DEMAM

Bagian Fisiologi
Fakultas Kedokteran
Universitas Muhammadiyah Purwokerto

Pendahuluan
Peningkatan suhu tubuh di atas rata2
variasi suhu tubuh yg normal
Suhu berasal dari: metabolisme tubuh
&
environment
Suhu oral dws normal 37ooC (38,6ooF),
atau bervariasi antara 37,2 37,7 ooC

Pendahuluan
<26,7 C : INDIVIDU TIDAK SADAR
< 35 C

: HIPOTERMI

< 36 C

: SUBNORMAL

35,9/36,5-37,2 (36-37,4) C : NORMAL

>41,1 C : HIPERTERMI/HIPERPIREKSIA
39-42 C : HIPERTERMI
MALIGNA/GANAS

 Hipertemia
menandakan
setiap
peningkatan suhu tubuh di atas
rentang yang dianggap normal
Demam biasanya digunakan untuk
peningkatan
suhu
tubuh
yang
disebabkan peningkatan titik patokan
hipotalamus oleh pirogen endogen
selama infeksi dan peradangan

TEMPAT PENGUKURAN
SUHU DIUKUR DENGAN TERMOMETER:
- AXILLA
- REKTUM
- VAGINA
- RONGGA MULUT (oral)
SUHU REKTAL/VAGINAL >0,5 ORAL >
AXILLA

Suhu tubuh diatur oleh hipotalamus

(thermoregulatory center)

Thermoregulator
y center

produksi panas
(otot, hepar)

dissipasi panas
(kulit, paru)

Normal body temperature homeostasis

37.5
T>37.5

hipotalamus

T<37.5

Heat production
heat loss
heat loss
Heat production

Normal

MAJOR THERMOREGULATORY
PATHWAYS I.
Skin temperature

Core temperature

Peripheral
thermoreceptors
(in skin)

Central thermoreceptors
( hypothalamus,other areas
of CNS & abdominal
organs)

Hypothalamic thermoregulatory
integrating center

MAJOR THERMOREGULATORY PATHWAYS II.

Hypothalamic thermoregulatory integrating center
Behavioral
adaptations

Control of
heat production
or loss

Motor
neurons

Sympathetic
nervous system

Sceletal
muscles

Skin
blood vessels

Skin
sweat glands

Muscle tone,
shivering

Skin
vasoconstriction,
vasodilataion

Sweating

Control of
heat loss

Control of
heat loss

Control of
heat
production

Sympathetic
nervous system

RESEPTOR
RESEPTOR
SENSITIF
SENSITIFPANAS
PANAS
(AREA
PRE
OPTTIK
(AREA PRE OPTTIK
HIPOT
HIPOTANTERIOR)
ANTERIOR)

ME OUTPUT SINYAL
Jika suhu meningkat
di atas suhu set point
(> 37,1 oC)

ME OUTPUT SINYAL
Jika suhu di bawah
suhu set point
(< 37,1 oC)

reseptor lainnya di
KULIT, SPINAL CORD &
ABDOMEN
impuls
HIPOTHALAMUS

Tipe peningkatan suhu tubuh

Fisiologis
Peningkatan
suhu tubuh

Demam
(T set-point )

(>0.5 C)

Patologis

Hipertermi
(T > set-point )

Demam
Pyrogens
Elevated set-point
Maintaining an abnormally elevated Temperature
BMR(basal metabolic rate) increases

= Elevated set-point

Hipertermi
overproduction
of heat

impediment in
heat loss

Passive increase of
body temperature
(>0.5 C)

T> setpoint

dysfunction of body
temperature center

PATHOGENESIS OF FEVER

 SITOKIN

 Peningkatan suhu tubuh akan

menyebabkan:
inhibisi s. simpatis vasodilatasi
pemb darah kulit & stimulasi kel
keringat evaporasi
Penurunan suhu tubuh menyebabkan:
aktivasi s. simpatis vasokonstriksi
& penghambatan keringat, produksi
panas
di
otot,
pelepasan
neurotransmitter peningkatan suhu
tubuh.

 reaksi fase akut suatu infeksi demam

pirogen yg dikeluarkan menyebabkan
perubahan pd set point
IL-1, 1, IL
6, IL-8, IL11, INF-,
INF-, TNF, TNF-

produksi

endo
gen

PIROGEN

Opsonisasi oleh
komplemen &
difagositer oleh
makrofag

ekso
gen

Endotoksin
(lipopolisak
arida) dari
bakteri
gram
negatif

JENIS-JENIS DEMAM
A. MENURUT KLINISNYA
B. MENURUT PENYEBABNYA
C. MENURUT LAMANYA

A. MENURUT KLINISNYA
1. DEMAM SEPTIK
- DEMAN SETIAP MALAM HARI
- TURUN PAGI HARI 2 C
- TIDAK SAMPAI NORMAL
- MENGGIGIL DAN KERINGAT
- KALAU TURUN SAMPAI NORMAL

DEMAM HEKTIK

GAMBAR DEMAM SEPTIK &

HEKTIK

2OC
SEPTIK

JAM

12

18

NORMAL

HEKTIK

2. REMITTEN FEVER
- SUHU TURUN SETIAP HARI
TIDAK SAMPAI NORMAL
- PERBEDAAN SUHU < 2 C

< 2 C

JAM 6

12

18 NORMA

3. INTERMITTEN FEVER :
- SUHU TURUN NORMAL SETIAP HARI
- VARIASI SUHU > 2 C
- BILA PEAK DAN NADIR BESAR HEKTIK
/SEPTIK

> 2 C

SUHU
JAM
6....

