dr. Meddy Setiawan, SpPD

FAKULTAS KEDOKTERANUNIVERSITAS MUHAMMADIYAH MALANG

Koma metabolik

Koma Uremikum

Patofisiologi

Koma uremikum.

Blood Urea Nitrogen (BUN)

Tata laksana koma uremikum

Terapi etiologiPengobatan berdasar kausa

HemodialisaDialisa peritoneal

Hiperkalemia > 8 mE/L beri 200-300 cc glukosa 20% yang mengandung insulin 20-30 unit slm 30-60 mntBila asidosis metabolik berat (>15mEL) beri bikarbonat per oralRestriksi protein (0,3 g/kg/BB) disertai karbohidrat min 100 g, folic acid, multivitamin

Koma DiabetikumDiabetic coma a medical condition in which, a patient suffering from diabetes loses his/her consciousness as a result of imbalance in blood sugar level. A patient suffering from very low blood sugar (known as severe hypoglycemia) or very high blood sugar (known as severe hyperglycemia) can get into diabetic coma.

Patient with high blood sugar dehydration condition, frequent vomiting and/urination, dryness of mouth and shortness in breathing (deep breathing). The patient may also experience increase in thirst.Patient with low blood sugar physical fatigue, increase in hunger, increase in sweatingPain in abdominal area

Koma Diabetikum

Resiko koma diabetes pd DM type 1 disebabkan oleh:- Gula darah rendah (hipoglikemia)- Diabetic ketoasidosisResiko koma diabetes pd DM type 2 disebabkan oleh:- Diabetic hyperosmolar sindrom (usia tua >>)Faktor Resiko

Apabila tidak diobati, koma diabetes dapat mengakibatkan:Kerusakan otak permanenKematian

Komplikasi

Diabetic Coma

Hypoglycemia

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One of the most serious acute complications of diabetes mellitus beside HHS (Hyperglicemic Hyperosmolar Syndrome)DKA consists of the biochemical triad of hyperglycemia, ketonemia and metabolic high anion gap acidosis

The pathogenesis of DKA and HHS are similar, however, in HHS: there is enough insulin to prevent lipolysis and ketogenesis but not adequate to cause glucose utilization possible smaller increases in counterregulatory hormones

PatofisiologiHipotesis ammoniaHipotesis neurotoksi sinergisHipotesis neurotransmitter palsuHipotesis GABA / benzodiazepine (Budihusodo., 2002)

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