{"id":989,"date":"2016-09-03T14:41:32","date_gmt":"2016-09-03T14:41:32","guid":{"rendered":"http:\/\/doktermuslim.com\/?p=989"},"modified":"2016-09-03T14:41:32","modified_gmt":"2016-09-03T14:41:32","slug":"protokol-pemberian-insulin-part-1","status":"publish","type":"post","link":"https:\/\/doktermuslim.com\/protokol-pemberian-insulin-part-1\/","title":{"rendered":"Protokol Pemberian Insulin (Part. 1)"},"content":{"rendered":"<p style=\"text-align: justify;\">Banyak protokol pemberian insulin yang dipakai di berbagai RS. Protokol harus memenuhi beberapa persyaratan:<\/p>\n<ul style=\"text-align: justify;\">\n<li>Mudah diperintahkan dan dilaksanakan oleh semua unit di RS (termasuk rawat jalan)<\/li>\n<li>Efektif (pasien mencapai kadar glukosa darah secara cepat)<\/li>\n<li>Aman (risiko hipoglikemi dan hipokalemi sekecil mungkin)<\/li>\n<li>Protokol harus termasuk cara merubah dosis infus insulin dan pemberian glukosa bila terjadi hipoglikemi<\/li>\n<li>Sediaan yang dipilih sebaiknya mudah didapat dan mudah dipakai<\/li>\n<li>Terjangkau dari segi biaya<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Agar target dapat tercapai dalam waktu relatif singkat maka perlu pemantauan kadar glukosa darah secara cepat (ditempat\/<em>bedside<\/em>), serta target kontrol glukosa darah yang harus dicapai. Untuk menghindarai efek samping hipoglikemi dan hipokalemi maka monitoring harus ketat (tiap 1-2 jam sekali)\u00a0 sampai tercapai target KGD dan stabil, dan diberikan infus dekstrosa (kalori) dan kalium. Suatu tim multidisiplin yang sudah terlatih harus dilibatkan dalam melakanakan suatu protokol, dari farmasi, administrasi, perawat, dokter dan laboratorium. Untuk beberapa RS pemberian infus insulin intravena diluar perawatan intensif (ICU\/ICCU) merupakan tantangan tersendiri.<\/p>\n<hr \/>\n<h3 style=\"text-align: justify;\"><span style=\"text-decoration: underline;\"><strong>Target kadar glukosa darah <\/strong><\/span><\/h3>\n<p style=\"text-align: justify;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dalam pengelolaan pasien dengan bermacam keadaan seperti perioperatif, operasi dengan perawatan ICU, Hamil, Partus, penyakit kritis ada target kadar glukosa darah tertentu agar angka kematian penderita tersebut dapat menurun.<\/p>\n<hr \/>\n<h3 style=\"text-align: justify;\"><span style=\"text-decoration: underline;\"><strong>Target Kadar Glukosa Darah pada Terapi Infus Insulin Intravena<\/strong><\/span><\/h3>\n<p style=\"text-align: justify;\">\u00a0\u00a0 =========================================================<\/p>\n<p style=\"text-align: justify;\">\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Populasi Pasien\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kadar Glukosa Darah\u00a0 mg\/dL<\/p>\n<p style=\"text-align: justify;\">\u00a0\u00a0 =========================================================<\/p>\n<p style=\"text-align: justify;\">\u00a0\u00a0\u00a0\u00a0\u00a0 Pasien bedah dengan kondisi kritis\/berat\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 80-110<\/p>\n<p style=\"text-align: justify;\">\u00a0\u00a0\u00a0\u00a0\u00a0 Pasien bedah dan non bedah\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a090-110<\/p>\n<p style=\"text-align: justify;\">\u00a0\u00a0\u00a0\u00a0\u00a0 Wanita selama melahirkan dan persalinan\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 70-100<\/p>\n<p style=\"text-align: justify;\">\u00a0 =========================================================<\/p>\n<hr \/>\n<h3 