18

NORMAL

* DEMAM TERTIANA
- DEMAM INTERMITTEN
- HARI 1 & 3 DEMAM
- HARI KE 2 APIREKSIA/ NORMAL

SUHU
HARI

NORMAL

DEMAM KUARTANA
- DEMAM INTERMITTEN SETIAP
HARI 1 & 4
- HARI KE 2 & 3 NORMAL

SUHU
HARI

NORMAL

4. SUSTAINED FEVER (KONTINYU)

* SEPANJANG HARI TETAP DEMAM
* VARIASI SUHU < 1 C
* SUHU TURUN TIDAK SAMPAI NORMAL

< 1 C

NORMA

SUHU
JAM 6

12

18

5. RELAPSING FEVER = SIKLIK FEVER

* DEMAM BEBERAPA HARI
* NORMAL BEBERAPA HARI
* DEMAM LAGI BEBERAPA HARI
- MALARIA KUARTANA
- RELAPSING FEVER
- PENY. HODGKIN PEL-EBSTEIN
FEVER

NORMAL

SUHU
1

B. DEMAM MENURUT PENYEBABNYA

1. INFEKSI
2. PENY. KOLLAGEN
3. PENY. SSP
4. TUMOR GANAS
5. PENY. DARAH
6. PENY. KARDIOVASKULER

7. PENY. GASTROINTESTINAL
8. PENY. ENDOKRIN
9. TRAUMA FISIK
10. BAHAN-2 KIMIA
11. GGN BALANS CAIRAN
12. PSIKOGENIK
13. FAKSISI/FALSE FEVER/DEMAM PALSU
14. FUO (FEVER OF UNKNOWN ORIGIN)

C. DEMAM MENURUT LAMANYA :

1. DEMAM TRIVIAL : DEMAM 1-3 HARI,
- URINE.
2. DEMAM TANGGUNG: DEMAM 4-7 HARI;
- RUTIN
- MIKROBIOLOGIK
- SEROLOGIK.
3. DEMAM SERIUS: DEMAM LEBIH 7 HARI
- KIMIA DARAH - FOTO - BIOPSI
- IMUNOLOGI

- EKG

d. FUO = FOO (FEVER /PYREXIA OF

UNKNOWN / UNDETERMINATED
/UNDIAGNOSED/ OBSCURE ORIGIN= FEBRIS
ET CAUSA IGNOTA
- DEMAM >38,3 C
- LAMA DEMAM >3 MINGGU
- USAHA INTENSIF DI RS (RAWAT INAP) LEBIH
1 MINGGU
- DIAGNOSIS BELUM DITEGAKKAN

KAUSA FUO:
- 40% INFEKSI
- 20% NEOPLASMA
- 15% PENYAKIT JARINGAN IKAT
- SISANYA(25% BERBAGAI SEBAB
- 5-10% TETAP TIDAK DIKETAHUI

Heatstroke
Sun Stroke
Caused by overexposure to sun and extremely
high temperatures
occurs when the brain fails to control its own
"thermostat".
Its a life-threatening condition which can
cause a casualty to become unconscious
within minutes.
As well as an unusually high temperature, a
casualty may show signs of restlessness,
headaches and hot, flushed skin.
34

Heatstroke
Sun Stroke

The underlying cause of heat stroke is

connected to the sometimes sudden
inability to dissipate (To drive away) body
heat through perspiration, especially after
strenuous physical activity

35

Heatstroke
Sun Stroke

This accounts for the excessive rise in body

temperature.
It is the high fever which can cause permanent
damage to internal organs, and can result in
death if not treated immediately.

Recovery depends on heat duration and

intensity.

The goal of emergency treatment is 36to maintain

Predisposing factors
Increased heat production
- hyperthyroidism
- exercise
- sepsis
Impaired heat loss -Impaired sweating
Drugs
- anticholinergics, anti-Parkinsonian drugs,
anti-histamines, butyrophenones,
phenothiazines, tricyclics
Abnormal sweat glands
- sweat gland injury following acute heat
stroke, barbiturate poisoning
- cystic fibrosis
- healed thermal burn
salt and water depletion
- diuretic induced
37

 Others
- elderly
- high ambient temperature and
humidity, poor ventilation
- lack of acclimatization
- obesity
- fatigue
- DM
- malnutrition
- alcoholism

Clinical features
3

cardinal signs are:

CNS dysfunction
hyperpyrexia (core temperature >40 C)
hot dry skin. Pink or ashen depending on
circulatory state. However may be clammy
and sweat

39

 KOMPRES
DINGIN????????
KOMPRES
HANGAT????????

