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Case Report

A MANAGEMENT OF HIV IN PATIENT WITH


TYPE 2 DIABETES MELLITUS, PREGNANCY AND
PRE-ECLAMPSIA
Ismayadi
Erwin Astha Triyono

Division of Tropical and Infection Disease


Department of Internal Medicine
School of Medicine - Airlangga University /
Dr. Soetomo General Hospital Surabaya
2016
CASE
Mrs. I, 26 y.o., housewife, Javanese, moslem.
History
History of illness : premature rupture of membrane (PROM) since 8 hours ago.
Past illness : DM (2013) and HIV (2012).
Risk factor : free sex since adolescence.
Medications : During pregnancy Novomix, Duviral & Neviral
PHYSICAL EXAMINATION
General Condition:
Moderate, GCS:456, BP:160/100 mmHg, Pulse:88x/min, RR:20x/min,
T:37.70C

Head,Neck :
No abnormalities

Chest :
Lung : vesikuler, ronkhi -, wheezing
Heart : ictus cordis at lmcs ICS V, S1 & S2 single, no gallop or murmur.

Abdomen :
No abnormalities

Extremitas :
pitting edema of both legs
Laboratory results
Parameters 6 h before admitted On admission Previous Laboratory Test of HIV
BUN (mg/dl) 9.2 6 In 2012
Serum Cr. (mg/dl) 1.0 0.61 HIV test positive; absolute
CD4 level 461 cells/ul.
AST (u/l) 19.2 16
ALT (u/l) 24.4 19
Albumin (g/dl) 3.59 3.23 On Sept` 2015
Absolute CD4 level 327
Random blood glucose 382 mg/dl 345 mg/dl cells/ul.
Urinalysis Glucose +3; protein 3+ Glucose +3; protein 1+
WBC (/ul) 15.160 Blood glucose level
Fasting 125 mg/dl;
Gr (%) 87.5 2-h-PP 184 mg/dl,
Lymphocyte (/ul) 1.190 HbA1c 7.2%.
Hb (gr/dl) 12.6
Plt (/ul) 178.000
HIV, rapid test Reactive
Serum electrolite (mmol/l) Na 143; Kalium 3.6.
LDH (U/L) 237
ECG = sinus rhytm, HR 96 x/min regular, & normal axis.
Obgyn : G1P0000 37/38 weeks, single, life, intra-uterine, head
position, premature rupture of membrane (PROM)>6 h, &
preeclampsia.

Working diagnosis
HIV stage 1, type 2 DM, G1P0000 37/38 weeks, single, life, intra-uterine,
head position, PROM>6 h, & preeclampsia.
Planning Diagnosa :
Fasting & 2-h-PP blood glucose level, HbA1c, Lipid Profile, serum
electrolite, CD4, and viral load.

Planning Therapy :
O2 masker 8 liter/min;
Diet B1-T3 2,200 kcal/day
Fluid intake max. 1 liter/24 hours
IVFD RL 500 ml/24 hour;
Empiric prophylaxis antibiotic : cefotaxime 1 gr/8 h. iv;
Insulin : novomix 2 x 12 iu sc.;
Antihypertension po : methyldopa 3 x 150 mg & nifedipine 3 x 10
mg p.o. if BP 160/110 mmHg;
cARV : Duviral 2 x 1 tab. po & neviral 1 x 1 tab. po.
Magnesium sulfate iv
Delivery planning : Termination of pregnacy per vaginam.

Planning Monitoring :
utery contraction, signs of eclampsia impending.
3th day
RPG 177 mg/dl.

Progress

2nd day
born a child with bodyweight 4th day
2,900 gr. S : No Complaint
O : Vital sign was stable
The patient discharged by forced.

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SUMMARY
There has reported a pregnant woman with
preeclampsia, 26 years old, living with HIV and
type 2 diabetes mellitus. The managements
which received by the patient include diet B1,
insulin, antihypertension drug, and magnesium
sulfate. Furthermore, the patient control at Ibnu
Sina Hospital of Gresik. The patient have a good
prognosis.
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