Skenario B block 8 2012 DM - KETOGENESIS

Mrs B 50 yo is a housewife. She was brought to the emergency room of Mohd. Hoesin Hospital by his family due to short of breath since 7 hours ago. She has been suffered from type 2 DM for 5 years and consumed 2 times Metformine 500 mg a day irregularly. Ten days ago she had a wound at the right foot and doesnt heal until now. Yesterday he got fever and his wound became swollen. He also felt nauseous, epigastric pain, very thirsty and fatigue. He refused to eat since yesterday. According to his family he started to be disoriented since 7 hours ago. Physical examination: Height: 150 cm & BW : 70 kg Patient was in delirious state BP: 95/50 mmHg, ;Pulse 110 x/min reguler, filliformis RR: 34 x/min, Kussmaul respiration, acetone odor (+);Temp 38,5OC Head: sunken eyes, dry tongue, Thorax: HR 110 x/min, reguler Abdomen: epigastric pain (+), turgor decrease Extremity: dry skin, turgor decrease Left foot: dirty and swollen wound Lab results: Routine blood assay: Hb 9,2 g%, Ht 27 vol%, Leucocyte 21.000/mm3, DC 0/1/0/70/25/4, Trombocyte 250.000/mm3 Random blood glucose: 529 mg/dl. & HbA1c : 14 Urinary Ketone: +++
Klarifikasi Istilah 1. Short of breath 2. Type 2 DM : keadaan dimana pancreas menahan kemampuan untuk memproduksi insulin meskipun tubuh masih membutuhkan insulin 3. OAD : obat anti diabetes 4. wound 5. Fever : peningkatan suhu tubuh diatas suhu normal (>37C) 6. Epigastric pain : rasa sakit pada bagian atas tengah perut 7. nauseous 8. fatigue: keadaan meningkatnya ketidaknyamanan dan menurunya efficienci akibat kerja yang berkepanjangan atau berlebihan 9. Very thirsty : rasa haus yang berlebihan

10. disoriented : hilangnya tingkah laku nyang tepat, atau keadaan kekacauan mental dalam mengenal waktu tempat atau identitas 11.Filliformis : Kecil dan cepat 12.Kussmaul respiration : pernapasan yang panjang dan dalam 13. Acetone odor : 14. Delirious state : 15. Random blood glucose 16. Swollen wound 17. Urinary ketone 18. Diabetic ketoacidosis : komplikasi akut diabetes mellitus yang serius akibat defisiensi berat insulin dan disertai gangguan metabolisme protein, karbohidrat dan lemah. 19. hyperglycemia : 20. Infection : Invasi dan pembiakan mikroorganisme pada jaringan tubuh. 21.Delusion 22.Hallucination 23.illusion IDENTIFIKASI MASALAH

1. Mrs B 50 yo is a housewife. She was brought to the emergency room of Mohd. Hoesin Hospital by his family due to short of breath since 7 hours ago 2. . She has been suffered from type 2 DM for 5 years and consumed 2 times Metformine 500 mg a day irregularly. 3. Ten days ago she had a wound at the right foot and doesnt heal until now. 4. Yesterday he got fever and his wound became swollen.

5. she also felt nauseous, epigastric pain, very thirsty and fatigue. He refused to eat since yesterday. 6. According to his family he started to be disoriented since 7 hours ago. 7. Routine blood assay: Hb 9,2 g%, Ht 27 vol%, Leucocyte 21.000/mm3, DC 0/1/0/70/25/4, Trombocyte 250.000/mm3 Random blood glucose: 529 mg/dl. & HbA1c : 14 Urinary Ketone: +++

8. Physical examination: Height: 150 cm & BW : 70 kg Patient was in delirious state BP: 95/50 mmHg, ;Pulse 110 x/min reguler, filliformis RR: 34 x/min, Kussmaul respiration, acetone odor (+);Temp 38,5OC Head: sunken eyes, dry tongue, Thorax: HR 110 x/min, reguler Abdomen: epigastric pain (+), turgor decrease Extremity: dry skin, turgor decrease Left foot: dirty and swollen wound 9. According to the examination Mrs B suffer from Diabetic Ketoabeticiodosis due to uncontrolled hyperglycemia and infection

ANALISIS MASALAH

1. Mrs B 50 yo is a housewife. She was brought to the emergency room of Mohd. Hoesin Hospital by his family due to short of breath since 7 hours ago. a. bagaimana keterkaitan umur, gender, short of breath pada kasus ini ? b. mengapa short of breath bisa terjadi pada kasus ini ? c. mengapa short of breath terjadi setelah 7 jam dari keluhan yang lain ? d. Apa hubungan pekerjaan (housewife) dengan keluhan pada kasus ini ? 2. She has been suffered from type 2 DM for 5 years and consumed 2 times Metformine 500 mg a day irregularly. a. apa efek mengosumsi OAD b. bagaimana patofisiologi dari DM type 2 c. bagaimana komplikasi DM type 2 d. mengapa mrs b mengalami DM type 2 e. apa penyebab DM type 2 f. apa saja gejala DM type 2 g. bagaimana cara kerja dan efek samping OAD pada DM type 2 3. Ten days ago she had a wound at the right foot and doesnt heal until now. a. Mengapa luka yang di derita mrs B belum sembuh selama 10 hari b. Mengapa luka terjadi pada kaki kanan?

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c. Apakah faktor yang mempengaruhi luka tidak sembuh selama 10 hari Yesterday he got fever and his wound became swollen a. Bagaimana hubungan antara demam dan luka yang membengkak pada kasus ini b. Mengapa mrs b bias mengalami demam pada kasus ini? c. Mengapa luka mrs b bisa membengkak? d. Apa jenis-jenis demam?. She also felt nauseous, epigastric pain, very thirsty and fatigue. He refused to eat since yesterday. a. Apa hubungan gejala-gejala (nauseus, epigastric pain, very thirsty, fatigue) pada kasus ini b. Apakah ada hubungan demam dengan keinginan untuk terus minum? c. Apakah ada hubungan epigastric pain, nausea dan tidak mau makan According to his family he started to be disoriented since 7 hours ago. Lab results: Routine blood assay: Hb 9,2 g%, Ht 27 vol%, Leucocyte 21.000/mm3, DC 0/1/0/70/25/4, Trombocyte 250.000/mm3 Random blood glucose: 529 mg/dl. & HbA1c : 14 Urinary Ketone: +++ Physical examination: Height: 150 cm & BW : 70 kg Patient was in delirious state BP: 95/50 mmHg, ;Pulse 110 x/min reguler, filliformis RR: 34 x/min, Kussmaul respiration, acetone odor (+);Temp 38,5OC Head: sunken eyes, dry tongue, Thorax: HR 110 x/min, reguler Abdomen: epigastric pain (+), turgor decrease Extremity: dry skin, turgor decrease Left foot: dirty and swollen wound According to the examination Mrs B suffer from Diabetic Ketoabeticiodosis due to uncontrolled hyperglycemia and infection