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DIABETIKUM
dr. Rima Rizqi Meltahayati
RPK :
Riwayat Diabetes melitus (-)
Riwayat Hipertensi (-)
Riwayat penyakit jantung (-)
Riwayat hiperlipidemia (-)
PEMERIKSAAN FISIK
Keadaan umum : Tampak sakit sedang, kesadaran Somnolen
Tanda vital : TD 90/60 mmHg RR 35 x/menit
N 110 x/menit S 37C
Status Generalis
Kepala : Mata conjunctiva anemis -/-, sklera ikterik -/-,
pupil bulat isokor, reflex cahaya +/+
Leher : KGB tidak teraba membesar
Jantung : BJ murni S1=S2, regular, murmur (-), gallop (-)
Paru : B/P simetris, VBS +/+ kanan=kiri, Rh -/-, Wh -/-
Abdomen : Datar, supel, BU (+) normal
Ekstremitas : Akral dingin, edema -/-
PEMERIKSAAN PENUNJANG
Tanggal Pemeriksaan Hasil Nilai Rujukan
23 Mar 2017 (00.27) Hb 15,5 gr/dl (L) 11,7-15,5
Ht 49,3 % (L) 36-47
Leukosit 16050/L 4000-11000
Trombosit 299000/L 154000-386000
Hitung Jenis
-Basofil 0,1 % 0,0-1,0
-Eosinofil 0,0 % 2,0-4,0
-Netrofil segmen 78,7 % 50,0-70,0
- Limfosit 11,5 % 25,0-40,0
- Monosit 9,7 % 2,0-8,0
SGOT 25 0 31
SGPT 25 0 32
PEMERIKSAAN PENUNJANG
Pemeriksaan Hasil Hasil
23 Mar 2017 (02.42) 23 Mar 2017 (22.24)
Ur 17
Cr 0,7
Ph 6,83 7,14
P Co2 12 21
P o2 128 215
BE -31,2 -20,0
HCO3 2,0 7,1
sO2 99 99
Laktat 1,4 1,1
Na 132
K 4,5
CL 104
Ca2++ 1,24
Pemeriksaan Urinalisa Hasil
26 Mar 2017 (12.44)
Makroskopis
Warna Kuning
Kejernihan Keruh
Rutin Urin
Glukosa +4
Bilirubin -
Keton Trace
Berat jenis 1,010
pH 6,5
Protein +1
Urobilinogen 0,1
Nitrit -
Blood +2
Leukosit +2
Sedimen
Sel epitel +1
Leukosit 9-10
Eritrosit 24-26
Silinder -
Kristal -
Jamur -
Bakteria -
Rontgen Thorax
Kesan :
-Tidak tampak kelainan radiologis
pada jantung dan paru
- Skoliosis thorakalis ke kanan
DIAGNOSIS KERJA
Ketoasidosis Metabolik
DM Tipe I
TATALAKSANA
- O2 NRM 10 lpm Konsul dr. Erwindo Sp.PD :
- IVFD Nacl 0,9% 250cc - Loading NaCl 4 Kolf
- OMZ 1 amp - Novorapid bolus 10 unit IV
- Ondancentron 4 mg - Metronidazol 3 x 500 mg
- PCT tab 3 x 500 mg - Aspar-K 2 x 1
- Ceftriaxone 2 x 1 gr - Ondancentron 2 x 4 mg
- DC & NGT - Ceftriaxone 2 x 1 gr
- Sliding scale kelipatan 5/ 4
jam
- Pro HCU
FOLLOW UP
23/4/17 24/3/17 25/3/17 26/3/17
O: O: O: O:
Kes : Somnolen Kes : CM Kes : CM Kes : CM
TD : 90/70 N: 150 RR : 30 TD : 110/70 N: 98 RR : 26 TD : 110/80 N: 79 RR : 20 TD : 100/70 N: 76 RR : 24
S : 37 S : 37,8 S : 37 S : 36,7
GDS : 358, 273, 375 GDS : 442, 165 GDS : 206, 294, 314 GDS : 208
A: A: A: A:
KAD KAD DM tipe I DM tipe I
DM tipe I DM tipe I
P: P: P: P : Boleh pulang
-Asering loading 300cc - cek GD/12 jam -Infus pump stop
30 tpm - Novorapid 3 x 20 U - Novorapid 3 x 20 U
-Syring pump 2cc/jam - Lavemir lantus 0 0 - Cek gds/12 jam
-Novorapid 3 x 20 U 14
- lavemir 0 0 14
-GDS/12 jam
PROGNOSIS
16
Ketoasidosis Diabetikum
Type
Type 11Diabetes
Diabetes Accounts
Accounts for thefor the of
Majority
Primary DKA
Majority ofEpisodes
Primay DKA Episodes
Primary DKA Episodes
134,633 (2006 34% of episodes are Type 2
~46,000 cases
T1D - Children 18%
Longer Hospital Stays
66%
T1D - Adults 48% 4.2 vs average of 3.5
Very few have CV issues or serious
T2D 34% 34% infections => Less than 15%
DKA HHS
Increased
glucose
Increased
production
ketogenesis
Insulin Counterregulatory
Deficiency Hormones
Decreased
glucose Metabolic
uptake acidosis
Electrolyte Hypertonicity
abnormalities
Umpierrez G, Korytkowski M. Nat Rev Endocrinol. 2016;12:222-232.
Insulin Deficiency
Hyperglycemia Lipolysis
Hyper-
osmolality
Glycosuria FFAs
Ketones
Dehydration
Acidosis
Electrolyte
Renal Failure Losses
Shock CV
Collapse
DIAGNOSIS
Management of DKA and HHS
NS at 250-500 NS at
mL/h 250-500 mL/h
HIPOGLIKEMIA
ASIDOSIS PERSISTEN
HIPOKALEMIA
EDEMA INTRASEREBRAL