toimm-ne

HH


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4ia/nosa4ia/nosa

(andin/ (andin/

Hb+ 13+1 gr=, Ht 3$=/ Leuko *1##5mm3,Hb+ 13+1 gr=, Ht 3$=/ Leuko *1##5mm3,

4rombosit *1+###5mm3+ engue in@etion ??4rombosit *1+###5mm3+ engue in@etion ??

Bandingkan kasus ini ! :

Hari I. Hb 16 gr%, Ht 55%, Leuko 4900, Trombo 19.000

Hari II : Hb, 15.5 gr%, Ht 51%, Trombo 1.000

Hari III: Hb 14.5 gr%, Ht 4%, Trombo .000

Hari I": Hb 14.5 gr%, Ht 46%, Trombo 10.000


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Hemato#og$ indings in a&ute s$m'tomati& un&om'#i&atedHemato#og$ indings in a&ute s$m'tomati& un&om'#i&ated

P.falciparumP.falciparumma#aria 'atients on admission ()*6+ma#aria 'atients on admission ()*6+

-nemia (%-nemia (% : +9: +9 (61.9(61.9

Hemog#obin: means (rangegd# : 1.+Hemog#obin: means (rangegd# : 1.+ (6.1 / 15.(6.1 / 15.

r$t2ro&$te: means (rangeu# in mi##ionr$t2ro&$te: means (rangeu# in mi##ion : 4.9: 4.9 (.6 35.9+(.6 35.9+

Leuko&$te: means (rangeu#Leuko&$te: means (rangeu# : 5,+ (,600 3 11,00: 5,+ (,600 3 11,00

#ate#et: means (rangeu# in t2ousand#ate#et: means (rangeu# in t2ousand : 9: 9 (15 3 1(15 3 1


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&'8O(ATA' &'8O(ATA'

*FC F # ta5C0m/7B ari , 1E ari*FC F # ta5C0m/7B ari , 1E ari

??

en/oatan yan/ enar ?en/oatan yan/ enar ?

1111


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LAMO4I$M >'OJL&ILAMO4I$M >'OJL&I

Te 6 Kift 6 MalariaTe 6 Kift 6 Malaria4-l- anya men/infe3si 3era 5Macaca M-llata74-l- anya men/infe3si 3era 5Macaca M-llata7 e9a3 t #00E dilapor3an retrospe3sif di eraa3e9a3 t #00E dilapor3an retrospe3sif di eraa3+ector Anopeles le-cospyr-s /ro-p 5An. Laten,+ector Anopeles le-cospyr-s /ro-p 5An. Laten,

cracens7cracens7Misdia/nosis sea/ai malaria malariae,Misdia/nosis sea/ai malaria malariae,

mi3ros3opi3 menyer-pai . malariaemi3ros3opi3 menyer-pai . malariae >linis TI4A> seperti malariae>linis TI4A> seperti malariae, demam tiap #E 9am,, demam tiap #E 9am,

diarea, nyeri adomen dan ditem-3andiarea, nyeri adomen dan ditem-3aniperparasitemia #!0.000B-Liperparasitemia #!0.000B-L

4apat memeri3an 3ompli3asi i3teri3, ipotensi,4apat memeri3an 3ompli3asi i3teri3, ipotensi,/a/al /in9al, sereral dan /a/al pernafasan/a/al /in9al, sereral dan /a/al pernafasan

4ia/nosa pasti identi;3asi den/an *R4ia/nosa pasti identi;3asi den/an *R


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Golongan ARTEMISININGolongan ARTEMISININArtemisinin, Artesunate, Artemether, Arteether, DHAArtemisinin, Artesunate, Artemether, Arteether, DHA

!inghaosu" # Ses$uiterpene %a&tone!inghaosu" # Ses$uiterpene %a&tone

%arut dalam air dan dia'sor'si 'aik%arut dalam air dan dia'sor'si 'aik

E(ek 'unuh parasit )ang &epatE(ek 'unuh parasit )ang &epat

*epat dikon+ersi ke 'ahan akti( DHA-*epat dikon+ersi ke 'ahan akti( DHA-

tt./0./0in malaria: 0 hoursin malaria: 0 hours

Spektrum )ang luas untuk semua 1enis parasit danSpektrum )ang luas untuk semua 1enis parasit dan

stagingstaging

2ila dipakai monotherap), perlu 3 hari2ila dipakai monotherap), perlu 3 hari

Direkomendasikan penggunaan A*TDirekomendasikan penggunaan A*T


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Artemisinin:ase *ominationArtemisinin:ase *omination

Terapy 5A.*.T7Terapy 5A.*.T7Rapid clerance parasitesRapid clerance parasites

Rapid resol-tion of symptomsRapid resol-tion of symptoms

Red-ce parasites y 10.000Bcycle 5pastRed-ce parasites y 10.000Bcycle 5past

antimalarial only 100:1000 parasitesBantimalarial only 100:1000 parasitesBcycle7cycle7

&liminated rapidly&liminated rapidly

en /iven to rapid dr-/ elimination, so-lden /iven to rapid dr-/ elimination, so-ld/ive on = days/ive on = days

Jen /iven com it slo eliminated, sorterJen /iven com it slo eliminated, sorter

co-rse treatment 5 C days are eective 7co-rse treatment 5 C days are eective 7


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The ideal ACT combinationThe ideal ACT combination

Resisten obat pasangan belum terjadiResisten obat pasangan belum terjadi %asangan obat mempunai hal@-li@e panjang (A * hr)%asangan obat mempunai hal@-li@e panjang (A * hr) &rtemisinin membunuh bentuk ase.ual dgn epat/&rtemisinin membunuh bentuk ase.ual dgn epat/

pasangan obat membersihkan parasit lainnapasangan obat membersihkan parasit lainna itolerensi baik, toksisitas rendahitolerensi baik, toksisitas rendah &rtemisinin memiliki e@ek spetrum luas ( termasuk&rtemisinin memiliki e@ek spetrum luas ( termasuk

membunuh gametosit)membunuh gametosit) Bila mungkin dosis tetap (Ci.ed dose )Bila mungkin dosis tetap (Ci.ed dose )

iproduksi seara standar D Good Manu@aturingiproduksi seara standar D Good Manu@aturing%ratie (GM%) D%ratie (GM%) D

MurahMurah

uppl obat ukupuppl obat ukup


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*4RRENT A55R6A*H MA%ARIA TREATMENT*4RRENT A55R6A*H MA%ARIA TREATMENT

2ased on mi&ros&opi& diagnosis2ased on mi&ros&opi& diagnosis *om'ination therap)*om'ination therap)Must radi&al treatmentMust radi&al treatment

6ut&ome (o&us on &lini&al &ure, parasitologi&al6ut&ome (o&us on &lini&al &ure, parasitologi&al&learan&e, and 'lo&king transmission&learan&e, and 'lo&king transmission

