Tri Kartika Setyarini, Aisyah Lahdji, Isna Zalwa Noor Fajri

QANUN MEDIKA
QANUN Vol 4 VOL.4

MEDIKA No4 2.l no
VOL JULY
no 20202019
11 Mei
Mei 2019
QANUN
QANUN MEDIKA
MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
http://journal.um-surabaya.ac.id/index.php/qanunmedika
CaseReport
Case Report
DiabetesArticle
Research insipidus in patiens with traumatic severe brain injury
Diabetes insipidus in patiens with traumatic severe brain injury
Yudha Adi Prabowo1, Prananda Surya Airlangga2
Pneumonia
Yudha Adi Prabowo1, degree Prananda
1) Resident of Anesthesiology correlation Surya inAirlangga2
and Intensive children
Care with
of RSUD clean and
Dr. Soetomo, healthy
Medical Faculty of
behavior
1) Resident
Airlangga (CHB)
of Anesthesiology
University. and Intensive Care of RSUD Dr. Soetomo, Medical Faculty of
Airlangga University.
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac-
Tri Kartika Setyarini1, Aisyah Lahdji2*, Isna Zalwa Noor Fajri3
ulty of Airlangga University.
ulty
1,2,3) of of
Faculty Airlangga University. Semarang University
Medicine, Muhammadiyah
A ABSTRACT
ABSTRACT
AR
R TT II C
C LLEE II NN FF O
O
Traumatic severe brain injury is a fatal injury, with a
Abstract
Submitted : Januari 2019 mortality rate of up to 50%. About 1.5 million people
Submitted
Accepted :: February
February 2020
2019 Pneumonia
experience is an acute
severe brain infection
injury in that
the affects
United the lung with
States. There
Accepted
Published : April 2020
: Mei 2019 symptoms of cough, shortness of breath, grunting, cyano-
are more than 50,000 deaths and 500,000 incidents of
Published : July 2020 sis, rhonchi, and infiltrates in thorax imaging. Based on The
permanent neurological sequelae. About 85% of mortality
Keywords: Integrated Management of Sick Children in handling Acute
occurs in the first 2 weeks after the injury. One complication
Keywords:
Respiratory Tract Infection program, pneumonia is classified
of a severe brain injury is diabetes insipidus. There are no
Diabetes insipidus, brain
pneumonia, CHB, children injury, as severe pneumonia, pneumonia
hypernatremia, desmopressin, ICU ofdefinitive data on the incidence and not pneumonia.
of diabetes One
insipidus in
the risk factors of pneumonia is the low level
patients with traumatic severe brain injury of Indonesia of Clean
and Healthy Behavior (CHB). The purpose of this study was
so far. In this case report, a male, 45 years old, was taken
Correspondence:
*Correspondence: to
to determine the degree
the Emergency of pneumonia
Installation (IRD) inafter
children with cleana
experiencing
yud180987@yahoo.com
lahdjiaa@unimus.ac.id and healthy behavior (CHB). The analytic observational
traffic accident 12 hours before being hospitalized. After
study with
surgery, the cross-sectional method.
signs of diabetes The was
insipidus sample was con-
presented by
ducted children under five years old diagnosed
polyuria of 300cc / hour urine production and 149mmol with pneu-/
monia in the Children’s Ward of Rachma Husada Hospital
L hypernatremia, although the immediate administration of
Bantul with duethe
desmopressin, regard to inclusion
patients and hemodynamic
clinical and exclusion criteria.
was
Sampling was carried out using consecutive techniques. The
not shown any improvements. The patient passed away in the
data was retrieved using secondary data (medical records)
days five of treatment in the Intensive Care Unit (ICU). The
and observing
main treatments CHBfor with questionnaire.
diabetes insipidus in The data was
traumatic an-
severe
alyzed using fisher’s
brain injury exact rehydration
are adequate test. From 32 and samples in this
administration
study, the majority ofAdequate
of desmopressin. samples suffered from severe
hypovolemic, pneumo-
polyuric and
nia (81.3%) and the most CHB indicators were the
hypernatremia corrections are the keys to the successful Interme-
diate category (50%). The result of bivariate analysis shows
treatment of diabetes insipidus. Diabetes insipidus in cases
there was injury
of brain a correlation
requires between the degree
complicated of pneumonia
treatment. in
Therefore,
children and the family’s CHB (p=0.01). There was a cor-
in the case of being handled improperly, it can bring death.
relation between the degree of pneumonia in children and
the clean and healthy behavior (CHB).
ABSTRAK
Cedera otak berat traumatis adalah cedera fatal, dengan tingkat kematian hingga 50%. Sekitar 1,5
juta orang mengalami cedera otak berat di Amerika Serikat. Terdapat lebih dari 50.000 kematian
dan 500.000 insiden gangguan neurologis permanen. Sekitar 85% kematian terjadi dalam 2 minggu
pertama setelah cedera. Salah satu komplikasi dari cedera otak yang parah adalah diabetes insipidus.
Tidak ada data pasti tentang kejadian diabetes insipidus pada pasien dengan cedera otak traumatis
1
217
QANUN MEDIKA Vol 4 No 2 JULY 2020 QANUN
QANUN MEDIKA
MEDIKA VOL.4
VOL 4 .lNo
no11 Mei
Mei2019
2019
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QANUN MEDIKA
MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
Case Report
berat di Indonesia sejauh ini. Pada laporan kasus ini, seorang pria, 45 tahun, dibawa ke Instalasi
INTRODUCTION category, (3) purnama category, (4) independent
Rawat Darurat (IRD) setelah mengalami kecelakaan lalu lintas 12 jam sebelum dirawat di rumah
Diabetes
Pneumonia
sakit. Setelah
insipidus
is the leading
operasi,
incause
patiens
tanda-tanda
with
ofdiabetes
death traumatic
category. Onesevere
ininsipidus ditandai
of the risk
dengan
brain
factorsinjury
adanya
for pneumonia
poliuria Kesehatan
produksi
childrenAdi under five yearsPrananda
old. WorldSurya in
HealthAirlangga2 children is low CHB (Kementerian
Yudha Prabowo1,
urin 300cc / jam dan hipernatremia 149 mmol / L, meskipun segera diberikan desmopresin, kondis
Organization
1) Resident of (WHO) Anesthesiology estimates that theCareRI, 2011; Sulistyowati, 2010).
