Hipertensi stage 2 ec Diabetes

Mellitus Tipe 2
OLEH
FARIDATUL LUTFI
BP : 1810312111

Preseptor : dr. Wahyudi, Sp.PD-KKV

PENDAHULUAN

T 0
 01 02
APA ITU DMT2? PREVALENSI
Indonesia menduduki
penyakit metabolik dengan
ranking ke-4 di dunia dalam
karakteristik hiperglikemia yang terjadi
hal jumlah penderita
karena kelainan sekresi insulin, kerja
diabetes setelah China, India
insulin atau kedua-duanya
dan Amerika Serikat

03
DMT2 DIMASA AKAN DATANG
Pada tahun 2000, jumlah penderita diabetes mencapai 8,4 juta dan diperkirakan
pada tahun 2030 jumlah penderita diabetes di Indonesia akan berjumlah 21,3
juta

T 0
 01 02 03
Tujuan BATASAN MASALAH METODE PENULISAN
membahas kasus DMT2
pemeriksaan langsung pada
memahami dan menambah mulai dari anamnesis hingga
pasien, tinjauan kepustakaan
pengetahuan tentang penatalaksanaannya
DMT2 dan komplikasi
01
DEFINISI
Diabetes Melitus tipe 2 disebabkan
oleh insulin yang ada tidak dapat
bekerja dengan baik. Meskipun kadar
insulin dapat normal, rendah atau
bahkan meningkat tetapi fungsi insulin
untuk metabolisme glukosa tidak ada
atau kurang.

T 1
Etiologi dan Faktor Resiko

T 1
 Patogenesis
02

T 2
Manifestasi Klinik

POILURIA POLIDIPSI POLIFAGI

MUDAH PENURUNAN
LELAH BERAT BADAN

T 2
 diagnosis
DIET
Mercury is the closest
planet to the Sun

MEDICATION
Despite being red, Mars is
actually a cold place

T 2
tatalaksana

T 2
Laporan kasus
IDENTITAS
Nama : Ny. N
Umur/ tanggal lahir : 49 tahun
Jenis kelamin : Perempuan
No. RM RS : 01200568
Alamat : Mekar Jaya Tambusai Utara
Status : Menikah
Pekerjaan : Ibu Rumah Tangga
Agama : Islam
Suku : Jawa
Negeri Asal : Indonesia
Telpon : 08122848xxxx
Tanggal Pemeriksaan : 27 Desember 2023
ANAMNESIS
(Alloanamnesis : anak)
Keluhan Utama
Penurunan kesadaran sejak 2 hari sebelum masuk rumah sakit

Riwayat Perjalanan Penyakit

Pasien tidak sadarkan diri sejak 2 hari sebelum masuk rumah sakit
Penurunan kesadaran terjadi secara perlahan
Penurunan kesadaran disertai demam sejak 2 minggu sebelum
masuk rumah sakit.
Demam naik turun dan tidak tinggi dan tidak menggigil.
Pasien sesak napas 2 bulan sebelum masuk rumah sakit. Sesak tidak menciut dan dipengaruhi
oleh aktivitas
Batuk sejak 1 minggu sebelum masuk rumah sakit, batuk sesekali dan tidak berdahak
Pasien sering merasakan nyeri di luka kaki kiri. Luka muncul akibat tertusuk paku 3 tahun lalu dan
tidak sembuh-sembuh
Psien merasakan mual dan muntah sejak 1 minggu sebelum masuk rumah sakit. Muntah sehari
hingga 3 kali dan berisi makanan
Pasien sebelumnya sering BAK malam hari, sering merasa haus, dan sering lapar
Pasien telah terdiagnosis diabetes mellitus tipe 2 sejak 5 tahun lalu dan tidak rutin minum obat
Pasien sebelumnya memiliki berat badan obesitas dan telah mengalami penurunan berat badan
sejak terdiagnosis diabetes mellitus tipe 2
BAB hitam tidak ada, nyeri ketika BAK tidak ada
Riwayat Penyakit Dahulu
Pasien ada riwayat penyakit diabetes mellitus tipe 2 sejak 5 tahun lalu
Tidak ada riwayat sakit kuning
Tidak ada riwayat hipertensi