Monitoring therapeuti& e((i&a&) antimalarial drugs 'asedMonitoring therapeuti& e((i&a&) antimalarial drugs 'asedon &lini&al and parasitologi&al responses on &lini&al and parasitologi&al responses in-vivoin-vivo 0789007890

da)sda)sith or ithout an&illar) measurements: drugith or ithout an&illar) measurements: drug'lood'loodle+el,le+el,genot)ping, and strain anal)sis usinggenot)ping, and strain anal)sis usingmole&ular markers-mole&ular markers-


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Malaria Pf tanpa komplikasi:1. RF:4DA F1

#. F'=4= F1

Malaria vivax:

1. RF:4DAF1E

#. F'=F1E

Pf Malaria berat:

1. Artemeter im

RF:4DAF15>M7

Artes-nate iv

RF:4DAF15R7

#. F' per:inf-sion:F'=4@=F1

Prophylaxis Pf

4o@ycycline

ACT

BARU


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A*T yan/ ada di IndonesiaA*T yan/ ada di Indonesia

Artes-nate amodiaG-ine 5ArtesdiaG-ine,Artes-nate amodiaG-ine 5ArtesdiaG-ine,

Ars-amoon7Ars-amoon7

ihdro-&rtemisinin E %iperakuin (&R4F2!M5ihdro-&rtemisinin E %iperakuin (&R4F2!M5

&R4F2' (uo-9ote.in )&R4F2' (uo-9ote.in )

Artemeter:l-mefantrine 5 *o:artem 7Artemeter:l-mefantrine 5 *o:artem 7

&rtesunate < ul@adoksin-%irimetamin&rtesunate < ul@adoksin-%irimetamin


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en/oatan Malariaen/oatan Malaria

Tanpa >ompli3asiTanpa >ompli3asiMalaria KALIAR$M Malaria KALIAR$M

Artes-nate AmodiaG-ine 5A Amo7Artes-nate AmodiaG-ine 5A Amo7

4iidroartemisinin " ipera3-in4iidroartemisinin " ipera3-in

Artemeter:L-mefantrine 5AL7Artemeter:L-mefantrine 5AL7

Lini ertama NArtes-nate Amodia3-in rima3-in

Ter9adi cross:resistensi d/n *FLaporan ter9adi LTK di Lamp-n/, ap-a dan -laesi $taraMasi 3emasan erpisa&fe3 sampin/ m-nta, i3teri3


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Hari

Jenis obat Jumlah tablet menurut kelompok umur

Dosistunggal

0 1bulan

11bulan

1 ! "tahun

# ! $tahun

10 ! 1"tahun

% 1#tahun

1 &rtesunate I 1 " 3 *

&modiakuin I 1 " 3 *

%rimakuin -- -- J 1 I " " - 3

" &rtesunate I 1 " 3 *




en/oatan Lini I, . Kalsipar-m men-r-t -m-r


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&R4F&K'F%rogram epkes

ARSUAMOONPraktek Swasta


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Ata-Ata-Lini ertama NLini ertama N

4iydroartemisinin piperaG-in 4iydroartemisinin piperaG-in rima3-inrima3-in

&fe3tif -nt-3 Kalcipar-m dan +iva3sK4*(ar- tersedia di rp propinsi Indonesia

Tim-r, -matra4isiap3an -nt-3 sel-r- Indonesia


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en/oatan den/an 4iydroartemisinin:ipera3-inen/oatan den/an 4iydroartemisinin:ipera3-in

54D:754D:7&ari&ari 'enis'enis

obatobat'mla tablet menrt kelom*ok mr'mla tablet menrt kelom*ok mr

(dosis tnggal)(dosis tnggal)

0 - 10 - 1

blanblan22

1111blbl

anan

11 $$

tata

nn

55 ++

tatann

1010 1$1$

tantan

1515

tatann

11 D&PD&P && '' 11 1,51,5 22 - $ - $

F, &1F, &1 PrimakiPrimakinn

---- ---- (( 11 '' 22 2 - 2 -

2-2- D&PD&P && '' 11 1,51,5 22 - $ - $Dihydroartemisinin(DH) : 2-4 mg ( 2,2mg)/kgBB (1tablet = 40 mg)i!erak"in !hos!hate(): 1#-$2mg (1%mg/kgBB (1tablet = $20 mg)

rimak"in : 0&' mg/kg BB


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Lini 3ed-aLini 3ed-a

>ina 4o3sisi3linB Tetrasi3lin rima3-in>ina 4o3sisi3linB Tetrasi3lin rima3-in


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Hari :enis obat :umlah tablet menurut kelompok umur osis tunggal #-11

bulan1 - *tahun

- $tahun

1# - 1*tahun

A 1tahun

1 2ina N) 3 . I 3 . 1 3 . 1 I 3 . ("-3)

oksisiklin -- -- -- " . # mg " . 1## mg

%rimakuin - J 1 I " " E 3

" - O 2ina N) 3 . I 3 . 1 3 . 1 I 3 . "

oksisiklin -- -- -- " . # mg " . 1## mg

osis 4F4R&2L' -- -- -- *.* mg5kgBB

* . "# mg

osis9L'&MP9'

-- -- -- ".1# mg5kgBB

".1# mg5kgBB

en/oatan lini II alternatif 3ominasi >ina 4o3sisi3linBTetrasi3linB *lindamycin 5 ila /a/al pen/oatan lini I 7


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A*T se3tor sastaA*T se3tor sasta

Artemeter:L-mefantrine 5 *o:Artemeter:L-mefantrine 5 *o:

Artem 7Artem 7K4*K4*

&fe3tif -nt-3 falcipar-m&fe3tif -nt-3 falcipar-m

>-ran/ efe3tif -nt-3 viva3s>-ran/ efe3tif -nt-3 viva3s

4osis # @ seari4osis # @ seari

Asorpsi menin/3at d/n lema3 5 s-s-7Asorpsi menin/3at d/n lema3 5 s-s-7


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Jenis obat )mur * +tahun

% + ! ,tahun

% $ 1"th

% 1" th

Hari Berat Badan(2g)

:am E 1*kg

1 E "* kg " E 3*kg

A 3* kg

1 & - L # jam 1 " 3 *

& - L 6 jam 1 " 3 *

%rimakuin 1" jam J 1 I " " - 3

" & - L "* jam 1 " 3 *

& - L 37 jam 1 " 3 *

3 & - L *6 jam 1 " 3 *

& - L 7# jam 1 " 3 *

Lini II A*T. 4osis pen//-naan artemeter:l-mefantrine 5A:L


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Time (rea3 .


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%F% P34 P43B4 ( 7&3 200 )

/ Tidak ada 'arasitemia sam'ai dengan abaikan

tem'. aksi#er, tidak sesuai dengan kriteria T7

L87L7.

