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LAPORAN KASUS PKL RUMAH SAKIT

PROGRAM PENDIDIKAN MAGISTER FARMASI KLINIK FAKULTAS FARMASI UNIVERSITAS AIRLANGGA 2011

BAB I

PENDAHULUAN

1.1 Definisi Diabetes mellitus

DM adalah sekelomok !a"!!#a" me$a%ol&k k'o"&k( d&$a"da& oleh

h&e'!l&kem&a )a"! %e'h#%#"!a" de"!a" a%"o'mal&$as( me$a%ol&sme ka'%oh&d'a$(

lemak( 'o$e&"( d&se%a%ka" oleh de*ek sek'es& &"s#l&"( dese"s&$&sas& 'ese$o'

&"s#l&" a$a# ked#a")a da" me"!ak&%a$ka" $e'+ad&")a koml&kas& k'o"&k $e'mas#k

m&k'o,ask#la'( mak'o,ask#la' da" "e#'oa$& )a"! me"!#'a"!& k#al&$as h&d#

se'$a me"&"!ka$ka" mo'%&d&$as da" mo'$al&$as -M#dal&a' a"d Edelma"( 2000. Ok&

a"d Isle)( 2002/

DM adalah e")ak&$ k'o"&s )a"! d&$a"da& oleh !a"!!#a" me$a%ol&sme

ka'%oh&d'a$( lemak( 'o$e&" )a"! d&se%a%ka" oleh de*&s&e"s& a%sol#$ ma##"

'ela$&* da'& ke'+a &"s#l&" da" kem#"!k&"a" ka'e"a e"&"!ka$a" sea'a a%"o'mal

da'& +#mlah !l#ka!o" da" ho'mo"ho'mo" “counter regulatory” see'$& ho'mo"

e'$#m%#ha"( s&ma$om&me$&k am&" da" ko'$&kos$e'o&d -Se$$e'( et al ( 2000/

1.2 Epidemiologi

Dalam D&a%e$es A$las -ADA/ 2000 (International Diabetes Federation)(

$e'a"$#m e'k&'aa" e"d#d#k I"do"es&a d& a$as 20 $ah#" se%esa' 123 +#$a

De"!a" as#ms& 'e,ale"s& DM se%esa' 4(56( d&e'k&'aka" ada $ah#" 2000

as&e" DM aka" %e'+#mlah 3(5 +#$a 7e'dasa'ka" ola e'$am%aha" e"d#d#k

see'$& saa$ &"&( d&e'k&'aka" ada $ah#" 2020 "a"$& aka" ada se+#mlah 189 +#$a

e"d#d#k %e'#s&a d& a$as 20 $ah#" da" de"!a" as#ms& 'e,ale"s& DM se%esa' 4(56 aka" $e'+ad& 9(2 +#$a as&e" DM -P'a"o$o( 200:/

1.3 Etiologi DM

E$&olo!& a$a# *ak$o' e")e%a% $e'+ad&")a DM mel&#$& o%es&$as( #s&a(

ke$#'#"a" -he'ed&$e'/( s$'es( ke'#saka" sel ; ka'e"a 'oses a#$o&m#"( e")ak&$

e"dok'&" see'$& e")ak&$ ”Cushing’s”( ,&'#s( ,ask#l&$&s ada +a'&"!a" e'*#s&

$&"!!& see'$& ma$a da" !&"+al( keaa$a" 'ese$o' &"s#l&" da" o%a$o%a$a" see'$&

ko'$&kos$e'o&d( $&'o&d( *e"&$o&"( d&a


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1.4 Batasan Klini

K'&$e'&a d&a!"os$&k #"$#k DM me"#'#$ Se$$e'( 2000 adalah >

-1/ Kada' !l#kosa da'ah aak ? 200 m!@dl -11(1 mmol@L/

-2/ Gl#kosa da'ah #asa ? 125 m!@dl -8(0 mmol@L/ P#asa d&de*&"&s&ka"

se%a!a& $&dak ada")a as#a" kalo'& selama m&"&mal 9 +am

-:/ Gl#kosa da'ah 2 +am ? 200 m!@dl selama $es $ole'a"s& !l#kosa o'al

-TTGO/ As#a" !l#kosa )a"! d&'ekome"das&ka" ada $es &"& adalah 83

!'am a$a# )a"! se%a"d&"!

1.! Klasifiasi

Klas&*&kas& DM me"#'#$ ADA - American Diabetes Associations/( )a&$#>

-1/ DM T&e 1( )a&$# DM )a"! d&se%a%ka" ka'e"a des$'#ks& sel ; a"k'eas

ak&%a$ ke'#saka" s&s$em &m#" $#%#h

-2/ DM T&e 2( )a&$# DM )a"! d&ak&%a$ka" $e'+ad&")a de*&s&e"s& &"s#l&" se'$a

'es&s$e"s& &"s#l&"

-:/ DM T&e Ses&*&k La&"

-4/ DM Ges$as&o"al( )a&$# DM )a"! $e'+ad& ada saa$ keham&la"

Ta%el I1 DM T&e Ses&*&k La&" -T'&l&$$ et al., 2003/

E$&olo!& o"$oh

A De*ek *#"!s& sel ; !e"e$&k 1 K'omosom 12( HNF1B -MODC:/

2 K'omosom 8( !l#kok&"ase -MODC2/

: K'omosom 20( HNF4 B -MODC1/

4 DNA m&$oko"d'&a

3 La&"")a

7 De*ek aks& &"s#l&" !e"e$&k 1 Res&s$e"s& I"s#l&" T&e A

2 Le'ek'a#"&sme

: S&"d'om Ra%so"Me"de"hall

4 D&a%e$es L&oa$'o*&k

3 La&"")a

Ta%el I1 DM T&e Ses&*&k La&" -T'&l&$$ et al., 2003/ -la"+#$a"/

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Pe")ak&$ ada a"k'eas

eksok'&"

1 Pa"k'ea$&$&s

2 T'a#ma@a"k'ea$ek$om&

: Neolas&a

4 F&%'os&s s&s$&k (cystic fibrous)

3 Hemok'oma$os&s

5 Pa"k'ea$oa$& *&%'okalk#lo#s

8 La&"")a

D E"dok'&"oa$&

-kada' ho'mo" a"$a!o"&s &"s#l&"