Riwayat Penyakit Keluarga

Tidak ada riwayat penyakit diabetes mellitus pada keluarga pasien

Pedigree Pasien
Riwayat Penggunaan Obat
Pasien pernah minum obat DMT2 tapi tidak rutin

Pekerjaan, faktor ekonomi, kejiwaan, dan kebiasaan

Pasien seorang ibu rumah tangga dengan 5 orang anak. Pasien suka
makan dengan porsi besar dan memiliki riwayat obesitas
PEMERIKSAAN FISIK
Keadaan umum
Keadaan umum : Berat
Kesadaran : Somnolen
Tekanan darah : 158/86 mmHg
Nadi : 98 x/menit
Pernapasan : 28 x/menit
Suhu : 37,9 ° C
SpO2 : 98%
Kulit
Warna sawo matang, efloresensi (-), scar (-), pigmentasi normal, ikterus (-),
sianosis (-), spider nevi (-), telapak tangan dan kaki pucat (+), pertumbuhan
rambut normal.

Kelenjar Getah Bening

Tidak ada pembesaran kelenjar getah bening di leher, submandibula,
supraklavikula, infraklavikula, aksila, inguinalis

Kepala
Bentuk normochepali, simetris, deformasi (-), rambut hitam, lurus, tidak
mudah dicabut

Mata
Edema palpebra (-), konjungtiva anemis (-/-), sklera ikterik (-/-)
Hidung
Bagian luar tidak ada kelainan, septum dan tulang-tulang dalam perabaan
baik, tidak ditemukan penyumbatan maupun perdarahan, pernapasan
cuping hidung (-).

Telinga
Kedua meatus acusticus eksternus normal, cairan (-), nyeri tekan
processus mastoideus (-), pendengaran baik.
Mulut
Gigi berlubang dan karies (+), pembesaran tonsil (-), pucat pada lidah (-),
atrofi papil (-), gusi berdarah (-), stomatitis (-), bau pernafasan khas (-).
Leher
Pembesaran kelenjar tiroid tidak ada, pembesaran kelenjar KGB tidak ada,
JVP (5-2) cmH2O, kaku kuduk (-).
Thoraks
Bentuk dada simetris, spider nevi (-).
Paru-paru
I : Statis,dinamis simetris kanan dan kiri, sela iga tidak melebar
P : fremitus tidak dapat dinilai karena pasien penurunan kesadaran
P : Sonor pada kedua lapangan paru
A: bronkovesikuler (+) di kedua lapangan paru, ronkhi basah kasar (+) di kedua
basal paru, wheezing (-).
Jantung
I : ictus cordis tidak terlihat
P : ictus codis teraba 1 jari lateral LMCS RIC V
P : batas atas ICS II, batas jantung kanan linea sternalis dextra, batas jantung kiri
LMCS RIC V
A: S1-S2 reguler, murmur (-), gallop (-)
Abdomen
I : tidak membuncit, venektasi (-)
P: supel, nyeri tekan (-), hepar teraba 2 jari di bawah arcus
costae kanan, dan 1 jari dibawah processus xipoideus, lien
tidak membesar.
P : timpani
A: BU (+) normal
Alat kelamin
Tidak diperiksa
Ekstremitas atas :
Nyeri sendi (-), gerakan bebas, edema (-), jaringan parut (-), pigmentasi normal,
telapak tangan pucat (-), jari tabuh (-), turgor kembali lambat (+), eritema
palmaris (-), sianosis (-).

