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  • Dks Hhs

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    Debora Putri Fernanda Saragih
    48 tayangan16 halaman
    1. Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are both life-threatening complications of diabetes that result from insufficient insulin. 2. DKA is characterized by high blood glucose, ketone production, and metabolic acidosis. It develops rapidly over hours to days. HHS features extremely high blood glucose and osmolality without significant acidosis or ketosis, developing over days to weeks. 3. The key differences are that DKA presents more commonly in younger type 1 diabetics and features acidosis, while HHS typically presents in older type 2 diabetics and does not involve significant acidosis.

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    1. Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are both life-threatening complications of diabetes that result from insufficient insulin. 2. DKA is characterized by high blood glucose, ketone production, and metabolic acidosis. It develops rapidly over hours to days. HHS features extremely high blood glucose and osmolality without significant acidosis or ketosis, developing over days to weeks. 3. The key differences are that DKA presents more commonly in younger type 1 diabetics and features acidosis, while HHS typically presents in older type 2 diabetics and does not involve significant acidosis.

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    48 tayangan16 halaman

    Dks Hhs

    Diunggah oleh

    Debora Putri Fernanda Saragih
    1. Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are both life-threatening complications of diabetes that result from insufficient insulin. 2. DKA is characterized by high blood glucose, ketone production, and metabolic acidosis. It develops rapidly over hours to days. HHS features extremely high blood glucose and osmolality without significant acidosis or ketosis, developing over days to weeks. 3. The key differences are that DKA presents more commonly in younger type 1 diabetics and features acidosis, while HHS typically presents in older type 2 diabetics and does not involve significant acidosis.

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    DIABETIC KETOACIDOSIS

    HYPERGLYCEMIC
    HYPEROSMOLAR STATE
    DKA DAN HHS
    DKA dan HHS

    Hyperglycemic Hyperosmolar
    Diabetic Ketoacidosis (DKA)
    State (HHS)

    Kadar gula darah >250 mg/dL Kadar gula darah >600 mg/dL

    PH Arteri <7.3 PH Arteri >7.3

    Kadar Bicarbonat <15 mEq/L Kadar Bicarbonate >15 mEq/L

    Ketonuria atau ketonemia Ketonuria dan ketonemia minimal

    Anion gap >12 mEq/L Osmolalitas serum >320 mosm/L

    2
    Karakteristik
    Hyperglycemic Hyperosmolar
    Diabetic Ketoacidosis (DKA)
    State (HHS)
    Absolute (or near-absolute) Severe relative insulin deficiency,
    insulin deficiency, resulting in resulting in
    Severe hyperglycemia Profound hyperglycemia and
    Ketone body production hyperosmolality (from urinary
    Systemic acidosis free water losses)
    No significant ketone
    production or acidosis
    Develops over hours to 1-2 days Develops over days to weeks
    Most common in type 1 diabetes,
    Typically presents in type 2 or
    but increasingly seen in type 2
    previously unrecognized diabetes
    diabetes
    Higher mortality rate

    3
    Definition of Diabetic Ketoacidosis*
    Acidosis

    *
    Ketosis
    Hyperglycemia
    Adapted from Kitabchi AE, Fisher JN. Diabetes Mellitus. In: Glew RA, Peters SP, ed. Clinical
    Studies in Medical Biochemistry. New York, NY: Oxford University Press; 1987:105.
    4
    PATHOGENESIS
    AND
    PATHOPHYSIOLOGY

    5
    Diabetic Ketoacidosis: Pathophysiology

    Unchecked gluconeogenesis Hyperglycemia

    Osmotic diuresis Dehydration

    Unchecked ketogenesis Ketosis

    Dissociation of ketone bodies into Anion-gap metabolic



    hydrogen ion and anions acidosis

    Seringkali peristiwa pencetus diidentifikasi (infeksi, kurangnya


    pemberian insulin)

    6
    Insulin Deficiency

    Hyperglycemia

    Hyper-
    osmolality
    Glycosuria

    MS
    Dehydration

    Electrolyte
    Renal Failure Losses

    Shock CV
    Collapse 7
    Insulin Deficiency

    Lipolysis

    FFAs

    Ketones

    Acidosis

    CV
    Collapse 8
    Insulin Deficiency

    Hyperglycemia Lipolysis

    Hyper-
    osmolality FFAs
    Glycosuria

    MS Ketones

    Dehydration
    Acidosis
    Electrolyte
    Renal Failure Losses

    Shock CV
    Collapse 9
    Hyperosmolar Hyperglycemic State:
    Pathophysiology

    Unchecked gluconeogenesis Hyperglycemia

    Osmotic diuresis Dehydration

    Menyajikan umum dengan gagal ginjal


    insulin tidak mencukupi untuk pencegahan hiperglikemia
    tetapi cukup untuk menekan lipolisis dan ketogenesis
    Tidak adanya asidosis signifikan
    Sering diidentifikasi acara pencetus (infeksi, MI)

    10
    Krisis Hiperglikem Diabetes
    overlapping syndromes

    Hyperglycemic Hyperosmolar
    Diabetic Ketoacidosis
    State
    (DKA)
    (HHS)
    Usia muda, diabetes tipe 1 Usia tua, diabetes tipe 2

    Hiperosmolalitas - Hiperosmolalitas +

    Penipisan volume Penipisan volume

    Gangguan elektrolit Gangguan elektrolit

    Asidosis + Asidosis -

    11
    Gambaran klinis DKA
    Anamnesis Pemeriksaan fisik
    Haus Pemeriksaan fisik
    Poliuria Respirasi kussmaul
    Nyeri perut Napas fruity
    Mual atau muntah Hipotermia relatif
    Kelemahan yang mendalam Takikardia
    Hipotensi terlentang,
    penurunan ortostatik
    tekanan darah
    Membran mukosa kering
    Turgor kulit buruk
    Lab pada DKA
    Hiperglikemia
    Ketonuria dan kenonemia
    bikarbonat rendah
    gap anion tinggi
    pH arteri rendah
    PCO2 rendah (kompensasi pernapasan)
    Gambaran klinis HHS
    Dehidrasi
    hiperglikemia
    hipernatremia
    Hiperosmolalitas
    Ketonuria dan ketonemia minimal / tidak ada
    Clinical Presentation of
    Hyperglycemic Hyperosmolar State
    Patient Profile Disease Characteristics
    Older More insidious development than
    More comorbidities DKA (weeks vs hours/days)
    History of type 2 diabetes, which Greater osmolality and mental
    may have been unrecognized status changes than DKA
    Dehydration presenting with a
    shock-like state

    16

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