$&"!!&/

1Ak'ome!al& -ho'mo" e'$#m%#ha"/

2 Cushing yndrome -ko'$&sol/

: H&e'$&'o&d&sme -$&'oks&"/

4 Feok'omos&$oma -ka$ekolam&"/3 Gl#ka!o"oma -!l#ka!o"/

5 Soma$os$a$&"oma -soma$os$a$&"/

8 Aldos$e'o"oma -aldos$e'o"/

9 La&"")a

E I"d#ks& o%a$o%a$a" 1 Vao'

2 Pe"$am&d&"

: Asam N&ko$&"a$

4 Gl#koko'$&ko&d

3 Ho'mo" T&'o&d

5 D&a


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F I"*eks& 1 o"!e"&$al '#%ella

2 )$ome!alo,&'#s

: La&"")a

G Fak$o' &m#" $#%#h 1 S&"d'oma S$&**ma"

2 Rese$o' a"$&%od& a"$& &"s#l&"

: La&"")a

H S&"D'oma !e"e$&k la&" )a"!

d&ka&$ka" de"!a" DM

1 S&"d'om La#'a"eMoo"7&edl

2 S&"d'om Re*s#m

: S&"d'om Do"

4 S&"d'om T#'"e'

3 S&"d'om F'ed'e&ha$aks&a

5 S&"d'om Kl&"e*el$e'

8 S&"d'om ol*'am

9 H#"$&"!$o"s ho'ea

D&s$'o*& m)o$o"&k

10 Po'*&'&a

11 S&"d'om P'ade' &ll&

12 La&"")a

1." Patofisiologi dan Patogenesis

Pada ked#a $&e DM( $e'+ad& de*&s&e"s& &"s#l&" &ka ada DM $&e 1(

de*&s&e"s& &"s#l&" d&se%a%ka" ka'e"a 'oses a#$o&m#"( ada DM $&e 2 d&se%a%ka"

%e%e'aa *ak$o'( )a&$# %e'k#'a"!")a massa sel ; a"k'eas( kada' asam lemak )a"!

$&"!!& -l&o$oks&s&$as/( h&e'!l&kem& k'o"&k( am&l&"( kelelaha" sel ; a"k'eas da"

*ak$o' !e"e$&k

7e'k#'a"!")a massa sel ; a"k'eas %a")ak $e'+ad& ada as&e" DM $&e 2

Pada s$#d& !ost"mortem $elah d&lao'ka" $e'+ad& e"!#'a"!a" sel ; a"k'eas

se%a")ak 40506 H&e'!l&kem& k'o"&k selal# d&&k#$& de"!a" me"#'#"")a 'eso"

sek'es& da" ke'+a &"s#l&" Hal &"& d&se%a%ka" ak&%a$ $e'+ad& !a"!!#a" ada

h&d'ol&s&s mem%'a" oso&"os&$&da )a"! me"!ak&%a$ka" e"#'#"a" ko"se"$'as&

d&as&l!l&se'ol da" &"os&$o*os*a$ dalam sel ; da" ada akh&'")a me"!#'a"!& sek'es&

&"s#l&" H&e'!l&kem& k'o"&k me")e%a%ka" 'es&s$e"s& &"s#l&" se%a!a& ak&%a$ do#n

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regulation da'& s&s$em $'a"so'$ !l#kosa de"!a" ada")a ko",e's& fru$tosa"%"fosfat

me"+ad& glu$osamin"%"fosfat )a"! me"#'#"ka" se"s&$&,&$as &"s#l&" d& e'&*e'

Res&s$e"s& &"s#l&" %a")ak d&$em#ka" ada as&e" DM $&e 2 Res&s$e"s&

&"s#l&" $e'+ad& %&la kemam#a" &"s#l&" #"$#k me"&"!ka$ka" am%&la" da" d&sosal

!l#kosa d& +a'&"!a" e'&*e' -o$o$ da" +a'&"!a" ad&osa/ $e'!a"!!# a$a# kada'

&"s#l&" "o'mal me"!has&lka" e*ek %&olo!&s )a"! k#'a"! da'& "o'mal Fak$o'*ak$o'

)a"! daa$ me")e%a%ka" 'es&s$e"s& &"s#l&" a"$a'a la&"( o%es&$as( d&e$( k#'a"! !e'ak

%ada"( h&e'!l&kem& k'o"&k( da" *ak$o' !e"e$&k -F#"k da" Fe&"!old( 13.

S#!&)a"$o( 2004/

1.# $e%ala lini

Ge+ala )a"! $&m%#l ada DM #m#m")a mel&#$& ol&d&s&( ol'&(

ol&*a!&a( lemah( e"#'#"a" %e'a$ %ada"( k#l&$ ke'&"! da" ke$oas&dos&s -Se$$e' et

al ( 2000/ Ge+ala k'o"&k la&" )a"! se'&"! $e'+ad& a"$a'a la&" kesem#$a"( ma$a

ka%#'( m&al!&a( a$'al!&a da" e"#'#"a" kemam#a" seks#al -T+ok'o'a&'o( et al (

14/

Pada DM $&e 2 kada"! $&dak d&se'$a& !e+ala a$a# !e+ala")a %e'+ala" lam%a$

a$a# ela" Ge+ala")a %a'# d&ke$ah#& ada saa$ d&$em#ka" !l#kosa ada $es #'&"

-!l#kos#'&a/ a$a# ada saa$ $e'+ad& ol'&@ol&d&s& Ge+ala la&" )a"! $&m%#l )a"!