klinis dan hemodinamik pasien tidak menunjukkan perbaikan. Pasien meninggal pada hari kelima
and Intensive of RSUD Dr. Soetomo, Medical Faculty of
incidence
perawatan
Airlangga of pneumonia
di Unit Perawatan
University. in children The purpose
under Perawatan
Intensif (ICU). utama ofuntuk
this study
diabetes wasinsipidus
to determinepada
five years old in developing countries is 0.29 the degree
cedera otak berat traumatis adalah rehidrasi dan pemberian desmopresin yang adekuat. Koreksi
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac- of pneumonia in children under
episodes
ulty ofperAirlangga
hipovolemik, child each
poliurik, yearhipernatremia
dan
University. or 151.8 million five years
yang adekuat old with
adalah kunci clean and healthy
keberhasilan behavior
pengobatan
cases ofinsipidus.
diabetes pneumonia each insipidus
Diabetes year, of dalam
which kasus (CHB).
cedera otak membutuhkan perawatan yang
8.7% or 13.1 million cases include severe
rumit. Karena itu, jika ditangani dengan tidak tepat, bisa menyebabkan kematian.
pneumonia and need to be hospitalized. There
ABSTRACT
A R15
are T Icountries
C L E Iwith N Fpredictions
O of new cases METHODS
Kata kunci : Diabetes insipidus, cederasevere
Traumatic otak, hipernatremia,
brain injury is desmopressin,
a fatal injury, ICUwith a
and the highest
Correspondence
Submitted incidence
: Januari 2019 of pneumonia
: yud180987@yahoo.com in
mortality rate The of study
up to was50%. conducted
About at1.5 the Rachma
million Husada
people
children under: February
Accepted five years 2019 old, covering 74%
Hospital in Bantul in July to
experience severe brain injury in the United States. There August 2019.
or 115.3 million
Published
INTRODUCTION : Meicases2019out of 156are million CASE REPORT
more than This50,000
type ofdeaths research and is 500,000
analytic observational
incidents of
cases worldwide. More than half are focused
Traumatic brain injury is a fatal injury, with
with neurological
permanent a cross-sectional
sequelae. About 85% of Based
approach.
A 45-year-old man was taken to the Emergency mortality on
in 6 countries, namely India, China, Pakistan,
a mortality rate of up to 50%. About
Keywords: 1.5 the calculation of the sample, 32 samples
Hospital (IRD) Dr. Soetomo after a motorcycle
Bangladesh, Indonesia, and Nigeria, where
million people with severe brain injury in of children under five 12 years
hours oldbefore
traffic accident who met the
being
Diabetes
up to 44% insipidus, brain injury,
of the population of children under
the United States have more than definitive 50,000 data inclusion and
on the incidence
hospitalized. exclusion criteria
of diabetes
The patient were needed.
insipidus
is unconscious in
since
hypernatremia,
five years old desmopressin,
in the world (Rudan, ICU Boschi-
deaths and 500,000 permanent neurological patients with Inclusion
traumatic criteria
severe include:
brain injury
the accident occurred. First aid was given in the (1)of diagnosed
Indonesia
Pinto, Biloglav, Mulholland, & Campbell,
2006). pneumonia as assessed by history taking and
sequelae (Agha and Thompson, so far. In this case report, a male, 45 years old, was taken
previous health facility; RSUD Tuban, thus the
Correspondence:
2008). The results of the 2013 Basic Health
Approximately 85% of mortality occurs in the supporting
to the Emergency examination
Installation (IRD) (chest
patient was referred to IRD Dr. Soetomo. after radiograph),
experiencing (2) a
Research (Riskesdas), based on the age group
yud180987@yahoo.com
first 2 weeks after the injury, which traffic exhibits having
accident
The 12 a KMS
hours
patient book,
before
has (3) a being
being
attached collar less
hospitalized. than
brace five
After
at the
of the population, the highest prevalence of
the initial impact of systemic hypotension and years
surgery, the arrival old. Exclusion
signs of indiabetes criteria
insipidus
resuscitation room include: (1)
was ofpresented having
Dr. RSUD by
pneumonia is 1-4 years of age (Kementrian
intracranial hypertension (Benvenga polyuria other
et al., of 300cc diseases
/ hour (asthma,
urine production
Soetomo. Responding to pain, with the bronchitis),
and (2)
149mmol not
/
Kesehatan RI, 2018).
2000). being willing to be a respondent
examination of anisocoria round pupils 4/3
Pneumonia
One is an acute oinfection
of the complications f a severe bofrain
theinjury
lung
desmopressin, mm, the both
patients
eye clinical
light and hemodynamic was
Data obtained fromreflexes
medical were decreased.
records and
tissue with symptoms of fever,
is diabetes insipidus. (Agha and Thompson, coughing,
Spontaneous breathing 30 times per minute
observations using a questionnaire. The
rapid breathing, wheezing (grunting),
2006; Hannon et al., 2012). Diabetes insipidus days five of treatment in the Intensive Care Unit (ICU). The
presented with an filled
additional gurgling breath
questionnaire was in by the respondent’s
nasal
is lobe caused
a disease breathing, retraction,
by the cyanosis,
lower production,
main treatments for diabetes insipidus in
with oxygen saturation of 92% using an oxygen traumatic severe
parents, and the researcher directly observed
soft wet and
secretion, crackles loud ofonAnti
function auscultation,
Diuretic
brain injury mask
are adequate
of 5 liters rehydration
per minute. and administration
Blood pressure
the respondent’s home environment. The
and infiltrates
Hormone (ADH). on lung Kidney X-rays. Following
abnormalities
of desmopressin. Adequate hypovolemic,
110/75 mmHg (MAP 86), pulse 120 times per polyuric and
questionnaire was taken from a guide to clean
Integrated
were marked Management of Sick Children
by the unresponsiveness in
of
hypernatremia andcorrections
minute.
