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Diare Akibat Susu

Gula atau karbohidrat

Dalam bahasa sehari-hari, kita mengenal istilah gula pasir, gula jawa, gula bit dan sebagainya. Dalam dunia kedokteran, yang dimaksud gula adalah karbohidrat. Dan istilah gula susu yang sering kita dengar berarti sejenis karbohidrat yang terdapat dalam susu.
Karbohidrat itu sendiri merupakan salah satu unsur gizi yang dibutuhkan tubuh dari makanannya di samping protein, lemak, vitamin, mineral dan air. Zat ini merupakan bahan bakar tubuh, karena dari zat ini kita mendapatkan energi datau tenaga untuk menjalankan aktivitas sehari-hari. Lebih dari 50 persen kalori yang didapat tubuh biasanya disediakan leh karbohidrat.
Ada berbagai macam karbohidrat, begitu juga dengan sumbernya. Seperti gula pasir yang sering kita gunakan termasuk dalam golongan karbohidrat yang disebut sukrosa. Sedang gula susu dikenal juga dengan laktosa.

Susu sebagai sumber laktosa

Air Susu Ibu (ASI) mengandung laktosa sebagai karbohidratnya. Demikian juga dengan susu sapi, susu kambing, dan susu dari hewan mamalia lainnya kecuali anjing laut. Susu formula atau susu botol dengan sendirinya juga mengandung laktosa.
Dari penelitian tersingkap bahwa kelenjar pankreas (yang menghasilkan enzim-enzim pencernaan) pada bayi baru lahir belum bekerja dengan sempurna. Akibatnya bayi baru lahir tidak dapat mencerna karbohidrat dari sumber lain seperti nasi. Di dalam jonjot-jonjot usus, terdapat enzim yang berfungsi memecah laktosa. Laktosa yang diminum bayi akan dipecah menjadi jenis gula yang lebih kecil molekulnya, yaitu glukosa dan galaktosa. Kedua gula inilah yang diserap usus masuk ke pembuluh darah dan kemudian diedarkan ke seluruh tubuh untuk digunakan sebagai bahan bakar.

Berkurangnya enzim laktase

Enzim laktase dalam usus bayi sudah terbentuk sejak janin. Kadar maksimal akan tercapai pada usia janin 6-7 bulan sampai bayi lahir. Bayi-bayi prematur atau bayi yang lahir dengan berat badan kurang dari 2500 gram, biasanya memiliki enzim laktase lebih kecil. Untuk kasus-kasus bayi dengan laktase kurang, mereka harus diberi makanan susu khusus.
Berkurangnya kadar enzim laktase di dalam jonjot-jonjot usus akan mengganggu kesehatan bayi. Pada penyakit diare misalnya, karena serangan kuman terjadilah kerusakan jonjot-jonjot. Kerusakan ini akan mengakibatkan jonjot-jonjot usus berkurang. Dan dengan sendirinya kadar enzim laktasepun akan berkurang.
Kemampuan seseorang untuk menangkal gangguan kesehatan akibat susu juga dipengaruhi oleh enzim laktase ini. Orang-orang kulit putih termasuk golongan yang tahan terhadap susu. Lain halnya dengan orang kulit berwarna seperti Asia, umumnya mereka tergolong yang tidak tahan susu. Pada orang kulit berwarna, kadar enzim laktase mereka umumnya menurun setelah berusia 3 tahun. Rendahnya enzim laktase ini pun tetap bertahan sampai dewasa. Lain halnya dengan orang kulit putih, mereka tetap dapat mempertahankan kada enzim laktase yang tinggi sampai mereka dewasa.
Berdasarkan teori, ketidakmampuan orang kulit berwarna memiliki enzim laktase rendah karena mereka tidak mendapatkan susu tambahan setelah mereka disapih. Akibatnya, tubuh mereka tidak dirangsang untuk cukup memproduksi enzim laktase. Dan karena terjadi setelah bertahun-tahun, dari generasi ke generasi, maka terjadilah perubahan genetik. Hasilnya, saat ini orang kulit berwarna akan sakit perut dan mencret kalau minum susu. Memang tidak semua orang, sebagian kecil orang kulit berwarna dapat tetap memiliki kadar enzim laktase tinggi. Walaupun kada enzim laktase di dalam tubuh rendah, sebagian besar dari kita masih dapat mengkonsumsi susu dengan toleransi baik. Asal, susu yang kita minum tidak terlalu banyak, misalnya hanya sekitar 200 sampai 400 cc sehari.
Penyakit kurang gizi (malnutrisi) juga dapat membuat anak tidak tahan susu. Sebab, dalam keadaan gizi buruk, jumlah jonjot usus berkurang. Akibatnya kadar enzim laktase pun berkurang.

