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

Penanganan pasien status hiperglikemik hiperosmoler yang disertai pankreatitis akut



Abstract

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.

Keywords: diabetes melitus sepsis iskemia hiperglikemia pankreatitis

References

  1. Davis SN, Umpierrez GE. Diabetic ketoacidosis in type 2 diabetes mellitus – pathophysiology and clinical presentation. Nat Clin Pract Endocrinol Metab. 2007; 3(11):730-731.
  2. Chen HF, Wang CY, Lee HY, See TT, Chen MH, Jiang JY, et al. Short-term case fatality rate and associated factors among inpatients with diabetic ketoacidosis and hyperglycemic hyperosmolar state: a hospital-based analysis over a 15-years period. Intern Med. 2010;49(8):729-737.
  3. Stoner GD. Hyperosmolar hyperglycemic state. Am Fam Physician. 2005;71(9):1723-1730.
  4. Quinlan, JD. Acute Pancreatitis. Am Fam Physician. 2014; 90(9):632-639.
  5. Macisaac RJ, Lee LY, McNeil KJ, Tsalamandris C, Jerums G. Influence of age on the presentation and outcome of acidotic and hyperosmolar diabetic emergencies. Intern Med J. 2002;32(8):379-385.
  6. Cohen J, Fadul C, Jenkyn L, Ward T. Chapter 25: Metabolic encephalopathy. In: Reeves AG, Swenson RS. Disorders of the nervous system – A Primer. Dartmouth Medical School. [serial online] 2008 [diakses Januari 2019]. Diunduh dari: http://www.dartmouth.edu/~dons/part_3/chapter_25-.html
  7. Adeyinka A, Kondamudi NP. Hyperosmolar hyperglycemic nonketotic coma (HHNC, Hyperosmolar hyperglycemic non ketotic syndrome) In: StatPearls Publishing. [serial online] 2018. [diakses Januari 2019] Diunduh dari: https://www.ncbi.nlm.nih.gov/books/NBK482142/?report=reader
  8. Ness-Otunnu RV, Hack JB. Hyperglycemic crisis. The Journal of Emergency Medicine. 2013:1-9.
  9. Chou W, Chung M, Wang H, Chen J, Chen W, Guo H, et al. Clinical characteristics of hyperglycemic crises in patients without a history of diabetes. J Diabetes Invest. 2014;5:657-662.
  10. Tenner S, Baillie J, DeWitt J, Vege SS. ACG Clinical Guideline: Management of Acute Pancreatitis. Am J Gastroenterol. 2013;108:1400-1415.
  11. Fayman M, Pasquel FJ. Management of hyperglycemic crises. Med Clin N Am. 2017;101:587-606.
  12. Kitabchi AE, Fisher JN. Hyperglycemic crises diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS). Dalam: Berghe GV, ed. Contemporary Endocrinology: Acute Cause to Consequence. Edisi ke-23. New York. 2013:119-147.
  13. Butler DC, Emanuel AJ, Self SE, Batalis NI. The interplay between diabetes and pancreatitis: two case reports of sudden, natural deaths and a review of the literature. J Forensic Sci. 2016;1-6.
  14. Das SLM, Singh PP, Phillips ARJ, Murphy R, Windson JA, Petrov MS. Newly diagnosed diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis. Gut. 2014;63:818-831.
  15. Xue Y, Sheng Y, Dai H, Cao H, Liu Z. Risk of development of acute pancreatitis with pre-existing diabetes: a meta-analysis. Eur J Gastroenterol Hepatol. 2012;24:1092-1098.
  16. Zechner D, Sempert K, Genz B. Impact of hyperglycemia and acute pancreatitis on the receptor for advanced glycation endproducts. Int J Clin Exp Pathol. 2013;6:2021-2039.

How to Cite

Tersinanda, N. N. T. Y., & Suastika, K. (2020). Penanganan pasien status hiperglikemik hiperosmoler yang disertai pankreatitis akut. Intisari Sains Medis, 11(3), 1271–1276. https://doi.org/10.15562/ism.v11i3.702
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
406

Total
653

Share

Search Panel

Ni Nyoman Trisna Yuliharti Tersinanda
Google Scholar
Pubmed
ISM Journal

Ketut Suastika
Google Scholar
Pubmed
ISM Journal