%e'ka&$a" de"!a" h&e'!l&kem&a see'$& e"!l&ha$a" ka%#'( eks$'&m&$as kak#(

meme'lam%a$ e"!o%a$a" &"*eks& k#l&$( !a$al( me"!a"$#k( m#dah $e's&"!!#"!

da" &"*eks& sal#'a" kem&h )a"! e's&s$e" -G'ee"e( et al ( 2000. Se$$e'( et al ( 2000/

1.& Kompliasi

1.&.1 Kompliasi A't(1) Hipogliemia

Reaks& h&o!l&kem&k me'#aka" koml&kas& $e'se'&"! ada as&e" DM

)a"! me"daa$ $e'a& &"s#l&" Koml&kas& &"& daa$ $e'+ad& ada as&e" )a"!

me"daa$ $e'a& s#l*o"&l#'ea o'al $e'#$ama as&e" la"+#$ #s&a de"!a" !a"!!#a"

*#"!s& ha$& a$a# !&"+al )a"! me"daa$ o%a$o%a$a" de"!a" masa ke'+a )a"!

a"+a"! da" sa"!a$ o$e" see'$& klo''oam&d a$a# !l&%#'&d( l#a a$a# $e'lam%a$

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maka" a$a# ak&%a$ la$&ha" *&s&k )a"! le%&h k#a$ da'& %&asa")a $a"a s#leme"

kalo'& a$a# ak&%a$ e"#'#"a" dos&s &"s#l&"

(2) Koma

Koma adalah s#a$# keadaa" !aa$ da'#'a$ )a"! meme'l#ka" e,al#as&

se!e'a #"$#k me"e"$#ka" e")e%a%")a a!a' daa$ d&%e'&ka" $e'a& )a"! ses#a&

Klas&*&kas& e$&olo!& koma d&a%e$&k >

A. Koma Hipe*gliemi

Koma h&e'!l&kem&k daa$ me")e'$a& de*&s&e"s& &"s#l&" )a"! %e'a$

-ke$oas&dos&s d&a%e$&k/ a$a# de*&s&e"s& &"s#l&" '&"!a" sama& seda"! -koma "o"

ke$o$&k h&e'!l&kem&k( koma h&e'osmola'/

Ke$oas&dos&s d&a%e$&k me'#aka" ma"&*es$as& e'$ama da'& kas#s )a"!

se%el#m")a $&dak $e'd&a!"os&s a$a# daa$ $e'+ad& ak&%a$ ke!a!ala" $e'a& &"s#l&"

ekso!e" ada as&e" DM Ke$oas&dos&s d&a%e$&k $elah d&$em#ka" ada as&e" DM

se%a!a& salah sa$# koml&kas& )a"! #k# se'&"! da'& $e'a& &"s#l&"

H&e'!l&kem&k da" h&e'osmola' "o"ke$o$&k d&$a"da& oleh h&e'!l&kem&a

%e'a$( h&e'osmolal&$as( da" deh&d'as& $a"a ada")a ke$os&s )a"! ")a$a

Koml&kas& &"& $e'+ad& ada as&e" a'#h %a)a a$a# la"+#$ #s&a de"!a" DM $&e 2

)a"! se'&"!kal& '&"!a" a$a# $e'sama' T&m%#l le$a'!& da" e'asaa" kaa# saa$

osmolal&$as se'#m melama#& :00 mosmol@L da" koma +&ka osmolal&$as se'#m

melama#& ::0 mosmol@L

B. Koma Hipogliemi

Koml&kas& &"& $e'+ad& ak&%a$ dos&s &"s#l&" a$a# o'al a"$&d&a%e$&ka -OAD/

)a"! d&%e'&ka" $e'lal# %e'le%&ha" Um#m")a $e'+ad& ada $e'a& e"!!a"$&a"

&"s#l&" ada as&e" DM H&o!l&kem&k daa$ $e'+ad& ada $&a as&e" de"!a"

$e'a& )a"! me"daa$ s#l*o"&l#'ea o'al( $e'#$ama +&ka as&e" s#dah la"+#$ #s&a(

me"de'&$a e")ak&$ !&"+al a$a# ha$&( a$a# $e"!ah me"daa$ e"!o%a$a" la&" )a"!

daa$ me"!#%ah me$a%ol&sme s#l*o"&l#'ea -see'$& *e"&l%#$a


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+. Asidosis Latat

Reaks& &"& $e'#$ama $e'+ad& me")e'$a& a"oks&a +a'&"!a" %e'a$( ses&s a$a#

kolas ka'd&o,ask#la' &ka as&e" DM da$a"! de"!a" as&dos&s he%a$ $e$a& kada'

asam ke$o dalam lasma 'ela$&* 'e"dah a$a# $&dak $e'de$eks&( maka e'l#

d&e'$&m%a"!ka" kem#"!k&"a" $&"!!&")a kada' lak$a$ lasma -le%&h da'& 5

mmol@L/( $e'#$ama +&ka se%a% as&dos&s la&"")a see'$& #'em&a $&dak d&$em#ka"

-F#"k da" Fe&"!old( 13. Ka'am da" Fo'sham( 19/

1.&.2 Kompliasi K*onis

(1) Mi*o,as'la*

Koml&kas& m&k'o,ask#la' &"& me'#aka" e")ak&$ ada em%#l#h da'ah

$e'ke&l( )a&$# e'&*e' da" a'$e'&ol 'aka&le' Koml&kas& &"& $e'#$ama $amak

se%a!a& e"e%ala" mem%'a" %asal&s ka&le'

A. -etinopati Diaeti

a. -etinopati non/p*olife*atif

Me"!!am%a'ka" s$adm al&"! aal da'& ke$e'l&%a$a" 'e$&"a ada d&a%e$es

da" d&$a"da& oleh e'#%aha"e'#%aha" see'$& m&k'oa"e#'&sme( e"da'aha"

%e'%&"$&k( eks#da$( da" edema 'e$&"a Pada s$adm &"&( ka&le'ka&le' 'e$&"a

meloloska" lemak( 'o$e&" a$a# sel da'ah me'ah ke dalam 'e$&"a 7&la 'oses &"&

%e'la"!s#"! d& mak#la -dae'ah de"!a" keada$a" sel e"!l&ha$a" $e'$&"!!&/( maka

aka" $&m%#l !a"!!#a" e"!l&ha$a" Ke+ad&a" &"& me'#aka" e")e%a% !a"!!#a"

e"!l&ha$a" $e'se'&"! ada DM $&e 2 da" $e'+ad& ada sek&$a' 56 as&e" se$elah

%e%e'aa ak$#

. -etinopati p*olife*atif

Pe")ak&$ &"& mel&%a$ka" e'$#m%#ha"e'$#m%#ha" ka&le' %a'# da" +a'&"!a" *&%'osa ada 'e$&"a ke dalam %ada" kaa Te'+ad& ak&%a$ ada")a s#m%a$a"

em%#l#h da'ah ke&l )a"! me")e%a%ka" h&oks&a 'e$&"a da" me'a"!sa"!