style=\"text-align: justify;\"><span style=\"text-decoration: underline;\"><strong>Protokol Pemberian Algoritma Infus Insulin Intravena<\/strong><\/span><\/h3>\n<p style=\"text-align: justify;\">Pasien yang akan diberikan Infus Insulin Intravena sebaiknya mempunyai persiapan sebagai berikut:<\/p>\n<ul style=\"text-align: justify;\">\n<li>KGD =\u00a0\u00a0\u00a0\u00a0 mg\/dL (umumnya 80-180 mg\/dL, pasien ICU 80-110 mg\/dL)<\/li>\n<li>Infus Standard: 100 unit RI\/100 ml NaCl 0,9% lewat <em>Infusion pump<\/em> atau <em>Syringe pump<\/em><\/li>\n<li>Pasien bedah yang mendapat obat oral anti diabetes dalam 24 jam harus mulai dilakukan infus insulin bila KGD &gt; 120 mg%, pasien yang lain dapat dimulai bila KGD &gt; 70 mg\/dL.<\/li>\n<li>Infus Insulin dapat dihentikan bila pasien sudah dapat diberikan makanan per oral dan dirubah pemberian insulin secara subkutan<\/li>\n<li>Setiap pasien membutuhkan 5-10 gram glikosa\/jam, maka sebelumnya diberikan Dekstrosa 5% atau D5% + \u00bd salin sekitar 100-200 ml\/jam (atau persamaannya bila diberikan secara oral\/NGT)<\/li>\n<\/ul>\n<hr \/>\n<h3 style=\"text-align: justify;\"><strong><u>REFERENSI<\/u><\/strong><\/h3>\n<p style=\"text-align: justify;\">Tulisan dikutip dari dr. Bowo<\/p>\n<p style=\"text-align: justify;\">Bode, B.W., Braithwaite, S.S., Steed, R.D. 7 Davidson, P.C., 2004, <strong><em>Intravenous Insulin Infusion Therapy: Indications, Methods and Transition to Subcutaneous Insulin Therapy<\/em><\/strong>, <em>Endocr Pract<\/em>. 2004; 10 (Suppl 2):71-80.<\/p>\n<p style=\"text-align: justify;\">Soegondo, S., 2005, <strong><em>Mekanisme Molekular Kendali Metabolik dalam Memperbaiki Kondisi Pasien<\/em><\/strong>, <em>Perkeni<\/em> <em>Advanced Insulin Course<\/em>, Cimacan, 19-20 Maret.<\/p>\n<p style=\"text-align: justify;\">Soewondo, P., 2005, <strong><em>Terapi Infus Insulin Intravena: Indikasi, Metoda dan Cara Pengalihan Pemberian Secara Subkutan<\/em><\/strong>, <em>Perkeni<\/em> <em>Advanced Insulin Course<\/em>, Cimacan, 19-20 Maret.<\/p>\n<p style=\"text-align: justify;\">Trence, D.L., Kelly, J.L. &amp; Hirsch, I.B., 2003, <strong><em>The Rationale and Management of Hyperglycemia for In Patient with Cardiovascular Disease: Time for Change,<\/em><\/strong>\u00a0<em>J Clin Endokrinol Metab<\/em> No 88: 2430-37.<\/p>\n<p style=\"text-align: justify;\">\n","protected":false},"excerpt":{"rendered":"<p>Banyak protokol pemberian insulin yang dipakai di berbagai RS. Protokol harus memenuhi beberapa persyaratan: Mudah diperintahkan dan dilaksanakan oleh semua unit di RS (termasuk rawat <a class=\"read-more\" href=\"https:\/\/doktermuslim.com\/protokol-pemberian-insulin-part-1\/\" title=\"Protokol Pemberian Insulin (Part. 1)\" itemprop=\"url\">[Read more]<\/a><\/p>\n","protected":false},"author":1,"featured_media":990,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[29,31],"tags":[183,182,184],"newstopic":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.9.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Protokol Pemberian Insulin (Part. 1) | Dokter Muslim<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/doktermuslim.com\/protokol-pemberian-insulin-part-1\/\" \/>\n<meta property=\"og:locale\" content=\"id_ID\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Protokol Pemberian Insulin (Part. 1) | Dokter Muslim\" \/>\n<meta property=\"og:description\" content=\"Banyak protokol pemberian insulin yang dipakai di berbagai RS. 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