Respon Klinis ; 5arasitologis

Adekuat ( -8 * -deuate

8#ini&a# and arasito#ogi&a#

es'onse

/ Berkembangn$a tanda ba2a$a ma#aria berat sete#a2

H+ dan 'arasitemia ( ;enis 'arasit * H0/ arasitemia dan tem'. aksi#er arasito#ogi&a#? 7ai#ure

( L7 * Late arasito#ogi&a#

7ai#ure

/ Berkembangn$a men;adi ma#aria berat 'ada 2ari H1,

H, H+ disertai 'arasitemia

/ arasitemia 'ada H+ dengan tem'eratur

aksi#er


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Datang

RS/Dr

D:# D0

Hasil

Mal

2il:0F3

*reat : ..9


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Mana/ement TreatmentMana/ement Treatment

Kail-resKail-resTreatment fail-re itin 1E days veryTreatment fail-re itin 1E days very

-n-s-al -n-s-al C# trials 5E1= patients7, no fail-re on 41EC# trials 5E1= patients7, no fail-re on 41E= trials fail-re at 41E 5 1 " = %7= trials fail-re at 41E 5 1 " = %7Kail-re after 1E days recr-descense or re:Kail-re after 1E days recr-descense or re:

infectioninfectionResc-e treatment Resc-e treatment

Alternative A*T 3non eective in tis re/ionAlternative A*T 3non eective in tis re/ionArtes-nate tetracyclinB do@ycyclineBArtes-nate tetracyclinB do@ycyclineB

clindamycinclindamycinF-inine tetracyclinB do@ycyclineB clindamycinF-inine tetracyclinB do@ycyclineB clindamycin


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WHO Guieline !""# $n treat%ent &ailure


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Malaria +iva3s 2 OvaleMalaria +iva3s 2 Ovale

Malaria +iva3s 2 Ovale Malaria +iva3s 2 Ovale Artes-nate " AmodiaG-ine 5A Amo7,Artes-nate " AmodiaG-ine 5A Amo7,

ATA$ATA$

4iidroartemisinin " ipera3-in 54D 74iidroartemisinin " ipera3-in 54D 7

en/oatan Lini I +iva3s men-r-t -m-r


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Hari

Jenis obat Jumlah tablet menurut kelompok umur

Dosis

tunggal

0 1

bulan

11

bulan

1 ! "

tahun

# ! $

tahun

10 ! 1"

tahun

% 1#

tahun



%rimakuin -- -- 15* 15" 35* 1

" &rtesunate I 1 " 3 *

&modiakuin

%rimakuin

I 1

15*

"

15"

3

35*

*

1

3

*-1*

&rtesunate I 1 " 3 *

&modiakuin

%rimakuin

%rimakuin

I 1

15*

"

I

15"

3

J

35*

*

1

1

en/oatan Lini I, +iva3s men-r-t -m-r

t d 4i d t i i i i 3 i t d 4i d t i i i i 3 i


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en/oatan den/an 4iydroartemisinin:ipera3-inen/oatan den/an 4iydroartemisinin:ipera3-in

54D:754D:7

$'T$> +I+A>$'T$> +I+A>&ari&ari 'enis'enisobatobat

'mla tablet menrt kelom*ok mr'mla tablet menrt kelom*ok mr(dosis tnggal)(dosis tnggal)

0 - 10 - 1

blanblan22

1111blbl

anan

11 $$

tata

nn

55 ++

tatann

1010 1$1$

tantan

1515

tatann

1--1-- D&PD&P && '' 11 1,51,5 22 - $ - $

!,&1!,&11$1$

PrimakiPrimakinn

-- -- && '' (( 11

Dihydroartemisinin(DH) : 2-4 mg/kgBB (1tablet = 40 mg)i!erak"in !hos!hate(): 1#-$2 mg/kgBB ( 1tablet = $20 mg)

rimak"in : 0&2 mg/kg BB


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Pengobatan #alaria !i8a9 : ; iniPengobatan #alaria !i8a9 : ; ini

&ari&ari 'enis obat'enis obat 'mla tablet menrt kelom*ok mr'mla tablet menrt kelom*ok mr

(dosis tnggal)(dosis tnggal)

< 1< 1tantan

1 - $1 - $tantan

55 ++tantan

10 - 1$10 - 1$tantan

1515tantan

1- "1- " %ina%ina =)=) 9 9 '' 9 1 9 1 9 1 9 1 '' 9 2 9 2

1-1$1-1$ PrimakinPrimakin -- && '' (( 11

emanta"an : H4 -- H2% : lide malaria gagal/!ositi! !engobatan *i*a+ rela!s


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Hari :enis obat :umlah tablet menurut kelompok umur

osistunggal

# - 11bulan

1 - *tahun

- $tahun

1# - 1*tahun

A 1tahun

1-O 2ina N) 3 . I 3 . 1 3 . 1 I 3 . ("-3)

oksisiklin -- -- -- " . # mg " . 1## mg

1 - 1* %rimakuin - I J 1

osis4F4R&2L'

-- -- -- *.* mg5kgBB

* . "# mg

osis9L'&MP9'

-- -- -- ".1#mg5kg BB

".1# mg5kgBB

5engo'atan multiresisten +i+a/ o+ale dengan kom'inasi Kina 'OJL&I


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LAMO4I$M >'OJL&ILAMO4I$M >'OJL&I

imian malaria 5 Maccaca m-llata7imian malaria 5 Maccaca m-llata7

$n-s-al presentation . Malariae$n-s-al presentation . Malariae 4ia/nosis y *R4ia/nosis y *R Ac-te diare, adominal pain, 9a-ndiceAc-te diare, adominal pain, 9a-ndice

Al/id malaria, ypotensionAl/id malaria, ypotension

Renal fail-re, respiratory fail-reRenal fail-re, respiratory fail-re


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Malaria RetinopatyMalaria Retinopaty

enelitian pada malaria eratoran/ deasa di (an/ladesmen-n9-33an retinopati pada


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#4#4 !#4#4 !

## &*IKI* TR&ATM&'T&*IKI* TR&ATM&'T

A'TI MALARIAL 4R$8A'TI MALARIAL 4R$8

OR8A' KAIL$R& TR&ATM&'TOR8A' KAIL$R& TR&ATM&'T $ORTI+& TR&ATM&'T$ORTI+& TR&ATM&'T

A'*ILLARY TR&ATM&'TA'*ILLARY TR&ATM&'T


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ANT' MA(AR'A( THERAP) FOR S.MANT' MA(AR'A( THERAP) FOR S.M

F$I'I'&F$I'I'&

F$I'I4I'&F$I'I4I'&

Artes-nateB ART 5 i.v.B i.m B s-pp 7Artes-nateB ART 5 i.v.B i.m B s-pp 7Artemeter B ARTM 5i.m.7Artemeter B ARTM 5i.m.7

Arte:eter 5i.m 7Arte:eter 5i.m 7

Artemisinin 5 s-pp 7Artemisinin 5 s-pp 74iydro:artemisinin 5 s-pp 74iydro:artemisinin 5 s-pp 7

