Case Report

Penanganan pasien status hiperglikemik hiperosmoler yang disertai pankreatitis akut

Ni Nyoman Trisna Yuliharti Tersinanda , Ketut Suastika

Ni Nyoman Trisna Yuliharti Tersinanda
Program Studi Pendidikan Dokter Spesialis Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/RSUP Sanglah, Denpasar, Bali Indonesia. Email: trisnatersinanda@gmail.com

Ketut Suastika
Departemen/KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/RSUP Sanglah, Denpasar, Bali Indonesia
Online First: December 01, 2020 | Cite this Article
Tersinanda, N., Suastika, K. 2020. Penanganan pasien status hiperglikemik hiperosmoler yang disertai pankreatitis akut. Intisari Sains Medis 11(3): 1271-1276. DOI:10.15562/ism.v11i3.702


Introduction. The hyperosmolar hyperglycemic state is a dangerous complication that can arise with diabetes mellitus. The emergent treatment is necessary to reinstate hemodynamic stability, as mortality rates for the hyperosmolar hyperglycemic state are exceptionally high and can have multiple complications.

Case. A 40-year-old male presented unresponsive to the emergency department. Upon arrival, the patient examination was consistent with dehydration and tachycardia. Review of systems included a one-week history of epigastrial pain, nausea and vomiting without a history of diabetes. The presenting blood sugar level was 1099 mg/dl with high osmolarity. Abdominal ultrasound revealed peripancreatic fluid suspicious for acute pancreatitis. Following successful treatment of acute pancreatitis and hyperglycemia with fluid and insulin, his serum glucose and pancreatic enzyme level decreased to normal range. The patient recovered and was discharged in stable condition.

Conclusion. This case study postulates that the correlation between hyperosmolar hyperglycemic state and pancreatitis may be explained by two causal relationships, one of them is the hyperosmolar hyperglycemic state can be induced by ischemic pancreatitis. This is important because hyperglycemia superimposed on any ischemic insult can increase the risk of multiorgan failure, as with our patient. Thus, recognition and management of resulting complications need to be emergent.

 

Pandahuluan. Status hiperglikemik hiperosmoler merupakan komplikasi berbahaya dari diabetes melitus. Terapi yang cepat sangat penting untuk mengembalikan stabilitas hemodinamik, dimana angka mortalitas untuk status hiperglikemik hiperosmoler sangat tinggi dan memiliki banyak komplikasi.

Kasus. Seorang pria usia 40 tahun datang dalam keadaan penurunan kesadaran ke unit gawat darurat. Saat datang, pasien didapatkan dehidrasi dan takikardia dari pemeriksaan tanda vital. Didapatkan riwayat nyeri ulu hati sejak satu minggu, mual dan muntah tanpa riwayat diabetes sebelumnya. Kadar glukosa darah sewaktu saat itu 1099 mg/dl dengan osmolaritas yang tinggi. Dari pencitraan ultrasound abdomen didapatkan cairan peripankreatik yang mengarah ke pankreatitis akut. Dengan berhasilnya terapi cairan dan insulin untuk penanganan pankreatitis akut dan hiperglikemia, kadar glukosa darah dan enzim pankreas pasien ini membaik ke rentang normal. Kondisi pasien membaik dan dipulangkan dalam keadaan yang stabil.

Kesimpulan. Laporan kasus ini menggambarkan korelasi antara status hiperglikemik hiperosmoler dan pankreatitis yang dapat dijelaskan dengan hubungan dua arah, dimana salah satunya bahwa status hiperglikemik hiperosmoler dapat dicetuskan oleh pankreatitis iskemik. Hal ini penting karena hiperglikemia yang dicetuskan oleh kondisi iskemik dapat meningkatkan risiko gagal multiorgan, seperti pada kasus ini. Sehingga, deteksi dan penanganan dari komplikasi ini harus dilakukan dengan segera.

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