e'$#m%#ha" em%#l#h da'ah %a'# Re$&"oa$& 'ol&*e'a$&* daa$ $e'+ad& ada

ked#a $&e e")ak&$ DM( $e$a& le%&h se'&"! $e'+ad& ada DM $&e 1 Pe")ak&$ &"&

$&m%#l 810 %#la" se$elah !e+ala aal

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B. Nef*opati Diaeti

T&a $ah#"")a( sek&$a' 4000 kas#s e")ak&$ !&"+al s$adm akh&' ak&%a$

"e*'oa$& d&a%e$&k $e'+ad& ada as&e" DM d& Ame'&ka A"!ka &"& meak&l& 236

da'& sel#'#h as&e" )a"! d&'aa$ se%a!a& kas#s !a!al !&"+al Pe"e%ala" mem%'a"

%asal&s ka&le' da" mesa"!m !lome'ol#s !&"+al me")e%a%ka"

!lome'#loskle'os&s dalam %e'%a!a& $&"!ka$a" se'$a &"s#*&s&e"s& !&"+al

+. Ne'*opati Diaeti

Ne#'oa$& e'&*e' da" o$o"om me'#aka" 2 %e"$#k koml&kas& $e'se'&"!

ada ked#a $&e DM Pa$o!e"es&s")a mas&h %el#m d&aham& 7e"$#k "e#'oa$&

e'&*e' )a"! le%&h se'&"! d&+#ma& )a&$# "e#'oa$& se"so'&k da" mo$o'&k s&me$'&s

se'$a "e#'oa$& o$o"om Koml&kas& &"& d&d#!a se%a!a& ak&%a$ $oks&s&$as me$a%ol&k

a$a# osmo$&k )a"! $e'ka&$ h&e'!l&kem&a

a. Ne'*opati pe*ife* senso*i ( me'#aka" de*&s&$ se"so'&k )a"! se'&"!kal&

d&dah#l#& a'es$es&a( 'asa !a$al da" ")e'& )a"! mak&" %e'$am%ah selama %e%e'aa

%#la" a$a# $ah#" S&"d'omas&"d'oma khas )a"! $e'+ad& ada as&e" DM de"!a"

"e#'oa$& se"so'&k( $e'mas#k os$eoa$& $a"!a" da" kak& d&s$al( de*o'm&$as l#$#$

a$a# e'!ela"!a" kak&( da" #lse'as& "e#'oa$&k ada kak&

. Ne'*opati moto*i ( e")ak&$ &"& le%&h se'&"! $e'+ad& d&%a"d&"!ka"

"e#'oa$& se"so'&k da" d&h#%#"!ka" de"!a" e'lam%a$a" ha"$a'a" sa'a* mo$o'&k

da" kelemaha" se'$a a$'o*& o$o$

0. Ne'*opati otonom( koml&kas& &"& se'&"! $e'+ad& ada as&e" DM )a"!

s#dah %e'la"!s#"! lama da" me'#aka" 'o%lem kl&"&s )a"! sa"!a$ me"!!a"!!#

Ne#'oa$& daa$ mel&%a$ka" !a"!!#a" ,&se'al Daa$ $e'+ad& h&o$e"s& os$#'al(

$ak&ka'd&a saa$ &s$&'aha$ )a"! me"e$a( e"#'#"a" 'eso" ka'd&o,ask#la'(!as$'oa'es&s( e&sodee&sode d&a'e -se'&"!kal& ada malam ha'&/ da" ko"s$&as&(

kes#l&$a" me"!oso"!ka" ka"d#"! kem&h( da" &mo$e"s&

(2) Ma*o,as'la*

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A. Penait ant'ng

Pada as&e" DM se'&"! d&se%a%ka" a$e'oskle'os&s ko'o"e' Ak&%a$ )a"!

se'&"! $e'+ad& adalah !a!al +a"$#"!( &"*a'k m&oka'dm )a"! me'#aka" e")e%a%

kema$&a" #$ama ada as&e" DM $&e 1

B. Penait as'la* Pe*ife*

Ma"&*es$as& kl&"&k")a mel&#$& &skem&a da'& eks$'em&$as %aah( &mo$e"s&(

da" a"!&"a #s#s

+. Penait se*e*o,as'la*

D&a%e$es me'#aka" *ak$o' 'es&ko $e'+ad&")a okl#s& ada a%a"! se'e%'al

da" a'$e'& %as&la' a"$e'&o'( e'$e"!aha"( da" os$e'&o' )a"! daa$ mem&#

$e'+ad&")a &"*a'k se'e%'al a$a# e"da'aha" &"$'ase'e%'al Te'+ad&")a &"*a'k se'e%'al

ada as&e" DM d&$a"da& e"&"!ka$a" +#mlah a'ea &"*a'k( $e'#$ama lak#"a da"

ada %e%e'aa kas#s d&$em#ka" %a")ak les& Les& &"& $e'#$ama $e'le$ak ada a'ea

)a"! me"daa$ s#la& da'& a'$e'& a'amed&a" ke&l -%asal !a"!l&a( $alam#s( kas#l

&"$e'"al( da" se'e%ell#m/ &nce!halomalacia +#!a %a")ak d&daa$ka" ada as&e"

DM Pe")ak&$ &"& mak&" a'ah de"!a" %e'$am%ah")a #s&a as&e" da" les& %&asa")a

$e'daa$ ada o$ak $e"!ah

(3) De*mopati diaeti

De'moa$& d&a%e$&k d&$a"da& oleh %e'ak%e'ak okla$ a$'o*&k ada k#l&$(

%&asa")a ada dae'ah 'e$&%&a -%e'ak%e'ak $#la"! ke'&"!J/

(4) Kompliasi t'lang dan sendi

Koml&kas& $#la"! da" se"d& %&asa")a d&h#%#"!ka" de"!a" !a"!!#a"

me$a%ol&k a$a# ,ask#la' da'& DM )a"! s#dah %e'la"!s#"! lama

a. Cheirarthropathy diabetic juvenilis )a&$# s&"d'oma kekak#a" k'o"&k 'o!'es&*

ada $a"!a" sek#"de' da'& ko"$'ak$#' da" e"!e"a"!a" k#l&$ d& a$as se"d&se"d&7&asa")a $&m%#l dalam 35 $ah#" ses#dah !e+ala aal ada DM $&e 1

