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IntroductionDengue shock syndrome (DSS) fluid resuscitation by following the World Health Organization (WHO) guideline usually required large volumes of Ringer lactate (RL) that might induce secondary fluid overload. Our objective was to compare the effectiveness of the recommended volume of RL versus a smaller volume of a hypertonic sodium lactate solution (HSL) in children with DSS. The primary end point was to evaluate the effect of HSL on endothelial cell inflammation, assessed by soluble vascular cell adhesion molecule-1 (sVCAM-1) measurements. Secondarily, we considered the effectiveness of HSL in restoring hemodynamic fluid balance, acid–base status, and sodium and chloride balances, as well as in-hospital survival.MethodsA prospective randomized single-blind clinical trial including 50 DSS children was conducted in the Pediatrics Department of Hasan Sadikin Hospital, Bandung, Indonesia. Only pediatric patients (2 to 14 years old) fulfilling the WHO criteria for DSS and new to resuscitation treatments were eligible. Patients were resuscitated with either HSL (5 ml/kg/BW in 15 minutes followed by 1 ml/kg/BW/h for 12 hours), or RL (20 ml/kg/BW in 15 minutes followed by decreasing doses of 10, 7, 5, and 3 ml/kg BW/h for 12 hours).ResultsIn total, 50 patients were randomized and included in outcome and adverse-event analysis; 46 patients (8.2 ± 0.5 years; 24.9 ± 1.9 kg; mean ± SEM) completed the protocol and were fully analyzed (24 and 22 subjects in the HSL and RL groups, respectively). Baseline (prebolus) data were similar in both groups. Hemodynamic recovery, plasma expansion, clinical outcome, and survival rate were not significantly different in the two groups, whereas fluid accumulation was one third lower in the HSL than in the RL group. Moreover, HSL was responsible for a partial recovery from endothelial dysfunction, as indicated by the significant decrease in sVCAM-1.ConclusionSimilar hemodynamic shock recovery and plasma expansion were achieved in both groups despite much lower fluid intake and fluid accumulation in the HSL group.Trial RegistrationClinicalTrials.gov NCT00966628. Registered 26 August 2009.

Masalah gizi yang paling umum dialami oleh ibu hamil adalah Kurang Energi Kronis (KEK). Program Pemberian Makanan Tambahan Pemulihan (PMT-P) diadakan untuk mengatasi masalah KEK, faktanya belum memberikan hasil sesuai harapan. Penelitian bertujuan mengetahui perbedaan asupan energi dan protein setelah program PMT-P terhadap keberhasilan perbaikan status gizi ibu hamil. Rancangan penelitian adalah mixed method dengan strategi triangulasi konkuren. Teknik pengambilan sampel penelitian kuantitatif adalah consecutive sampling, dengan responden 47 ibu hamil KEK. Partisipan penelitian kualitatif diambil secara purposive sampling. Analisis data kuantitatif diolah dengan uji Mann-Whitney. Hasil penelitian menunjukkan bahwa program PMT-P pada ibu hamil KEK hanya mampu memperbaiki status gizi menjadi normal sebesar 13%. Asupan energi dan protein ibu hamil KEK setelah program PMT-P mampu mengubah status gizi menjadi normal sebesar 20%. Tidak terdapat perbedaan asupan energi dan protein setelah program PMT-P terhadap status gizi ibu hamil KEK dan normal (p>0,05). Penyebab ibu hamil KEK tidak mengalami perubahan status gizi setelah program PMT-P adalah pola makan, konsumsi makanan, status ekonomi, status kesehatan dan faktor internal yang meliputi pekerjaan dan pengetahuan.Simpulan penelitian ini adalah program PMT-P belum memberikan hasil sesuai harapan, ditandai dengan sedikitnya jumlah ibu hamil KEK yang mengalami perubahan status gizi menjadi normal. Terdapat faktor-faktor lain yang mempengaruhi perbaikan status gizi ibu hamil KEK seperti pola makan, konsumsi makanan, status ekonomi, status kesehatan dan faktor internal yang meliputi pekerjaan dan pengetahuan. Hal yang dilakukan adalah dengan meningkatkan pengetahuan gizi seimbang ibu hamil melalui penyuluhan.