208629991 LAPSUS Koma Hipoglikemia
Transcript of 208629991 LAPSUS Koma Hipoglikemia
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LAPORAN KASUSKOMA HIPOGLIKEMI
Pembimbing :dr. Dian Samudra, Sp.PD
Vicky Gunawan Oeibisono, S.Ked
06700 !"
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IDENTITAS PASIEN• #$%$ : #&. '
• '%'( : 6! )*
• $+$%$) : '( P S'%O*$(-O !+$($#G$# /$#D
• - # S K +$% # : P ( %P'$#
• P K (-$# : 1' ('%$* )$#GG$
• S)$)'S %$( )$+ : % # K$*
• #O. (% : "!2067
• )G+ %(S : 03 07 !0 " 40".5"
• )G+ P % ( KS$$# : 05 070 !0 5
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ANAMNESAHeteroanamnesa:
KU = tidak sadar
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RPS =
Pasien ditemukan tidak sadar o e! ke uar"a#k$ %&$'% di kamar tidur$ Se(e umn)a #asienmasi! da#at me akukan ke"iatan se!ari* !ari+)aitu s!o at su(u!$ Sete a! itu #asien
ditemukan tak sadar+ men"orok Se(e um tidak sadar #asien tidak men"e u!#usin" ,*- mua ,*- munta! ,*- #anas ,*- (atuk,*- #i ek ,*-+ se#aru! (adan emas. tidakda#at di"erakkan ,*-+ ma* mi me/+ 0AK d(n+0A0 d(n
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RPD =
HT ,1-2 se3ak ' t! ) + tertin""i 45%.62 tidakrutin kontro mau#un minum o(at
DM ,*- disan"ka 2 #erna! #riksa ke (idan 4572tidak di(eri o(at
Sakit #un""un" ,1-2rutin kontro di #o i (eda!tu an"
sakit 3antun" ,*-
stroke ,*-
se(e umn)a #asien tidak #erna! sakit se#erti ini
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RPK =
DM ,*-
HT ,*-
Ast!ma ,*-
RPO= Asam Me8enamat
So!o(ion
#i #uti! ke9i 2 tak ta!u naman)a
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Ri a)at MRS =
tidak #erna! MRS se(e umn)a
Ri a)at sosia ; ke(iasaan =
minum 3amu* 3amuan ,*-makan makanan (er emak+ (ersantan ,*-
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PEMERIKSAAN ITAL SIGN =
TD : 4?%.4%% mmH" N: 47@ .m
t : 'B+' %
RR : 7& .m
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K.L=
a.i.9.d = *.*.*.*
Mata 9o on" = ,*-
Dr) i#s = ,*-
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T!ora =
or= Inspeksi : i9tus 9ordis tak tam#ak
Palpasi : i9tus tera(a di I S > 7 9m atera M L Sinistra
Perkusi :
* (atas kanan 3antun" : I S > PSL De tra
* (atas kiri 3antun" : I S > 7 9m atera M L Sinistra
Auskultasi : S4 S7 tun""a + murmur ,*- "a o# ,*-
Pumo= "erak na8as simetris
Cesiku er 1.1
r!onkie *.* !ee in" *.*
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A(domen =
Soe#e + 0U ,1- N+ met ,*-
H.L= tt(
Ekstremitas =
Akra !an"at 1.1
Oedem *.*
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LA0ORATORIUM1/ 8500
*b ,!
*c9 36,"
P 9 3 3.000
GD$ !"
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1'# ",7
/rea9inin 0,62
1i . 9o9a 0,62
1i . direc9 0,!6
SGO) 30
SGP) "5/;o es9ero 8
)ryg iserida 25
*bS $g 4 nega9i<
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PLANNING
P annin" d =
GDP
GD7 PP
H(A4
P annin" t =
Konsu dr$ S#+ PD
Loadin" :In8 D&%F ' s2
GDA4?72 G S &* *B
Maintenan9e:
In8 D4%F 7% t#m
andesartan 4 4
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DIA0ETES MELITUSAda a! #en)akit meta(o ik aki(at kuran"n)a insu ine8ekti8 (aik o e! karena dis8un"si se (eta #ankreasatau am(i an " ukosa di 3arin"an #eri8er den"an tanda!i#er" ikemia dan " ukosuria disertai "e3a a k inis
(eru#a #o iuria+ #o idi#si dan #enurunan (erat (adan
Sumber: Askandar, Buku Ajar Ilmu Penyakit Dalam , Fakultas Kedokteran Univ Airlangga
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KLASI
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Pan9reas=4$Se α → Glukagon2.Sel β → Insulin3.Sel C → calcitonin4.Sel δ → somatostatin5.Sel PP (Polypepti e!
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KRITERIA DM ,PERKENI+ 7%%7-4$ Kadar " ukosa dara! se aktu !"" mg#dl
disertai "e3a a #o iuri+ #o idi#si dan#enurunan (erat (adan
7$ Kadar " ukosa dara! #uasa ≥ 125 mg/dl
3. Kadar glukosa plasma ≥ 200 mg/dl pada 2 jamsesudah makan
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PENATALAKSANAAN4$ PRIMER
Pen)u u!an Kese!atan Mas)arakat
Lati!an Jsik Diet
7$ SEKUNDER
o(at !i#o" ikemi ,ora atau insu in-
9an"kok #ankreas
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PENATALAKSANAAN KOMAHIPOGLIKEMI('%'S 3 !
GDA '% m".d → 3 "las# $4%&
G$' 3% )% mg* l → 2 "las# $4%&G$' + )% mg* l atau )% ,% mg* l → - "las# $4%&
et#yl p/e nisolon 0ila G$' 13%
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KO%P+ K $S
$K')K(O#
K
HIPOGLIKEMI HIPERGLIKEMI
KAD+K*
HONK+KLA+
SEPSIS
$apar,lema%,leti%,lesu%,keringat
dingin,gemetar,berdebar&debar,kesadaran
''
ANGIOPATI NEUROPATI
MIKRO MAKRO
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