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Mekanisme terjadinya Asidosis Metabolik Di dalam Tubuh akibat bakteri
Asidosis metabolik merupakan gangguan klinis yang ditandai dengan peningkatan keasaman plasma, diikuti dengan penurunan tekanan parsiil CO2 di dalam arteri dan berhubungan dengan kondisi mengancam nyawa. Asidosis metabolik dapat juga diartikan sebagai penurunan ion hidrogen (H+). Asidosis metabolik bukan merupakan penyakit tetapi lebih kepada keadaan abnormal biokimia. Asidosis metabolik disebabkan antara lain oleh produksi asam yang terlalu banyak, berkurangnya ekskresi asam, atau hilangnya alkali tubuh. Pada analisa gas darah menunjukan pH kurang dari 7,35 dan serum bikarbonat (HCO3-) kurang dari 18 mRq/L. Tanda dan gejala asidosis metabolik tidaklah spesifik dan diagnosisnya berdasarkan hasil pemeriksaan laboratorium. Keterlambatan dalam diagnosis asidosis metabolik akan meningkatkan mortalitas dan mordibitas. Asidosis metabolik juga merupakan kompensasi terhadap peningkatan pCO2 dalam darah. Penyebab lainnya termasuk akumulasi keton dan asam laktat, gagal ginjal, konsumsi obat atau racun. Walaupun gejala dan tanda asidosis tidak spesifik, namun umumnya berupa mual dan muntah, lethargi, serta takipneu. Syok septik adalah suatu sindroma klinik dimana akhir-akhir ini sangat populer. Syok septik mempunyai angka mortalitas yang tinggi yaitu antara 40-90% (Bone, 1987). Sepsis sebagai komplikasi dari penyakit lain yang berat yaitu keganasan, sirhosis hati, diabetes, payah ginjal, pasien tirah baring lama, pasien yang mendapatkan pengobatan sitotoksik, serta pasien yang memakai kateter dan nasogastrictube. Syok septik juga disebabkan oleh infeksi bakteri batang gram negatif. Infeksi nasokomial adalah penyebab tingginya kejadian sepsis. Menurut Petersdorf (1991) dari seluruh pasien yang dirawat di RS 5% diantaranya terkena infeksi. Infeksi nasokomial yang sering ditemukan adalah kemih (40%), infeksi luka operasi (25%), infeksi saluran nafas (15%).
BAB II PEMBAHASAN
A. Kasus Wanita,
40 tahun datang ke IGD dengan keluhan sakit pinggang bawah, demam, mual, muntah, menggigil, pusing dan sesak nafas. Pasien menyatakan kalau kencing rasa panas (disuria). Dia juga mempunyai riwayat diabetes melitus yang tidak tergantung insulin tetapi menyangkal masalah medis lain. Hasil laboratorium menunjukkan hitung jumlah sel darah putih 20.000/mm2. hemoglobin dan hematokrit normal. Kadar glukosa darah 200 mg/dL dan kadar bikarbonat serum rendah. Hasil AGD menunjukkan pH darah arterial 7,28 dan diduga asidosis metabolik. Urinalisanya menunjukkan jumlah abnormal batang gram negatif.
