HYPEROSMOLAR HYPERGYLICEMIC Radya Agna Nugraha

1610211011

STATE Pisi Nopita Wigati

1610211016
DEFINISI
• Merupakan komplikasi akut dan kegawatdaruratan/emergency diabetes mellitus.
(ilmu penyakit dalam UI).
• Hyperglicemic hyperosmolar nonketotic syndrome (HHNS) atau Sindrom hiperglikemik
hiperosmolar (SHH) adalah komplikasi yang mengancam nyawa dari penyakit
diabetes mellitus yang tidak terkontrol.
• Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus
(DM) characterized by severe hyperglycemia, extreme dehydration, hyperosmolar
plasma, and altered consciousness.
•HHS adalah istilah untuk HHNK (Hiperglikemia-hiperosmolar non ketotik) dan HHK
(Hiperglikemia-hiperosmolar koma)
EPIDEMIOLOGI
• Sekitar 5-15% dari seluruh kasus emergensi hiperglikemi pada diabetes.
• Frekuensi 17,5 kasus per 100.000 penduduk per tahun.
• The average age of patients with HHS is 60 years ( 50-69 years on most published
series) t
• The prevalence is slightly higher in females than in males.
• Increased prevalence of type 2 DM in these populations.
• The mortality rate for patients with HHS is between 10 and 20 percent, which is
approximately 10 times higher than that for DKA
•Afrika amerika, hispanik, native amerika meningkat
ETIOLOGI
• Hyperglicemia
• Complication of diabetes melitus  Hyperglicemia
• The stress response to any acute illness tends to increase counterregulatory hormones that favor
elevated glucose levels.
• Patients with underlying renal dysfunction
• Drugs that raise serum glucose levels, inhibit insulin, or cause dehydration may contribute to
development of HHS. (Antidiabetic medications)
RISK-FACTOR
GEJALA KLINIS
-Lemah -Perubahan status mental : coma
-gangguan penglihatan -kejang: umum, lokal, mioklonik
-Kaki kejang -85% disertai penyakit penyerta
-mual muntah -takikardia dan hipotensi
-letargi, pusing bingung -hipotermia: prognosis buruk
-Hemiparesis
-tanda2 dehidrasi berat
-peningkatan suhu tubuh karena infeksi
GEJALA KLINIS
DIAGNOSIS
• Anamnesis : lihat riwayat pengobatan terkontrol •Physical exam findings and signs related to HHS
atau tidak include the following:
• Altered mental status, confusion
• Px Fisik :
• Vital signs related to HHS include the following : • Lethargy
• Tachycardia • Ill appearance
• Orthostatic decrease in blood pressure • Dry mucous membranes
• Hypotension • Sunken eyes
• Tachypnea • Decreased skin turgor
• Hyperthermia, if infection is present • Poor capillary refill
• Weak thread pulse
• Anhidrosis
• Decreased urine output
• Coma
DIAGNOSIS
CAIRAN
INSULIN
ELEKTROLIT
TATALAKSANA
PROGNOSIS
• Overall mortality for HHS is estimated at 5-20%
• Prognosis is worse for elderly patients and patients in whom coma and hypotension
are found.
• In children, mortality from complications from HHS also appears to be higher than
mortality from DKA.