Krisis Hiperglikemia

7/17/2019 Krisis Hiperglikemia

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KRISISHIPERGLIKEMI

PENYUSUN:

BENEDICTUS YUDHA B.

ENISA NUR AMALIA

PEMBIMBING: DR. SURYANTO, SP.EM



DIABETES MELITUS

Kriteria Diagnoa

1. Gejala klasik DM + GDA 200 mg/dL

ATAU

2. Gejala klasik DM

+

GDP 126 mg/dL dengan puasa 8 jam

ATAU

3. 2 jam PP TTG 200 mg/dL

TTG dengan !e!an "# g gluk$sa

PAPDI, !""#



KOMPLIKASIAKUT

%&'('()'P*&GL'%

*M'

%AD

))(

HIPOGLIKEMI



KRISIS HIPERGLIKEMI

$. Dia%eti& Ketoa&i'oi

!. H()ero*o+ar ()erg+(&e*i& tate

DKA %an(a-

tera'i )a'a/ia */'a 012 ta/n

Morta+ita)a'a -rii

i)erg+i-e*iter/ta*a

tera'i -arena)en(a-it)en&et/

(ang*en(ertai.

HHS %an(a-tera'i )a'a

/ia t/a 3 12ta/n

Onet DKA

'a+a* a*ingga arie'ang-anHHS ariingga*ingg/

U)to'ate, !"$2



!45 )en'eritaDKA a'a+a)aien DM ti)e

$.

Prognoi %/r/-)a'a )aien

/ia t/a (ang*enga+a*i

-o*a,i)oteni, 'an

)en(a-it)en(erta (ang

)ara.

Morta+ita )a'aHHS 3 DKA

A%%a et a+, !""#



6AKTOR PENCETUS

• In7e-i 8!"9 ;"9< = Par/ 'an tra-t/ /rinari/

• C>A

• M(o&ar'ia+ in7ar&tion

• Pan&reatiti

• Pe*%erian in/+in (ang ti'a- a'e-/at 'an %erenti -on/*iin/+in.

•

Dr/g 8teroi', (*)ato*i*eti&, tia?i'e<

ADA, !""#



DIABETIC KETOACIDOSIS

• Tria DKA :

$. Ketone*ia 8-etoi<

!. Hi)erg+i-e*ia5. A&i'e*ia

• Biaan(a DKA 'iin'i-ai-an, %a-an /nt/- *en'iagnoi)en'erita DM ti)e $, na*/n ter'a)at )ening-atan -a/ )a'a

DM ti)e ! (ang ter%/-ti ter'a)at -eton 8-etoi< 'ie%/t /gaketosis-prone diabetes mellitus.

ADA, !""#



HYPEROSMOLAR HYPERGLYCEMIC STATE

Di'a)at-an :

@ Hi)oo+e*ia@ Hi)erg+i-e*ia 831""*g4'L< anpa 'iertai i)er-etone*iaigni-an 80 5 **o+4L< ata/ ai'oi 8)H3,5, %i-ar%onat 3$2**o+4L<

@ Hi)ero*o+a+ita 3 5!" *O*4-g

ADA, !""#



PATOGENESIS

ADA, !""#



DIAGNOSIS

$. ANAMNESIS

!. PEMERIKSAAN 6ISIK

5. PEMERIKSAAN PENUNANG

ADA, !""#



Anamnesis 'i'a)at-an :

$. Po+i/ria

!. Po+i'i)i

5. eigt +o

;. Dei'rai

2. Tan'atan'a in7e-i4 7a-tor )en&et/

1. Per/%aan -ea'aran

. RiFa(at )engo%atan

. RiFa(at -e+/arga

Peme,iksaan -isik 'i'a)at-an :

#. T/rgor -/+it *en/r/n

$". Re)irai -/*a/+ 8DKA<

$$. Ta-i-ar'ia

$!. Hi)oteni

$5. Per/%aan -ea'aran 8+etargi ingga -o*a<

$;. Tan'a ne/ro+ogi 7o-a+ 'an -eang )a'a HHS

$2. M/a+, */nta, 'i7/e a%'o*ina+ )ain %an(a- 'ite*/-an )a'a )aien DKA 832"9<.ADA, !""#



Peme,iksaan Penunjang• Ka'ar g/+a 'ara

• Keton er/* 'an -eton /rine• E+e-tro+it er/*, o*o+a+ita, anion ga)

• BGA

• B+oo' /rea nitrogen4&reatinine

• Urina+(i

• Dara +eng-a)

• EKG

• K/+t/r %a-teri /rine, 'ara, ata/ tenggoro-.