healthy of are
Tip life the the keys
extremity
behavior (CHB). to were
the successful
Thewarm,
study wasdry
the prevention ADH
physiological of acute respiratory infections
stimulation, which is
and red with an examination of capillary refill
conducted after obtaining a research permit and
(ARI), pneumonia is classified asof severe
characterized by excessive thirst (polydipsia) brain injury
time requires complicated
<2 Clearance
seconds. The treatment.
right Therefore,
parietooccipital
Ethical from the medical research
pneumonia, pneumonia and not
and large amounts of urine (polyuria). There is pneumonia
hematoma was found. The patient was
ethics committee at the Muhammadiyah
(Eka Cahyani & Anggrainingsih, 2016; WHO,
no definitive data on the incidence of diabetes immediately suctionedand andafter oxygenated
Semarang University obtainingwith the
2014).
insipidus in patients with severe brain injury
ABSTRAK Jackson Reese 10 liters per minute, a two-lane
respondent’s approval to take part in the study.
in Indonesia
Clean and so far. behavior (CHB) is the
healthy intravenous
Data tingkat line was using
is processed attached and
the50%. 30° head-
SPSS21.0 for
Cedera
Diabetes otak berat traumatis
insipidus in cases adalah
of cedera
brain fatal, dengan
injury kematian hingga Sekitar 1,5
main capital for the eradication of ARI, which up position.
Windows The patient
program. Data was prepared
analysis was usingto the
be
juta orang complicated
requires mengalami cedera otak berat
treatment. di Amerika Serikat. Terdapat lebih dari 50.000 kematian
Diabetes
can 500.000
be assessed bygangguan
indicators of household intubated
chi-square using ETT No.7
and Fisher’s
testkematian and
exact. the lip border
dan
insipidus insiden
can lead clean
to death neurologis
when life. permanen.
handled Sekitar 85% terjadi dalam 2 minggu
members behaving and healthy CHB was 21cm. The ventilator used PCV mode with
pertama
improperly. setelah cedera.
Therefore, Salah satu komplikasi
the authors are dari cedera otak yang parah adalah diabetes insipidus.
classification is based on accumulated scores, RR 16, PC 15, trigger 2, I: E 1: 2, FiO2 50%.
Tidak ada datadiscussing
interested pasti tentang thekejadian diabetesofinsipidus pada pasien dengan cedera otak traumatis
namely, (1)inprimary category, management
(2) intermediate
2
218
QANUN MEDIKA
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MEDIKA No4 2.l no
VOL JULY
no 20202019
11 Mei
Mei 2019
Data obtained from medical records and observations using a questionnaire. The
QANUN
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questionnaire was filled in by the respondent's parents, and the researcher directly
observed the respondent's home environment. The questionnaire was taken from a guide
to clean and healthy life JURNAL
JURNAL
behavior KEDOKTERAN
KEDOKTERAN
(CHB). The study FKUM
FKUM SURABAYA
wasSURABAYA
conducted after obtaining a
research permit and Ethical Clearance from the medical research ethics committee at the
Muhammadiyah Semarang University and after obtaining the respondent's approval to
Case
Case
RESULTS Report
takeReport
Data obtained
part from Data
in the study. medical records using
is processed and observations
theTable
SPSS21.0 using
2 shows for the adegree
Windowsquestionnaire.
program.
of pneumonia The in the
Data
questionnaire
Diabetes
analysis insipidus
was usingwas thefilled
in in bywith
patiens
chi-square the respondent's
testtraumatic
and Fisher's parents,
severe ofand
exact. brain the researcher
injury directly
Diabetes
This researchinsipidus
observed the
was conducted
respondent's
in patiens
from July
home environment.
with to traumatic
majority severe
samples brain
was severe
The questionnaire was taken from a guide
injurypneumonia
Yudha Adi Prabowo1, Prananda Surya
August 2019 in 32 children under five years (81.3%). Airlangga2
Yudha
towho
cleanAdiand Prabowo1, Prananda Surya Airlangga2
1)
old Resident ofhealthy thelife
Anesthesiology
had fulfilled behavior
inclusion and (CHB).
Intensive
criteria. TheThe
Carestudy
of RSUD was Dr.
conducted
Soetomo, after obtaining
Medical a of
Faculty
1)research
Resident ofUniversity.
permit Anesthesiology
and and Intensive From
Caremedical
of RSUD table 3, the indicators
Dr. Soetomo, for families
Medical Faculty
at the of who
RESULTS
data Airlangga
was taken from theEthical
medical Clearance
records from
at Thethe research ethics committee
Airlangga
Muhammadiyah University.
Semarang University and are at risk of pneumonia are the study samples,
Husada Hospital Bantul and then theafter obtaining the respondent's approval to
Rachma
the2019
majority
This research of which doundernot provide exclusive
ulty
take part
children’s thewas
ofparents
inAirlangga conducted
study. University.
filled Data from
out isaprocessedJuly using
questionnaire to August
the SPSS21.0 in 32
for children
Windows program. five years
Data
ulty breastfeeding,
was taken do notthe
wash handsrecords
with soap, do
old
related toofCHB.
who
analysis Airlangga
had
was fulfilled
using the University.
the inclusiontest
chi-square criteria. The data
and Fisher's exact. from medical
not use healthy latrines, do not eradicate mos-
at The Rachma Husada Hospital Bantul and then the children's parents filled out a
Based on Table 1, the results show that the quito larvae, do not eat fruits and vegetables
questionnaire
majority of the agerelated to CHB. in this study every day, and smoke in the house. Table 4
of respondents
A RESULTS
R T I Cthe LE ABSTRACT
ABSTRACT
between agesI NofF2Oto 4Table years1. Characteristics
with each shows that the category
Traumatic severe of Respondents
brain injury is aoffatal
CHBinjury,
in the with
largesta
number
Submitted is 10 respondents
: Januari 2019 with a percentage of sample is the Intermediate category (50.0%),
This research was No it wasfrom
conducted mortality
Indicators
July rate Frequency
of up into 3250%.
(%)About 1.5 five
million
yearspeople
31.2%.