Artelinate 5 i.v7Artelinate 5 i.v7

! #! #


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! #! #

ReG-ired parenteral or s-ppossitoria treatmentReG-ired parenteral or s-ppossitoria treatment 4ecreased parasitemia rapidly4ecreased parasitemia rapidly

Less side eectLess side eect

F-inine vs Artemisinin 5 ARTM , ART 7F-inine vs Artemisinin 5 ARTM , ART 7

ARTM trend to ave lo mortality -t comaARTM trend to ave lo mortality -t comarecovery prolon/, more conv-lsionrecovery prolon/, more conv-lsion

ART (etter tan F-inine 5 &F$AMAT 7ART (etter tan F-inine 5 &F$AMAT 7

:3##4DD D3 3F 4 # D? F3:3##4DD D3 3F 4 # D? F3


63/114

osis

:3##4DD D3 3F 4 # D? F3:3##4DD D3 3F 4 # D? F3

#4 3F ! ##4 3F ! #

i.v. #,E m/B3/ (( pada 9am 0, dani.v. #,E m/B3/ (( pada 9am 0, dan9am 1#, 3em-dian dilan9-t3an9am 1#, 3em-dian dilan9-t3an9am #E, EH dst sampai = ari.9am #E, EH dst sampai = ari.4osis total 1= " 1H m/B = ari4osis total 1= " 1H m/B = ari5 1 AmpN iv 51 amp N H0m/7m/7

-ppositories, 10 m/B3/ at 0 2 E-ppositories, 10 m/B3/ at 0 2 E

r folloed y = m/B3/ atr folloed y = m/B3/ at#E,C


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D$sis ARTEM'S'N'N PADA MA(AR'AD$sis ARTEM'S'N'N PADA MA(AR'A*ERAT*ERAT

0 F-D 1#.) #E.) EH.) =#.) Ma@ = ari

#.EM/B>/((

#.EM/B>/((

#.EM/B>/((

#.EM/B>/((

#.EM/B>/((

ARTESUNATE '.+, '.M

- ARTEMETER /an0a '.M $sis 1# %g,kg **

ARTESUNATE


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ARTESUNATE

I.V / I.M

1 Kl N


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/2C


67/114

;engobatan 7ina HCl8di hidroklorid parenteralg p

00 "" ,, 11 1B1B 00 ""

oadingoading

0 mg8kg33 inus8100!00 ml8" 9am0 mg8kg33 inus8100!00 ml8" 9am

3erat badan . 7g3erat badan . 7g

Tak pakai 7ina8-eloEuin " 9am sebelumnFaTak pakai 7ina8-eloEuin " 9am sebelumnFa

Tidak lan9ut usia atau GT8GTc int. pan9angTidak lan9ut usia atau GT8GTc int. pan9ang

10 mg8kg3310 mg8kg33

inus 00 ml8" 9am inus 00 ml8" 9am

diulang tiap , 9amdiulang tiap , 9amnus kosong , 9amnus kosong , 9am

tanpa kinaItanpa kinaI

nus kosong , 9amnus kosong , 9am

tanpa kinaItanpa kinaI

A7T) JA-IA7T) JA-I

tandardtandard

10 mg8kg33 10 mg8kg33

inus800 ml8" 9aminus800 ml8" 9am

SETELAH KESADARAN MEMBAIK/DAPAT MINUM :SETELAH KESADARAN MEMBAIK/DAPAT MINUM :

GANTI PER-ORAL 10 MG/KGBB/8 JAMGANTI PER-ORAL 10 MG/KGBB/8 JAM

SAMPAI HARI KE-7SAMPAI HARI KE-7

APABILA SETELAH 48 JAMAPABILA SETELAH 48 JAM

KEADAAN TIDAK MEMBAIK :KEADAAN TIDAK MEMBAIK :

GCS TETAP/MEMBURUKGCS TETAP/MEMBURUK

BILIRUBIN / KREATININ NAIKBILIRUBIN / KREATININ NAIK

URIN KURANG / TAK ADAURIN KURANG / TAK ADA

DOSIS DITURUNKAN 30-50%DOSIS DITURUNKAN 30-50%

10 mg8kg3310 mg8kg33

inus 00 ml8" 9am inus 00 ml8" 9am


68/114

e.trose =

Kina

Mirodrips

1##-"##

%igg

Bak9airan

Maintenane

: P#B4: P#B4

%4%4PDPD# B# B

;engobatan 7ina HCl8di!hidroklorid parenteral;engobatan 7ina HCl8di!hidroklorid parenteral


69/114

g pg p

00 "" 11 1B1B 00 ""

A7T) JA-IA7T) JA-I

#00 mg 7ina HCl 1 ampI#00 mg 7ina HCl 1 ampI

dalam #00 cc DeKtrose #6dalam #00 cc DeKtrose #6#00 mg 7ina HCl 1 ampI#00 mg 7ina HCl 1 ampI

dalam #00 cc DeKtrose #6dalam #00 cc DeKtrose #6#00 mg 7ina HCl 1 ampI#00 mg 7ina HCl 1 ampI

dalam #00 cc DeKtrose #6dalam #00 cc DeKtrose #6

SETELAH KESADARAN MEMBAIK/DAPAT MINUM :SETELAH KESADARAN MEMBAIK/DAPAT MINUM :

GANTI PER-ORAL 10 MG/KGBB/8 JAMGANTI PER-ORAL 10 MG/KGBB/8 JAM

SAMPAI HARI KE-7SAMPAI HARI KE-7

APABILA SETELAH 48 JAMAPABILA SETELAH 48 JAM

KEADAAN TIDAK MEMBAIK :KEADAAN TIDAK MEMBAIK :

GCS TETAP/MEMBURUKGCS TETAP/MEMBURUK

BILIRUBIN / KREATININ NAIKBILIRUBIN / KREATININ NAIK

URIN KURANG / TAK ADAURIN KURANG / TAK ADA

DOSIS DITURUNKAN 30-50%DOSIS DITURUNKAN 30-50%

enyes-aian dosis pada /an//-an K-n/si Or/anenyes-aian dosis pada /an//-an K-n/si Or/an


70/114

enyes-aian dosis pada /an//-an K-n/si Or/anenyes-aian dosis pada /an//-an K-n/si Or/an

Tiak 2erlu 2en0esuaian $sis $bat eri3at arte%isininTiak 2erlu 2en0esuaian $sis $bat eri3at arte%isinin2aa gangguan &ungsi /ati an atau gin4al2aa gangguan &ungsi /ati an atau gin4al D$sis kina 2arenteral iturunkan 1,5 setela/ 67 4a%D$sis kina 2arenteral iturunkan 1,5 setela/ 67 4a%

2e%berian 2aa 82e%berian 2aa 8 Gagal gin4al akutGagal gin4al akut Gangguan &ungsi /atiGangguan &ungsi /ati Tiak aa 2erbaikan klinis setela/ 67 4a%Tiak aa 2erbaikan klinis setela/ 67 4a% *ila 2asien sua/ /e%$ialisis tiak 2erlu*ila 2asien sua/ /e%$ialisis tiak 2erlu