. Kont*at'* D'p't*en adalah e"e%ala" *as&a alma'&s $a"!a"( me"&m%#lka"

de*o'm&$as see'$& aka' Pada as&e" DM( hal &"& me'#aka" ak&%a$ "ek'os&s

s&s$em&k da" em%e"$#ka" +a'&"!a" a'#$ sek#"de' ada +a'&"!a" &ka$ se%a!a&

ko"sek#e"s& m&k'oa"!&oa$& d&a%e$&k

9


10/34



0. Demine*alisasi t'lang( de"s&$as $#la"! see'$& $e'#k#' de"!a" a%so'%s& *o$o"

ada le"!a" %aah adalah 1020 6 d& %aah "o'mal ada as&e" DM

d&%a"d&"!ka" de"!a" ko"$'ol )a"! seada"

d. B'*sitis( $e'#$ama $e'+ad& d& dae'ah %ah# da" &"!!#l ada as&e" DM

(!) Infesi

7e%e'aa +e"&s &"*eks& see'$& %ak$e''&a( eso*a!&$&s ka"d&da( da" ,a!&"&$&s

ka"d&da le%&h se'&"! me")e'a"! as&e" DM d&%a"d&"!ka" ko"$'ol la&" )a"!

seada" A$e'oskle'os&s de"!a" e")ak&$ ,ask#la' e'&*e' sa"!a$ la


11/34



$olongan Meanisme

Ke*%a

Kont*a

Indiasi

Dosis8

9a*i

(mg)

6*e'ensi

Pemaaian8

9a*i

(ali)

:at'

Peme*ian

Inte*asi

7at

Efe ;amping

1Pem&# Sek'es&

I"s#l&"

A S#l*o"&l#'ea

•Ge"e'as& I >

Klo''oam&d

Tol%#$am&d

Tola


12/34



$olongan Meanisme

Ke*%a

Kont*a

Indiasi

Dosis 8 9a*i

(mg)

6*e'ensi

Pemaaian8

9a*i (ali)

:at'

Peme*ian

Inte*asi 7at Efe ;amping

2 Insulin sensitier

7&!#a"&d@Me$*o'm&"

a S$&m#las&

!l&kol&s&s %

!l#ko"eo!e

"es&s hea$&kmeme'

lam%a$ a%so's&

!l#kosa da'&

GITd Red#ks&

+#mlah

!l#ka!o" lasma

I"s#*&s&e"s&

ha$& da"!&"+al(

!a!al

+a"$#"!ko"!es$&*(

alkohol&sm

e(e")ak&$

a'#k'o"&k(e

")ak&$

,ask#la' e'&*e'

230:00 1:

7e'sama@

ses#dahmaka"

F#'osem&d(

N&*ed&&"(s&me$&d&"

M#al( m#"$ah(

kem%#"!( d&a'e(a"o'eks&a( k'am

e'#$( metallic

taste

:A!o"&s

*ero'isomal *roliferator

Actiated

+ese!tor"-PPAR/

T&a


13/34



1..2 Ins'lin

I"s#l&" me'#aka" s#a$# 'o$e&" )a"! $e'd&'& da'& 31 asam am&"o )a"!

$e'ka"d#"! dalam 2 'a"$a& e$&da Ra"$a& A de"!a" 21 asam am&"o da" 'a"$a& 7

de"!a" :0 asam am&"o Ra"$a& &"& d&h#%#"!ka" oleh 2 +em%a$a" s#l*&da D&

sam&"! &$#( $e'daa$ #la s#a$# +em%a$a" d&s#l*&da dalam 'a"$a& )a"!

me"!h#%#"!ka" os&s& 5 da" 11 da'& 'a"$a& A 7e'a$ molek#l &"s#l&" adalah 3909

Gam%a' 11 Ra"$a& &"s#l&" -F#"k da" Fe&"!old( 13/

I"s#l&" ma"#s&a ha")a sed&k&$ %e'%eda dalam s#asa"a asam am&"o")a da'&

2 &"s#l&" mamal&a )a"! k&"& +#!a d&aka& se%a!a& $e'a& e"!!a"$& I"s#l&" %a%&

ha")a %e'%eda 1 asam am&"o de"!a" &"s#l&" ma"#s&a( )a&$# ala"&" ada #+#"!

ka'%oks&l 'a"$a& 7 -7:0/ Seda"!ka" &"s#l&" sa& %e'%eda : asam am&"o da'&

&"s#l&" ma"#s&a( d&ma"a ala"&" me"!!a"$&ka" &sole#s&" ada os&s& A10

I"s#l&" e"do!e" mem&l&k& ak$# a'#h d& s&'k#las& selama :3 me"&$

Ka$a%ol&sme $e'#$ama oleh e"


14/34



306 &"s#l&" d&el&m&"as& ada first !ass metabolism d& ha$& -Ka'am da" Fo'sham(

19/

Ta%el I: Klas&*&kas& da" *a'makok&"e$&ka &"s#l&" -Nol$e da" Ka'am( 2001.

P'a"o$o( 200:/

Ma0am Ins'lin 7nset

(%am)

Efe p'n0a

(%am)

D'*asi

Efetif

(%am)

Lama

e*%a

(%am)

Ultra short Acting

Insulin

a Asa'$

% L&s'o Gl#l&s&"e

0(3

0(230(230(3

12

0(31(312

:4

:4:4

59

5959

Short Acting Insulin

a Re!#la'

% A$'a&d

Velos#l&"

d Sem&le"$e

0(31(0

1:

1:

1:

2:

412

412

412

:5

:5

:5

:5

1924

1924

1924

1924

Intermediate Acting

Insulin

a NPH

% Le"$e

Mo"o$a'd

24

:4

1(32(3

410

412

413

1015

1219

1219

H&"!!a 24

Long Acting Insulina Ul$'a Le"$e

% Gla'!&"e

510

4

1015

1920

24

24:5

14


15/34



BAB II

;5UDI KA;U;

2.1 Identitas Pasien

Nama > N) K

Us&a@77 > 58 $ah#" @ 43 k!

