Ritonga, Ervita
Divisi Endokrinologi, Metabolik Dan Diabetes, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Padjadjaran – RSUP Dr. Hasan Sadikin Bandung, Indonesia

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Laporan Kasus: Tantangan Pengelolaan Krisis Hiperglikemia Pasien Penyakit Ginjal Kronik (PGK) Tahap Akhir dalam Hemodialisa Rutin Davin Takaryanto; Maya Kusumawati; Nenny Agustanti; Rudi Supriyadi; Ervita Ritonga; Nanny N. M. Soetedjo; Hikmat Permana
Jurnal MedScientiae Vol. 2 No. 1 (2023): April
Publisher : Fakultas Kedokteran dan Ilmu Kesehatan Ukrida

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Abstract

Introduction Hyperglycemic crisis is a life threatening medical emergency which occur in any individuals, including end stage renal disease (ESRD). The altered renal, glucose, electrolyte, and body fluid dysregulation seen in ESRD patients affects the management. Objective: Hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA) are life threatening hyperglycemic emergencies that warrant immediate and adequate management. The incidence of hyperglycemic crises among ESRD patients who undergo routine hemodialysis remains unknown. Furthermore, several available studies reported in case reports. Methods: We hereby report a case of hyperglycemic crisis of 61years old woman with medical history of type 2 diabetes mellitus (DM) and ESRD as the complication, she undergoes routine hemodialysis. Results: The patient was admitted with decreased consciousness that was preceded by dyspnea, active cough and fever. Then, the patient treated for the hyperglycemic crisis as in ESRD patient and for the with septic shock due to pneumonia. Conclusion: The management of hyperglycemic crises consist of fluid, potasium corection and insulin administration, however there were some adjustment in ESRD patients. At present therere were no spesific guidelines to manage hyperglicemic crisis and ESRD which is challenging.
Laporan Kasus: Tantangan Pengelolaan Krisis Hiperglikemia Pasien Penyakit Ginjal Kronik (PGK) Tahap Akhir dalam Hemodialisa Rutin Davin Takaryanto; Maya Kusumawati; Nenny Agustanti; Rudi Supriyadi; Ervita Ritonga; Nanny N. M. Soetedjo; Hikmat Permana
Jurnal MedScientiae Vol. 2 No. 1 (2023): April
Publisher : Fakultas Kedokteran dan Ilmu Kesehatan Ukrida

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jmedscientiae.v2i1.2800

Abstract

Introduction Hyperglycemic crisis is a life threatening medical emergency which occur in any individuals, including end stage renal disease (ESRD). The altered renal, glucose, electrolyte, and body fluid dysregulation seen in ESRD patients affects the management. Objective: Hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA) are life threatening hyperglycemic emergencies that warrant immediate and adequate management. The incidence of hyperglycemic crises among ESRD patients who undergo routine hemodialysis remains unknown. Furthermore, several available studies reported in case reports. Methods: We hereby report a case of hyperglycemic crisis of 61years old woman with medical history of type 2 diabetes mellitus (DM) and ESRD as the complication, she undergoes routine hemodialysis. Results: The patient was admitted with decreased consciousness that was preceded by dyspnea, active cough and fever. Then, the patient treated for the hyperglycemic crisis as in ESRD patient and for the with septic shock due to pneumonia. Conclusion: The management of hyperglycemic crises consist of fluid, potasium corection and insulin administration, however there were some adjustment in ESRD patients. At present therere were no spesific guidelines to manage hyperglicemic crisis and ESRD which is challenging.
Rhabdomyolysis in Thyroid Crisis Soetedjo, Nanny Natalia Mulyani; Loe, Luse; Kusumawati, Maya; Ritonga, Ervita; Permana, Hikmat
Majalah Kedokteran Indonesia Vol 72 No 5 (2022): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.72.5-2022-829

Abstract

Introduction: Hyperthyroidism might lead to rhabdomyolysis. Rhabdomyolysis in thyroid crisis is very rare, currently there are only 7 cases in the world. This is the eight cases in the world that had been reported.Cases: We reported a case of a 46-year-old man with Graves’ Disease who presented with thyroid crisis and rhabdomyolysis.Discussion: The patient came with shortness of breath and palpitations for 10 hours before admission. Tachycardia, tachypnea, thyroid enlargement, motoric weakness, and bilateral lung crackles were noted. The Burch-Wartofsky Point Scale was 60 and the Japan Thyroid Association grade was TS2 first combination. Laboratory showed hyperkalemia (7.7 meq/L), increase in urea (144 mg/dl), creatinine (1.92 mg/dl), fT4 ( greater than 5.0), TSHs (0.06 uIU/ml) creatine kinase (3645 U/L), positive TRAb and Anti-TPO. The patient was treated with thyroid crisis management (propylthiouracil, lugol, dexamethasone) and supportive treatment (dobutamine, digoxin, furosemide, antibiotics, hyperkalemia therapy). After hospitalized for 11 days, the patient was discharged with resolution clinical symptom and levels of CK, urea, and creatinine. Conclusion: Hyperthyroidism might lead to rhabdomyolysis. This condition needs to be recognized and becomes a differential diagnosis in non-traumatic rhabdomyolysis accompanied by acute kidney injury. Therefore, can lead to appropriate and prompt management.