2engurangan $sis kina2engurangan $sis kina


71/114

en/oatan lan9-tanen/oatan lan9-tan Setela/ 2asien saar,KU %e%baik t9. Awal 2arenteralSetela/ 2asien saar,KU %e%baik t9. Awal 2arenteral

a2at iuba/ gn. T9. Orala2at iuba/ gn. T9. Oral Diteruskan engan 8Diteruskan engan 8 A:T $sis lengka2 ;sela%a 5 /ariA:T $sis lengka2 ;sela%a 5 /ari Artesunate,arte%et/er tab. ;t$tal ? /ari < = $ksisiklin 5@Artesunate,arte%et/er tab. ;t$tal ? /ari < = $ksisiklin 5@

Kg ** 1 kali se/ari sela%a ? /ari Kg ** 1 kali se/ari sela%a ? /ari Kina tab.;t$tal ? /ari< = $ksisiklin ? /ariKina tab.;t$tal ? /ari< = $ksisiklin ? /ari *agi bu%il anak@anak 8 $ksisiklin iganti engan*agi bu%il anak@anak 8 $ksisiklin iganti engan

klina%isin 1" %g,Kg ** ! kali se/ariklina%isin 1" %g,Kg ** ! kali se/ari

TR&ATM&'T OK OR8A' KAIL$R&TR&ATM&'T OK OR8A' KAIL$R&


72/114

TR&ATM&'T OK OR8A' KAIL$R&TR&ATM&'T OK OR8A' KAIL$R&

4:P&3P&@/ :34!?344:P&3P&@/ :34!?344 F?4 F?

:D3:D3

&@P3@:#&@P3@:#&@PB?B4#&@PB?B4#

P3@ F?P3@ F?

&@P3434&@P3434 PP

! 4#! 4#

*LI'I*AL MA'IK&TATIO'*LI'I*AL MA'IK&TATIO'


73/114

*LI'I*AL MA'IK&TATIO'*M*M

NE4R6%6GI*A% SNDR6ME : DIBB4SE, 56TENTIA%%NE4R6%6GI*A% SNDR6ME : DIBB4SE, 56TENTIA%%

RA5ID% REJERSI2%E EN*E5HA%65ATH ASS6*IATEDRA5ID% REJERSI2%E EN*E5HA%65ATH ASS6*IATED

ITH %6SS 6B *6NS*I64SNESS AND BITTINGITH %6SS 6B *6NS*I64SNESS AND BITTING

mi#d meningism, no ne&k rigidit$mi#d meningism, no ne&k rigidit$

d$s&on;ugate gaGed$s&on;ugate gaGe

erti&a# n$stagmuserti&a# n$stagmus

)."I 'a#s$)."I 'a#s$

do##s e$e, o&u#oestibu#ar re#eA norma# res'onsedo##s e$e, o&u#oestibu#ar re#eA norma# res'onse

s$metri D), in&reased tone > ;erk, onus, eAtensors$metri D), in&reased tone > ;erk, onus, eAtensor '#antar res'onse J , brisk FaE ;erk'#antar res'onse J , brisk FaE ;erk

'out re#eA J , abdomina# re#eA /, &remasteri& re#eA J .'out re#eA J , abdomina# re#eA /, &remasteri& re#eA J .

&erebe##ar sign 'resent&erebe##ar sign 'resent

lasgoA :oma alelasgoA :oma ale


74/114

gg es*on mataes*on mata ; s*ontan; s*ontan $$

dgn saradgn sara dgn nCeridgn nCeri 22tak ada reaksitak ada reaksi 11

es*on Biaraes*on Biara ; normal res*on; normal res*on 55bingngbingng $$

berkata kaaberkata kaa

sara merintisara merinti 22tak ada saratak ada sara 11

es*on motorikes*on motorik ; gerakan normal; gerakan normal66

da*at melokalisir nCerida*at melokalisir nCeri 55eksi td* nCerieksi td* nCeri $$e9tensie9tensi deerebrate rigiditCdeerebrate rigiditC 22

tak ada reaksitak ada reaksi 11T6TA% @ 88 .>

2lant)re *oma S&ale modi(ikasi-2lant)re *oma S&ale modi(ikasi-


75/114

2lant)re *oma S&ale modi(ikasi-2lant)re *oma S&ale modi(ikasi-

es*on mataes*on mata ;;

mengikti Aaja ibmengikti Aaja ib 11tak ada reaksitak ada reaksi 00

es*on Biaraes*on Biara ;;

menangis Aajarmenangis Aajar 22menangis merintimenangis merinti 11

tak ada saratak ada sara00

es*on motorikes*on motorik ;;

melokalisir nCerimelokalisir nCeri 22

menarik anggota o.k. nCerimenarik anggota o.k. nCeri 11

tak ada reaksitak ada reaksi 00

T6TA% 883

A*$T& >I4'&Y I')$RY 5A>I7A*$T& >I4'&Y I')$RY 5A>I7


76/114

A*$T& >I4'&Y I')$RY 5A>I7A*$T& >I4'&Y I')$RY 5A>I7

Malaria related Ac-te >idney In9-ry 5MA>I7Malaria related Ac-te >idney In9-ry 5MA>I7

en-r-nan f-n/si /in9al dalam EH 9am en-r-nan f-n/si /in9al dalam EH 9am enin/3atan ser-m 3reatinin 0.C m/BdL, ata-enin/3atan ser-m 3reatinin 0.C m/BdL, ata-

enin/3atan ser-m 3reatinn !0% dan nilaienin/3atan ser-m 3reatinn !0% dan nilai

dasar, ata-dasar, ata-en-r-nan -rin o-tp-t 0.! mlB3/B9am -nt-3


77/114

A*$T& R&'AL KAIL$R& I' &+&R& MALARIAA*$T& R&'AL KAIL$R& I' &+&R& MALARIA

PRE-RENAL RENAL

U!"# S$G 1$0&0 '1$010

U!"# O()$ 500 '350

*)O()/+, H&O

U!"# N. *)#/L '10 &0P.(). BUN/C#.!"!"# 15:1 '10-15:1

U/P U#. &0:1 '10:1

U/P C#.!"!"# 40:1 '10:1

U/P O()2.! &:1 '1:1

R#". .!# I"6# '1 1

.9!2". #9#!2" 2

!##6 N. '1 1

$LMO'ARY MA'IK&TATIO' I' MALARIA$LMO'ARY MA'IK&TATIO' I' MALARIA


78/114

$LMO'ARY MA'IK&TATIO' I' MALARIA$LMO'ARY MA'IK&TATIO' I' MALARIA

Distorically Distorically (roncitic(roncitic

ne-monicne-monic

(roncopne-monic(roncopne-monic

Ac-te L-n/ In9-ry 5ALI7Ac-te L-n/ In9-ry 5ALI7

Ac-te Respiratory 4istressAc-te Respiratory 4istress

yndrome 5AR47yndrome 5AR47

A R 4 A R 4


79/114

A.R.4.A.R.4.