Alama$ > S#'a%)a

MRS > 2 #l& 2011

KRS > 22 Se$em%e'

S$a$#s > Askes

D&a!"osa > DM Q os$ ses&s

Alasa" MRS > as&e" da$a"! de"!a" e"#'#"a" kesada'a" se+ak 2 ha'&

se%el#m MRS da" %e's&*a$ 'o!'es&* Pas&e" me"!alam& &mmo%&l&$as

seme"+ak +a$#h : m&"!!# )a"! lal# seh&"!!a $&dak %&sa %a"!#" da"

me"!alam& e"#'#"a" "a*s# maka" se+ak 1 m&"!!# se%el#m MRS( as&e"

s#ka maka" )a"! ma"&sma"&s( oleh ka'e"a &$# *'ek#e"s& 7AK me"&"!ka$(

*'ek#e"s& m&"#m me"&"!ka$ Pas&e" me!el#hka" ")e'& saa$ %e'kem&h(

a'"a #'&" k#"&"! da" kada"! #'&"")a %e'a'"a ke'#h Pas&e" $&dak %&sa

7A7 se+ak 3 ha'& se%el#m MRS da" 7AK a!ak $e'se"da$

R&a)a$ e")ak&$ as&e" d&d&a!"osa d&a%e$es mell&$#s se+ak 9 $ah#" )a"!

lal#( "am#" seme"+ak : $ah#" )a"! lal# as&e" $&dak e'"ah la!& ko"$'ol

'#$&" ke dok$e' da" m&"#m o%a$ Pas&e" d&d&a!"osa HT %a'#%a'# &"&

R&a)a$ e"!o%a$a" as&e" adalah e"!!#"aa" Me$*o'm&" da" Gl&la


16/34



2.2 Data lini

16


17/34



2.3 Data Lao*ato*i'm

17


18/34



2.4 Data Pen'n%ang

Has&l eme'&ksaa" Fo$o 7OF -13@9/ me"#"+#ka" s#se$ )s$&$&s k'o"&s

)a"! me"!ak&%a$ka" h&d'o"e*'os&s !'ade 1 ada !&"+al k&'& da" d&la$as& '&"!a"

ada #'e$e' k&'& h&"!!a see'$&!a d&s$al( has&l USG a%dome" -2:@9/ me"#"+#ka"

18


19/34



$&dak ada kela&"a" ada !&"+al k&'& da" ka"a" se'$a $&dak $e'daa$ %a$# ada !&"+al

da" ka"d#"! kem&h seda"!ka" has&l USG ada -@/ me"#"+#ka" ada")a

e"e%ala" d&*#s da" &''e!#le' ada ka"d#"! kem&h )a"! ses#a& de"!a" !e+ala

)s$&$&s( $&dak ada kela&"a" ada !&"+al k&'& da" ka"a"( *o$o $ho'a= -21@/

me"#"+#ka" $&dak ada kela&a"a" ada o' da" #lmo

Ko"s#l #'olo!&> as&e" hema$#'& se+ak 2 ha'& )a"! lal#( saa$ &"& as&e" $&dak

$e'asa"! ka$e$e' Sa'a" d&lak#ka" *o$o Tho'a=( 7OF( U'olo!) USG( P #'&"e

#'e$e'( SST( Ga"$& ka$e$e' d! $'eea) a$h 24 F' km#d&a" d&s#l de"!a" NS

h&"!!a #'&" +e'"&h( d&%e'&ka" Kal"e= I"+ :=300m!( V&$ K &"+ 1=1am( $e'a&

la&"")a ses#a& se+aa$ e")ak&$ dalam

19


20/34



BAB III

P-76IL 5E-API

3.1 P*ofil 5e*api Pasien

20


21/34



21


22/34



3.2. PE-ALANAN PEN 140@0. RR> 20.

Nad& > 99

S#h#> :8

D&a%e$es Mell&$#s Q Ses&s Q

ko"s$&as& Q O%s ,om&$&"!

I"*#s P 14 $m( o"da"se$'o" &, 2 = 4 m!(

ome'a 90

S#h# > :5(4

D&a%e$es Mell&$#s Q Ses&s Qko"s$&as& Q O%s ,om&$&"!

I"*#s P 14 $m( o"da"se$'o" &, 2 = 4 m!(ome'a 1>1.e'"e,&$

d'& &" P( S&m,as$a$&" 0020m!( V&$ K &, : = 1

am#l

:1@9 7e"!kak %a!&a" kak&

se%elah k&'&

Ome'a T#$o*#s&"> 1>1.Al%#m&"

206. S&m,as$a$&" 0020m!( V&$ K &, : = 1 am#l

1@ DM h&e'!l&kem&a Q ses&s Q

le#kos&$os&s Q h&oal%#m&"

Ome'a T#$o*#s&"> 1>1.

S&m,as$a$&" 0020m!( V&$ K &, : = 1 am#l.

P'a!esol &, : = 1 !

Sela&" $a"!!al )a"! $e'daa$ d& a$as( $&dak $e'daa$ dok#me"$as& la&"")a

22


23/34

LAPORAN KASUS PKL RUMAH SAKITPROGRAM PENDIDIKAN MAGISTER FARMASI KLINIK

FAKULTAS FARMASI UNIVERSITAS AIRLANGGA 2011

BAB I

PEMBAHA;AN

Pe"#aa" %#ka" me'#aka" 'oses &"$'&"s&k( "am#" me'#aka" 'oses )a"!

$e'+ad& ak&%a$ &"$e'aks& da'& o'!a"&sme de"!a" l&"!k#"!a" Mesk&#" !e"e$&k

mema&"ka" e'a"a" e"$&"! ada 'oses e"#aa"( ko"$'&%#$o' #$ama 'oses &"&

$e'daa$ ada e"#m#ka" da'& ke'#saka" )a"! $e'+ad& ada %e'%a!a& $ema$ )a"!

