Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Hypoglycemia is a reduction in blood glucose level below 60 mg'/o Epidemiologic data report a 0.02/1000 patent/year mortality rate due to hypoglycemia in patients using insulin in the United Kingdom. Reports from Indonesia are still quite rare. Parto Almojo (1993) reported the incidence rate of hypoglycemia in diabetic patients hospitalized at Sardjilo Hospital, Yogyakarta. Conditions are quite different than in Western nations, perhaps due to a smaller population of patients with type I diabetes mellitus in Indonesia

Abstrak :
Latar belakang: Ketoasidosis diabetik (KAD) merupakan komplikasi DM tipe-1 yang dapat mengakibatkan kematian atau kecacatan neurologis permanen. Data IDAI tahun 2017 menyatakan sebanyak 71% anak DM tipe-1 pertama kali terdiagnosis dengan KAD yang meningkat dari tahun sebelumnya. Cedera otak merupakan komplikasi KAD berkaitan dengan kerusakan struktural dan fungsional otak sehingga menyebabkan kerusakan fungsi neurokognitif. Anak-anak DM tipe-1 dengan riwayat KAD menunjukkan kesulitan dalam waktu merespon, penalaran abstrak, fleksibilitas kognitif dan memori verbal. Pemeriksaan tingkat kecerdasan intelektual berupa pemeriksaan IQ diperlukan untuk menilai fungsi kognitif. Penelitian ini bertujuan untuk mengetahui gambaran fungsi kognitif berupa nilai IQ pada pasien DM tipe-1 usia sekolah dengan riwayat KAD. Metode: Dilakukan studi potong lintang deskriptif pada pasien DM tipe-1 dengan riwayat KAD yang dilaksanakan pada bulan Februari-Maret 2020 di RSUPN dr. Cipto Mangunkusumo, Jakarta. Sampel penelitian adalah pasien anak berusia 7-18 tahun yang pernah mengalami KAD sejak pertama kali terdiagnosis DM tipe-1 dan kooperatif untuk dilakukan pemeriksaan. Subyek melakukan tes IQ kemudian hasilnya dilaporkan. Hasil: Sebanyak 27 subyek memenuhi kriteria inklusi dengan 14 subyek perempuan dan 13 subyek lelaki. Rerata usia subyek adalah 13,5 tahun dengan rerata usia saat terdiagnosis adalah 8 tahun dan lama menderita DM adalah 48 bulan. Median nilai IQ yang didapatkan 91 (62-120), median verbal IQ 90 (67-113) dan median performance IQ 94 (61-118). Frekuensi KAD  2x, riwayat KAD < 18 bulan dan lama menderita DM tipe-1 5 tahun, usia saat terdiagnosis 7 tahun memiliki kecenderungan nilai IQ lebih rendah dibandingkan kondisi sebaliknya yaitu termasuk dalam kategori IQ di bawah rata-rata skala Wechsler. Kesimpulan: Nilai IQ pasien DM tipe-1 usia sekolah dengan riwayat KAD termasuk dalam kategori IQ rata-rata skala Wechsler. ......Background and aim: Diabetic ketoacidosis (DKA) is a complication of type-1 diabetes that results in death or permanent neurological disability. IDAI data for 2017 stated that 71% of patients with type-1 diabetes were first diagnosed as DKA which increased from the previous year. Brain injury is a complication of DKA associated with structural and functional damage to the brain and causes neurocognitive function impairment. Children with type-1 diabetes with history of DKA show difficulties in response time, abstract reasoning, cognitive flexibility and verbal memory. An examination for the level of intelligence as an IQ examination is needed to assess cognitive function. This study aims to determine the description of cognitive function as IQ scores in school age patients of type-1 diabetes with history of DKA. Method: A cross-sectional descriptive study was performed to type-1 diabetic patients with history of DKA started from February-March 2020 at the RSUPN Dr. Cipto Mangunkusumo, Jakarta. The study subjects were pediatric patients aged 7-18 years who had experienced DKA since they were first diagnosed as type-1 diabetes and were cooperative for examination. Subjects performed an IQ test then the results were reported. Results: A total of 27 subjects met the inclusion criteria with 14 females and 13 males. The mean age was 13.5 years with the average age at diagnosis was 8 years and the duration of diabetes was 48 months. The median IQ score was 91 (62-120), verbal IQ IQ 90 (67-113) and performance IQ 94 (61-118). Frequency of DKA twice or more, history of DKA <18 months, length of suffering of type-1 diabetes 5 years or more and age at diagnosis 7 years or more have a tendency of lower IQ scores which is included in the IQ category below the average for Wechsler scale. Conclusion: The IQ score of type-1 diabetes school-age patients with history of DKA is categorized as the average of Wechsler scale

