Porto Folio ketoasidosis diabetikum intenship

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    PORTOFOLIO KASUS

    No. ID dan Nama Pee!"a d!. Ya#$n"a O%"a&$an '$"a Se"(anda

    No. ID dan Nama Wa#ana RSUD Adnaan WD Pa(a)*m+*#

    To,$) Ke-an Demam Kom,/e) Tana/ )a*  Deem+e! 2013

    Nama Pa$en N(.R No. RM 4 05223

    Tana/ P!een"a$ Pendam,$n 4 d!. E/a S!$ Fad$/a 7 d!.

    Ma"!*8$

    Tem,a" P!een"a$ R*an Kon9!en RSUD Adnaan WD Pa(a)*m+*#

    O+-e)"$9 P!een"a$

    % Keilm#an % Keteram&ilan % Penye!aran % Tin'a#an P#sta(a

    % Dia!n)sti( % Mana'emen % Masalah % Istime*a

    % +e)nat#s % Bayi % Ana( % ,ema'a % De*asa % -ansia % B#mil

    % Des(ri&si Pasien *anita #sia / tah#n datan! dia*a (el#ar!a den!an (el#han tida( sadar

    se'a( 0 hari SM,S

    % T#'#an Mene!a((an dia!n)sis dan &enatala(sanaan Ket)asid)sis Diaeti(#m

    Ba#an

    Ba#aan

    : Tin'a#an P#sta(a % ,iset % Kas#s % A#dit

    ;a!a

    Mem+a#a

    : Dis(#si % Presentasi dan Dis(#si % E1mail % P)s

    Da"a Pa$en  +ama : +y., +). ,e!istrasi : 2/3345

     +ama ,S : ,SUD Adnaan 6D Paya(#m#h Tel& : Terda7tar se'a( :

    Da"a U"ama *n"*) Ba#an D$)*$ 4

    0. Dia!n)sis8Gamaran Klinis:

    1 Tida( sadar se'a( 0 hari SM,S

    1 Seel#mnya )s sem&at min#m Gl#ren)rm /2m! dan d#min

    1 Demam se'a( tadi &a!i SM,S9 tin!!i9 men!!i!il 1;

    1 ,i*ayat hi&ertensi . K)ndisi -in!(#n!an S)sial dan "isi( : Tin!!al di r#mah ersama ana( dan c#c#nya.

    PEME,IKSAA+ "ISIK 

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    Um#m

    1 Keadaan #m#m : B#r#(

    1 Kesadaran : S)mn)len

      ?ital Si!n

    1 +adi8 irama : irama terat#r9 7re(#ensi 02@8menit

    1 Perna7asan : Terat#r9 7re(#ensi [email protected]

    1 Te(anan darah : 04282 mm!

    1 S#h# : /9/)

    Pemeri(saan Sistemi( 

    1 T#r!)r (#lit : Bai(  

    1 K#lit dan (#(# : I(teri( 1;9 cat 1;9 sian)sis 1;

    1 Mata : K)n'#n!tiva anemis 1819 S(lera i(teri( 1819 P#&il is)()r 3mm83mm9 ,e7le( cahaya

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    1 emat)(rit : /F

    1 Tr)m)sit : 0/4.2228mm/

    1 GD, : //> m!F

    1 Ure#m : 024 m!F

    1 Kreatinin : 09> m!F

    1 Urin -en!(a& :

     "isi( : *arna (#nin!9

    (er#h9 & >

     Kimia : &r)tein 

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    1 e( (ali#m tia& > 'am9 'i(a :

    Kali#m  /95  ()re(si =2 mcH dalam 322 cc +al 29F8= 'am

    Kali#m /951=95 ()re(si 32 mcH dalam 322 cc +al 29F8= 'am

    Kali#m =951595 

     ()re(si 02 mcH dalam 322 cc +al 29F8= 'amKali#m 595  tida( di()re(si

    1 e7)&era$)n 3 @ 0 !r I?;