Accepted In the sex
: February 2019 found
indicator, thatto19August 2019 children under
experience severe brain injury in the United States. There
old who
children
Published had
had :fulfilled
male Meisex20191the Age
inclusion
(59.4%) and 13criteria. y.oThethan
children data was 1 taken from the medical records
are 1more 50,000 3,1 and
deaths 500,000 incidents of
hadatfemale sex (40.6%).
The Rachma Husada Hospital Bantul and then the children's parents filled outmortality
a
permanent
2 y.o neurological 10 sequelae. About
31,2 85% of
questionnaire related to CHB.
Keywords: occurs in the first 2 weeks after the injury. One complication
3 y.o 10 31,2
Diabetes insipidus, brain injury, of a severe brain injury is diabetes insipidus. There are no
Table 1. Characteristics of Respondents
hypernatremia, desmopressin, ICU 4 y.o data on 10
definitive 31,2 of diabetes insipidus in
the incidence
No Indicators
patients with Frequency
traumatic severe (%) brain injury of Indonesia
5 y.o 1 3,1
Correspondence: 1 Age so far. In this case report, a male, 45 years old, was taken
1 y.o 1 3,1
2 Sex Male
to the Emergency 19 59,4
Installation (IRD) after experiencing a
yud180987@yahoo.com 2
traffic y.oaccident 12 10hours 31,2
before
Female 13 40,6 being hospitalized. After
surgery,
3 y.o the signs 10 of diabetes 31,2insipidus was presented by
polyuria of 300cc / hour urine production and 149mmol /
4 y.o 10 31,2
Based on table 1, the results show that L hypernatremia, although the immediate administration of
the majority of the age of respondents in this study
5 y.o 1 3,1
between the ages of 2 to 4 years withdesmopressin, each number is the
10patients clinical
respondents withand hemodynamic
a percentage of was
2 Sexit was found not shown any improvements. The patient passed away in the
Male 19 had male 59,4 sex (59.4%) and 13
31.2%. In the sex indicator, that 19 children
children had female sex (40.6%). main Female
treatments for 13 diabetes 40,6
insipidus in traumatic severe
brain injury are adequate rehydration and administration
Table 2. Distribution of degree of ofdesmopressin. Adequate
pneumonia in children underhypovolemic,
five years old polyuric and
Based on table 1, the results show that the majority of
hypernatremia the age of are
corrections respondents
the keys into
this study
the successful
between the ages Noof 2Pneumonia eachFrequency (%) with a percentage of
to 4 years withtreatment of diabetes insipidus. Diabetes insipidus in cases
number is 10 respondents
31.2%. In the sex 1 indicator,
Pneumonia it was found
of brain thatinjury
19
6 children
requires had male
18,8 sex (59.4%)
complicated andTherefore,
treatment. 13
children had female sex (40.6%). in the case of being handled improperly, it can bring death.
2 Severe 26 81,3
ABSTRAK Pneumonia
Table 2. Distribution of degree of pneumonia in children under five years old
juta orang No Pneumonia
mengalami Frequency
cedera otak berat di Amerika (%) lebih dari 50.000 kematian
Serikat. Terdapat
dan 500.000 insiden
1 gangguan
Pneumonianeurologis permanen.
6 Sekitar 85% kematian
18,8 terjadi dalam 2 minggu
3
2 tentang
Severekejadian diabetes insipidus
26 81,3
Tidak ada data pasti pada pasien dengan cedera otak traumatis
Pneumonia
1
219
3
QANUN MEDIKA Vol 4 No 2 JULY 2020 QANUNQANUN MEDIKA
MEDIKA VOL.4
VOL 4 .lNono11 Mei
Mei2019
2019
Table 2 shows the degree of pneumonia in the majority of samples was severe pneumonia
(81.3%).
QANUN
QANUN MEDIKA
MEDIKA Jurnal Kedokteran Qanun Medika
Table 3. Characteristics of CHB indicators (Kementerian Kesehatan RI, 2011)
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
No Indicators
http://journal.um-surabaya.ac.id/index.php/qanunmedika samples (N=32)
Table 2 shows the degree of pneumonia in the majority of samples was severe pneumonia
Yes % No %
(81.3%).
Case Report
1 Labor is assisted by medical 32 100
berat di Indonesia sejauh ini. Pada laporan kasus ini, seorang pria, 45 tahun, dibawa ke Instalasi 0 0,0
Table 3. Characteristics of CHB indicators (Kementerian Kesehatan
Rawat Darurat (IRD) setelah mengalami kecelakaan lalu lintas 12 jam sebelum dirawat di rumah RI, 2011)
Diabetes
sakit. Setelah
insipidus
personnel in patiens with traumatic severe brain injury
operasi, tanda-tanda diabetes insipidus ditandai dengan adanya poliuria produksi
No Indicators samples (N=32)
2 Give exclusive breastfeeding 14 43,8 18 56,3
Yes %
klinis dan hemodinamik pasien tidak menunjukkan perbaikan. Pasien meninggal pada hari kelima No %
1) Resident of Anesthesiology and Intensive Care of RSUD Dr. Soetomo, Medical Faculty of
perawatan 13 di Labor
Airlangga Weigh
Unit is
University.every
Perawatan
assistedmonthIntensif
by medical (ICU). Perawatan 3218 utama 56,3 untuk 014
100 diabetes 43,8
0,0 insipidus pada
4 personnel
Use cleandan water 16 adalah
50,0kunci 16 50,0 pengobatan
hipovolemik, poliurik,
ulty of Airlangga hipernatremia yang adekuat
University. keberhasilan
diabetes 25 insipidus.