Abstrak :
Alcoholic ketoacidosis is a common disorder in chronic alcoholic persons. The Pathogenesis is complex associated with extracellular fluid volume depletion, alcohol withdrawal, abdominal pain, and acid abnormalities. The syndrome is rapidly reversible and has a low mortality. The treatment is administration with normal saline, glucose, potassium and thiamine. We report two cases of Alcoholic Ketoacidosis, first case with classically picture of AKA and the second one AKA with Decrease consciousness and concomitant illness, pneumonia. We believe this report possibly to be the first report of AKA in Indonesia

Abstrak :
Background: diabetic ketoacidosis (DKA) is a potentially lethal complication of diabetes mellitus (DM). There is no study in Indonesia that compares the much-preferred capillary beta hydroxybutirate (β-OHB) measurement to urine acetoacetate in monitoring therapeutic response of DKA in adolescents. Methods: a prospective study of 37 adolescents and children with DKA in Cipto Mangunkusumo Hospital was done between June 2006 and March 2011. The patients were followed until the time of DKA resolution. Hourly measurement of random blood glucose, capillary β-OHB concentration, and urine ketones were done, while blood gas analysis and electrolyte were measured every four hours. Results: median time to resolution was 21 (9-52) hours. Compared to urine ketones, capillary β-OHB concentration showed stronger correlation with pH (r= -0,52, p= 0,003 vs r= -0,49, p= 0,005) and bicarbonate level (r=-0,60, p=0.000 vs r= -0.48, p=0.007) during the median time of DKA resolution. All capillary β-OHB measurement yielded negative results at median time of DKA resolution, while urine ketones were still detected up to 9 hours after resolution. Conclusion: blood ketone concentration showed better correlation with pH and bicarbonate level, as a tool to monitor therapeutic response in DKA in adolescent, compared to traditional urine ketones test in adolescents.

Abstrak :
Latar Belakang. Mortalitas KAD sebagai komplikasi akut DM di negara berkembang seperti Indonesia masih tinggi. Karena itu, diperlukan model prediksi untuk menapis pasien-pasien KAD yang memiliki risiko mortalitas tinggi. Tujuan. Mendapatkan model prediksi mortalitas 72 jam pasien KAD di IGD RSUPN Cipto Mangunkusumo. Metode. Penelitian dengan desain kohort retrospektif menggunakan rekam medik pasien KAD di IGD RSUPN Cipto Mangunkusumo periode Januari 2011 - Juni 2017 dengan metode sampling konsekutif. Hubungan mortalitas 72 jam dengan prediktor yaitu, usia, tingkat kesadaran, jenis DM, riwayat KAD, jumlah komorbid dan parameter laboratorium kadar bikarbonat, kalium, anion gap, ?-hidroksibutirat, laktat dan fungsi ginjal akan dinilai dan dilanjutkan dengan pembuatan model prediksi. Seluruh analisis dilakukan menggunakan program SPSS Statistics 20.0. Hasil. Sebanyak 86 subjek 28,57 dari 301 subjek yang dianalisis meninggal dalam waktu 72 jam. Prediktor yang berhubungan bermakna dengan mortalitas pada analisis multivariat p 4 mmol/L HR 5,585; IK 95 2,966 - 10,519 . Keempat prediktor dilanjutkan ke dalam sistem skor dan didapatkan model prediksi mortalitas 72 jam pasien KAD RSCM yang memiliki performa baik dengan probabilitas mortalitas sebesar 15,41 untuk skor 0 - 2, 78,01 untuk total skor 3 - 4 dan 98,22 untuk total skor 5 - 6. Simpulan. Mortalitas 72 jam pasien KAD di RSUPN Cipto Mangunkusumo adalah 28,57 . Model prediksi mortalitas memiliki performa yang baik dan terdiri dari komorbid, riwayat KAD, tingkat kesadaran, dan kadar laktat.Kata Kunci. Model Prediksi, Mortalitas, Ketoasidosis Diabetikum. ......Mortality rate of DKA as acute complication of DM in Indonesia is still high. Therefore, a mortality prediction model is needed to screen high risk mortality DKA patients. Aim. To identify prediction model of 72 hours mortality in diabetic ketoacidosis patients at emergency unit Cipto Mangunkusumo General Hospital. Methods. This was a retrospective cohort study with consecutive sampling method. Subjects were adult DKA patients in emergency unit Cipto Mangunkusumo General Hospital from January 2011 to June 2017. Data were obtained from medical records. Association of predictors age, type of DM, history of DKA, comorbidities, level of consciousness, bicarbonate, potassium, anion gap, lactate, hydroxybutirate and renal function and 72 hours mortality was analyzed and submitted to prediction model. All analysis was done using SPSS Statistics 20.0. Results. A total of 86 subjects out of 301 subjects did not survive in 72 hours since hospital admission. Comorbidities HR 2,407 95 IC 1,181 - 4.907 , level of consciousness HR 10,345 95 IC 4,860 - 22,019 , history of DKA HR 2,126 95 IC 1,308 - 3,457 and lactate level HR 5,585 95 IC 2,966 - 10,519 were significant predictors and submitted to scoring system. A prediction model was derived with a good performance. Subjects with 0 - 2 points were at 15,41 risk of mortality, 3 - 4 points were 78,01 and 5 - 6 points were 98,22 risk of mortality. Conclusion. Seventy two hours mortality rate in Cipto Mangunkusumo General Hospital was 28,57. The mortality prediction model had a good performance, consisted of comorbidities, history of DKA, level of consciousness dan lactate level.

