Curiculum Vitae

 
A. Data Pribadi
Nama Lengkap : Siska Dewi Roslani
Nama panggilan : Siska
Agama : Islam
Jenis kelamin : Perempuan
Tempat Tanggal lahir : Banjar, 29 Januari 1980
Alamat : Jln. Sudiro W No. 79 Kota Banjar
Hp : 082116345863
Status : Menikah
Perguruan tinggi :
Universitas Padjadjaran, Fakultas kedokteran umum- Bandung
Universitas Padjadjaran, Fakultas kedokteran spesialis dalam (internist) -
Bandung
Anak : Keira ghania hanif
Hasna maisya hanif
B. Course
Hemodialysis Training Habibie Hospital
C. Medical Society
Member of Indonesia Medical Association
Member of Banjar Medical Association
Member of Indonesia socity ot internist (PAPDI)
HYPERGLYCEMIA
CRISIS
dr.Siska Dewi Roslani,Sp.PD
Hyperglycemia in hospitalised patients

Hyperglycemia in a known diabetic

Hyperglycaemia in an undetected diabetic

Stress hyperglycaemia .
 Goals of inpatient Diabetes
management

Avoid Hypoglycemia

Avoid Hyperglycaemia

Assess outpatient glycemic control and consider adjusments

 Hyperglycemia Crisis

DKA (Diabetic Ketoacidosis)

4,6 sampai 8 kejadian per 1000 pasien diabetes

HHS (Hyperosmolar Hyperglycemia Syndrome)

<1% kasus
 ALOGORITMA TERAPI INSULIN
PADA KRISIS HIPERGLIKIMIA
Insulin:reguler

0,1/kgBB sebagai bolus IV

0,1 U/KGBB/Jam sebagai infus

insulin kontinyu IV

Jika GD tidak turun 50-75 mg/dl,

Naikan drip insulin 2x

Ketika GD < 300 mg/dl

Ketika kadar GD < 200mg/dl
Turunkan infus insulin reguler
turunkan infus insulin reguler
menjadi 0,05-0,1 U/kgBB/Jam IV.
menjadi 0,05-0,1 U/kgBB/jam IV.
Pertahankan kadar GD antara
Pertahankan kadar GD antara
200 - 300 mg/dl, penurunan
180 - 200 mg/dl
osmolaritas , pasien sadar penuh
Sampai terjadi resolusi KAD
(HHS)
ANALOG insulin
 Summary
• Admission hyperglicemia crisis has been associated with increased hospital mortality in
critically ill patients

• There are two major hyperglycemic crises associated with diabets: diabetic ketoacidosis and
the hyperosmolar hyperglycemic syndrome.

• In the critical care setting, continous intravennous insulin infusion is the most effective method
for achieving glycemic targets.

• Intravenous treatments with regular insulin and analog insulin are equally effective with no
Differences in the mean duration of treatment or in the amount of insulin infusion
 Insulin

IV REGULER INSULINE

Insulin 0.1 U/kg body

weight as IV bolus

0.1 U/kg/hr IV continuous

insulin infusion

If serum glucose does not

fall by 50-70 mg/dl in first
hour,double insuline dose

When serum glucose reaches 300 Check electrolytes BUN,Creatinine and

mg/dl,reduce regular insulin infusion to
0.05-0.1 U/kg/hr IV.Keep serum glucose
between 250 and 300 mg/dl until plasma
osmotality is < 15 mOsm/kg and patient is
mentally alert
glucose every 2-4 hours until stable. After
resolution of HHS and when patient is
able to eat, initiate SC multidose insulin
regimen continue IV insulin infusion for
1-2 hr after SC insulin begun to ensure
adequate plasma insulin levels.
 IV FLUIDS

Determine hydration status

Servere Cardiogenic
hypovolemia shock

Administor 0.9% Mild HEMODYNAMIC

NaCL (1.0L/HR) Dehydration MONITORING
PRESSORS

Evaluate corrected serum Na

Serum Na Serum Na Serum Na

high normal low

0.9% NaCl
0.45% Nacl
(250-500 ml/hr)
(250-500 ml/hr)
Depanding on hydration state
Depanding on hydration state

Whens serum glucose reaches 200-250 mg/dl,change to 5% dextrose with 0.45% NaCl at
150-250 ml/hr