Give Diabetes breastfeeding
exclusive insipidus dalam kasus cedera 14 otak membutuhkan perawatan yang
Washing hand 14 43,8 43,8 1818 56,3
56,3
A R T I36C L EWeigh Use every
I Na F O month
healthy latrine ABSTRACT 18 10 56,3 31,3 1422 43,8
68,8
Kata kunci : Diabetes insipidus, cedera otak, hipernatremia,
Traumatic severe brain injury is a fatal injury, desmopressin, ICUwith a
4
Correspondence
Submitted 7 Use clean
: Januari
Eradicate water
2019
mosquito larvae 16 50,0 16 50,0
: yud180987@yahoo.commortality rate of 6up to 18,8 50%. About 26 1.5 81,3 million people
Accepted : February 2019
Published 58
INTRODUCTION Washing
Eat
: Mei hand and fruitexperience
vegetables
2019 every day CASE
severe 14 brain
11REPORT
injury in 18
43,8
34,4
the United
21 56,3
65,5
States. There
are more than 50,000 deaths and 500,000 incidents of
Traumatic 69 brain Use injury
a healthy
Physical is alatrine
activityfatal injury, with neurological
permanent sequelae. About 85%
50,0 of mortality
A 45-year-old man was taken to the Emergency
1016 31,3 50,0 2216 68,8
Keywords: 1.5
million 710 people Eradicate
Smoking mosquito
with severe
in the larvae
brain
house injury in 625 accident
18,8 267 hours 81,3
traffic 78,1 12 21,9before being
Diabetes insipidus, brain injury,
the United States have more than definitive 50,000 data on the incidence
hospitalized. of diabetes
The patient insipidus
is unconscious in
since
hypernatremia, Eatdesmopressin, ICU
deaths 8and 500,000 vegetables
permanent and fruit every daywith traumatic
neurological
patients 11 34,4
severe 21 injury
brain 65,5 of Indonesia
the accident occurred. First aid was given in the
sequelae (Agha and Thompson, 2006).
From9 tablePhysical
Correspondence: activity for families who previous health facility; RSUD Tuban, thus the
3, the indicators are 16
at risk50,0 of pneumonia16 are50,0 the study
Approximately 85% of mortality occurs in the to the Emergency Installation (IRD) after
patient was referred to IRD Dr. Soetomo. experiencing a
samples, the majority of which do not provide exclusive breastfeeding, do not wash
yud180987@yahoo.com hands
first 2 10
weeks Smoking
after the in injury, which traffic
exhibits accident The 12 hours
patient before
has being
attached hospitalized.
7 doa notcollar After
with soap, do the house
not use healthy latrines, do not eradicate 25 78,1
mosquito larvae, eat brace
21,9 fruits at the
the initial impact of systemic hypotension and surgery, the arrival
signs of indiabetes insipidus
resuscitation room was ofpresented
Dr. RSUD by
and vegetables
intracranial every day,(Benvenga
hypertension and smoke et in the
al., house.
polyuria of 300cc / hour urine production
Soetomo. Responding to pain, with the and 149mmol /
2000). L hypernatremia, although the immediate administration of
examination
From
One table
of the 3, the indicators
complications of a s4.
Table
for
evere bfamilies
rain
Frequency injury who are
Distribution
at CHB
of
of of
risk categoriesanisocoria
pneumonia areround
the studypupils 4/3
desmopressin, the patients clinical and hemodynamic
mm, both eye light reflexes were decreased. was
samples, the majority of which do
is diabetes insipidus. (Agha and Thompson, not provide exclusive breastfeeding, do not wash
not shown any improvements. The patient passed away in the hands
Spontaneous breathing 30 times per minute
with soap, do not use healthyCHB latrines,
2006; Hannon et al., 2012). Diabetes insipidus do not
Frequencyeradicate mosquito
with larvae,
(%) do not eat
presented an additional fruits breath
gurgling
is and vegetables
a disease every
caused by day,
the and
lower
Primary
smoke in the
production,
main house.
treatments for diabetes insipidus in traumatic severe
1 with oxygen saturation of 92% using an oxygen
3,1
secretion, and function of Anti brain Diuretic injury mask
are adequate rehydration
of 5 liters per minute. and Blood
administration
pressure
Hormone (ADH). Table Intermediate
Kidney abnormalities
of 16
desmopressin. 50,0
Adequate hypovolemic, polyuric and
4. Frequency Distribution 110/75 mmHg (MAP 86), pulse 120 times per
of CHB categories
were marked by the unresponsiveness
Purnama hypernatremia of
12 minute. corrections
Tip of are
37,5 the the keys to were
extremity the warm,
successful
dry
physiological ADH stimulation, which is
CHB treatment of diabetes insipidus. Diabetes insipidus in cases
Frequencyand red with an examination of capillary refill
(%)
Independent
characterized by excessive thirst (polydipsia) 3 9,4
of brain injury requires complicated
time <2 3,1seconds. The treatment. Therefore,
right parietooccipital
Primary 1
and large amounts of urine (polyuria). There is
Totals in the case of being handled improperly, it can bring death.
32 hematoma 100.0was found. The patient was
no definitive data on the incidence of diabetes
Intermediate 16 immediately 50,0 suctioned and oxygenated with
ABSTRAK Purnama 12 Jackson Reese 10 liters per minute, a two-lane
37,5
in Indonesia so far. intravenous line was attached and 30° head-
Cedera
Diabetes otak berat traumatis
insipidus adalah
Independent
in cases cedera
of brain fatal,
injury 3 dengan tingkat kematian hingga 50%. Sekitar 1,5
9,4 The
up position. patient was prepared to be
juta orang mengalami cedera
requires complicated treatment. otak berat di
Diabetes Amerika Serikat. Terdapat lebih dari 50.000 kematian
Totals 32 intubated 100.0using ETT No.7 and the lip border
dan 500.000can
insipidus insiden
lead gangguan
to death neurologis
when handled permanen. Sekitar 85% kematian terjadi dalam 2 minggu
was 21cm. The ventilator used PCV mode with
pertama
improperly. setelahTherefore,
cedera. Salah satuauthors
the komplikasi are dari cedera otak yang parah adalah diabetes insipidus.
RR 16, PC 15, trigger 2, I: E 1: 2, FiO2 50%.