Abstrak :
Kegiatan Pemantauan Terapi Obat (PTO) di Rumah Sakit dilakukan oleh Apoteker untuk mencegah, mengidentifikasi dan memberikan rekomendari penyelesaian terkait permasalahan yang terjadi. Salah satu kriteria kondisi pasien yang menjadi target kegiatan PTO yaitu komplikasi penyakit dan polifarmasi. Komplikasi dan polifarmasi sering kali ditemui pada pasien Diabetes Melitus yang tidak diobati dengan optimal. Penelitian dilakukan untuk mengevaluasi masalah terkait obat dan memberikan rekomendasi penyelesaian masalah terkait obat pada pasien Diabetes Melitus dengan komorbid di rawat inap RSUD Cengkareng. Kegiatan PTO dilakukan pada pasien dengan kriteria berupa pasien dewasa dengan diagnosis Diabetes Melitus disertai komorbid yang menerima pengobatan rawat inap selama 20 September – 3 Oktober 2023. Data pasien yang diperoleh dari catatan rekam medis pasien, catatan perkembangan pasien terpadu dan kegiatan visite selanjutnya dilakukan observasi, pemantauan perkembangan terapi, identifikasi masalah dan rekomendasi tidak lanjut. Hasil PTO pada pasien Ny.S yaitu terdapat beberapa permasalahan terkait obat yang ditemukan. Permasalahan terkait obat yang teridentifikasi yaitu terdapat obat yang tidak sesuai indikasi pasien (Ondansetron), masalah terkait lama pemberian obat (Omeprazole injeksi), dan obat yang kontraindikasi dengan kondisi pasien (Metformin). Rencana tindak lanjut terkait permasalahan obat yang telah diidentifikasi yaitu melakukan komunikasi dengan DPJP terkait masalah dan memberikan rekomendasi kepada DPJP untuk mempertimbangkan terapi dengan obat lain. ...... Medication Therapy Monitoring (MTM) activities in hospitals are conducted by pharmacists to prevent, identify, and provide recommendations for resolving related issues. One criterion for patient conditions targeted by MTM activities includes disease complications and polypharmacy. Complications and polypharmacy are often encountered in patients with suboptimally managed Diabetes Mellitus. Research is conducted to evaluate medication-related issues and provide recommendations for resolving them in Diabetes Mellitus patients with comorbidities admitted to RSUD Cengkareng. MTM activities are performed on adult patients diagnosed with Diabetes Mellitus accompanied by comorbidities receiving inpatient treatment from September 20 to October 3, 2023. Patient data obtained from medical records, integrated patient progress notes, and subsequent visit activities involve observation, therapy progress monitoring, problem identification, and recommendations. The MTM results for patient Ny.S reveal several identified medication-related issues. These include medications not matching patient indications (Ondansetron), issues related to the duration of drug administration (Omeprazole injection), and medications contraindicated with the patient's condition (Metformin). The follow-up plan for identified medication issues involves communicating with the attending physician regarding the problems and recommending consideration of alternative therapies.