Ekstremitas bawah :
Kelemahan otot (-), nyeri sendi (-), edema pretibia (-) pada kedua tungkai, jaringan
parut (-), pigmentasi normal, jari tabuh (-), turgor kembali lambat (+), akral
pucat (-), sianosis (-).
PEMERIKSAAN PENUNJANG
Pemeriksaan Laboratorium
Darah rutin:
Desember 2023
Hb : 11 gr/dl
Leukosit : 13.650/mm3
Trombosit : 158.000/mm3
Hematokrit : 31 %
MCV/MCH/MCHC : 76/27/35
Ureum darah : 197 mg/dl
RDW-CV : 14.6%
Kreatinin darah : 10,9 mg/dl
GDS : 128 mg/dl
Natrium : 129 mmol/L
Klorida : 100 mmol/L
Kalium : 4,8
PH : 7,359
PCO2 : 18,4
PO2 : 71,1
SO2% : 94,7
HCT : 34
HCO3- : 10,5
TCO2 : 11
BEect : -15,2
BE (B) : -12,3
Kesan : Leukositosis, ureum dan kreatinin meningkat, natrium manurun
Desember 2023
SGOT : 22 U/L
SGPT : 8 U/L
Asam urat : 11,2 mg/dL
Kolesterol total : 227 mg/dL
Kolesterol HDL : 27 mg/dL
Kolesterol LDL : 156 mg/dL
Trigliserida : 221 mg/dL
Gula darah puasa : 69 mg/dL
HBA1C : 5,8%
Kalsium : 8.8 mg/dL
Anti HIV : non reaktif
HBsAg : non reaktif
Anti HCV Rapid : non reaktif
Total protein : 6,1 g/dL
Albumin : 2,5 g/dL
Globulin : 3,6 g/dL
Bilirubin total : 0,3 mg/dL
Bilirubin direk : 0,1 mg/dL
Bilirubin indirek : 0,2 mg/dL
Kesan : total protein dan albumin menurun, asam urat meningkat, dyslipidemia
Hb : 9,9 gr/dl
Leukosit : 15.820/mm3
Trombosit : 177.000/mm3
Hematokrit : 29 %
Eritrosit : 3.750.000
MCV/MCH/MCHC : 77/26/35
Ureum darah : 152 mg/dl
RDW-CV : 14.6%
Kreatinin darah : 8,6 mg/dl
Eosinophil : 3%
Neutrophil segmen : 80%
Limfosit : 10%
Monosit : 7%
Total protein : 5,2 g/dL
Albumin : 2,5 g/dL
Globulin : 27 g/dL
SGOT : 10 U/L
SGPT : 7 U/L
Natrium : 132 mmol/L
Kalium : 3,7 mmol/L
Klorida : 104 mmol/L
Kesan : total protein dan albumin menurun,ureum dan kreatinin meningkat,
natrium menurun, anemia, leukositosis dengan neutrofilia shift to the right
Urinalisis
Warna : kuning muda
Kekeruhan : positif
Leukosit : 300-350/LPB
Eritrosit : 250-350/LPB
Epitel : positif/LPB
Bakteri : positif
BJ : 1,008
PH :6
Protein : +1
Kesan : leukosituria, hematuria, proteinuria (+1),
ditemukan bakteri, nitrit (-)
Hb : 8 gr/dl
Leukosit : 7.180/mm3
Trombosit : 61.000/mm3
Hematokrit : 24 %
MCV/MCH/MCHC : 80/26/33
RDW-CV : 15%
PH : 7,49
PCO2 : 29,4
PO2 : 66,1
SO2% : 95,3
HCT : 28
HCO3- : 22,8
TCO2 : 23,8
BEect : -1
BE (B) : 0,2
Kesan : Anemia, trombositopenia
Pemeriksaan rongsen thorax

Kesan : bronkopneumonia
Penurunan kesadaran
KAD
DM tipe 2
hipertensi
Diagnosis Banding
KHONK
Diagnosis Kerja
CKD grade 5
Penurunan kesadaran ec CKD
DM tipe 2
Hipertensi grade 2
Penatalaksanaan
Nonfarmakologis
Istirahat
O2 8 liter nasal kanul