    1 In7#s Paracetam)l (8&;

    1 Pasan! +GT

    1 Pasan! (ateter 

    1 Aml)di&in 0 @ 5 m!

    1 DD 0422 ((al via +GT

    FOLLOW UP

     Deem+e! 2013

    P*)*/ 21.00 'am

      1 I?"D +al 29F 32 tetes8menit

      1 tera&i lan'#t

    3 Deem+e! 2013

    P*)*/ 02.00 WIB

    S8 sadar 95

      GD, :  !rF

    A8 Ket)asid)sis Diaeti(#m < i&ertensi sta!e II < In7e(si Se(#nder 

    P8 1 a77 +al

      1 I?"D D02F 32 tetes8menit

      1 tera&i lan'#t

    P*)*/ 0=.00 WIB S8 sadar 

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    O8 KU : sedan!9 Kes : A&atis9 TD : 0=282 mm!9 +d : 4@8menit9 +7: [email protected] T : />95

      GD, : 050 !rF

    A8 Ket)asid)sis Diaeti(#m < i&ertensi sta!e II < In7e(si Se(#nder 

    P8 1 Paracetam)l / @ 522m!

      1 I?"D +al 29F 32 tetes8menit

      1 tera&i lan'#t

    6 Deem+e! 2013

    S8 sesa( 1;9 ()m#ni(asi [email protected] +7: [email protected] T : />95

      GD, : 322 !rF

    A8 Ket)asid)sis Diaeti(#m < i&ertensi sta!e II < In7e(si Se(#nder 

    P8 1 Di!)@in 3 @ 0 ta

      1 tera&i lan'#t

     Deem+e! 2013

    S8 demam 282 mm!9 +d : [email protected] +7: [email protected] T : /

       : 0/94 t : =/ -e# : 422 Tr)m : 35.222

      GD, : 0= !rF

    A8 Ket)asid)sis Diaeti(#m < i&ertensi sta!e II < ISK 

    P8 1 I?"D ,- 32 tetes8menit

    1 -ev)7l)@acin 0 @ 522 m!

    1 Aml)di&in 0 @ 02 m!

    1 #rc#ma / @ 0 ta

    1 Di!)@in 3 @ 2935 m!

    1 andesartan 0 @  m! malam; 1 e( ele(tr)lit

    1 tera&i lan'#t

    Da9"a! P*"a)a

    1.  Hyperglycemic Crises in Diabetes. K$"a+%#$> AE> e" a/. S#&lement 09 Can#ary 09 322=9

    Diaetes are9 ?)l. 349 &&. S=1S023.

    2.  Recent advances in the monitoring and management of diabetic ketoacidosis. TM> Wa//a%e

    and DR> Ma""#e?. 322=9 J C Med9 ?)l. 49 &&. 44/142.

    5.  Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state.

    ;#$aon> @L> e" a/. 49 A&ril 09 322/9 anadian Medical Ass)ciati)n C)#rnal9 ?)l. 0>9 &&.51>>.

  • 8/18/2019 Porto Folio ketoasidosis diabetikum intenship

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    . Thirty years of personal experience in hyperglicemic crises: Diabetic ketoacidosis and

    hypergycemic and hyperosmolar state. K$"a+%#$> AE> e" a/. 59 May 3229 C lin Endr)cin)l

    Meta9 ?)l. /9 &&. 05=010553.

    3.  Narrative review: etosis prone type ! diabetes mellit"s. Um,$e!!e8> 'E> Sm$/e(> D and

    K$"a+%#$> AE. March 49 322>9 Ann Intern Med9 ?)l. 0==9 &&. /521/54.

    6.  etosis prone diabetes: Dissection of a heterogeneo"s syndrome "sing an imm"nogenetic and beta cell f"nction classification# prospective analysis and clinical o"tcomes.

    Ma/donado> M> e" a/. +)vemer 322/9 C lin End)crin)l Meta9 ?)l. 9 &&. 522152.