Bahaya tidak tahan susu

Tidak tahan susu atau lebih sering intoleransi laktose diartikan sebagai gejala gangguan kesehatan berupa perut kembung, mencret, dan sakit perut kalau minum susu yang mengandung laktosa. Keadaan ini bisa saja menyerang semuaorang baik tua maupun muda seperti Ibu Vina dan bayinya. Kalau seorang bayi terserang diare, untuk sementara waktu ia tidak dapat menerima laktosa. Bila ia masih terus diberikan susu yang mengandung tinggi laktosa, maka mencretnya akan berlangsung terus. Padahal, laktosa yang tidak dapat dicerna usus tersebut merupakan makanan empuk bagi bakteri yang ada di dalam usus. Akibatnya, bakteri itupun akan berkembang baik.
Pada saat memanfaatkan laktosa tersebut, bakteri tidak menghabiskan seluruhnya. Tetapi terdapat sisa-sisa berupa asam-asam organik yang bersifat dapat menambah kerusakan jonjot-jonjot usus. Penambahan bakteri yang berlipat ganda ini pun akan membahayakan usus yang telah rusah tadi. Akibatnya diare pun akan berkepanjangan dan akan terjadi gangguan pencernaan dan penyerapan makanan. Pada akhirnya gangguan ini akan mempengaruhi tumbuh kembang anak.
Tidak semua bayi yang menderita diare akan tidak tahan susu atau laktosa. Biasanya dokter akan menentukan apakah perlu diganti susu yang didapat bayi. Kalaupun perlu, penggantian tersebut hanya bersifat sementara.

Diare dan susu khusus

Laktosa memang tidak sembarangan ada di dalam ASI atau susu formula kalau tidak ada keunggulannya. Keunggulan utama adalah dalam penyerapan mineral kalsium yang sangat dibutuhkan bayi untuk pertumbuhan tulangnya. Sebagian ahli juga berpendapat bahwa laktosa juga berguna dalam mematangkan susunan saraf pusat (otak) bayi, karena ia dibutuhkan dalam pembentukan sarung serabut saraf.
Walaupun laktosa sangat dibutuhkan oleh tubuh karena ketidakmampuan tubuh menerimanya terpaksa susu harus diganti dengan susu khusus. Tetapi susu ini juga bisa digunakan oleh penderita diare pada saat serangan saja, untuk kemudian kembali pada susu biasa. Hal ini mengingatkan laktosasangat dibutuhkan bayi. Komposisi susu khusus ini disesuaikan dengan keadaan penderita diare. Disesuaikan dengan berkurangnya laktase dalam tubuh penderita, maka jumlah laktosa tersebut dikurangi dan diganti dengan jenis karbohidrat lain atau jenis glukosa polimer. Bisa juga laktosa tersebut dihilangkan dan diganti dengan jenis glukosa lain.

Tiga golongan susu khusus untuk diare adalah:

Formula susu sapi rendah laktosa
Pada jenis susu ini kadar laktosa susu normal yaitu 7 gram/100 milimeter diturunkan menjadi kira-kira 1 gram/100 milimeter. Contoh susu : LLM dan Almiron


Formula susu sapi bebas laktosa
Laktosa yang ada pada susu dihilangkan dan diganti dengan gula lain. Contoh susu : Bebelac FL dan Pregetismil


Formula susu kedele
Formula ini terbuat dari kedele sehingga tidak mengandung susu sapi. Otomatis susu ini tidak mengandung laktosa.
Contoh: Nursoy, nutrisoya, dan Prosobee

oleh Agus Firmansyah at website Ikatan Dokter Anak Indonesia

PR: wait… I: wait… L: wait… LD: wait… I: wait… wait… C: wait… SD: wait…

Allergies

Almost everyone has allergies but of course no one wants them. Allergies run the gamut from minor annoyances to life threatening emergencies. But allergies all have one thing in common - they are the body's immune system overreacting to allergens - things that aren't a problem to most people most of the time.

Our immune system detects irritants, toxins and potentially infectious agents and works to protect us from them. With allergies, something the body has been exposed to triggers an inflammatory response. What happens within the body when sensitivity to an allergen has developed is quite complex. The bone marrow releases eosinophils, and many other cell types from the immune system are thrown into overdrive, creating an inflammatory cascade. The treatment of allergies is geared toward the management of symptoms by mediating the inflammatory response triggered by exposure to an allergen. Scientific breakthroughs concerning the immune system and the inflammatory response have helped bring to market many new drugs, bringing relief to millions of people around the world.

Once the body has developed sensitivity to an allergen, an allergic response is initiated every time you're exposed to it again. Airborne allergens like pollen trigger responses such as hay fever or seasonal allergies. Mold, dust and pet dander can trigger asthma attacks. Irritants like poison ivy or chemicals can trigger skin allergies. Many people, especially kids, have food allergies which can create such a dangerous reaction - anaphylactic shock - a true medical emergency. Insect stings are another potentially life threatening allergy.

The prevention of symptoms is the key to allergy control, and that means controlling the environment through vigilance against whatever allergens trigger an allergic response for you. The Allergies Learning Center offers multimedia information - video, expert articles, quizzes and much more to help you understand and manage allergies. Scientific breakthroughs concerning the immune system and the inflammatory response have helped bring to market many new drugs, bringing relief to millions of people around the world.

Bipolar Disorder

Definition
Bipolar disorder involves periods of excitability (mania) alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.