Farmakologis
Renxamin 200 cc/24 jam (untuk hipoalbumin)
Drip nicardipin, asam folat 1x5 mg
Natrium bicarbonat 3x500 mg
Amlodipine 1x10 mg (hipertensi)
Candesartan 1x16 mg (hipertensi)
Asetilsistein 3x200 mg (bronkopneumonia)
Cefepime 3x500 mg drip 4 jam dengan syringe pump (antibitik)
Levofloxacin 1x500 mg/48 jam (antibiotik)
Rencana Lanjutan
Konsul bagian neurologi
Prognosis
Quo Ad functionam : dubia ad bonam
Quo Ad vitam : dubia ad bonam
Quo Ad sanationam : dubia ad bonam
DISKUSI
Seorang pasien perempuan usia 49 tahun dirawat di bangsal Penyakit Dalam RSUP M
Djamil Padang dengan diagnosis DMT2, Hipertensi stage 2, CKD, dan ulkus diabetikum
telapak kaki kiri. Penegakan diagnosis pada pasien ini, berdasarkan anamnesis,
pemeriksaan fisik, dan pemeriksaan penunjang. Pada pasien mengalami penurunan
kesadaran dengan kesadaran somnolen, tekanan darah 185/92 mmHg, nadi 89 x/menit,
pernapasan 28 x/menit, suhu 37,9 ° C, SpO2 97%. Pada pasien terjadi penurunan
kesadaran. Tekanan darah 185/92 mmHg yaitu hipertensi grade 2, suhu 37,9 ° C yaitu
terjadi demam pada pasein, nadi 89 x/menit yaitu normal, pernapasan 28 x/menit yaitu
sesak napas.
Berdasarkan hasil pemeriksaan fisik, didapatkan turgor kulit menurun dan gigi
geraham kanan atas karies disertai adanya karies di gigi seri bawah. Turgor
kulit menurun menandakan terjadi dehidrasi. Dehidrasi terjadi karena
pengikatan air oleh glukosa dalam urin, sehingga pada pasien juga terjadi
poliuria. Ini merupakan gejala klasik dari diabetes mellitus. Gigi berlubang dan
karies pada pasien merupakan sumber infeksi yang dapat memicu terjadinya
ketoasidosis metabolik. Berdasarkan hasil rongsen thorax, tampak
bronkopneumonia. Bronkopneumonia merupakan sumber infeksi terjadinya
ketoasidosis.
Berdasarkan pemeriksaan penunjang, didapatkan GDS 128 mg/dl, natrium 129
mmol/L, klorida 100 mmol/L, kalium 4,8, PH 7,359 mmHg, HCO3 10,5 mmol/L.
Pada pasien dengan GDS 128 mg/dl, kreatinin 10,9 mg/dl. GDS 128 mg/dl
menandakan hiperglikemia, natrium 129 mmol/L menandakan hiponatremia,
dan kreatinin 10,9 mg/dl menandakan peningkatan kreatinin dalam darah.
Peningkatan kreatinin dalam darah menandakan adanya gangguan di ginjal. Pada
pasien, nilai kreatinin clearance 5,52 ml/menit. Pada pasien ini, telah memenuhi
syarat untuk dilakukan hemodialisis.
Penatalaksanaan pada pasien ini yaitu dengan Renxamin 200 cc/24 jam untuk
mengatasi hipoalbumin, drip nicardipin untuk menurunkan tekanan darah pasien,
natrium bicarbonat 3x500 mg untuk mengatasi hiponatremia pada pasien. Amlodipine
1x10 mg dan candesartan 1x16 mg untuk mengatasi hipertensi. Asetilsistein 3x200 mg
untuk mengatasi infeksi bronkopneumonia, cefepime 3x500 mg drip 4 jam dengan
syringe pump dan levofloxacin 1x500 mg/48 jam sebagai antibiotik untuk ulkus diabetic
pada telapak kaki kiri pasien.
Thank you
 TREATMENT PHASES
PHASE 1
Despite being red, Mars
is a cold place

PHASE 2
Saturn is a gas giant and
has several rings
PHASE 3
Venus is the second
planet from the Sun

T 2
 The discovery of insulin
Venus is Mercury is the
extremely hot smallest planet

1921 1923

1920 1922 1924

Mars is a very Saturn is the Neptune is very
cold place ringed one far from the Sun

T 2
 SYMPTOMS OF DIABETES
THIRSTY
DIZZINESS Mercury is the HUNGRY
Neptune is very smallest planet Saturn is the
far from the Sun planet with rings

WEIGHT tingling
Jupiter is the Venus has a
biggest planet beautiful name

T 2
 03
GET
INVOLVED
You can enter a subtitle
here if you need it

T 3
gET INVOLVED!
Do you know what helps you make
your point clear?
Lists like this one:

● They’re simple
● You can organize your ideas
clearly
● You’ll never forget to buy milk!

