Skip to main content Skip to main navigation menu Skip to site footer

Aspek laboratorium pemeriksan keton pada kasus preeklamsia berat: laporan kasus



Abstract

Background: Ketones are the product of fat metabolism, consisting of 20% aceto-acetic acid, 78% β-hydroxy butyrate and 2% acetone. Aceto-acetic acid and acetone that experience an increase is called ketosis while ketosis that occurs in the urine is called ketonuria. This case report aims to evaluate the laboratory aspects of ketone testing in cases of severe preeclampsia.

Case Presentation: Increased levels of ketonuria in the body can cause ketoacidosis and a decrease in blood pH if not treated immediately, in pregnant women it can cause fetal death and ketoacidic coma. A 30 year old female patient with a diagnosis of G4P3003 UK 26 mg T/IUFD accompanied by ketonuria and severe preeclampsia. At the diagnostic examination, blood pressure was found: 170/100 mmHg, urine examination: protein 1+ and ketones 2+. The patient was treated with MgSO4, nifedipine, drip transamin 1 ampoule 28 tpm, cefotaxime and observation for bleeding.

Conclusion: During early pregnancy, there were persistent complaints of nausea and vomiting where laboratory tests, especially urine for remote areas and blood ketone examination for urban areas, were needed in early pregnancy to prevent preeclampsia.

 

Latar Belakang: Keton merupakan produk hasil dari metabolisme lemak, terdiri dari 20% asam aseto-asetat, 78% β-hidroksi butirat dan 2% aseton. Asam aseto-asetat dan aseton yang mengalami peningkatan disebut ketosis sedangkan ketosis yang terjadi di dalam urin disebut Ketonuria. Laporan kasus ini bertujuan untuk mengevaluasi aspek laboratorium pemeriksan keton pada kasus preeklamsia berat.

Presentasi Kasus: Peningkatan kadar ketonuria didalam tubuh dapat menyebabkan ketoasidosis dan penurunan pH darah jika tidak segera mendapatkan penanganan, pada ibu hamil dapat menyebabkan kematian janin serta ketoacidic koma. Pasien perempuan umur 30 tahun dengan diagnosis G4P3003 UK 26 mg T/IUFD disertai ketouria dan  Preeklamsia Berat. Pada pemeriksaan penegakan diagnosis didapatkan tekanan darah: 170/100 mmHg, Pemeriksaan urin : protein 1+ dan keton 2+. Pasien diterapi dengan MgSO4, nifedipine, drip transamin 1 ampul 28 tpm, cefotaxime dan observasi perdarahan.

Kesimpulan: Pada masa kehamilan awal didapatkan keluhan mual muntah terus menerus dimana pemeriksaan laboratorium khususnya urin untuk daerah terpencil dan pemeriksaan keton darah untuk daerah perkotaan pada awal kehamilan diperlukan untuk mencegah preeklamsia.

Keywords: Keton Ketonuria pemeriksaan urin

References

  1. Moore AR, Holland-Winkler AM, Ansley JK, Boone EDH, Schulte MKOR. Reliability and diagnostic performance of a new blood ketone and glucose meter in humans. Journal of the International Society of Sports Nutrition. 2021;18(1):6.
  2. Gibson AA, Eroglu EI, Rooney K, Harper C, McClintock S, Franklin J, et al. Urine dipsticks are not accurate for detecting mild ketosis during a severely energy restricted diet. Obesity Science & Practice. 2020;6(5):544-551.
  3. Pulungan AB, Juwita E, Pudjiadi AH, Rahmayanti S, Tsaniya I. Diabetic ketoacidosis in adolescents and children: a prospective study of blood versus urine ketones in monitoring therapeutic response. Acta Med Indones. 2018;50(1):46-52.
  4. Barac-Nieto MARIO. Renal hydroxybutyrate and acetoacetate reabsorption and utilization in the rat. American Journal of Physiology-Renal Physiology. 2985;249(1):F40-F48.
  5. Behre JA. A modified salicylaldehyde method for the determination of acetone bodies in blood and urine. Journal of Biological Chemistry. 2940;136(1):25-34.
  6. Nguyen KT, Xu NY, Zhang JY, Shang T, Basu A, Bergenstal RM, et al. Continuous ketone monitoring consensus report 2021. Journal of Diabetes Science and Technology. 2022;16(3):689-715.
  7. Tommaso MD, Aste G, Rocconi F, Guglielmini C, Boari A. Evaluation of a portable meter to measure ketonemia and comparison with ketonuria for the diagnosis of canine diabetic ketoacidosis. Journal of veterinary internal medicine. 2009;23(3):466-471.
  8. Araújo CASC, Minervino AHH, Sousa RS, Oliveira FLC, Rodrigues FAML, Mori CS, et al. Validation of a handheld β-hydroxybutyrate acid meter to identify hyperketonaemia in ewes. PeerJ. 2020;8(1):e8933.
  9. Timur B, Guney G. The role of serum ADAMTS-1 levels in Hyperemesis Gravidarum. BMC Pregnancy and Childbirth. 2022;22(1):1-7.
  10. Adnyana IBP, Liwang F, Negara KS, Manuaba IBP, Bhargah A, Prabawa IPY. Clinical risk factor of preeclampsia: a five-year retrospective study in Bali Royal Hospital, Bali-Indonesia. Gineco. Eu. 2018;14(53):89-93.
  11. Liwang F, Bhargah A. Preeclampsia management: different insight from hospital to hospital approach in Indonesia. Indonesia Journal of Biomedical Science. 2019;13(1):1–6.
  12. Desetyaputra DR, Prasetyo B, Damayanti HE. Root cause analysis of maternal deaths at Dr. Soetomo General Academic Hospital Surabaya, Indonesia in 2019. Bali Medical Journal. 2021;10(3):874–880.

How to Cite

Perdana, I. G. S. O., I Nyoman Gde Sumardika, Made Dharma Pramana, & Ni Luh Putu Siska Kahari Sari. (2023). Aspek laboratorium pemeriksan keton pada kasus preeklamsia berat: laporan kasus. Intisari Sains Medis, 14(1), 492–495. https://doi.org/10.15562/ism.v14i1.1634
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
0

Total
0

Share

Search Panel

I Gede Sukma Okta Perdana
Google Scholar
Pubmed
ISM Journal

I Nyoman Gde Sumardika
Google Scholar
Pubmed
ISM Journal

Made Dharma Pramana
Google Scholar
Pubmed
ISM Journal

Ni Luh Putu Siska Kahari Sari
Google Scholar
Pubmed
ISM Journal