• 6oto tora

ADA, !""#



KRITERIA DIAGNOSA

DKA HHS

Mi+' Mo'erate Seere

P+a*a g+/&oe8*g4'+<

Arteria+ )H

Ser/* %i&ar%onate

8*E4+<

Urine -etone

Ser/* -eton

EJe&tie er/*o*o+a+it(

8*o*4-g<

Anion ga)

A+teration in enoriaan' *enta+

3 !2"

.!2.5"

$2$

8<

8<

>aria%+e

3 $"

A+ert

3 !2"

."".!;

$" to $2

8<

8<

>aria%+e

3 $!A+ert4'roF(

3 !2"

0 .""

0 $"

8<

8<

>aria%+e

3$!St/)or4&o*a

3 1""

3 .5"

3 $

S*a++

S*a++

35!"

>aria%+eSt/)or4&o*a

Ani$n gap a+ l + )3 m*4/l.

sm$lali5 2a+ glu$se 18

ADA, !""#



DI66ERENTIAL DIAGNOSIS

Tintina++i EM t E', !"$$



MANAEMEN KAD DAN HHS

ADA, !""#



MONITORING

• G/+a 'ara )eri7er 8tia) a*<

• E+e-tro+it er/* 'an %i-ar%onat 8! a* )erta*a<

• Pro'/-i Urin

• Te-anan 'ara 4 Na'i

• Kea'aran

ADA, !""#



PEMELIHARAAN

• Pertaan-an g+/-oa er/* $2"!"" *g4'L ingga -ontro+ *eta%o+i-ter&a)ai

• Ce- e+e-tro+t, BUN, PH 'ara, -reatinin, 'an g+/-oa etia) !; a*

ingga )aien ta%i+• Sete+a reo+/i DKA ata/ HHS 'an -eti-a )aien /'a *a*)/ /nt/-

*a-an, */+ai+a regi*en in/+in */+ti'oe SC

• Unt/- *eng/%a 'ari I> -e SC, teta) +an/t-an in7/ in/+in $! a*ete+a in/+in SC /nt/- *e*ati-an +ee+ in/+in )+a*a /'a a'e-/at

• Pa'a )aien (ang %e+/* )erna *en'a)at-an tera)i in/+in , 'i*/+ai

'ari ".2 U4-g ingga ". U4-gBB4ari 'an tent/-an 'oi in/+in e/ai-e)er+/an

• Teta) &ari 7a-tor )en&et/

ADA, !""#



KRITERIA RESOLUSI DKA

$. G+/-oa 'ara 0 !"" *g4'L

!. )H 3 .5 /nit

5. Bi-ar%onat 3 $." **o+4L




KOMPLIKASI KAD




KOMPLIKASI HHS

• Hi)og+i-e*ia

• Hi)o-a+e*ia

• P/+*onar( e'e*a

GraJeo, !"$$



LAPORAN KASUS



IDENTITAS

• Na*a : N(. S

• eni Ke+a*in : anita

• Uia : ! ta/n

• No. Regiter : $$!2

• A+a*at : Singoari, Ma+ang

Datang -e IGD RSSA )a'a tangga+ !1 Ag/t/ !"$2 )/-/+ $.5"IB



PRIMARY SUR>EY

A : Paten, /ara na7a ta*%aan 8snoring, gargling, stridor < 8<.

B : E-)ani 'a'a i*etri, RR 55 4*enit, reg/+ar, &e)at 'an 'a+a*, retra-i

'in'ing 'a'a 8<.

C : TD: $51415 **Hg, Na'i : $!$4*enit, -/at, reg/+ar, a-ra+ angat 'an

-ering, CRT 0 ! 'eti-

D : GCS 5!;, ree- &aa(a 4, )/)i+ %/+at io-or 5** 4 5**

E : S// a-i+a 5#"

C

Pasien masuk ,iage P 1



INITIAL TREATMENT

•

A : • B : O! ia NRBM $" +)*

• C : I> +ine NaC+ ",#9 !" &&4-gBB4 a*

• D :



ANAMNESIS 8HETEROANAMNESIS<

• Ke+/an /ta*a: Ti'a- a'ar

Paien 'i%aFa -e IGD 'engan -e+/an ti'a- a'ar ea- $! a* SMRS. AFa+n(a )aien ti'/r teta)i /+it 'i%ang/n-an, /+it

'iaa- -o*/ni-ai.