    .  $oint of care ketone testing: %creening for diabetic ketoacidosis at the emergency

    department. ;#a!/e> RA> YM Bee> PHK En and 'o#> SY. 009 32249 Sin!a&)re C)#nal )7

    Medicine9 ?)l. =9 &&. >1.

    =. Can ser"m beta&hydroxyb"tyrate be "sed to diagnosed diabetic ketoacidosis' S#e$)#

    Mae> e" a/. 3229 Diaetes are9 ?)l. /09 &&. >=/1>=4.

    .  (dvantages to "sing capillary blood beta hydroxyb"tyrate determination for the detection

    and treatment of diabetic ketosis. '*e!%$> B> e" a/. 32259 Diaetes Meta9 ?)l. /09 &&. =201

    =2>.

    10. )ns"lin analogs vers"s h"man ins"lin in the treatment of patients with diabetic ketoacidosis: a randomi*ed controlled trial. Um,$e!!e8> 'E> e" a/. Online "irst9 A&ril 3229 Diaetes

    are9 &&. 01>.

    11. The efficacy of s"bc"taneo"s ins"lin lispro vers"s contin"o"s intraveno"s reg"lar ins"lin for 

    treatment of diabetic ketoacidosis. Um,$e!!e8> 'E> e" a/. 322=9 American C)#rnal )7

    Medicine9 ?)l. 0049 &&. 3013>.

    12. Treatment of diabetic ketoacidosis with s"bc"taneo"s ins"lin aspart. Um,$e!!e8> 'E> e" a/.

    322=9 Diaetes are9 ?)l. 349 &&. 04/104.

    Ha$/ Pem+e/a-a!an 4

    0. Dia!n)sis Ket)asid)sis Diaeti(#m KAD;

    3. Tatala(sana a*al KAD /. Penan!anan ()m&rehensi7 KAD dan &eny#litnya

    Ran)*man Ha$/ Pem+e/a-a!an Po!"o9o/$o

    S*+-e)"$9 4

    Se)ran! *anita er#sia / tah#n dia*a )leh (el#ar!anya (e IGD ,SUD Adnan 6D

    Paya(#m#h den!an (el#han tida( sadar se'a( 0 hari seel#m mas#( r#mah sa(it.

    Seel#mnya )s sem&at memin#m Gl#ren)rm + /2 m! dan d#min. Demam se'a( tadi

     &a!i seel#m mas#( r#mah sa(it9 demam tin!!i9 dan ter#s mener#s. ,i*ayat sa(it

    se&erti ini seel#mnya disan!(al. Os terda&at ri*ayat sa(it DM9 hi&ertensi9 dan

     'ant#n!.

    O+-e)"$9 4

    Dari &emeri(saan 7isi( ditem#(an ()ndisi #m#m &asien #r#(9 (esadaran s)mn)len9

    te(anan darah 04282 mm!9 nadi 02@8menit9 na7as [email protected] Tida( ditem#(an

    (a(# (#d#( &ada leher &asien. Dari &emeri(saan mata &il is)()r den!an [email protected]

    cahaya

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    s#&el dan isin! #s#s dalam atas n)rmal serta t#r!)r ai(9 e(stremitas tida( terda&at

    edema serta re7illin! (a&iler dalam atas n)rmal. Os lan!s#n! di&eri(sa gl"co check 

    dan dida&at(an GD, : //> !rF

    Aemen" &enalaran (linis; 4

    Ket)asid)sis diaeti( KAD; adalah (eadaan de()m&ensasi (e(aca#an meta)li( 

    yan! ditandai )leh trias hi&er!li(emia9 asid)sis dan (et)sis9 ter#tama disea(an )leh

    de7isiensi ins#lin as)l#t ata# relati7. Pada &asien ini trias terse#t telah ter&en#hi9 dimana

    terda&at hi&er!li(emi den!an GD, : //> !rF9 tanda1tanda asid)sis er#&a sesa(9 serta

    terda&at (et)n dalam #rin &asien. KAD dan hi&)!li(emia

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