B. Hubungan Klinis
Pasien ini mengalami syok septik, diawali dengan masuknya bakteri dengan adanya keadaan proses syok septik major, seperti pneumonitis, endokarditis. Agen pencetus (bakteri batang gram negatif-positif) diopsonisasi dan difagositosis yang melepaskan fragmen ke aliran darah yang mengandung eksotoksin (kandungan intrasel bakteri) atau endotoksin suatu makromolekul lipoprotein polisakarida (LPS) membran sel. Hal itu timbul karena fagolisosom fagositik mendegragasi sitoplasma dan bagian membran sel bakteri. Bila dikeluarkan pada darah, endotoksin mendorong pembentukan antibodi dan interaksi komplemen yang mendorong opsonisasi fragmen endotoksin sehingga sel retikuloendotel (RES) dapat menyerap untuk detoksifikasi infeksi yang terkait hipotensi atau tekanan darah rendah. (Sabiston, 1995) Penurunan tekanan darah kemudian mengarah ke kekurangan penyaluran sel darah merah dan oksigen ke berbagai jaringan tubuh. Maka, jaringan harus berubah dari metabolisme aerob ke metabolisme anaerob. Laktat menumpuk, menyebabkan asidemia. Pengobatan syok septik diawali dengan cairan intravena, karena tubuh relatif kekurangan volume cairan akibat vasodilatasi sebagai respon terhadap infeksi. Kadang-kadang, tekanan darah tetap rendah vasoaktif digunakan misalnya infus dopamin untuk menyebabkan vasokonstriksi dan karena itu meningkatkan tekanan darah. Antibiotik juga penting untuk mengobati infeksi. Akhirnya, kontrol dari sumber sepsis adalah penting. Ini dapat termasuk operasi untuk menyingkirkan usus yang abses atau nekrosis, atau menyingkirkan benda asing, atau sekedar debridement (mengeluarkan sisa jaringan terinfeksi). Jadi, syok septik diobati dengan mengatur tekanan darah, antibiotik dan pengawasan sumber penyakit. Bertambah parahnya asidemia dan penumpukan laktat merupakan tanda prognosis jelek dalam syok septik (Eugene, 2011).
C. Definisi Syok Septik
Definisi sepsis adalah kondisi kolaps vascular hebat dan berat akibat infeksi sistemik yang umumnya disebabkan oleh organisme gram-negatif. Bukti klinisnya berupa suhu tubuh yang abnormal (>38oC), takikardi, asidosis metabolik, dan peningkatan atau penurunan jumlah sel darah putih. Sepsis juga dapat disebabkan oleh infeksi virus atau jamur. Berkembangnya status syok yang berkaitan dengan infeksi diyakini berhubungan dengan pelepasan endotoksin dari dinding sel bakteri. Untuk alasan ini, secara umum syok septik mengacu pada syok endotoksin atau sederhananya syok toksik (Jan Tambayong, 2000). Sepsis tidak hanya terbatas pada darah, tapi dapat mempengaruhi seluruh tubuh, termasuk organ-organ. Sepsis yang berat disertai dengan satu atau lebih tanda disfungsi organ, hipotensi, atau hipoperfusi seperti menurunnya fungsi ginjal, hipoksemia, dan perubahan status mental. Syok septik merupakan sepsis dengan tekanan darah arteri<90 mmHg atau 40 mmHg di bawah tekanan darah normal pasien tersebut selama sekurang-kurangnya 1 jam meskipun telah dilakukan resusitasi cairan atau dibutuhkan vasopressor untuk mempertahankan agar tekanan darah sistolik tetap ≥90 mmHg atau tekanan arterial rata-rata ≥70 mmHg. Syok septis berasal dari berasal dari penyebaran dan perluasan yang mulanya terlokalisasi (misalnya abses, peritonitis, pneumonia) ke dalam aliran darah.



how to behave to neighbors by islam
How does Islam view against the life of society?
