????: Acute hepatitis

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• ???? ?????
• ??? ???

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????

• ????
• ???
• ??56?
• ???? 2012/10/2
• ???? Acute hepatitis
• ???? 28?
• ?? ????

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????

• ???????????????B???

?????????? (Ethambutol and Rifinah)
(1)?????(?????????????? ???? ????38.8C)?????????
(2)???????AST/ALT 1111/1253 ,????????,????,????
???????
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????
???????????? (?????2012/09/202012/09/27 )
(1)????B?????,??Lamivudine?? (2)????????????
(3)????????????????,???? ?????
(1)??????????,?????????? ???? (2)????????,????
,???????? ??
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????

• 1.Acute hepatitis ????
• 2.Viral hepatitis B ,chronic
• 3.Peptic ulcer disease
• 4.Gastritis
• 5.Toxic hepatitis
• 6.Progressive intrahepatic cholestasis
• 7.Tuberculosis of lung ,infiltrative
• 8.Bacteremia

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2012 / 10 / 04 ??

• ????
• ?????????????????????

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????
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• SOAP -I
• 2012/10/04

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2012/10/04 SOAP I

• Subjective
• 1.???????????????60-70 ,????
• ????? ?? ?? 1?? ??2?
• ??(1200) ??2? ???? 23 ???
• ??(1900) ????
• ??(2200) 34 ?(????????)
  ??(?????) ?1?
• 2.????????
• 3.??????????1??/????2?

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• Objective - Lab Data

??
Lab \ Date 09/27 09/28 09/30
Alb. 3.1 - -
T-Bil 24.4 22.6 22.8
AST 183 142 122
ALT 344 267 211
BUN 12.4 - -
CRE 1.0 - -
Na 128 133 133
K 5.7 4.0 3.3
Hb 12.7 - 11.2
?? 43 - -
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Objective anthropometry data

• ?? 171 cm
• ?? 57.5 kg
• BMI 19.7 kg/m2
• IBW 64.3 kg
• Estimated Energy needs?1800 Kcal(30 Kcal/kg/CBW)
• Estimated Protein needs?60 g (1 g/kg/CBW)

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Objective Energy

• Diet order????? - ? (??)

Energy (Kcal) Protein (g)
Oral 810 30
Parenteral 480 0
Total ( requirement) 1290 (71.6) 30 (50)
Estimated requirement 1800 60
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• Objective - Medication

?? ?? ??
Mosapride Citrate 1 tab ?????????????????,????????????
Esomeprazole Magnesium 1 tab ??????,????????????
Prochlorperazine Maleate 1 tab ??/?????/????????
Potassium Chloride 1 tab ??????
Phytonadione 10 mg (1amp) ???K???????????K??????
Dextrose and Electrolyte Solution (Taita No. 5 ) 1200mL (3 btl) ???????????????????????????
Lactulose 20mL ????????????????
Zolpidem Hemitartrate 1 tab ??
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• Assessment
• 1.?????????
• 2.???????
• 3.??????? (?50)
• 4.?????? (?71.6)

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• Plan
• ???????????
• 1.?????????
• 2.?????????
• 3.????(6-7?/?)
• 4.?? 60 g protein meal plan
• 5.???????

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• SOAP- II
• 2012/10/12

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2012/10/12 SOAP II

• Subjective
• 1.????
• ??? 1???? 3-6?
• ??? 1? ??? 0.5? ?? 1?(1EX)/? 1?
• ??(??/?? 2-3?)
• ??? 1? ??? 0.5? ?? 1?(1EX)/??
• ??(??/?? 2-3?)
• 2.????????????7-8?,???????????
• 3.???????????????(??????????)

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• Objective - Lab Data

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??
Lab\Date 10/04 10/08 10/09
CRP - 1.6 1.7
T-Bil 19.6 17.2 15.5
AST 96 82 74
ALT 130 - 78
BUN 10.0 9.8 11.1
CRE 0.8 0.8 0.9
Na 131 134 -
K 3.7 3.3 -
Hb - - 10.0
?? - 74 -
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Objective anthropometry data

• ?? 171 cm
• ?? 57.5 kg
• BMI 19.7 kg/m2
• IBW 64.3 kg
• Estimated Energy needs?1800 Kcal(30 Kcal/kg/CBW)
• Estimated Protein needs?50 g (0.8 g/kg/CBW)

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Objective - Energy

• Diet order????? - ? (??)