Tidak ada data
interested pasti tentang
in discussing thekejadian
managementdiabetes ofinsipidus pada pasien dengan cedera otak traumatis
2
220
QANUN MEDIKA
QANUN Vol 4 VOL.4
MEDIKA No4 2.l no
VOL JULY
no 20202019
11 Mei
Mei 2019
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MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
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SURABAYA
Table 4 shows that the category of CHB in the largest sample is the Intermediate category
(50.0%),
CaseReport
Case Report
Table 5. Relationship of the degree of pneumonia with CHB
Yudha Adi Prabowo1, Prananda Pneumonia
Surya Airlangga2
1) Resident
CHB of Anesthesiology and Intensive Care of RSUD Dr. Soetomo,
Severe Totals MedicalPFaculty of
1) Resident of Anesthesiology and
Pneumonia
Airlangga University. Intensive Care of RSUD Dr. Soetomo, Medical Faculty of
Airlangga University. Pneumonia
ulty of AirlanggaNUniversity.
% N % N %
Primary 0 0,0 1 100 1 100
Intermediate 0 0,0 16 100 16 100
A R TPurnama
I C L E I N F4 O ABSTRACT
ABSTRACT 0,010£
33,3 8 66,7 12 100
SubmittedIndependent : Januari2 2019 66,7 mortality
1 rate
33,3of up to 350%. About 100 1.5 million people
Accepted : February 2019 experience severe brain injury in the United States. There
Published : Mei 2019 are more than 50,000 deaths and 500,000 incidents of
BasedBased on on table
table 5, 5,
thetheobtained
obtainedCHB CHB sample in
sample
permanent the Primary
proportion
neurological and Intermediate
ofsequelae. About
pneumonia with85% categories
retraction. This
of mortality
in the
all Primary
Keywords: suffered andfromIntermediate categories
severe pneumonia. all Purnama
is due tocategory,
the lack samples
of exclusive
In the 66.7% breastfeeding
suffered in
suffered from severe
from insipidus,
Diabetes pneumonia.
severe pneumonia.
brain injury, In the Purnama infants and respiratory
Whereas in CHB 66.7% of the Independent category sample air exposed
of a severe brain injury is diabetes insipidus. There are no to cigarette
category,
suffered samples
hypernatremia, from 66.7% suffered
pneumonia.
desmopressin, from
Statistical
ICU severe
definitive smoke.
data
test results on In the
the
showed study,
incidence
that thereitof
was found
diabetes
was that p value
insipidus
a significant in
pneumonia. Whereas in CHB 66.7% of
patients the with
relationship between the degree of pneumonia with CHB (p = 0.01).= 0.016,
traumatic which means
severe brain there is
injury a relationship
of Indonesia
Independent
Correspondence: category sample suffered from between CHB and the incidence of pneumonia
pneumonia. Statistical test results showed to the that in infants
Emergency (Idris, 2018).
Installation (IRD) While
after inexperiencing
this research,a
yud180987@yahoo.com
there was a significant relationship between the the cause of pneumonia was not only theAfter
lack
DISCUSSION traffic accident 12 hours before being hospitalized.
degree of pneumonia with CHB (p = 0.01). surgery, the of exclusive
signs breastfeeding
of diabetes insipidus and was breathing
presented air by
polyuria of exposed
300cc / to cigarette
hour urine
The results of this research, it was found that the degree of pneumonia in children under smoke
production but the
and lack (56.3%)
149mmol /
five years old was significantly related of maintaining cleanliness
to CHB (p: 0.01). This finding is like
in washing
line withhands
DISCUSSION
Sugihatono's research (p: 0.015; OR: desmopressin,
3.121 C195%: before eating- 7.957)
the 1.225
patients and after
clinical anddefecating.
and (p:In
hemodynamic
Domili addition,
0.05), was
due to only half the study sample conducted
Thewhich
resultsstates
of thisthat
research,
CHB isit awas
riskfound
factorthat
forthe
several diseases including pneumonia. Children
physical activity (50.0%).
degree of pneumonia in children under five years
who live in environments with low CHB are more susceptible to pneumonia. It is caused
main treatments for
Therespiratory
resultsdiabetes
of tractinsipidus
this study in traumatic
the majority severe
of the
old by
wasimperfect
significantly related and
immunity to CHB (p: 0.01).narrow
a relatively (Rachmawati, 2013;
brain injury sampleare adequate
included rehydration
in the and administration
Intermediate category
ThisZairinayati,
finding is inArilineUdiyono,
with Sugihatono’s
2013) of research
desmopressin. Adequate hypovolemic, polyuric and
(p: 0.015; OR: 3.121 C195%: 1.225 - 7.957) and (50.0%). The Associate category is included in
This study found that the majorityhypernatremia of samples suffered from severe
corrections are the pneumonia
keys to the (81.3%).
successful
Domili (p: 0.05), which states that CHB is a risk the category of CHB that is lacking, so the risk
These results are in line with Idristreatment of diabetes insipidus. Diabetes insipidus in cases
Handriana's study which states that a low CHB has a
factor for several diseases including pneumonia. of a toddler suffering from pneumonia is quite
greaterwho proportion of pneumonia with of
withbrain injury
retraction. requires
large. Thisisiscomplicated
This due to the
in line with treatment.
lack of exclusive
Ratna Therefore,
Sulistyawati’s
Children live in environments low
CHBbreastfeeding in infantstoand
are more susceptible respiratory
pneumonia. Itair
is exposed
research to cigarette
which states smoke. thatIntoddlers
the study, who it live
wasby
caused found that p immunity
imperfect value = 0.016,and a which
relativelymeans withthereaislow a relationship
CHB have abetween 3.24 times CHB and risk
greater
ABSTRAK
the incidence
narrow respiratoryof tract
pneumonia in infants2013;
(Rachmawati, (Idris, 2018). While from
of suffering in thispneumonia
research, the thancause
thoseof who
Zairinayati,
pneumonia
Cedera Ari
otak beratUdiyono,
wastraumatis 2013).
not only the
adalahlackcedera
of exclusive live with
breastfeeding
fatal, dengan a good
tingkat and CHB
Cedera otak berat traumatis adalah cedera fatal, dengan tingkat kematian hingga 50%. Sekitar 1,5 with
breathing
kematian statistical
hingga air exposed test
50%. Sekitar results
to 1,5
cigarette smoke but the lack (56.3%) of maintainingshowing there
cleanliness
juta orang mengalami cedera otak berat di Amerika Serikat. Terdapat is
like a
lebihsignificant
washing dari hands
50.000relationship
before
kematian
This study found that the majority of samples
dan 500.000
eating insiden
and after gangguan
defecating. neurologis permanen.