Occ-rs in . Kalcipar-m, . +iva@, . Ovale 2 ? .Occ-rs in . Kalcipar-m, . +iva@, . Ovale 2 ? .>nolesi>nolesi

*ommon in ad-lt tan cildren, pre/nancy and*ommon in ad-lt tan cildren, pre/nancy and

non:imm-nenon:imm-ne

Mecanism Increased alveolar cappilaryMecanism Increased alveolar cappilarypermeailitypermeaility intravasc-lar P-id loss into teintravasc-lar P-id loss into te

l-n/sl-n/s

resentation initial presentation or after initiationresentation initial presentation or after initiation

treatmenttreatment*linical ac-te onset dyspnea*linical ac-te onset dyspnea respiratory fail-rerespiratory fail-re

*LI'I*AL KI'4I'8*LI'I*AL KI'4I'8


80/114

*LI'I*AL KI'4I'8*LI'I*AL KI'4I'8 Manifest ar-pt onset dyspnoea, co-/, ti/tness inManifest ar-pt onset dyspnoea, co-/, ti/tness in

te cest tat pro/resses rapidly over a fe o-rste cest tat pro/resses rapidly over a fe o-rs 4isorientation and a/itation is freG-ently present.4isorientation and a/itation is freG-ently present.

ysical e@aminationysical e@amination si/ns of respiratory distress 5 air si/ns of respiratory distress 5 air

-n/er, -se of accessory m-scles of respiration,-n/er, -se of accessory m-scles of respiration,

s-prasternal and intercostal indrain/ 7, central ands-prasternal and intercostal indrain/ 7, central andperiperal cyanosis 5arterial ypo@aemia7, asalperiperal cyanosis 5arterial ypo@aemia7, asal

crepitations and e@piratory eeQin/.crepitations and e@piratory eeQin/.

In tese patients, i/ parasitaemia,ac-te renal fail-re,In tese patients, i/ parasitaemia,ac-te renal fail-re,

ypo/lycemia, metaolic acidosis, disseminatedypo/lycemia, metaolic acidosis, disseminatedintravasc-lar coa/-lation 54I*7, and acterial sepsisintravasc-lar coa/-lation 54I*7, and acterial sepsis

-s-ally co:[email protected] co:e@ist.

*est radio/rapy *est radio/rapy


81/114

*est radio/rapy *est radio/rapy (ilateral frontal opacities 5alveolar(ilateral frontal opacities 5alveolar

pattern7, increased interstitial mar3in/spattern7, increased interstitial mar3in/sTe cardiac siQe is -s-ally normalTe cardiac siQe is -s-ally normal

Rarely, tic3enin/ of l-n/ ;ss-res,Rarely, tic3enin/ of l-n/ ;ss-res,

interlo-lar septal linesinterlo-lar septal lines

le-ral e-sionle-ral e-sion

In assisted ventilator In assisted ventilator complications pne-motora@,complications pne-motora@,

pne-momediastin-m , pne-monia may occ-rpne-momediastin-m , pne-monia may occ-r


82/114


83/114


84/114

; i i i i b l; i i i i b l


85/114

O3si/enasiO3si/enasi

ence/aan 3e9an/ diaQepam,ence/aan 3e9an/ diaQepam,

l-minal, lar/actill-minal, lar/actil

Mence/a tra-maB 9at-Mence/a tra-maB 9at-

Men/atasi an@iety, deliri-m stateMen/atasi an@iety, deliri-m state

;enanganan insuisiensi serebral;enanganan insuisiensi serebral

* l i*onv-lsions


86/114

*onv-lsions*onv-lsions

I.v. diaQepam 10 m/ "ad-lt or rectalI.v. diaQepam 10 m/ "ad-lt or rectal0.!:1.0 m/B3/0.!:1.0 m/B3/

i.m paraldeyde o.1 m/B3/ " ad-lti.m paraldeyde o.1 m/B3/ " ad-lt

Repeated conv: clormetiaQolRepeated conv: clormetiaQolinf-ssion 0.H %,inf-ssion 0.H %,

enytoin ! m/B3/ i.v. #0 min-tesenytoin ! m/B3/ i.v. #0 min-tes

Kospenytoin =.! m/B3/ i.v #0Kospenytoin =.! m/B3/ i.v #0mn-tesmn-tes


87/114

&'A'8A'A' I>T&RI>&'A'8A'A' I>T&RI>Tida3 ada yan/ 3-s-sTida3 ada yan/ 3-s-s

Dati:ati ipo/li3emiaDati:ati ipo/li3emia

Dati:ati teradap perdaraanDati:ati teradap perdaraan

emerian vit. > pada i3ter-s yan/emerian vit. > pada i3ter-s yan/

dalamB tanda perdaraan 10 m/BdalamB tanda perdaraan 10 m/B

ari selama C ari.ari selama C ari.

$lan/i ilir-in, 8OTB 8T ari 3e$lan/i ilir-in, 8OTB 8T ari 3e

:C:C

5 t *ria


88/114

5 t, *ria,Demam ad mnm :

# 6-10-02Fali* 0.&1; Par 0.H&2; Par 0.$G&; Par 0.1GBil 1+ mg&ari ;Bill H." mgG

DYO8LY*A&MIA 5 (l. -/ar E0 m/% 7DYO8LY*A&MIA 5 (l. -/ar E0 m/% 7


89/114

DYO8LY*A&MIA 5 (l. -/ar E0 m/% 75 / / 7

*oma, #0 :!0 ml !0% de@trose i.v. ! " 10*oma, #0 :!0 ml !0% de@trose i.v. ! " 10

min-tes 5 ro-tine is not recommended 7min-tes 5 ro-tine is not recommended 7 Inf-ssion 10 % de@trose 5 cildren " !%Inf-ssion 10 % de@trose 5 cildren " !%

de@trose7 " eare yponatremiade@trose7 " eare yponatremia

Dypo/lycaemia may developed 4ay 1 ::: =Dypo/lycaemia may developed 4ay 1 ::: =

-sed !0% de@trose if necessary-sed !0% de@trose if necessary

8l-ca/on in9ection8l-ca/on in9ection

+ia naso/astric , eare /astric distension+ia naso/astric , eare /astric distension

In peritoneal dialysis, add /l-cose in dialysisIn peritoneal dialysis, add /l-cose in dialysisP-idP-id

omatostatin analoG-e octreotide 5andostatin7omatostatin analoG-e octreotide 5andostatin7

#4#4 :? %D4@ 4'?@


90/114

**ro*riate nti-#alaria**ro*riate nti-#alaria

#aintenane Flid I letrolCtes#aintenane Flid I letrolCtes

enal e*laement tera*Cenal e*laement tera*C

reatment :om*liationsreatment :om*liations

#anagemeni nJetions#anagemeni nJetions

8oids ne*roto9is drgs8oids ne*roto9is drgs

#4#4 :? %D4@ 4'?@#4#4 :? %D4@ 4'?@

Kl-id 2 4i-reticsKl-id 2 4i-retics


91/114

Oli/-riaB deydrated inf-ssion of '.Oli/-riaB deydrated inf-ssion of '.

saline #0 mlB 3/ (JB


92/114

4OAMI'&4OAMI'&

#.! -/B3/B min improved R(K inde@#.! -/B3/B min improved R(K inde@C= % and cardiac o-tp-t C! %C= % and cardiac o-tp-t C! %

10 -/B3/B min10 -/B3/B min 'OT'OT

&pineprine, dopamine , no role in&pineprine, dopamine , no role inrenal o@y/en s-pplyrenal o@y/en s-pply

+asopressine ?+asopressine ?