Paien an(a %er%aring 'i te*)at ti'/r ea- 2 ari *r-arena ti'a- %ia a-tiita 'an +e*a. Paien /ga *e*i+i-i +/-a'i%agian )antat, +/-a e)erti +e&et, -/+it ter-e+/)a, nana 8<.Paien /ga *e*i+i-i +/-a 'i -a-i -anan ea- $ *ingg/ SMRS,

aFa+n(a e)erti *e+e)/, %eng-a-, n(eri 8< 'an e+an/tn(a 2ari -e*/'ian */n&/+ +/-a -eita*an 'i -a-i t%, nana 8<,-e+/ar &airan 'ara 'an %er%a/.

Paien /ga 'i-e+/-an 'e*a* ea- 2 ari SMRS, 'e*a*tinggi 'iertai *enggigi+. Bat/- 8<, */a+ */nta 8< $ -a+i.



• RiFa(at Pen(a-it Da/+/

Paien *e*i+i-i riFa(at DM ea- ta/n !"", ti'a- ter-ontro+.

Paien *e*i+i-i riFa(at i)erteni (ang ti'a- ter-ontro+ 8$"4$$"<.

an/ari !"$2 )aien 'iraFat 'i RSUD LaFang -arena */a+ */nta 'an g/+a'ara ren'a.

• RiFa(at Pen(a-it Ke+/arga

DM 8< HT 8<

• RiFa(at Pengo%atanUnt/- )en(a-it DM )aien %iaa -on/*ig+i%en&+a*i'e $2 *g.



(*DA&7 (U&*7

Kea'aan /*/*: ta*)a- a-it %eratGCS 5!;

B 1" -g Heigt $1" &*BMI !5.; -g4*!

BP Q $5115 **Hg

PR Q $!$4*enit, reg/+ar, -/at RR Q 55 4*enit, reg/+ar,&e)at 'an 'a+a*

Ta : 5#"C

Hea' Con/&tia ane*i& 8<S&+era i&teri& 8<

P/)i+ io-or 545**

Ne&- >P R " &* H!", 5""

)oition Lnn. En+arge*ent 8<

ToraCor I&t/ inii%+e )a+)a%+e at ICS > MCL S , RHM SL D, LHM i&t/ . S$ S! reg/+ar, */r*/r 8<, ga++o) 8<

P/+*o Si*etri Ste* 7re*it/ DQS Sonor % % R

% %

% %

A%'o*en 6+at, oe, BoFe+ So/n' N, +ier )an &*. Tra/%e )a&e ti*)ani, Si7ting '/++ne

Etre*itie E'e*a A-ra+ angat -ering

U+-/ )e'i 'etra 1; &*, )/ 8<, 'aar ten'on.CRT0! 'eti-

P/ngg/ng U+-/, Ø 5 cm

PEMERIKSAAN 6ISIK



La% >a+/e La% >a+/e

Le/-oit !".;"" ;.5""$".5""4VL GDS ;"$ 0!"" *g4'+

He*og+o%in $$,1" $$,;$2,$ g4'L Ka+i/* ," ,1$$," *g4'L

Tro*%oit 55!.""" $;!.""";!;."""4VL

Po)or 5,! !,;,2 *g4'L

MC> ;,; " #5 7L Natri/* $21 $51$;2 **o+4L

MCH !2,$" ! 5$ )g Ka+i/* 5,$ 5,22," **o+4L

MCHC !#," 5! 51 g4'L K+ori'a $52 #$"1 **o+4L

DiJ &o/nt "4",$4#,;4;,142,#

";4"$42$14!2554!2

O*o+arita 555,; !"!#2 *O*4KgH!O

Ure/* !2," $1,1;,2 *g4'L Anion ga) ,2 $1 **o+

Kreatinin 5,"# 0 $,! *g4'L Aa* +a-tat !,2 >ena: ",2!,!Arteri: ",2$,1

PEMERIKSAAN LABORATORIUM



La! alue

)H ,!2 ,52,;2

)CO! !,2 52;2 **Hg

)O! $;!,$ "$"" **Hg

HCO5 $!,2 !$! **o+4L

BE $2," 85< 85<

Sat O! #,9 3#2

Kei*)/+an :

