A. Guntur H - jadeiisic2013 · Bagian Alergi-Imunologi dan Penyakit Tropik-Infeksi Bagian Ilmu Penyakit Dalam RSUD.Dr. Moewardi / FK. UNS. Surakarta Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI

A. Guntur H

Sub. Bagian Alergi-Imunologi dan Penyakit Tropik-Infeksi

Bagian Ilmu Penyakit Dalam RSUD.Dr. Moewardi / FK. UNS. Surakarta

Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta

INTRODUCTION

• Infection disease patients → Malnutrition

• Malnutrition → long time treatment & healing; mortality and morbidity

• Macronutrition-micronutrition: Supportif treatment


METABOLIC DISFUNCTION

• Critical infection ( CI ) may have problem of

metabolism : 10% - 20 % ( Harris -

Benedict).

• At CI : nutrition requirement increase up to

50 %.

• Glucose : Glucogenolysis and

Gluconeogenesis

• Increased Metabolism rate → CO2


• Lipid : increased Lipooxidation

• Protein : proteolitic muscle cell → body weight

loss; immune respons ; disparity of amino

acid profile ; plasma glutamin; decreasing

amino acid level.

• Vitamin rate decreased


Biological body response either innate or adaptive

immune system on exogenous agent to keep

homeostasis ;

1. to neutralize immunogen

2. to eliminate tissue damage

3. inhibiting excessive proliferations

IMMUNE RESPONS


Physical barrier Complement Innate NK cells Phagocytic cells - neutrophils - macrophages IMMUNITY Eosinophils Mast Cells

Humoral ( B cells) Specific CMI ( T cells)


Nutrition and Immune Function

Nutrients are required to help the immune

system meet the increased demand for

building blocks and energy during processes

such as :

regulation of biosynthesis (folate, iron, zinc,

magnesium),

cell signaling (calcium, sodium, potassium)

protection against damage (copper, zinc,

selenium, anitoxidants such as vitamin C dan E)

Redoxon Immune Cocktail Panel Meeting Consiederation for the Redoxon Immune Cocktail Clinical Trial – 20th July 2005


Nutrition and Immune Function

Micronutrients that have been demonstrated in human and animal

studies to be essential for an optimal immune response include :

essential amino acids,

linoleic acid,

vitamin A,

vitamin B6,

folic acid,

vitamin B12,

vitamin C,

vitamin E,

zinc, copper, iron and selenium.

Redoxon Immune Cocktail Panel Meeting Consiederation for the Redoxon Immune Cocktail Clinical Trial – 20th July 2005


Celluler Reconstruction

Celluler Protection

Co-Enzym Reaction – Signalling

VITAMIN


VITAMINS

Vit B1 (Thiamin)

The Importance of vitamins is used to :

- Carbohydrate Metabolism

- Increase the energy

- Improve the nerve function

- Reduce the burden of nerve function

- Metabolism regulator

- Strengthen heart muscle contraction

- Lactic Acid ↓


Siklus krebs atau siklus

asam sitrat atau siklus

asam trikarboksilat, terjadi

di mitokondria. Merupakan

mekanisme secara umum

yang melengkapi oksidasi

molekul-molekul bahan

bakar terutama acetyl

CoA, hasil dari dekar-

boksilasi oksidasi piruvat

dan tiamin pirofosfat

(TPP). Acetyl CoA masuk

dalam siklus dan akan

melewati sepuluh tahap

reaksi yang hasilnya

adalah energi (ATP) dan

CO2.

Di kutip dari : Mihardja, 2004 Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI RS Dr.Moewardi Surakarta

Neurologic & cardiovasculer disturbances :

periferal neuritis , sensoric disturbances.

depressive, fatigue, bad tempered, and altered ability to recall and concentration.

Improvement of lactic acid.

