Presentasi Kasus

Hipoglikemia
DM Tipe II

Ammalia Rachmi
18712010
Pembimbing : dr. R. Hantyanto Norieswanto, Sp.PD
Identitas pasien

Nama : Tn.P
Tanggal Lahir : 1 Juli 1979
Umur : 40 tahun
Alamat : Mongol-Saptosari
Tanggal masuk RS : 16 Februari 2020
Pekerjaan : buruh lepas
Agama : Islam
Status Perkawinan : Menikah
No. RM : 438116
Ruang : Bangsal Bakung bed 13 RSUD Wonosari
DPJP : dr. R. Hantyanto Norieswanto, Sp. PD
Riwayat Penyakit Sekarang
Keluhan Utama

• Penurunan kesadaran

Riwayat Penyakit Sekarang

• Pasien datang ke IGD RSUD Wonosari pada tanggal 16

Februari 2020 dengan keluhan penurunan kesadaran sejak
45 menit yang lalu. Keluhan tersebut dirasakan saat pasien
baru pulang bekerja dan mengeluh kelelahan tiba tiba saja
pasien tidak sadar dan dibawa ke RSUD Wonosari.
 Riwayat Penyakit Dahulu

Pasien mengaku memiliki riwayat penyakit DM tipe 2 sejak tahun 2018. Pasien pernah
megalami keluhan serupa pada tahun 2019 dengan gula drah yang terlalu rendah.

Pasien tmenyangkal memiliki alergi obat makanan atau keadaan lingkungan tertentu.
Riwayat Penyakit Keluarga
▫ Keluhan serupa disangkal
▫ HT disangkal
▫ Diabetes Mellitus disangkal
▫ Dislipidemia disangkal
▫ Asma disangkal
▫ Penyakit jantung disangkal
▫ Alergi disangkal
 • Riwayat pengobatan:

Pasien menjalani pengobatan DM tipe II sejak tahun 2018 pernah opname sebelumnya tahun 2018 karena
hiperglikemia dan Tahun 2019 karena hipoglikemia, pasien rutin memeriksakan kondisi kesehatannya, walaupun
begitu pasien sering mengabaikan kondisi kesehatannya dengan bekerja terlalu berat.
• Riwayat Kebiasaan:

Pasien masih bekerja dan keluarga mengatakan pasien sellu bekerja dari pagi hingga sore hari sebagai buruh
harian tanpa libur dalam 1 minggu. Pasien makan seadanya, terlalu mantang pantangan makanan atauminuman
manis dan olahraga jarang, pasien sering tidak memperhatikan kondisi tubuh saat sedang sakit karena sibuk
bekerja.
Pemeriksaan Fisik

Keadaan Umum Lemah. Delirium, GCS 2-4-2

BB=42 kg TB=149 cm IMT= 18,9 (Normal)
Tekanan Darah 100 / 60 mmHg
Nadi `112 x/menit, reguler, kuat
Respirasi 20 x/menit, Spo2 : 98 %
Suhu axiler 36.40C
Kepala Anemia (-); Ikterus (-); Cyanosis (-); Dyspneu (-)
Leher Pembesaran KGB (-); Pembesaran thyroid (-); JVP
5+2 cm
Interpretasi : HR irregular, JVP normal
 Pemeriksaan Fisik
Thorax
Jantung
Inspeksi : Normochest, Iktus kordis tidak
terlihat Auskultasi : S1 S2 tunggal reguler,
Palpasi : Iktus qordis tidak teraba
Perkusi : ▫ murmur (-), BJ tambahan S3 (-)
▫
Paru
Batas Kanan terletak pada SIC IV line parasternal
I : Pengembangan simetris
dextra
P: Fremitus teraba normal, pengembangan
▫ Batas Kiri terletak pada SIC V line midclavicula simetris kanan kiri
sinistra 1 jari ke medial P: Sonor semua lapang paru
▫ Batas Atas terletak pada SIC II linea sternalis A: Vesikuler + +, Ronkhi - - , Wheezing - -
sinistra ++ -- --
▫ Batas Pinggang terletak pada SIC III line
parasternal Interpretasi : cor dan pulmo normal
▫ Apex terletak pada SIC V linea axila anterior
sinistra
Pemeriksaan Fisik
Abdomen I : Sikatriks (-), massa (-), asites (-)
A : Bising usus (+) dbn
P : Timpani semua region
P : Supel (+), Nyeri tekan (-)
Hepar & spleen tidak teraba membesar.
Pemeriksaan Turgor Kulit : Cepat Kembali.