BLOOD GAS ANALYSIS



URINALISIS

Re/+t Re/+t

SG $."!2 $"W

PH 2,2 E)ite+ia !,1

Le/&o&(te 5 C(+in'er

Nitrite H(a+ine

Protein ! Gran/+ar

G+/&oe ;" W

Er(tro&(te $ Eritroit !;#,

Denit( Ker/ E/*or- Poiti7 Keton /rine Di*or-

Uro%i+inogen Le/-o&(te 2!2,2

Bi+ir/%in Cr(ta+

Ba&teria 12$,5

W$"5

arna

K/ning



6OTO THORAW



EKG



HYPERKALEMIA

ECG &ange in H()er-a+e*ia:



PENATALAKSANAAN

• O! $" +)* ia NRBM

• I>6D NaC+ ",#9 !" &&4-gBB4 a*

• Dri) KCL !2 *e

• In in/+in 2 i/ i

• Dri) in/+in 2 i/4a*

• In. Ci)rooa&in !"" *g i

•

In. O*e)ra?o+e ;" *g i• In. Meto&+o)ra*i'e $" *g i



DIAGNOSIS KERA

$. Krii Hi)erg+i-e*ia 't KAD

!. Se)i 't /+-/ )e'i initra



PEMBAHASAN



DKA HHS

Mi+' Mo'erate Seere

P+a*a g+/&oe8*g4'+<

Arteria+ )H

Ser/* %i&ar%onate

8*E4+<Urine -etone

Ser/* -eton

EJe&tie er/*o*o+a+it(

8*o*4-g<

Anion ga)

A+teration in enoriaan' *enta+

3 !2"

.!2.5"

$2$

8<

8<

>aria%+e

3 $"

A+ert

3 !2"

."".!;

$" to $2

8<

8<

>aria%+e

3 $!A+ert4'roF(

3 !2"

0 .""

0 $"

8<

8<

>aria%+e

3$!St/)or4&o*a

3 1""

3 .5"

3 $

S*a++

S*a++

35!"

>aria%+eSt/)or4&o*a

8ADA, !""#<



KESIMPULAN



KESIMPULAN

DKA *er/)a-an -o*)+i-ai a-/t (ang ering 'ite*/-an)a'a DM ti)e $.

Ko*)+i-ai ini /ga 'ie%a%-an o+e %e%era)a 7a-tor)en&et/ (ang ter%an(a- a'a+a -arena in7e-i 'an

)engg/naan in/+in (ang ti'a- a'e-/at.

Ana*nea, )e*eri-aan i-, 'an )e*eri-aan)en/nang (ang %ai- 'a)at *enega--an 'iagnoa

'engan te)at )a'a DKA 'an DKA 'a)at egera 'itangani'engan tera)i &airan (ang agrei7 /nt/- tata+a-ana

aFa+ )a'a triae.

DKA 'an HHS 'a)at 'i%e'a-an *e+a+/i )e*eri-aan

)en/nang 'engan *ei+at ai+ BGA, Ser/* e+e-tro+it8o*o+a+ita<, 'an /rina+ii 8-eton<.

Ko*)+i-ai (ang *en(e%a%-an *orta+ita 'ie%%a-ano+e 7a-tor )en&et/n(a, e)erti in7e-i 'an *(o&ar'

in7ar&t. Se+ain it/ )a'a /ia t/a, *e*i+i-i )en(a-it gina+ata/ ant/ng, 'an -o*a *ening-at-an *or%i'ita



TERIMA KASIH



AGNER GRADING SYSTEM 6OR DIABETIC

6OOT IN6ECTION

" Inta&t S-in

$ /)er&ia+ /+&er o7 -in or /%&/taneo/ ti/e! /+&er eten' into ten'on, %one, or &a)/+e

5 'ee) /+&er Fit oteo*(e+iti or a%&e

; Gangrene o7 toe or 7ore7oot

2 Mi'7oot or in'7oot gangrene

Documents

Krisis Hiperglikemia