Muscle Strength → lower extremity and cardiac muscle paralysis

Epigastric pain and queasy

Lactic acid ↑

Vit. B1 ( Thiamin) supplement is needed

Insuffiency Conditions :


Vitamin B6 :

Pyridoxine, pyridoxal, and pyridoxamine

Pyridoxal amino acid decarboxylation

converse metionin become cystein

Decrease homosistinurea

Role with vit. B12 and folic acid


(Guntur, 2004)

Vit B12

Influence the enzymatic metabolism

Influence intracell purin & pirimidin (DNA) metabolism

Co-working with folic acid to ;

prevent anemia

Maintain myelin sheath function

Insuffiency conditions;

altered blood cell forming (eritrophoesis)

Neurologic disturbance : muscle pain

Damage of epithel cell in Gastro intestinal


FOLIC ACID

Metabolic functions :

PmGA

Purin Syntesis

Syntesis : Nukleotide pirimidin

Interconvertion : Homocystein methionin

Requirement :

Increase at : infection, anemia, ferocity ; CI

Definition of Folic :

Disturbance for nukleotida pirimidin Forming

DNA syntesis failure

Megaloblastic Anemia


THE ROLE OF FOLIC ACID

As Catalyst in purin nukleutide syntesis

Interconvertion amino acid; Serin → Glysin ;

histidin → glutamic acid ; homocystein →

methionin.

Homocystein → decrease Stress Cell

Pada CI , Infection disesase, anemia, cancer; folic

acid contents decrease → giving of acid folat

improve body condition

Folic acid - micronutrition ; as supportive therapy


ROLE OF FOLIC ACID

THF

5, 10-methylene THF

MTHFR

5-methyl THF

MS B12

Methionine

Homocysteine

Betaine

Cystathionine

CBS B6

SAH

SAM

Methyl

Transfer

Reactions

Guntur (2004)


HOMOCYSTEIN

• Endothel dysfunction

• Thrombocyte aggregation and fibrin

• Thrombosis

• Micro emboli


The FOLIC Requirement

Body Requirres 50 mcg folic daily, was used for :

The metabolism need more calories

Infection Disease

Anemia

Malignancy

Some reactions use single carbon :

1. To synthesize purin by forming Isonic Acid

2. To synthesize pyrimidin nucleutide

3. Amino Acid Interconversion

4. Glutamatic Acid

5. Homocystein with methionin (needed Vit. B12)


Vit. A, C and

E

• Protec barier membran,

• Increase IgA prevent to respirato track infecktion,

Activation macrophag

• Antioxidant

• Cell Wall protections

• May have potentiation effect with vitamin & mineral

• Increasing immune respons

• Increasing defens to viral infection


Zn : nucleic acid metabolism.

Protein Synthesis

Wound healing

Cell defense↑

Immune response ↑

Stimulatid to CD4

MINERAL


Selenium : Potentiation effect with vitamin E

Repairing cell wall

Co-enzyme in protein synthesis

Signaling to DNA repair selanometionin and cistein

Strong antioksidan

Selenium vit C and vit E using HIV treatmen

Fe (Ferrum) :

- Metabolic Neuron

- Oxydative Phosphorilation ATP

- Co-factor for Tirosin Hidroksilase, Triptofan

Hidroksilase – Metabolism : neurotransmiter,

RNA, DNA

- Metabolism rate Fe


Conclusion

More than 40% patients with former treatment, will

fall to severe malnutrition

Patients with critical condition (CI) will raise

metabolism energy counted 50 %.

By giving nutrition support adequadly to patient with

infection diseases & CI, can improve general

condition, reducing complications of infection,

mortality and prolong treatment.


CI with complex circumtances influence glucose

matabolism, lipid, protein and Vitamins.

micronutrient plays a role in purin & pirimidin

synthesis → DNA and cell regeneration

Vitamin B1, B6, B12 and Zn, Fe and Selenium, folic

acid able to repair the metabolism and function of

vascular endothels, by reducing serum homocystein

Vitamins plays role as mikronutrient and as

supportive treatment at infection diseases and CI.


A. Guntur H - jadeiisic2013 · Bagian Alergi-Imunologi dan Penyakit Tropik-Infeksi Bagian Ilmu Penyakit Dalam RSUD.Dr. Moewardi / FK. UNS. Surakarta Prof.DR.Dr.HA.Guntur Hermawan,SpPD-KPTI

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