Ny.

R, 60 tahun, RM 887xxx
Anamnesis Pemeriksaan Fisik Pemeriksaan Penunjang
KU: tidak sadarkan diri 4 jam SMRS Keadaan Koma, lemah Hb 8.1 g/dL BUN 5 mg/dL
umum: AL 11.70 10^3/mL Creat 0.5 mg/dL
AT 467 10^3/mL Na 141 mmol/L
TD 110/70 mmHg AE 2.85 10^6/mL K 3.5 mmol/L
RPS: 4 jam SMRS OS kejang kemudian Hmt 23 % Cl 90 mmol/L
tidak sadarkan diri. Tidak diobati, baru Nadi 88 x/m MCV 80.7 fL GDS 30 mg/dL
MCH 28.4 pg
dibawa ke RSUD Banyumas 4 jam Saturasi 96 % S 87 %
pasca kejang. Respirasi 22 x/m
L 10 %
M 2.4 %
E 0.2 %
Suhu 36.9 o
C
1 Minggu SMRS OS post amputasi B
OT
0.2
7
%
U/L
cruris sinistra bellow knee ec selulitis VAS Tvd
PT 6 U/L
et gangrene pedis et cruris sinistra, 3 Pemeriksaan Fisik
Kepala
hari SMRS os pulang dengan insulin Conjunctiva pucat (+) Sklera GD Post koreksi D40: 78
novomix 2x12 unit. Saat di rumah OS ikterik (-),
tidak mau makan namun tetap disuntik Leher
JVP 5+2cmH20
insulin rutin, semakin hari OS semakin Limfonodi tidak teraba
lemah hingga akhirnya kejang dan
tidak sadar. Thorax
Pulmo: Ves +/+, RBK -/-, RBB-/-,
wheezing -/-
OS riwayat DM sejak 5 tahun SMRS, Cor: S1-2 normal regular,
minum metformin 2x500 mg namun murmur (-), gallop (-),
cardomegali (-)
tidak rutin, GD tertinggi 400an, rerata
100-200an. Mulai insulin sekitar 2 Abdomen
minggu terakhir ini Datar (+) Supel, BU (+) N, Nyeri
tekan epigastrium (-), shifting
dullness (-), Hepar, lien tidak
Riwayat HT(-), sesak (-), alergi (-) teraba

Ekstremitas
Post amputatum cruris sinistra
bellow knee, tampak pus dan
eritem pada bekas operasi
Lateralisasi Dextra
 ASSESSMENT
• Penkes ec suspek related hipoglikemia berat et CVA
• Hipoglikemia berat teratasi
• Hemiparese sinistra ec suspek SNH dd SH
• Post amputatum bellow knee cruris Sinistra dengan
ILO
• DM2
TERAPI PLAN
Inf. D10% 12 tpm
Monitoring GD berkala sesuai
Ceftazidime 1 gram/8 jam IV
klinis (15’ -> 2 jam -> 4 jam)
Paracetamol 1 gram IV KP
Bila GD < 50 -> D40% 2 flask
Citicolin 500 mg/12 jam IV
Bila GD < 10 -> D40% 1 flask

Head CT Scan tanpa kontras

Rawat luka per hari

Konsul Neuro
Hipoglikemia
Definition
Hypoglycemia: plasma glucose level < 70 mg/dL or < 80 mg/dL with
symptoms of hypoglycemia,
Symptoms of hypoglycemia generally classified as:
• The neurogenic symptoms include tremor, palpitations, and
anxiety/arousal (catecholamine-mediated, adrenergic) and sweating,
hunger, and paresthesias (acetylcholine-mediated, cholinergic)
• The neuroglycopenic symptoms include dizziness, weakness, drowsiness,
delirium, confusion, and, at lower plasma glucose concentrations, seizure
and coma. Prolonged hypoglycemia can cause brain death
The rare fatal episodes are generally thought to be the result of ventricular
arrhythmia.

Older adults and patients with long-term diabetes may have more
neuroglycopenic than neurogenic manifestations of hypoglycemia.
Etiology
Risk Factor
• Hypoglycemia-associated autonomic failure (including the syndromes of
impaired awareness of hypoglycemia and of defective glucose counter-
regulation)
• Longer duration of diabetes
• Older age
• Lower levels of glycemia, when achieved with medications
• Erratic timing of meals, including missed meals and low carbohydrate
content of meals
• History of recent severe hypoglycemia
• Exercise
• Alcohol ingestion
• Chronic kidney disease
• Malnutrition with glycogen depletion
Treatment
• Asymptomatic — Defensive options include repeating the
measurement within 15 to 60 minutes avoiding critical tasks such as
driving, ingesting carbohydrates, and adjusting the treatment regimen
• Symptomatic — Patients with symptomatic hypoglycemia should ingest
15 to 20 grams of fast-acting carbohydrate (2 tablespoons), which is
usually sufficient to raise the blood glucose into a safe range, retest
after 15 minutes. If the glucose remains ≤70 mg/dL (3.9 mmol/L),
repeat treatment may be necessary.
• Severe — Severe hypoglycemia requires the assistance of another
person to actively administer carbohydrate, glucagon (0.5-1 mg), or
other resuscitative actions.
• With IV access — Patients already in the hospital can usually be treated
quickly by giving 25 g of 50 percent glucose (dextrose) intravenously
(IV). Maintenance: Dextrose 10% 500 c/8 hr (w/o other comorbid)
Monitoring
• Target: > 100 mg/dL
• Interval : 15’ 3x -> 2 hr 3x -> 4 hr 3x -> adjusted as
needed
• If:
• < 50 mg/dL: D40% 50 cc IV
• < 100 mg/dL: D40% 25 cc IV
• 100-200 mg/dL: D10% without D40% IV
• > 200 mg/dL: Consider ↓ D10%
Mohon Bimbingan
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