And the most important thing: the

audience won’t miss the point of your
presentation

T 3
 WDD CAMPAIGN
ACTIONS
Mercury is the closest planet to
the Sun and the smallest one in
the Solar System—it’s a bit
larger than the Moon
T 3
PREVENTION
Venus has a beautiful name
and is the second planet from
the Sun. It’s hot and has a
poisonous atmosphere
 Some activities

Media activity Physical activity

Venus is the second Jupiter is the biggest
planet from the Sun planet of them all

Meeting & fair Nurse activity

Despite being red, Mars Saturn is a gas giant and
is a cold place has several rings

T 3
 STEPS TO CONSIDERER

MEDICATION
Venus is the second planet
01 from the Sun 03

PREVENTION 02 ENJOY
Mercury is the closest Despite being red, Mars is
planet to the Sun a cold place

T 2
“This is a quote, words
full of wisdom that
someone important said
and can make the reader
get inspired.”
—SOMEONE FAMOUS

T 3
WDD around the world
JUPITER
It is the biggest planet

VENUS
It is the second planet

NEPTUNE
It’s an ice giant

SATURN
Saturn is a gas giant

T 3
 Components of care

insulin medicine blood

Mercury is the Venus is the second Mars is actually a
smallest planet planet from the Sun very cold place

support exercise food

Jupiter is the biggest Saturn is the only Neptune is far from
planet of them all planet with rings the Sun

T 3
 COMPONENTS OF TREATMENT

INSULINE EXERCISE
Despite being red, Mars Saturn is a gas giant and
is a cold place has several rings

FOOD MEDICINE
Venus is the second Jupiter is the biggest
planet from the Sun planet of them all

T 3
 04
MEDIAHUB
You can enter a subtitle
here if you need it

T 4
AWESOME
PREVENTION
T 4
 Blood sugar chart
Fasting Value (mg/dl) Postprandial (mg/dl)
Category
Min. Value Max. Value Value 2h after eating glucose

Normal 70 100 Less than 140

Early Diabetes 101 126 140 to 200

Established
More than 126 - More than 200
Diabetes

T 4
 A HISTORY OF DIABETES

1500 BC 200 AD 1100 1500

Neptune is the Venus is the Despite being red, Jupiter is the

farthest planet second planet Mars is a cold biggest planet of
from the Sun from the Sun place them all

T 4
A PICTURE ALWAYS
REINFORCES THE CONCEPT
Images reveal large amounts of data, so remember: use an image instead of a long
text. Your audience will appreciate it

T 4
 IMPORTANT DATES
MON TUE WED THU FRI SAT SUN
Talks 01 02 03 04 05 06
Mercury is a very
small planet 07 08 09 10 11 12 13

14 15 16 17 18 19 20
events 21 22 23 24 25 26 27
Venus has a
beautiful name 28 29 30

World Diabetes Day

T 4
 05
DATES
You can enter a subtitle
here if you need it

T 5
 463 million
Adults were living with diabetes in 2019
The number of people living with diabetes is expected
to rise to 578 million by 2030

T 5
 FACTS IN NUMBERS

232 MILLION 20 MILLION

Jupiter is a gas giant and the biggest Venus has a beautiful name and is the
planet in the Solar System second planet from the Sun

136 MILLION $760 BILLION

Saturn is composed mostly of hydrogen Despite being red, Mars is actually a
and also helium cold place full of iron oxide dust
T 5
 DIABETES INCIDENCE

WomeN
Mercury is the closest
planet to the Sun

men
Venus has a beautiful
name, but it’s hot

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here

T 5
 Patient incidence
PATIENTS GENDER MAIN TYPES

45% 55%
women men Women Men
Mercury is the Mars is actually a Follow the link in the graph to modify its data and then
closest to the Sun very cold place paste the new one here. For more info, click here

T 5
 ILLNESS INCREASE
Women Men

2019 2021
Mercury is a Mars is actually
small planet a cold place

2020 2022
Venus has a Jupiter is a very
beautiful name big planet

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here

T 5
 WORLD PREVALENCE

75% 71%

EEUU EUROPE
Mercury is a very Mars is actually a
small planet very cold place

T 5
 482
million of people worldwide are
living with diabetes today

642
million of people worldwide will have
diabetes in 2040

T 5
 GESTATIONAL DIABETES
Of women after pregnancy suffer from
10% TYPE 1 type 1 diabetes within 7 years

