Hipoglikemia Berat pada Pasien Syok Sepsis karena Perforasi Gaster

*Andre Ferdinand Karema  -  Departemen Anestesiologi dan Reanimasi; Fakultas kedokteran; Universitas Airlangga/RSUD Dr. Soetomo; Surabaya, Indonesia
Eddy Rahardjo  -  Departemen Anestesiologi dan Reanimasi; Fakultas Kedokteran; Universitas Airlangga/RSUD Dr. Soetomo; Surabaya, Indonesia
Prananda Surya Airlangga  -  Departemen Anestesiologi dan Reanimasi; Fakultas Kedokteran; Universitas Airlangga/RSUD Dr. Soetomo; Surabaya, Indonesia
Bambang Pujo Semedi  -  Departemen Anestesiologi dan Reanimasi; Fakultas Kedokteran; Universitas Airlangga/RSUD Dr. Soetomo; Surabaya, Indonesia
Published: 1 Nov 2019.
DOI: https://doi.org/10.14710/jai.v11i3.23947 View
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Abstract

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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Keywords: hipoglikemia; pasien kritis; pemeriksaan kadar glukosa; perforasi gaster; syok septik

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Section: Laporan Kasus
Language: ID
In Vol 11, No 3 (2019): Jurnal Anestesiologi Indonesia
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