Ekstremitas Akral Hangat (--/--), CRT <2 detik, Oedema - -

--
Interpretasi : Dalam Batas Normal
 Jenis Pemerikaan Hasil Nilai Rujukan

Hb 12,1 12-16 gr%

Hasil AL 8.700 4.300-11.000/uL

LAB
HEMATOLOGI Hmg 0/0/0/66/26/8

HMT 40% 37%

AT 264.000 150.000– 450.000/uL

Jenis Pemerikaan Hasil Nilai Rujukan

GDS 19 80-140 mg/dL

Urea 25 15-45 mg/dL

Creatinin 1 0.6-1.3 mg/dL

KIMIA
DARAH
Kesan :
Irama sinus regular
Aksis normoaksis +20
R-R regular
HR : 83x
Catatan Kemajuan Pasien
Follow Up hari 1 pasien di RS (17Januari 2020)
P: - Infus D10 20 tpm diganti NaCl
S: Lemas (+) mual muntah (-) napsu makan menurun - Humalog SC 14-14-14 iu--- Stop
O: KU = Lemah, CM - Cek GDS Premeal
T = 90/50 mmHg S = 36,4o C
N = 66 x/menit R = 18x/menit
K/L CA -/- SI -/- Tho: SDV +/+ Wz -/- Rh -/-
Abd: BU (+) NT (-) Supel S1-S2 Reguler
Eks AH (+) CRT < 2dtk GDS: 247 mg/dL
A: Hipoglikemia
DM 2
Catatan Kemajuan Pasien
Follow Up hari 2 pasien di RS (18Januari 2020)
P: - Infus NaCl 20 tpm
S: Lemas (-) mual muntah (-) napsu makan biasa - Humalog SC 14-14-14 iu--- Stop
O: KU = Cukup, CM - Boleh Rawat jalan cek GDP saat kontrol.
T = 120/90 mmHg S = 36,6o C
N = 84 x/menit R = 18x/menit
K/L CA -/- SI -/- Tho: SDV +/+ Wz -/- Rh -/-
Abd: BU (+) NT (-) Supel S1-S2 Reguler
Eks AH (+) CRT < 2dtk GDS: 81 mg/dL
A: Hipoglikemia
DM 2
Tinjauan Pustaka

14
15
▫ Hiperglikemia berbahaya terhadap berbagai sel dan sistem organ pengaruhnya
terhadap sistem imun, bertindak sebagai mediator inflamasi, respon vaskular, dan
respon otak
▫ Hiperglikemia mudah terjadi infeksi karena adanya disfungsi fagosit
▫ hiperglikemia akut : efek buruk kardiovaskular → gagal jantung
▫ Trombosis : Penurunan aktivitas fibrinolitik plasma & aktivator plasminogen
jaringan → peningkatan aktivitas inhibitor aktivator plasmin (PAI - 1) dan
peningkatan aktivitas trombosis
▫ Inflmasi akut : Peningkatan sitokin proinflamasi (TNF alfa, IL - 6)
▫ Hiperglikemia akut : kerusakan sel saraf → iskemia otak (Peningkatan asidosis
jaringan dan kadar laktat akibat peningkatan kadar glukosa darah)
▫ Stres oksidatif
Menurut PERKENI 2015

POLI
POLI URIA
FAGIA
DIPSI
Onset Peak Effective
Duration
Klasifikasi Hipoglikemia

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Trias Whipple

Kadar Gula Darah Munculnya tanda Gejala menghilang

gejala jika kadar gula naik

Kadar gula darah < 60 mg/dL Gejala hipoglikemia hilang

Adanya gejala hipoglikemia
jika kadar gula mulai normal
kembali

Trias Whipple sering dipakai sebagai dasar diagnosis hipoglikemia

Pathofisiologi Hipoglikemia

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Tatalaksana Hipoglikemia
Komplikasi

 Pada pasien lansia komplikasi hipoglikemi bisa mengarahkan pada penurunan fungsi kognitif dan akibat
buruk lainnya.
 Lansia memiliki resiko hipoglikemia tinggi dikarenakan memerlukan terapi insulin dan insufisiensi ginjal
progresif.
 Manifestasi gangguan kognitif meliputi gangguan eksekutif yang halus hingga kehilangan memori dan
demensia. Lansia dengan DM memiliki kecenderungan demensia Alzheimer dan demensia penyakit
vascular lebih tinggi.
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Identitas
Nama : Ny. D
Tanggal Lahir : 31 Desember 1949
Umur : 70 tahun
Alamat : Kenteng 04/08 Pacarejo Semanu
Tanggal masuk RS : 25 Januari 2020
Pekerjaan : IRT
Agama : Islam
Status Perkawinan : Menikah
No. RM : 00670600
Ruang : Bangsal Bakung bed 20 RSUD Wonosari
DPJP : dr. R. Hantyanto Norieswanto, Sp. PD

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 1
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 Let’s review some concepts
Yellow
Is the color of gold, butter and ripe
lemons. In the spectrum of visible
light, yellow is found between
green and orange.
Blue
Is the colour of the clear sky and
the deep sea. It is located between
violet and green on the optical
spectrum.
Red
Is the color of blood, and because
of this it has historically been
associated with sacrifice, danger
and courage.

Yellow
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lemons.
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green and orange.
spectrum. and courage.

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