In addition, due tobetween
Sekitar
only half maternal
85%the CHBsample
kematian
study with the
terjadi incidence
dalam
conducted2 minggu of
suffered from severe pneumonia (81.3%).
pneumonia (p: parah
0,0; OR:
pertama setelah 3,24) (Rachmawati,
Thesephysical
results arecedera.
activity Salah
with satu
(50.0%).
in line Idriskomplikasi
Handriana’s dari cedera otak yang adalah diabetes insipidus.
pasti tentang kejadian diabetes 2013;pada
insipidus Sulistyowati,
Tidak ada data pasien 2010).cedera otak traumatis
dengan
study which states that a low CHB has a greater
5
1
221
QANUN MEDIKA Vol 4 No 2 JULY 2020 QANUN
QANUN MEDIKA
MEDIKA VOL.4
VOL 4 .lNo
no11 Mei
Mei2019
2019
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QANUN MEDIKA
MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
Case Report
berat di Indonesia sejauh ini. Pada laporan kasus ini, seorang pria, 45 tahun, dibawa ke Instalasi
In this study it was found that the majority status will increase the susceptibility and
Rawat Darurat (IRD) setelah mengalami kecelakaan lalu lintas 12 jam sebelum dirawat di rumah
Diabetes
of sample family
sakit. Setelah
insipidus
operasi,
members in patiens
were smokers with traumatic
severity of severe
pneumonia brain injuryproduksi
infection.
poliuria Exclusive
(78.1%). This study is intanda-tanda
line with the diabetes
researchinsipidus ditandai dengan adanya
breastfeeding can prevent pneumonia due
of Dinda Rachma Anggraini, who found that toof bacteria and viruses.Medical
While Faculty in this of study
klinis dan hemodinamik pasien tidak menunjukkan perbaikan. Pasien meninggal pada hari kelima
1) Resident
there of Anesthesiology
was a relationship betweenand theIntensive
presenceCarethe RSUD Dr. Soetomo,
perawatan di majority (65.5%) of the sample didpada
not
Airlangga
of smokers andUnit Perawatan
University.
the incidence ofIntensif
pneumonia (ICU).
in Perawatan
consume
utama
fruits
untuk diabetes
and vegetables
insipidus
every day so that
infants. Children who live in one house with
hipovolemik,
ulty ofhave poliurik,
Airlangga dan times
hipernatremia it could adalah
yang adekuat cause low nutritional
kunci keberhasilan status pengobatan
(Ningsih &
smokers a risk University.
3.4 greater than Jonyanis, 2014).
diabetes
children insipidus.
who do not Diabetes
live in insipidus
one housedalam with kasus cedera otak membutuhkan perawatan yang
smokers. Cigarette smoke is a pollutant in the In this study, the results were obtained that
Aliving
R T space
I C L andE Iwill N Fincrease
O ABSTRACT
the risk of illness all research samples were assisted by the
Kata kunci : Diabetes
from toxic materials in infants and will insipidus, cedera
Traumatic
cause severe otak,
birth hipernatremia,
of
brain medical
injurystaff.desmopressin,
is a This
fatal isinjury,inICU line
with witha
Correspondence
Submitted : Januari : 2019
yud180987@yahoo.com
respiratory problems, especially increasing Ratna Sulistyawati’s research
mortality rate of up to 50%. About 1.5 million people which states
Accepted : February 2019
the risk of acute respiratory infections experience
and severe that all study
brain samples
injury in the were
United bornStates. There
by medical
Published
INTRODUCTION : Mei 2019
lung disorders (Anggiani, 2016). are more than CASE
personnel REPORT
50,000 (Rachmawati,
deaths and 500,000 2013). Provisions
incidents for of
Traumatic brain injury is a fatal injury, delivery
with neurological
permanent must be assisted by medical
sequelae. About 85% of mortality
A 45-year-old man was taken to the Emergency personnel
Other CHB factors, such as eradication of in accordance with government policies in
Keywords: 1.5
mosquito larvae around the house, were
million people with severe brain injury
Diabetes
not carried insipidus,
out by brain injury, of the
the majority
in traffic accident maintaining
the program of 12 hours maternal
study before health being
the United States have more than definitive 50,000 data and reducing
on the incidence
hospitalized. maternal
The patient mortality
of diabetes (Ningsih
insipidus
is unconscious &
in
since
hypernatremia,
sample (81.3%). desmopressin,
An environment ICU that does
deaths and 500,000 permanent neurological patients with Jonyanis,
the accident2014).
traumatic severe
occurred. Labor
brain that
First aidiswas
injury not helped
of given
Indonesia by
in the
not make efforts to eradicate mosquito larvae medical personnel, there will likely be a large
sequelae (Agha and Thompson, so far. In this case report, a male, 45 years old, was taken
2006). previous health facility; RSUD Tuban, thus the
Correspondence:
will trigger the arrival of mosquitoes where
Approximately 85% of mortality occurs in the infection
to the Emergency because the
Installation toolsafter
(IRD)
patient was referred to IRD Dr. Soetomo. usedexperiencing
to help deliver a
mosquitoes are a source of disease and host
yud180987@yahoo.com labor are not sterile, making it easier for bacteria
first 2 weeks after the injury, which traffic exhibits accident
The 12 hours has
patient before being a hospitalized.
attached collar brace at After
the
of infectious diseases. Also, the use of clean to grow.
the initial impact of systemic hypotension and surgery, the arrival
signs of indiabetes insipidus
resuscitation room was ofpresented
Dr. RSUD by
water for daily activities such as bathing,
intracranial hypertension (Benvenga polyuria et al., of 300cc
Soetomo. / hour
In this study, urine
Responding production
the majorityto of pain, and
the study 149mmol
with sample /
the
cooking, and drinking water is only carried
2000). L hypernatremia, although the immediate administration of
examination
(68.8%) did not of anisocoria
use healthyround latrines.pupils This4/3 is
out by half of the study sample, so that it can
One of the complications of a severe brain injury
desmopressin, mm,
in the
linepatients
both eye
with clinical
light and hemodynamic
reflexes
Sulistyowati’s were
research was
decreased.