Coexistence
A.Tetangga and His position
1.kategori neighbors
In Islam there are only 2 neighbors categories: close neighbors and distant neighbors. It is, as the word of Allah SWT
".... And do good to the mother-father, dear relatives, orphans, the poor, neighbors close and far neighbors .... "(An-Nisa: 36)
In this verse clearly mentioned about the problems the neighbors category. As is the near and far there is nothing linking him to the place, kinship and are associated with the Muslim and not Muslim (translation of the Qur'an, the religion department RI, hlm.124)
Which is associated with the place, that is to say about the whereabouts of the .keberadaannya bias neighbor near the house, the neighborhood unit (RT), Pillars of citizens (RW), complex and village. But closer to home also must choose the neighbor which should take precedence, then according to the guidance Rasululloh SAW is triaging close to the door of his house. It is asked Aisha,
"Yes Rasululloh, I have two neighbors then told which one should be air-hadiyah? Replied the Prophet .... The closer to you the door .... "(HR.Bukhori)
Then that is associated with the relationship kkeluargaan close neighbor means it is a relative or family, while distant neighbors mean that not including siblings or family. Therefore, it could happen in a social environment, there are neighbors who still have family, or besan and unisex others. Thus the closer is that there is a family relationship than the lain.Sebagaimana Allah SWT states,
"Any wealth you spend let awarded to the father's mother, relatives, children, the poor and those who were on the way ..." (Qur'an, Al-Baqarah: 21)
As for who is associated with the Muslim and not Muslim means, is a close neighbor is a fellow Muslim. While distant neighbors are the ones who are not or non-Muslims. Because it could happen, in the neighborhoods there are religionists, both Muslims and different religions. Which is close to a religion course in accordance with the Word Rasululloh .This SAW
"A Muslim is the brother of another Muslim, because he did not molest his brother, not degrading derajatnyadan not consider trivial and contemptible." (Abu Dawud)
Thereby, a person who lived next door to sesame should be close to those who are not Muslims. Because the word, Allah SWT., "Surely every believer are brothers ...." (Al-Hujurat: 10)
They should prioritize the brother of the same religion (Islam) rather than a different religion (pagans). For Rasululloh SAW said,
"Not a person of faith you so love to his brother, as in love with himself." (HR.Bukhori, Muslim, Tirmidhi, and Nasa'i)
Neighbors 2.Kedudukan
Neighbors in the view of Islam has a glorious position as well as guests who come home. Rasululloh SAW said,
"Who would believe kepadaHari later, then do not disturb neighbors and anyone who believes in Allah and the Last Day, then it should honor his guests ......" (HR.Bukhori and Muslim)
Then the neighbor mentioned in this SAW Rasululloh word is they should not be disturbed and do good to them as honor guest. They are a measure of one's faith. Some neighbors glory are as follows:
a. As brothers and family
b. As Business Partners
c. As a companion in arms
d. As uswah
e. As fellow citizens
B. Rights and Responsibilities neighbors
Coexistence is part of the human nature and the laws. For nature, as in humans, as social beings, have kecenderunganuntuk friends, berkelompk-groups, and live together in one place or region. This is because the laws of Allah SWT says that means
"O mankind! We created you from a male and a female and made you nations and tribes that ye may know each other-know ...." (Al-Hujurat: 13)
But in life there are rights and obligations neighbors. Rights and obligations between the same neighboring one another. Only that distinguishes adalh in things that are special. In social life all have the same rights except in terms of faith., Worship, and religion are distinct and different. The rights of people who are in a neighboring one religion can not be equated with those of different religions, except in the case of community social activities. These differences matter Allah SWT, said:
"Comparison of the two groups (the infidels and the believers), such as the blind and the deaf and people who can see and hear. if the two groups were the same circumstances and nature? .... "(Hud: 24)
1.Hak and similar obligations
The same rights and obligations in the neighboring there are some hala especially that has been running, are as follows:
a. Mutual guard her honor and her family,
Everyone should maintain mutual self respect and family neighbor. Therefore, every Muslim in the neighboring prohibited meyakiti neighbors,
Rasululloh said:
"Anyone who believes in Allah and the Last Day do not like to hurt his neighbor" (HR.Bukhori, Ahmad, Abu Dawud and Ibn Majah)
b. Maintain mutual security of any disturbance.
Each neighbor must erusaha not to disturb each other are causing a sense of security themselves and their families disrupted. This sense of security is needed, not only about the preservation of property, but also related to the security of themselves and their families while their own homes.
On the need to maintain mutual security against property in this neighboring, Rasululloh SAW, said.,
"Anyone who takes an inch of land owned by others or neighbors, then Allah will be in on him with seven earth."
