Robert Sinto

Formal education

2008: dr. , Universitas Indonesia ;

2014: Sp.PD, Universitas Indonesia
2018: K-PTI, Universitas Indonesia
2021-now: PhD – DPhil ClinMed., University of Oxford, UK

Informal education
2015:
Clinical training on Transplant-Oncology-
Immunocompromised Host Infectious Diseases,
Singapore General Hospital, Singapore
2018-2021:
Clinical Epidemiology, Julius Centre UMC Utrecht,
University College of London and
Autonomous University of Barcelona

Workplace & Position

2016-now:
Department of Internal Medicine,
RS Cipto Mangunkusumo - FM Universitas Indonesia
2015-now:
Indonesian College of Internal Medicine (Officer)
2014-now:
The Indonesian Society of
Tropical Medicine and Infectious Diseases (Officer)
Strategic Diagnosis of Dengue and COVID-19

Robert Sinto
Division of Tropical and Infectious Diseases
Department of Internal Medicine
Faculty of Medicine Universitas Indonesia
Cipto Mangunkusumo National Hospital
Perbedaan & Persamaan gejala dari Dengue & COVID-19
Metode yang tepat untuk diagnosis Dengue atau COVID-19
Apakah pasien dapat terinfeksi Dengue & COVID-19
bersamaan ( co-infection ) ?
Tsheten et al. BMC Infectious Diseases (2021) 21:729
International Journal of Infectious Diseases 102 (2021) 152–154
 Bagaimana siklus Dengue & COVID -19 ?
( Apakah sama–samamemiliki fasekritis / sitokin )
 COVID-19:
A Clinical – Therapeutic Staging

Siddiqi HK, et al. The Journal of Heart and Lung Transplantation, 2020;39:405-7.
Bagaimana treatment untuk pasien tersebut saat di rumah
maupun di rumah sakit ?
What happen when you have a fever?

Increased Fluid loss

Metabolism through urine

Fever
Body temperature >37.5°C

Increased Fluid loss

Perspiration through lung

Fluid loss
through skin

When you have FEVER: not only lose water, but IONs inevitably lost as well
Metheny, NM. . Fluid and Electrolyte Balance Nursing Considerations. 4th Ed. Philadelphia: Lippincott. 2000. p 41-42.
Silbernagl, S. & Lang, F.. Color Atlas of Pathopgysiology. Stuttgart: Thieme. 2000.
Hall JE, Guyton AC. Guyton and Hall Textbook of Medical Physiology. Philadelphia, PA: Saunders Elsevier. 2011. p 867-77.
 Home Supportive Treatment

• Take adequate bed rest.

• Keep body temperature below 39 °C. If the temperature
goes beyond 39 °C, give the patient paracetamol.
• Tepid sponging of forehead, armpits and extremities.
A lukewarm shower or bath is recommended for
adults.
• Adequate intake of fluids (no plain water)

WHO SEARO. Comprehensive guidelines for prevention and control of dengue and DHF. 2011
Cairan apa yang disarankan untuk Home Supportive
Treatment, Dok ?
Berapa kebutuhan cairan per hari dan kapan pasien
membutuhkan terapi cairan berupa IV solution ?
 Fluid Oral Therapy Requirement

• Normal maintenance fluid per hour

(equivalent to Holliday-Segar formula):
– 100 mL/kg/h for first 10 kg body weight
– + 50 mL/kg/h for next 10 kg body weight
– + 20 mL/kg/h for subsequent kg body weight
OR: 1500 mL + (BW-20)x 20 mL/day
• Insensible water loss 2,5 mL/BW/day for each
increment of 1oC from 37oC.
WHO. Dengue: guidelines for diagnosis, treatment, prevention and control.2009
Guyton and Hall Textbook of Medical Physiology. 2011
 Indication for IV Fluid

• When the patient cannot have

adequate oral fluid intake or is
vomiting
• Impending shock/shock
• Dengue infection: when HCT
continues to rise 10%–20% despite
oral rehydration

WHO SEARO. Comprehensive guidelines for prevention and control of dengue and DHF. 2011
 Conclusions
• Dengue and COVID-19 infection shared
similar characteristics.
• Establishing diagnosis is the first
important step.
• Determination of fluid therapy choice,
amount and administration time are
important to be considered as supportive
treatment of fever.
 Conclusions
• Oral rehydration solution choice: fluids
(no plain water) such as isotonic
electrolyte solution, milk, fruit juice,
and barley/rice water.
• Amount: normal maintenance fluid per
hour + insensible water loss.
• Timing: caution for indication for IV fluid.