which
cause bacteria to grow (Anggiani, 2016).
is diabetes insipidus. (Agha and Thompson, not shown any improvements. The patient passed away in the
Spontaneous
states that notbreathing
using healthy 30 times
latrinesper canminute
cause
In this study, the majority of mothersdays five of treatment in the Intensive Care Unit (ICU). The
2006; Hannon et al., 2012). Diabetes insipidus did not presented
infections in with an additional
children (Idris, 2018; gurgling breath
Sulistyowati,
provide
is exclusive
a disease caused breastfeeding
by the lower (56.3%) main due
production,
treatments for This
diabetes insipidus
to thein large
with oxygen saturation of 92% using an oxygen
2010). is due traumatic number severe of
to a lack of knowledge
secretion, and function of Anti brain about the benefits
Diureticof
injury mask
are adequate
of 5 rehydration
liters per and
minute.
bacteria that arise in latrines so that hygiene administration
Blood pressure
exclusive breastfeeding.
Hormone (ADH). Kidney In addition, of some
abnormalities
desmopressin. Adequate hypovolemic, polyuric and
110/75 mmHg (MAP 86), pulse 120 times per
must always be considered.
mothers are not diligent
were marked by the unresponsiveness in bringing their
of
hypernatremia corrections
minute. Tip of are the the keys to were
extremity the warm,
successful dry
children to the
physiological ADH posyandu to weigh
stimulation, which their
is
and red with an examination of capillary refill
bodies so that mothers do not know that
characterized by excessive thirst (polydipsia) their injury
of brain requires
CONCLUSION
time complicated
<2 seconds. The treatment. Therefore,
right parietooccipital
children are experiencing poor
and large amounts of urine (polyuria). There is or even poor
hematoma was found. The highest patient degree was
nutrition. One of the factors that influence the This research found that the
no definitive data on the incidence of diabetes immediately
emergence of pneumonia and the severity of of pneumoniasuctioned in childrenand under oxygenated
five yearswith old
ABSTRAK Jackson Reese 10 liters per minute, a two-lane
theIndonesia
disease issothe was severe pneumonia, while the classification
in far.children’s immune system. intravenous line ofwas attached and 30° head-
Cedera
The immuneotak berat traumatis
system adalah cedera fatal,
by dengan of thetingkat
majority kematian CHB was the
hingga 50%.Intermediate
Sekitar 1,5
Diabetes insipidus in can
cases be of influenced
brain injury up position. The ispatient was prepared to be
juta orang
several things mengalami cedera
including: otak berat di
nutritionalDiabetes Amerika
status, category.
Serikat. There
Terdapat a
lebihsignificant
dari 50.000 relationship
kematian
requires complicated treatment. intubated using ETT No.7 and the lip border
dan 500.000can insiden between the degree of terjadi
pneumonia dalamin2 mingguchildren
immunization
insipidus lead gangguan
status, to death neurologis
exclusive when permanen.
breastfeeding
handled was
Sekitar 85%
21cm. The
kematian
ventilator used PCV mode with
pertama
and the agesetelah cedera.
ofTherefore,
the child.Salah
The satu
poor komplikasi
nutritional and CHB.
dari cedera otak yang parah adalah diabetes insipidus.
improperly. the authors are RR 16, PC 15, trigger 2, I: E 1: 2, FiO2 50%.
Tidak ada data
interested pasti tentang
in discussing thekejadian
management diabetes ofinsipidus pada pasien dengan cedera otak traumatis
2
222
QANUN MEDIKA
QANUN Vol 4 VOL.4
MEDIKA No4 2.l no
VOL JULY
no 20202019
11 Mei
Mei 2019
QANUN
QANUN MEDIKA
MEDIKA
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KEDOKTERANFKUM
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Case Report
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Anggiani, D. insipidus
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2019 mortality rate of up to 50%. About 1.5 million people
https://doi.org/10.20961/its.v1i2.602
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Published
Idris, H. (2018).: Mei 2019
Hubungan perilaku dian Pneumonia Pada Balita Di Ka-
are hidup
more than 50,000 deaths and 500,000 incidents of
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Keywords: occurs in the first 2 weeks after the injury. One complication
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lengka tahun 2018. VII(14), 47–56. ac.id/6429/1/171891512201011031.pdf
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severe brain WHO
injury Classification
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Peraturan Menteri Kesehatan No. 2269the signs from
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TAHUN 2011 Tentang Pedoman Pem- polyuria of 300cc handle/10665/137319/9789241507813_
/ hour urine production and 149mmol /
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adequate
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Ningsih, F. G., & Jonyanis. (2014). Perilaku brain injury requires complicated treatment. Therefore,
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tang-
ga (PHBS) masyarakat , Desa Gunung
ABSTRAK
Kesiangan, Kec Benai, Kab Kuantan. Jom
FISIP,
otak1(2).
Cedera berat traumatis adalah cedera fatal, dengan tingkat kematian hingga 50%. Sekitar 1,5
juta orang mengalami
Rachmawati, cedera
D. A. (2013). otak Risiko
Faktor berat diyang
Amerika Serikat. Terdapat lebih dari 50.000 kematian
dan 500.000 insiden gangguan
Berhubungan neurologis Pneu-
dengan Kejadian permanen. Sekitar 85% kematian terjadi dalam 2 minggu
pertama setelah
monia padacedera.
BalitaSalah
Umur satu
12komplikasi
- 48 Bulandari cedera otak yang parah adalah diabetes insipidus.
Tidakdiada data pasti
Wilayah tentang kejadian
Kerjapuskesmas diabetes
Mijen Kotainsipidus pada pasien dengan cedera otak traumatis
Semarang. Jurnal Kesehatan Masyarakat
1
223

Tri Kartika Setyarini, Aisyah Lahdji, Isna Zalwa Noor Fajri

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Tri Kartika Setyarini, Aisyah Lahdji, Isna Zalwa Noor Fajri

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QANUN MEDIKA

QANUN Vol 4 VOL.4

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