Causes, incidence, and risk factors
Bipolar disorder affects men and women equally. It usually appears between ages 15 - 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.
Bipolar disorder results from disturbances in the areas of the brain that regulate mood.
There are two primary types of bipolar disorder. People with bipolar disorder I have had at least one fully manic episode with periods of major depression. In the past, bipolar disorder I was called manic depression.
People with bipolar disorder II seldom experience full-fledged mania. Instead they experience periods of hypomania (elevated levels of energy and impulsiveness that are not as extreme as the symptoms of mania). These hypomanic periods alternate with episodes of major depression.
A mild form of bipolar disorder called cyclothymia involves periods of hypomania and mild depression, with less severe mood swings. People with bipolar disorder II or cyclothymia may be misdiagnosed as having depression alone.

Symptoms
The manic phase may last from days to months and can include the following symptoms:
Agitation or irritation
Elevated mood
Hyperactivity
Increased energy
Lack of self-control
Racing thoughts
Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)
Little need for sleep
Over-involvement in activities
Poor temper control
Reckless behavior
Binge eating, drinking, and/or drug use
Impaired judgment
Sexual promiscuity
Spending sprees
Tendency to be easily distracted
These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.
The depressed phase of both types of bipolar disorder involves very serious symptoms of major depression:
Difficulty concentrating, remembering, or making decisions
Eating disturbances
Loss of appetite and weight loss
Overeating and weight gain
Fatigue or listlessness
Feelings of worthlessness, hopelessness and/or guilt
Loss of self-esteem
Persistent sadness
Persistent thoughts of death
Sleep disturbances
Excessive sleepiness
Inability to sleep
Suicidal thoughts
Withdrawal from activities that were once enjoyed
Withdrawal from friends
There is a high risk of suicide with bipolar disorder. While in either phase, patients may abuse alcohol or other substances, which can worsen the symptoms.
Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur simultaneously or in quick succession in what is called a mixed state.


Signs and tests
A diagnosis of bipolar disorder involves consideration of many factors. The health care provider may do some or all of the following:
Ask about your family medical history, particularly whether anyone has or had bipolar disorder
Ask about your recent mood swings and for how long you've experienced them
Observe your behavior and mood
Perform a thorough examination to identify or rule out physical causes for the symptoms
Request laboratory tests to check for thyroid problems or drug levels
Speak with your family members to discuss their observations about your behavior
Take a medical history, including any medical problems you have and any medications you take
Note: Use of recreational drugs may be responsible for some symptoms, though this does not rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.

Treatment
For the manic phase of bipolar disorder, antipsychotic medications, lithium, and mood stabilizers are typically used. For the depressive phase, antidepressants are sometimes used, with or without the manic phase treatment.
There is very little long-term evidence suggesting that any medication has great success in the maintenance phase. However, in studies that followed patients for 2 years, lithium and some antipsychotics were found to be moderately successful.
Antipsychotic drugs can help a person who has lost touch with reality. Anti-anxiety drugs, such as benzodiazepines, may also help. The patient may need to stay in a hospital until his or her mood has stabilized and symptoms are under control.
Electroconvulsive therapy (ECT) may be used to treat bipolar disorder. ECT is a psychiatric treatment that uses an electrical current to cause a brief seizure of the central nervous system while the patient is under anesthesia. Studies have repeatedly found that ECT is the most effective treatment for depression that is not relieved with medications.
Getting enough sleep helps keep a stable mood in some patients. Psychotherapy may be a useful option during the depressive phase. Joining a support group may be particularly helpful for bipolar disorder patients and their loved ones.


Expectations (prognosis)
Mood-stabilizing medication can help control the symptoms of bipolar disorder. However, patients often need help and support to take medicine properly and to ensure that any episodes of mania and depression are treated as early as possible.
Some people stop taking the medication as soon as they feel better or because they want to experience the productivity and creativity associated with mania. Although these early
manic states may feel good, discontinuing medication may have very negative consequences.
Suicide is a very real risk during both mania and depression. Suicidal thoughts, ideas, and gestures in people with bipolar affective disorder require immediate emergency attention.

Complications
Stopping or improperly taking medication can cause your symptoms to come back, and lead to the following complications:
Alcohol and/or
drug abuse as a strategy to "self-medicate"
Personal relationships, work, and finances suffer
Suicidal thoughts and behaviors
This illness is challenging to treat. Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder.

Calling your health care provider
Call your health provider or an emergency number right way if:
You are having thoughts of death or suicide
You are experiencing severe symptoms of depression or mania
You have been diagnosed with bipolar disorder and your symptoms have returned or you are having any new symptoms

References
Moore DP, Jefferson JW. Bipolar disorder. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier;2004:chap 80.
Schiffer RB. Psychiatric disorders in medical practice. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 420.
Benazzi F. Bipolar disorder -- focus on bipolar II disorder and mixed depression. Lancet. 2007;369:935-945.
Morriss RK, Faizal MA, Jones AP, Williamson PR, Bolton C, McCarthy JP. Interventions for helping people recognise early signs of recurrence in bipolar disorder. Cochrane Database Syst Rev. 2007;24;(1):CD004854.
Sachs GS, Nierenberg AA, Calabrese JR, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007;356:1711-1722
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