$&dak daa$ d&e'%a&k& ak&%a$ k#'a"!")a e*&s&e"s& da'& s&s$em $#%#h Pe")e%a%

ke'#saka" $e'se%#$ a"$a'a la&" adalah s$'ess oks&da$&*( mod&*&kas& 'o$e&" oleh

!l&kas&( da" e"#aa" sel -olled!e( 2008/

Telah $e'%#k$& %aha 'oses me"#a aka" me")e%a%ka" e"#'#"a" *#"!s&

o'!a"( %a&k se%a!a& ak&%a$ 'oses de!e"e'as& )a"! sea'a &lm&ah aka" d&alam& oleh

se$&a o'a"!( ma##" ak&%a$ e")ak&$e")ak&$ )a"! d&de'&$a se%el#m")a De"!a"

dem&k&a"( ada kem#"!k&"a" %aha a%so's&( d&s$'&%#s&( me$a%ol&sme( ma##"

eksk'es& o%a$ %e'#%ah ada #s&a la"+#$ ada o%a$ )a"! mem%#$#hka" $'a"so'

ak$&* dalam a%so'%s&")a maka %&oa,a&la%&l&$as")a daa$ %e'k#'a"! Sed&aa" o%a$

)a"! me"!alam& first !ass metabolism aka" me"&"!ka$ a%so'%s&")a ada as&e"

la"s&a seh&"!!a ko"se"$'as& o%a$ dalam lasma aka" me"&"!ka$ Pe"#'#"a" da'&

keea$a" e"!oso"!a" lam%#"! ada as&e" !e'&a$'& mem%e'&ka" ak$# )a"!

le%&h da'& sed&aa" o%a$ #"$#k ko"$ak de"!a" e'm#kaa" lam%#"! -M&lle'( 2000/

Mesk&#" +#mlah $o$al 'o$e&" $&dak d&e"!a'#h& oleh e'$am%aha" #s&a(

+#mlah da'& al%#m&" dalam lasma se'&"! me"!alam& e"#'#"a" ada as&e"

la"s&a( $e'#$ama ada as&e" )a"! mo%&l&$as")a $e'%a$as Se&'&"! de"!a"

e'$am%aha" #s&a( kada' a&' dalam $#%#h aka" me"#'#" da" $o$al lemak $#%#h

aka" me&"!ka$ O%a$o%a$a" )a"! la'#$ lemak aka" me"!alam& o"se$ )a"!$e'$#"da seh&"!!a aka" $e'ak#m#las& ada +a'&"!a" lemak( meme'a"+a"! d#'as&

ke'+a")a seh&"!!a daa$ me"!ak&%a$ka" $&m%#l")a e*ek sam&"! me"&"!ka$

Se+ak #s&a 23 $ah#" $e'daa$ e"#'#"a" ko"$&"# da'& al&'a" da'ah ke hea'

da" de"!a" ada")a !a!al +a"$#"! ko"!es$&* maka al&'a" da'ah ke hea' aka" le%&h

$e'ed#ks& la!& Hal &"& aka" me"#'#"ka" kl&'e"s hea' da'& o%a$o%a$a" )a"!

d&el&m&"as& melal#& hea' Us&a +#!a daa$ me")e%a%ka" e'#%aha" ak$&,&$as

&"$e'&"s&k %e%e'aa e"


24/34



)a"! me"#'#" ada as&e" !e'&a$'& Oleh ka'e"a &$# "&la& se'#m k'ea$&"&" )a"!

"o'mal ada as&e" #s&a la"+#$ %el#m $e"$# me'#aka" 'ed&k$o' el&m&"as& o%a$

)a"! ,al&d N&la& GFR daa$ me"#'#" h&"!!a 306 se&'&"! de"!a" e'$am%aha"

#s&a seh&"!!a daa$ la"!s#"! meme"!a'#h& el&m&"as& da'& %e'%a!a& o%a$ a$a#

me$a%ol&$")a -Ma"!o"& e$ al( 200/

Pada as&e" la"+#$ #s&a $e'daa$ e'#%aha" me$a%ol&sme !l#kosa )a"!

mel&#$& !a"!!#a" sek'es& &"s#l&"( !a"!!#a" $ole'a"s& !l#kosa se'$a e'#%aha"

"&la& $aha"a" !&"+al $e'hada !l#kosa seh&"!!a 'e"$a" me"!alam& e")ak&$ see'$&

d&a%e$es Pada as&e" de"!a" &"*eks& aka" $e'+ad& e"&"!ka$a" ko'$&sol ak&%a$

ko"d&s& s$'ess $#%#h seh&"!!a aka" me")#l&$ka" e"!e"dal&a" !#la da'ah ada

as&e"( oleh ka'e"a &$#lah d&%e'&ka" &"s#l&" #"$#k me"!o"$'ol !#la da'ah as&e"

-M&lle'( 2000/

Pas&e" saa$ MRS d&d&a!"osa ses&s Pas&e" d&a%e$es mell&$#s de"!a" ses&s

-&"*eks&/ me'#aka" salah sa$# &"d&kas& #"$#k em%e'&a" &"s#l&" Saa$ !l#kosa

da'ah #asa $&"!!& maka daa$ d&%e'&ka" &"s#l&" kom%&"as& %asal %ol#s -&"s#l&

lo"! a$&"! Q &"s#l&" 'a&d a$&"!/

Ta"!!al 9 See$em%e' 2011 as&e" me"!alam& h&o!l&kem& ka'e"a &"$ake )a"!

k#'a"! seh&"!!a "o,o'a&d d&he"$&ka" ada $a"!!al Se$em%e' 2011 Se%el#m

em%e'&a" &"s#l&"( ha'#s d&as$&ka" $e'le%&h dah#l# aakah &"$ake as&e" #k#(

%&la &"$ake k#'a"! &"s#l&" +a"!a" d&s#"$&kka" $e'le%&h dah#l# ka'e"a aka"

me")e%a%ka" h&o!l&kem& Pe'l# d&lak#ka" ed#kas& ke as&e" e"$&"!")a &"$ake

)a"! #k# saa$ $e'a& &"s#l&"

Ses&s me'#aka" 'eso" s&s$em&k $e'hada &"*eks& d&ma"a a$o!e" a$a#

$oks&" d&leaska" ke dalam s&'k#las& da'ah seh&"!!a $e'+ad& ak$&,as& 'oses

&"*alamas& 7&la ada keadaa" &"*eks& %ak$e'&( komo"e" %ak$e'& a$a# $oks&" -e"doa$a# ekso$oks&"/ mas#k ke dalam s&'k#las& da'ah da" me"&m%#lka" 'eso"s &m#"

ada e+am# see'$& ak$&,as& mak'o*a!( med&a$o' &"*lamas& da" la&"la&"( maka hal

&"& daa$ d&se%#$ ses&s 7a&k %ak$e'& !'am -Q/ ma##" !'am -/ daa$

me"&m%#lka" ses&s -Aelmelk( 2000/

Me"#'#$ Pedoma" Pe"!elolaa" Pe"de'&$a Mas#k R#mah Sak&$ de"!a"

Demam d& 7a!&a" Ilm# Pe")ak&$ Dalam $ah#" 2004( ses&s daa$ d&$e!akka" %&la

ada k'&$e'&a SIRS )a"! $e'e"#h& da" ada s#m%e' &"*eks& e")e%a% K'&$e'&a &"&

24


25/34



$&dak $e'mas#k #"$#k as&e" "e#$'oe"&a ka'e"a em%e'&a" kemo$e'a& da"

e"de'&$a HIV -Q/ ystemic Inflammatory +es!onse yndrome -SIRS/ me'#aka"

ma"&*es$as& da'& 'eso" ke'ada"!a" s&s$em&k d&+#ma& %&la ada d#a a$a# le%&h da'&

keadaa" kl&"&s( a"$a'a la&" $eme'a$#'e $#%#h :90 a$a# :50( de")#$ +a"$#"!

