Puji Pinta O. Sinurat
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Hubungan terapi manitol 20% dengan fungsi ginjal pada penderita stroke perdarahan intraserebral dengan peningkatan tekanan intrakranial Anyta Prisca Dormida; Yuneldi Anwar; Puji Pinta O. Sinurat
Majalah Kedokteran Nusantara The Journal Of Medical School Vol 47, No 3 (2014): The Journal of Medical School
Publisher : Fakultas Kedokteran USU

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Abstract

Background : Intracerebral hemorrhage can increase intracranial pressure. Treatment of increased ICP is one of the most important and most common problems. Mannitol has been seen as one of the first choices in the immediate-treatment of increased ICP. The most common complications of mannitol therapy are fluid and electrolyte imbalances, hypersensitivity reactions and might also cause renal failure even in therapeutic doses. However the influence of osmotherapy on renal function in patients treated with mannitol due to increased intracranial pressure was not so far well described.Method : This was a cross sectional study of 39 subjects in Haji Adam Malik General Hospital. Subjects were patients who diagnosed with stroke caused by intracerebral hemorrhage with increasing of intracranial pressure based on neurological examination and head CT scan examination and treated with mannitol 20% dose 0.5 g/kg body weight for 3 days. Renal function were measured before and after mannitol 20% administration.Results : Of 39 patients (21 males, 18 females), mannitol 20% administration showed changes of renal function parameter on the 3rd day. There were increasing of serum creatinine level 0.21 (SD 0.51) mg% (p=0.014), increasing of serum ureum level 18.44 (SD 25.7) mg% (p=0.000), increasing of serum osmolality 8.64 (SD 17.95) mmol/kgH2O (p=0.005) and decreasing of serum sodium level 3.03 (SD 6.68) mEq/L (p=0.007). Increasing of serum potassium level and decreasing of serum chloride level were also found (p>0.05). None of patients developed anuria or oliguria. There was decreasing of GFR 14.87 (SD 36.42) mL/menit (p=0.015), but none of patients developed acute renal failure. There was a significant relationship between creatinine level and serum osmolality on the 3rd day (r=0.415, p=0.009).Conclusion : Mannitol 20% administration for stroke caused by intracerebral hemorrhage with increasing of intracranial pressure showed changes of serum creatinine, ureum, osmolality and natrium level significantly (p<0.05) and also decreased of glomerular filtration rate (p<0.05).Keywords : mannitol 20%; renal function; stroke caused by intracerebral hemorrhage; intracranial pressure
Hubungan penggunaan nasogastric tube dengan kejadian pneumonia pada pasien stroke akut dengan disfagia Eva Rahmi Halim; Yuneldi Anwar; Puji Pinta O. Sinurat
Majalah Kedokteran Nusantara The Journal Of Medical School Vol 47, No 3 (2014): The Journal of Medical School
Publisher : Fakultas Kedokteran USU

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Abstract

Background : Aspiration pneumonia is the most important acute complication of stroke related dysphagia. Tube feeding is usually recommended as an effective and safe way to supply nutrition in stroke patients with dysphagia. On the cointains, many patients on continued to aspirate eventhough the used the nasogastric tube.The purpose of this study was to confirm that there werethe is correlation between nasogastric tube usege and incidence of pneumonia in acute stroke patient with dysphagia. Methods : This cross sectional study observed 60 acute stroke patients with dysphagia consist, 30 patiens using tube feeding and 30 were not using tube feeding, who stayed in Adam Malik General Hospital. Patients who admitted with pneumonia or other pulmonary infection or decreased level of conciussness were excluded. Patients were follow up in acute phase and pneumonia was diagnosed based on Center for Disease Control Criteria that were adopted by Indonesia Association of Lung Doctors.Results : In 30 acute stroke group patients with dysphagia who used nasogastric tube mean age is of 59 years old, 13(43.3%) females and 17(56.7%) males. While the other group who not do use nasogastric tube tube feeding were 30 acute stroke patients the mean age of 54 years old, 16(53.3%) males and 14(46.7%) females. There was no significant association with very weak correlation between Nasogastric tube usedwith pneumonia ( p=0591, r=0.063).Conclusion: Nasogastric Tube using does not have a significant with very weak correlation to the occurance of pneumonia. Keywords : nasogastric tube; pneumonia; dysphagia