Hipoglikemia Berat pada Pasien Syok Sepsis karena Perforasi Gaster
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Latar Belakang: Secara umum pasien kritis dengan syok septik mengalami hiperglikemia. Hipoglikemia berat sangat jarang terjadi pada pasien kritis. Pada penelitian Bagshaw dkk, hipoglikemia berat terjadi sekitar 1,4 % dari populasi pasien kritis. Hipoglikemia berat disebabkan gagal hati fulminan atau gagal adrenal, syok septik, dan komorbid berat (malnutrisi, sirosis hati, gagal ginjal kronik).Pasien perforasi gaster yang dirawat di ruang intensif emergensi RSUD Dr. Sutomo selama satu tahun (2017) berjumlah 11 pasien. Pada laporan kasus ini 3 pasien mengalami hipoglikemia dimana 2 diantaranya hipoglikemia berat.Pada umumnya pasien kritis dengan syok sepsis mengalami hiperglikemia, namun pada 3 pasien terjadi hipoglikema dan 2 di antaranya hipoglikemia berat .
Kasus: Tiga kasus dilaporkan sebagai pasien hipoglikemia berat yang mengalami syok septik disebabkan perforasi gaster. Ketiga pasien dengan mengalami acute kidney injury, hipoalbumin, serta mendapat support ventilator.
Diskusi: Hipoglikemia harus segera diatasi untuk mencegah komplikasi yang tidak diinginkan. Pasien yang tidak mendapat asupan glukose selama 2 hari harus segera diberikan asupan. Bila hipoglikemia terjadi maka mortalitas akan meningkat 40% dan hipoglikemia berat akan meningkat sampai 80%. Penyebab Hipoglikemia paling banyak antara lain acute kidney injury, hipoalbumin, dan ventilasi mekanik.
Kesimpulan: Apabila dijumpai pasien kritis perforasi gaster, laparatomi, acute kidney injury, puasa dan menggunakan mekanikal ventilator sebaiknya kadar gula darah diperiksa seawal mungkin dan berulang. Apabila pasien mengalami hipoiglikemia, pasien diterapi secepatnya untuk meningkatkan gula darah, serta perlu diberikan asupan glukosa yang memadai.
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- Arik PE, Raghavan M .Stress-hyperglycemia insulin and immunomodulation in sepsis. In: Applied Physiology in intensive care medicine 2, Spinger 2012, 153-61
- Lacherade JC, Jacqueminet S, Preiser JC. An Overview of hypoglycemia in critically ill. J diabetes Sci tech, vol3, issue 6. Nov 2009:1252-8
- Finter S, Liu B, Chittock DR, et all. Hypoglycemia and risk of death in critically ill patients, the NICE-SUGAR. N Eng J Med 2012;367:1108-18
- Kalton P. Manach YL, Ichai C, et all. Severe and multiple hypoglycemia episodes are associated with increased risk of death in ICU patients. Critical care 2015; 19: 153.
- Hulkower RD, et all. Understanding hypoglycemia in hospitalized patients. Diabetes manage 2014;4(2): 160-76
- De Galan, et al. Hypoglycaemia and hypoglycaemia unawareness, Ned JM, sept 2006; 6 4 no.8
- Seaquist ER, Beyond the brain: do peripheral mechanisms develop impaired awareness of hypoglycemia?,J Clin Invest. 2018;128(9):3739–3741
- Krinsley JS, Grover A, Severe hypoglycemia in crittically ill patients: risk and outcomes. Crit Care Med.2007;35(10): 2262-7
- Hirsberg B, et all. Fourty eight hour fast: the diagnostic test for insulinoma. J Clin Endoc & Metab.2000;85:3222-6
- Bagshaw SM, et all. The impact of early hypoglycemia and blood glucose variability on outcome in critical illness. Critical care. 2009;13:R91
- Carmody D, Philipson L. Hyperglycemic Crisis and Hypoglycemia. In: Pinciples of critical care 4th, McGratHill;2015,987-9
- Kagansky M, et all. Hypoglycemia as a predictor of mortality in hospitalized elderly patients. Arc Int Med ;11 aug,2003,1825-9
- Khadori R, Danielle C, Endocrine and Metabolic changesDuring Sepsis : an Update, Med Clin N Am. 2012;96,1095-105
- Marik PE, Zaloga GP. Adrenal insufficiency in critically ill, a new look at an old problem. Chest , Nov 2002;122(5):1784-96
- Moore C, Woolard M. Dextrose 10% or 50% in treatment of hypoglycemia out of hospital, a randomized control trial. Emerg Med J. 2002; 22: 512-5
- Cooper MS, Steward PM. Corticosteroid insufficiency in acutely ill patients. NEJM. 2003: 727-34
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