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Remed PK HHS - Resistensi Insulin
Remed PK HHS - Resistensi Insulin
PK
Diabetic hyperglycemic
hyperosmolar syndrome is a
condition of:
- Extremely high blood sugar
(glucose)
levels
- Extreme lack of water
(dehydration)
- Decreased consciousness
DEFINITION
HYPEROSMOLAR NONKETOTIC COMA (HONK)
Severe hyperglycemia(>600
mg/dL )
Hyperosmolarity (>320 mOsm/L)
Dehydration in the absence of
significant ketoacidosis (the
presence of ketonuria or mild
ketonemia and an arterial pH<7.3
or serum bicarbonate<15 mEq/L
do not preclude the diagnosis)
PATHOGENESIS
Blood glucose exceeds the renal threshold for glucose
osmotic diuresis
glucosuria and urinary loss of water,Na,K,Mg,Ca,P
dehydration/hyperosmolality
hypovolemia
shock
coma/renal failure
PRECIPITATING FACTORS
ACUTE ILLNESS
Infections (pneumonia, UTI, sepsis)
Myocardial infarction
CVA
GI (gastroenteritis,pancreatitis)
renal failure
burns
endocrine(hypercortisol / thyrotoxicosis)
surgery
PRECIPITATING FACTORS
DRUGS
thiazide/furosemide
glucocorticoids
-adrenergic blockers
cyclosporine
cimetidine
nalidixic acid
OTHER STRESSES
LABORATORY VALUES
Plasma glucose >600 mg/dL
WBC increased
MCV artificially elevated
LFT abnormal
Potassium initially may be high, may
LABORATORY VALUES
Leucocyturia
Cholesterol/Triglyceride
Blood gas analysis
(pH,bicarbonate,pO2, pCO2)
Blood/urine culture
Coagulation studies (DIC?)
Renal Function Tests abnormal
(glucose/18)
Osm = 2(Na + K) + (glucose/18)
Nilai normal untuk manusia =
Terimakasih
PENDAHULUAN
Resistensi insulin :
Suatu keadaan terganggunya respon biologis terhadap
insulin shg terjadi penurunan sensitivitas insulin.
Sensitivitas insulin :
Efektivitas insulin untuk menurunkan glukosa darah
dengan cara :
- memacu uptake glukosa pada otot dan sel lemak,
- meningkatkan simpanan glikogen hepar, serta
- mengurangi produksi glukosa hepatik.
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Sindroma metabolik
National Cholesterol Education Program (NCEP),
Minimal kriteria sbb:
1. GDP 110 mg/dL,
2. Obesitas abdomen (lingkar perut: 102 cm, 88 cm)
3. TG serum 150 mg/dL,
4.HDL serum < 40 mg/dL dan < 50 mg/dL,
5. TD 130/85 mmHg
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RINGKASAN
Resistensi insulin : terganggunya
respon biologis terhadap insulin
penurunan sensitivitas insulin.
Sensitivitas insulin :
kemampuan utk menurunkan glukosa darah
dgn cara memacu uptake glukosa pd otot & sel
lemak, meningkatkan simpanan glikogen hepar
serta mengurangi produksi glukosa hepatik.
06/25/16
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