Al-min ??Al-min ??

4IALYI4IALYI


93/114

&arly dialysis improved s-rvival&arly dialysis improved s-rvival

Intermittent D4 5dailyB alternatin/7Intermittent D4 5dailyB alternatin/7*ontin-o-s venoveno-s emo;ltration*ontin-o-s venoveno-s emo;ltration

*ontin-o-s artrioveno-s emo;ltration*ontin-o-s artrioveno-s emo;ltration

eritoneal dialysis L& eectiveeritoneal dialysis L& eectiveIndications Indications

*linical -remic symptoms, vol-me overload*linical -remic symptoms, vol-me overload

5 p-lm. &dema, con/est eart fail-re 7, pericardial5 p-lm. &dema, con/est eart fail-re 7, pericardialr-.r-.

La D*OC 1! meGB L, >


94/114

Peritoneal dialCsisin malaria


95/114

in malariaAit renal Jailre

$5 Crs Jemale, rianis,4o, Je8er, tired.Fali* , &b. 1.", . "?rem 211, :reat. ".0mgBill.tl. 1."$ mgGlose 12H mgG: 15DaC ; rem 1, reatDaC 6 ; rem 10$, :reatDaC 2. P.ont +0

DaC . P.ont DaC $. P.ont 5DaC 5 K 6 ; smear ; negatiDialCsis D1 K 6 .Deat on daC ".

Management ARF in severe Mal.


96/114

PERITONEAL ( HEMO - 6!.(!(

rea learane 1 - "# ml5min 1## - 1# ml5min

impliit ost es heap mahine e.pensie

9irulator ompl+ @ew ususal

Lung ompliation usual @ew%rotein loss large @ew

%eritonitis oasional - - -

4hrombophlebitis - - - oasional

Heparin administ+ not neess+ neessar

seuilibrium sn+ @ew oasional

Hperglaemia oasional @ew

AdeG-acy of 4ialysisAdeG-acy of 4ialysis


97/114

AdeG-acy of 4ialysisAdeG-acy of 4ialysis

4ialysis is considered adeG-ate4ialysis is considered adeG-ate

en te post:dialysis creatinineen te post:dialysis creatinine

and -rea levels decrease to !0% orand -rea levels decrease to !0% or

less of te predialysis val-es.less of te predialysis val-es.

#4#4 3F :? P3@#4#4 3F :? P3@


98/114

D @4D3#D @4D3#

P4:P ;P4:P ;= arlC Diagnosis= arlC Diagnosis

= a*id 9 anti-malarial= a*id 9 anti-malarial

= ssisted 8entilation= ssisted 8entilation= :onsider aggra8ating Jators ;= :onsider aggra8ating Jators ;

- baterial se*sis- baterial se*sis

- sereting obstrting airAaCs- sereting obstrting airAaCs

- *nemotora9- *nemotora9


99/114

:erebral #alaria, resisten Einine , es*iratorC Failrein #anado &os*ital


100/114

CM-ARDS, RSUP 2000

Indi&ations (or proph)la&ti& me&hani&al +entilation 'e(oreIndi&ations (or proph)la&ti& me&hani&al +entilation 'e(ore


101/114

p p )

se+ere malaria patients deteriorate to respirator) (ailure Lse+ere malaria patients deteriorate to respirator) (ailure L

5ormal alue ndications or -.

/espiratorF rate 1 ! 0 % +#

/espiratorF muscle respiratorF alternans8paradoKical

abdomen

Tidal Lolume ml8kgI B# ! ># * 1#

@21 ml8kgI ># ! 100 * 1#nspired 0oKFgen maskI

;A!aD


102/114

Mana/ement ALIB AR4Mana/ement ALIB AR4

I*$I*$ -pported prevent nosocomial infection, 8I leed,-pported prevent nosocomial infection, 8I leed,

tromo:emolismS adeG-ate n-tritional enteral inta3etromo:emolismS adeG-ate n-tritional enteral inta3e

Monitorin/ o@y/en sat-rationMonitorin/ o@y/en sat-ration

Kl-id 6 conservative 6 5 1C


103/114

#B3: :D3#B3: :D3

Occ-r in Occ-r in : ac-te renal fail-re: ac-te renal fail-re: ypovolaemia: ypovolaemia: soc3: soc3: p-lmonary oedema: p-lmonary oedema: yperparasitemia: yperparasitemia

Mana/ement Mana/ement 4ialysis 4ialysis od.icaronate if pD =.1!, eare od.icaronate if pD =.1!, eare

of sodi-m overloadof sodi-m overload -lm edema-lm edema reverale TDAM tris 5ydro@ymetyl7: reverale TDAM tris 5ydro@ymetyl7:aminoamino

metan, no sodi-mmetan, no sodi-m yr-vate deydro/enase activator dicloro " yr-vate deydro/enase activator dicloro "

acetateacetate

DYOT&'IO' 5al/id malaria7DYOT&'IO' 5al/id malaria7


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DYOT&'IO' 5al/id malaria7DYOT&'IO' 5al/id malaria7

:ases; gram - 8e bateriaemia,:ases; gram - 8e bateriaemia,

#3F#3F

#anagement ;#anagement ;

1. :!P ; 0 -- 5 m &23 Ait1. :!P ; 0 -- 5 m &23 Ait

rCstalloid/rCstalloid/

olloid inJsionolloid inJsion

2. .!. Do*amine / dobtamine2. .!. Do*amine / dobtamine

. Blood ltre. Blood ltre

$.ntibioti ( :arba*enem/ :e*. !)$.ntibioti ( :arba*enem/ :e*. !)

Daniestasi @om'#ikasi Tindakan aEa#

8oma (ma#aria serebra# erta2ankan oksigenasi, #etakkan 'ada sisi tertentu, sam'ingkan 'en$ebab

TI'4A>A' T&RDA4A >OMLI>AI


105/114

8oma (ma#aria serebra# erta2ankan oksigenasi, #etakkan 'ada sisi tertentu, sam'ingkan 'en$ebab#ain dari &oma (2i'og#ikemi, stroke, se'sis, diabetes &oma, uremia, gangguane#ektro#it ,2indari obat tak bermanaat, intubasi bi#a 'er#u.