Energy (Kcal) Protein (g)
Oral 1200 40
Parenteral 160 0
Total ( requirement) 1360 (75) 40 (80)
Estimated requirement 1800 50
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• Objective Medication (??)

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?? ?? ??
Imipenem and Cilastatin Sodium 1000 mg (2 vial) ???????
Piperacillin Sodium and Tazobactam Sodium 3000mg (1.5 vial) ??????????
Ampicillin Sodium and Sulbactam Sodium 2000 mg (2 vial) ???-????
Lamivudine 1 tab ?B???????
Dextrose and Electrolyte Solution (Taita No. 5 ) 400mL (1btl) ???????????????????????????
Dimethicone 1 tab ??????????????
Acetaminophen 1 tab ?????
Ursodiol 2 tab ??????????
Esomeprazole Magnesium 1 tab ??????,????????????
Bisacodyl 1 pill ??????????????
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• Assessment
• Dietary compliance Fair
• 1.?????? (?75)
• 2.??????? (?80)

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• Plan
• ???????????
• 1.????????? 50g/?
• 2.?????????
• 3.????????????

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2012/10/18 ??

• ???????????10/12 ??,?????????????? , ???????????

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• SOAP -III
• 2012/10/25

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2012/10/25 SOAP- III

• Subjective
• 1. ????
• ???1??/??12? ??/??1-2?
• ????/???(??1??)1? ??1-2??
• ????/???(??1??)1? ??1-2??
• ??????1/3???
• 2. ???????????????????
• 3. ?????????????
• 4. ????????????????

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• Objective - Lab Data

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Lab.\Date 10/15 10/18 10/25
Alb. 2.5 - -
T-Bil 14.1 11.6 8.3
AST 88 77 56
ALT 59 43 29
BUN 11.8 15.0 15.2
CRE 0.8 0.8 0.7
Na 132 136 136
K 3.3 3.1 4.2
?? 46 57 72
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Objective - Energy

• Diet order????? - ? (??)

Energy (Kcal) Protein (g)
Oral 1115 36
Parenteral 0 0
Total ( requirement) 1115 (62) 36 (45)
Estimated requirement 1800 50
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• Objective Medication (??)

?? ?? ?? ??
Diphenidol HCl 1 tab PO ????,??
Spironolactone 1 tab PO ??????????????????
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• Assessment
• Dietary compliance Fair
• 1.?????? (?62)
• 2.??????? (?45)

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• Plan
• ??????
• 1.??????????
• 2.????????????
• 3.???????????(23?/?)
• 4.????????????

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10/29 ????????
Lab.\Date 10/29
T-Bil 7.3
AST 53
ALT 28
BUN 16.6
CRE 0.7
Na 135
K 4.3
?? 56
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11/9 ????

• 1.?????9?,???????????
• 2.???????????,????????
• 3.????3?
• 4.???????????????11.5?
• 5.????????
• ??1?????? ????13551445 Kcal
• ??12EX??3EX??2EX??1EX??46EX

1. ???????? ??????2-3?/? 2. ????????,????????????
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??

• Energy intake

????
35
??

• Protein intake

?????
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?? ??-1

• 1. ?????????????
• A (1) B?????
• (2) ????????????
• 2. ?????????????
• A????2??????????,????????,??????????6?????
• 3. ??1g / kg ??????????
• A ??,1 1.2 g / kg ????????????? ?????????0.6
  0.8 g / kg

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?? ??-2

• 4. ???????????????????????????,??????????????
• A ?????????????????,??????????,??????????????,???
  ???????
• 5. ?????????????????????
• A ????????????????????????,?????????????????,????
  ??????,?????????

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• ?????????,???????????????,???????????????????,????
  ?????,????????????????,??????????????????

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Thanks for your attention!