Of women after pregnancy suffer from

51% TYPE 2 type 2 diabetes within 23 years

Using of insulin therapy was greatest

32% THERAPY predictor of future diabetes

T 5
 333,000
The Sun’s mass compared to Earth’s

24h 37m 23s

Jupiter's rotation period

386,000 km
Distance between Earth and the Moon

T 5
 Nursing in percentages

60% 90% 10% 35%

Despite being Venus is the Saturn is a gas Jupiter is a gas

red, Mars is a second planet giant and has giant and the
cold place from the Sun many rings biggest planet

T 5
 pREVALENCE IN THE U.S.
> 12 %
11.0 - 11.9 %
10.0 - 10-9 %
9.0 - 9.9 %

You can give a brief description of the <9%

topic you want to talk about here

T 5
 Media hub
You can replace the image on the
screen with your own work. Just
right-click on it and select
“Replace image”

T 5
 EVENT app
You can replace the image on
the screen with your own work.
Just right-click on it and select
“Replace image”

T 5
HEALTHY
FOOD app
You can replace the image on
the screen with your own
work. Just right-click on it
and select “Replace image”

T 5
OUR TEAM

EMILIA ZOE
You can speak a bit
about this person here

JENNA smith
You can speak a bit
about this person here

T 5
 06
CONCLUSIONS
You can enter a subtitle
here if you need it

T 6
 reviews
mercury
Mercury is the closest
planet to the Sun

mars
Despite being red, Mars
is actually a cold place

T 6
 Areas in action
society family
Mercury is a very Venus is the second
small planet planet from the Sun

school worked
Mars is actually a Neptune is very far
very cold place from the Sun

friends medicine
Jupiter is the biggest Saturn has several
planet of them all beautiful rings

T 6
 Best process area
Best areas Best process

Society Venus has a beautiful name,

but it’s terribly hot
Exercise Despite being red, Mars is
actually a cold place
Mercury is the closest planet
Treatment to the Sun
Neptune is the farthest planet
Food from the Sun

T 6
 improvement measures

Quality assurance
Mercury Mercury is the closest planet to the Sun

Venus Venus is the second planet from the Sun

Sun The Sun is the star at the center of the Solar System

Saturn Saturn is the ringed planet and a gas giant

T 6
 Reviews areas
Jupiter is the biggest
Area 1 planet of them all

Venus is the second

areas Area 2 planet from the Sun
Mercury is the closest
planet to the Sun

Despite being red,

Area 3 Mars is a cold place

T 6
 CONCLUSIONS

● Write your final conclusions here

● Write your final conclusions here
● Write your final conclusions here
● Write your final conclusions here
● Write your final conclusions here
● Write your final conclusions here
● Write your final conclusions here

T 6
 Thanks!
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MARS
Mars is cold

JUPITER
55% Venus

Jupiter is big
30%
Mars
VENUS
Venus is hot

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Premium alternative resources

skill 1
Mercury is very small

skill 2 STEP 1 STEP 2 STEP 3

Saturn has several rings Venus has a Pluto is a Neptune is an
nice name dwarf planet ice giant

skill 3
Mars is a cold planet

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 Fonts & colors used
This presentation has been made using the following fonts:

Bungee
(https://fonts.google.com/specimen/Bungee)

Cairo
(https://fonts.google.com/specimen/Cairo)

#f6efe4 #f6bc9b #f08f58 #fe5145

#8cd8e1 #53a2b9 #103c60 #1c5f5d

 Storyset
Create your Story with our illustrated concepts. Choose the style you like the most, edit its colors, pick the background
and layers you want to show and bring them to life with the animator panel! It will boost your presentation. Check out h
ow it works.

Pana Amico Bro Rafiki Cuate

 Use our editable graphic resources...
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 JANUARY FEBRUARY MARCH APRIL MAY JUNE

PHASE 1

Task 1

Task 2

PHASE 2

Task 1

Task 2

JANUARY FEBRUARY MARCH APRIL

PHASE 1

Task 1

Task 2
 ...and our sets of editable icons
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