First Aid for Heatstroke

or Sunstroke

HEATSROKE IS LIFE THREATENING!

Remove victim to cooler location, out of the
sun
Loosen or remove clothing and immerse
victim in very cool water if possible
If immersion isn't possible, cool victim with
water, or wrap in wet sheets and fan for
quick evaporation
Use cold compresses-especially to the head &
neck area, also to armpits and groin41

42

Once in the hospital, an examination is

done, and blood tests are carried out to
assess the level of salts in the blood.

Treatment of heat stroke is usually carried

out in a critical care unit.
The body temperature is lowered by
sponging the body with tepid water or
loosely wrapping the person in a wet sheet
and placing him or her near a fan.
Intravenous fluids are given.
43

Pendekatan terhadap penderita dgn

demam

Pemeriksaan Fisis:
- Kronologi demam
& gejala/keluhan
yg mendahului
- Pengukuran suhu
oral/rektal

Pemeriksaan
sitokin dari
sirkulasi
Kadar C-reaktif
protein
Laju endap darah

Pendekata
n
diagnosis

Pemeriksaan Lab:
- CBC (complete blood
count)
- Hitung jenis sel, infeksi
virus netropenia

PEMERIKSAAN LABORATORIUM MENCARI

PENYEBAB DEMAM

1. PEM. DARA RUTIN 7 DARAH

FERIFER
2. KULTUR
3. SGOT/SGPT, ALKALI
FOSFATASE,
AMILASE
4. URINE
5. SUMSUM TULANG
6. TES IMUNOLOGIS: ASTO, C-RP,
ANA
7. DLL

PEMERIKSAAN-2 UNTUK FUO

SERO-IMUNOLOGI
-------------------------------------------------------------------------------------PENYEBAB
UJI SEROLGIK
PENYAKIT
VIRUS
PAUL BUNNEL
MONONUKLEO
SUS INFEKSIOSA
BAKTERI WIDAL
DEMAM TIFOID
ASTO
STAFLOKOKKUS
BETA HEMOLITIKUS
WR/VDRL
SIFILIS
LEPTOSPIRA Ab. LEPTOSPIROSIS
BRUCELLA Ab.
BRUCELLOSIS
PROTOZOA SABIN FELDMAN TOXOPLASPLASMOSIS
IDT
AMEBIASIS
HELMINTES IFAT
FILARIASIS
JAMUR
HISTOPLASMIN Ab. H.PLASMOSIS
MUKOPLASMIS Ab. MYCOPLASMOSIS
LAIN-LAIN
WEIL-FELIX
RICKETSIA
WESTERN BLOT HIV/AID

CARA & BANYAKNYA PANAS YG HILANG

JENIS
KEHILANGAN
KONDUKSI
KONVEKSI
EVAPORASI

RADIASI

CARA HILANG

PANAS TUBUH
YG HILANG

KONTAK
LANGSUNG

2%

- KE UDARA
- KE UAP AIR

10%

PENGUAPAN
KERINGAT

30%

GEL. ELEKTRO
MAGNETIK

65%

ANTIPIRETIK DAN ANALGESIK

Mekanisme
Mekanisme anti
anti piretik
piretik

Prinsip: menurunkan kadar PGE22 pd

pusat termoregulasi
Penghambatan enzim siklo oksigenase
(hambat asam arakhidonat PGE22)
Rejimen
Rejimen untuk
untuk menurunkan
menurunkan demam
demam

Tujuan : menurunkan set point demam pd

hipotalamus & memfasilitasi heat loss
Demam kebutuhan O2 meningkat (13
% setiap 1ooC) & memperburuk ggn
kardivask, paru & cerebrovaskular

 Asetaminofen relatif aman (aspirin &

NSAID trombosit / perdarahan GI)
Cooling blanket menurunkan suhu
tubuh ( dengan antipiretik)

OBAT AP/AG EF. SAMPING BIASA

OVERDOSIS
1. Aspirin
- Iritasai & perdarahan - Ulkus peptikum
Lambung
- Nekrosis papil ginjal
- Waktu perdahan
- Sefalgi, tinitus,
hiperventilasi
2. Salisil amid
3. Paracetamo
- Ruam kulit
- Nekrosis ginjal/hepar
- Trombositopeni
- Hepatitis kronik
4. Fenasetin
- Ruam kulit
- Akut: nek. tub. ginjal,
- Kronis: Anemia hemolitik, MetHb-emia
- Nefrotoksik
5. Metamisol
- Ruam kulit

6. Aminopirin

- ruam kulit

- karsinogenik

- nekrosis tubuler
7. Fenibutazol

- ggn sal. Cerna

- ruam kulit

- ulkus, perdrh/perporasi

- hepato/nefrotoksik
- ggn hematologik

8. oksifenbutazon - = fenilbutazon
9. mefenamat

- dispepsi

- ggn fgs hepar/ren

10. keto/ibuprofen - ggn sal. cerna

- sefalgia, vertigo
11. fenoprofen

- saluran cerna
- gejala SSP

- dispepsi

- ruam kulit

- sal. cerna
- SSP

Terimakasih
Terimakasih