Hi'er'ireksia Turunkan su2u badan dengan kom'ress, an, air &ondition, anti/'iretika

8onu#sike;ang erta2ankan oksigenasi, 'emberian anti/ke;ang i 'er re&ta# diaGe'am, i.m.'ara#de2$de

Hi'og#ikemia ( K# dara2 40 mg% Beri 50 m# deAtrose 40% dan inus deAtrose 10% sma'ai gu#a dara2 stabi#, &ari'en$ebab 2i'og#ikemia

-nemia berat ( Hb 5 gr% atau8" 15%

Berikan transusi dara2 dara2 segar, &ari 'en$ebab anemian$a

dema aru -kut , sesak naas,res' < +5 A

Tidurkan 450, oksigenasi, berikan 7urosemide 40 mg i, 'er#ambat &airan inus,intubasi/enti#ation ,

Kaga# Kin;a# -kut @esam'ingkan gaga# gi;a# 're/rena#, bi#a de2idrasikoreksiM bi#a gaga# gin;a#

rena# segera dia#$sis

erdara2an s'ontan koagu#o'ati Berikan itamin @ 10 mg 2ari se#ama + 2ariM transusi dara2 segarM 'astikanbukan I8

-sidosis Detabo#ik @esam'ingkan koreksi bi#a 2i'og#ikemia, 2i'oo#emia, se'tikemia. Bi#a 'er#udia#$sis 2emoi#trasi

N$ok astikan tidak 2i'oo#emia, &ari tanda se'sis, berikan anti/biotika s'ektum #uas$ang adeuat

Hi'er'arasitemia Negera anti ma#aria ('i#i2an artesunate, transusi ganti (eA&2ange transusion

4 ?PP3!4 ?PP3!

#?#?


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#?#? atients so-ld e treated in an I*$atients so-ld e treated in an I*$

In endemic areas treatment so-ld eIn endemic areas treatment so-ld ecommenced as early as possile, sometimescommenced as early as possile, sometimes

efore positive parasitolo/yefore positive parasitolo/y

atients so-ld e ei/ed so tat dose ofatients so-ld e ei/ed so tat dose of

anti malarial can e calc-latedanti malarial can e calc-lated I+ P-ids so-ld e /iven to maintain P-idI+ P-ids so-ld e /iven to maintain P-id

alance and caloric reG-irements. A centralalance and caloric reG-irements. A central

line and monitorin/ of central veno-sline and monitorin/ of central veno-s

press-re may e necessary, especially inpress-re may e necessary, especially in

elderly. All inta3e so-ld e recorded caref-llyelderly. All inta3e so-ld e recorded caref-lly

Airay, O@y/en reG-irementAiray, O@y/en reG-irement

Treat yperpyre@iaTreat yperpyre@ia

4 ?PP3!4 ?PP3!


107/114

#?#? $rinary cateteriQation so-ld e -sed to monitor$rinary cateteriQation so-ld e -sed to monitor

o-tp-to-tp-t atients so-ld e oserved for vomitin/. Toatients so-ld e oserved for vomitin/. To

ens-re patientUs safety, cot:sides may e reG-iredens-re patientUs safety, cot:sides may e reG-ired

Re/-lar re:positionin/ of patient is necessary toRe/-lar re:positionin/ of patient is necessary to

prevent development of press-re soresprevent development of press-re sores 'aso/astric t-e so-ld e avoided eca-se of te'aso/astric t-e so-ld e avoided eca-se of te

ris3 of aspirationris3 of aspiration MO'ITORI'8 8* 2 +ITAL I8'MO'ITORI'8 8* 2 +ITAL I8'

LA( K(*, 8L$*O&, AR.*O$'T, *R&ATI'I'&, $R&$M,LA( K(*, 8L$*O&, AR.*O$'T, *R&ATI'I'&, $R&$M,(LOO4 8A, $RI'& .8, O4I$M, OTAI$M.(LOO4 8A, $RI'& .8, O4I$M, OTAI$M.

R&+&'T DO*>, &TI*A&MIA, A*I4OI, AR4,R&+&'T DO*>, &TI*A&MIA, A*I4OI, AR4,

DYO8LY*A&MIA, AIRATIO', (&4OR&.DYO8LY*A&MIA, AIRATIO', (&4OR&.

Treatment evere MalariaTreatment evere Malaria


108/114

:#010:#010

evere Malaria is a medical emer/encyevere Malaria is a medical emer/ency

Ad-lt Artes-nate iv B imAd-lt Artes-nate iv B im

*ildren Artes-nate ivBim, F-inine*ildren Artes-nate ivBim, F-inine

ivBim, Artemeter imivBim, Artemeter im

8ive arenteral at least #E o-rs8ive arenteral at least #E o-rs

ict to oral A*T, artes-nate ict to oral A*T, artes-nate

clindamycinBdo@ycyclin, G-inine *lBd@clindamycinBdo@ycyclin, G-inine *lBd@

If not posile, /ive pre:referal R@, tenIf not posile, /ive pre:referal R@, ten

referred immediatelyreferred immediately

>&Y $**&&4 KOR MA'A8I'8>&Y $**&&4 KOR MA'A8I'8


109/114

&+&R& MALARIA&+&R& MALARIA

Acc-racy dia/nosis 5 microscopic "iocemical 7

Malaria dr-/ 5 to comat resistency 7

Aility to treat or/an fail-re 5 I*$ 2Medical eG-ipment 7

8ood man poer5 n-rses ::: doctor 7

8ood referral system

*ase Malaria complicated*ase Malaria complicated


110/114

*ase Malaria , complicated*ase Malaria , complicated

!1 years omen, admitted it istory E!1 years omen, admitted it istory Edays fever it reatless, temp C=.!,days fever it reatless, temp C=.!,( 1!0B100, p-lse 10H resp. C


111/114


112/114

D 1


113/114

:B:BH#B1B:, Tromo 10.000. MalariaB BH#B1B , Tromo 10.000. Malariafalcipar-m , 1100B #00 J(*, l.falcipar-m , 1100B #00 J(*, l.

-/ar DI ,101!m/%, 00m/%, (il.-/ar DI ,101!m/%, 00m/%, (il.Total#.E=, il direct1.1! m/%,-re-mTotal#.E=, il direct1.1! m/%,-re-mH


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r. au# Hari;anto, N'./@TIi. en$akit Tro'ik > Ineksi

ND7 Bag. en$akit a#am

7@ )N-T N Danado

N Bet2esda /Tomo2on

Te#'.:

04+1/+5104046 ( N Bet2esda

01/4+0/69 ( H 04+1/+511 (es

/mai# : 'au#2ari;antoOgmai#.&om

Sampai Baku Dapa !

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Update Malaria 2012