Then on the need to maintain a mutual sense of security to yourself and your family this neighbor, Rasululloh also besabda
"By Allah, no faith, no faith for the sake of Allah, Allah's sake do not believe. O Rasululloh Who? (who do not believe) people who are not describing the peace of the neighbors, by performing various kinds of noise and ugly deeds "(HR.Bukhori and Muslim)
c. Engage in mutual deliberation
Coexistence need to be invited to deliberation, ask for opinions and consideration. Rasululloh SAW said,
"Someone neighbors over the right to decide something useful and mudharatnya, come to feel of his property" (HR.Abu Dawud, Tirmidhi, Ibn Majah and Ahmad)
d. Assist in virtue and kindness
2.Hak and Liabilities different
Rights and obligations are different in neighboring especially between the sisters and fellow Muslims with non-Muslims, which deals with issues of aqidah and worship, among other things,
a. Pray for one another. In the case of pray this is only possible with fellow Muslims. With people of different faith and religion, it is forbidden to pray, even though their parents or family.
This was stated by a relatively Allah SWT. in firmnannya
"Is it not for the Prophet and the believers ask forgiveness (to Allah) for the idolaters, even though the polytheists were relatives (her), after obvious to them that they were idolaters, is dwellers hell . "(QS. At-Tauba: 113)
b. Being a witness. Only people who are believers and fellow Muslims alone can bear witness to its neighbors, such as the wedding ceremony. Allah SWT, berfiman "and people who really give testimony and those who keep their prayers." (Al-Ma'aarij: 33-34)
c. Take care of the bodies. When someone dies, then his neighbor and fellow Muslim faith have a right and an obligation to help take care of the bodies.
d. Married. It could happen neighborly married. In Islam is the faith and fellow Muslims alone were allowed to marry. This is in accordance with the word of Allah SWT; "... They were not kosher (married) for infidels and unbelievers are not kosher (married) also for them" (Al-Mumtahanah: 10)
e. Greet each other. Muslims are greeted each other when meeting, parting, entered, and left the house. Allah Almighty says "... And when you enter (a house) houses (it) be ye salute (its occupants)" (An-Nur: 61)
C.Akhlak neighbors
In neighboring course there are rights and obligations as well as bnayka encountered various problematic that appears. Rights and obligations should be accepted and fulfilled, then the problem of neighbors need to look for solutions and solving them. Islam is a religion that is perfect and complete this matter stated by Allah SWT. In his words, "... This day have I perfected for you your religion and I have both ends meet My favor unto you; and I ridha Islam as your religion" (Surah Al-Maidah: 3)
When the neighbor's attention lingkunggan by examining the arguments in the Qur'an al hadith, then some scholars divide the neighbors becoming five kinds
a. Neighbors are brothers and sisters or their own families and fellow Muslims
b. Neighbor is a friend and a fellow Muslim faith
c. Neighbors are brothers and not seagama
d. Neighbors others and fellow Muslims
e. Neighbors are other people and not seagama (Salim Abdullah, a Muslim Akhlaq, p 115-116)
1.Sikap
Morals in neighboring them in the form of attitudes and actions. Morals in the form shown in the attitude of good behavior towards its neighbors, including, among others, as follows:
a. Maintain a good relationship
b. Not being arrogant. Allah says, "Thou shalt not palingkan face of a human and that you do not walk on earth with sikapsombong and verily Allah does not love her the proud and arrogant. "(Luqman: 18)
c. Not hate and envy. Rasululloh SAW said: "Do not hate-hate and do not hasud (envy / jealousy) and the rear let-backs and jnganlah memutskan relationship (friendship). Be ye servants of Allah are brothers ... "(HR.Bukhori)
2.Perkataan
In addition to attitudes, morals neighbors also about words. meaning how to keep the words properly. Rasululloh SAW said "Anyone who believes in Allah and the Last Day should speak good or keep quiet ..." (HR.Bukhori and Muslim)
D.cara-way taught by the Prophet Muhammad in attitude to neighbors:
1. Do not hurt him with words or deeds
2. Do good to him
3. Help him if he asks for help
4. visit him when he was ill
5. Congratulate him if he is happy
6. comfort him if he got the unfortunate
7. Start a greeting for him
8. Say to him with gentle
9. Courtesy when talking to him
10. guide him to what is in it contained religious goodness and his world
11. Protecting the land area
12. Forgive mistakes
13. Do not peek at his private parts
14. Do not troubling with house building or running
15. Not to hurt the water that hits, or dirt dumped in front of his house
16. Be generous with giving kindness to him
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