0 =@me"&$( RR 20= @me"&$ a$a# PaO2 :2 mmH!( le#kos&$ 12000 sel@mm:

a$a# 4000 sel@mm: a$a# 106 %e"$#k &mma$#'e -%a"d/

Te'a& a"$&%&o$&k me'#aka" $e'a& )a"! e"$&"! dalam e"!o%a$a" ses&s

Pem&l&ha" a"$&%&o$&k e'l# meme'$&m%a"!ka" sek$'#m ak#a" a$o!e"

e")e%a%( 'o*&l *a'makok&"e$&k o%a$( dos&s( a'a em%e'&a" se'$a keama"a" %a!&

as&e" $e'ka&$ de"!a" #s&a ma##" *#"!s& *&s&olo!&s o'!a" Pada #m#m")a( ses&s

d&se%a%ka" oleh &"*eks& %ak$e'& !'am "e!a$&* Pe"!!#"aa" a"$&%&o$&k daa$

me"e!ah eleasa" e"do$oks&"( $e'#$ama ada keadaa" 'oses &"*lamas& )a"!

he%a$ ak&%a$ eleasa" e"do$oks&" -7oed&a'so"o( 2011/

Pem%e'&a" a"$&%&o$&ka #"$#k ses&s daa$ %e's&*a$ em&'&k oleh ka'e"a

s&*a$")a emergency de"!a" mo'$al&$as )a"! $&"!!& kem#d&a" d&la"+#$ka" de"!a"

e"!o%a$a" definitie %e'dasa'ka" k#l$#' da" sensitiity test. Pem%e'&a"

a"$&%&o$&ka sea'a em&'&k %&sa %e'dasa'ka" ko"d&s& e"de'&$a a$a# asal s#m%e'

&"*eks& Pe"!o%a$a" de*&"&$&* d&lak#ka" %e'dasa'ka" has&l k#l$#' da" $es

se"s&$&,&$as a"$&%&o$&ka -&"dal( 2000/

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Demam d& 7a!&a" Ilm# Pe")ak&$ Dalam $ah#" 2004( aa%&la $e'daa$ &"d&kas&

&"*eks& sal#'a" ke"&"! -#'oses&s/ de"!a" %ak$e'& a$ho!e" &scherichia coli,

&nterobacter s!!, *roteus s!!, 1lebsiella s!!, *seudomonas s!!,

&nterobacteriaceae, maka a"$&%&o$&k &l&ha" )a"! daa$ d&%e'&ka" #"$#k adalah

&'o*lo=a&" 2=300 m! -814 ha'&/ a$a# am&&ll&"s#l%a$am 2=:83830 m!@ha'&-814 ha'&/ A"$&%&o$&k &l&ha" ked#a )a"! daa$ d&%e'&ka" adalah e*o$a=&me &,

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26/34



#"$#k memas$&ka" ke$ea$a" em%e'&a" a"$&%&o$& Ta"!!al 5 A!#s$#s as&e"

me"e'&ma : a"$&%&o$&k )a&$# &'o*lo=a&"( me$'o"&da


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al( 2003/ Pada $a"!!al 21 A!#s$#s( $eka"a" da'ah as&e" 190@0 mmH!( "am#"

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de"!a" le"!ka

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da" AR7 me'#aka" a"$&h&e'$e"s& )a"! $&$&k $a"!ka")a me"!ham%a$ ak$&,as&

+al#' RAAS -Tashko( 2010/ Me"#'#$ Asso&a$&o" D&a%e$es Ame'&a( AEI aka"

me"!#'a"!& 'o$e&"#'&a se%esa' 306( AR7 se%esa' 496 seme"$a'a kom%&"as&AEI da" AR7 aka" me"!#'a"!& 'o$e&"#'&a se%esa' 806 Daa$ d&s&m#lka"

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de"!a" a'a me"!ham%a$ kome$&$&* e"


28/34



da" lae%o( d&ma"a se$elah 3 $ah#" e"!ama$a" d&daa$ka" e"#'#"a" a"!ka

'&s&ko e")ak&$ +a"$#"! ko'o"e' %&la d&%e'&ka" s&m,as$a$&" Pe"el&$&a" la&" )a&$#

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s$a$&" mas&h d&'ekome"das&ka" ada as&e" !e'&a$'& #"$#k me"!#'a"!& '&s&ko

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$e'daa$ e"&"!ka$a" koles$e'ol $o$al da" LDL D&sa'a"ka"( em%e'&a" s&m,as$a$&"

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29/34



No. 7at8 5e*api Monito*ing

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30/34



1 Pas&e" d&%e'&ka" Ome'a


31/34



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d&'aa$ d& '#mah sak&$ da" d&d&a!"os&s se%a!a& se$&kem&a

: Amo=&la, %&sa d&he"$&ka" ka'e"a k#'a"!")a $em#a" kl&"&s( la%o'a$o'm

da" m&k'o%&olo!&

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d&ma"a k#l$#' #'&"e de"!a" has&l se"s&$&* $e'hada Me'oe"em( "am#"

e*$'&a=o"e $&dak d&he"$&ka" sama& 11@/

3 Me'oe"em se%a!a& $e'a& de*&"&$&* ada as&e" $&dak $ea$ Te'a& a"$&%&o$&k

de*&"&$&d ha'#s d&ses#a&ka" de"!a" $a"da kl&"&s( la%o'a$o'm da"

eme'&ksaa" m&k'o%&olo!&

DA65A- PU;5AKA

A"o"&m( 2004( Statistik Rumah Sakit di Indonesia( Ed&s& 2004( aka'$a >

D&'ek$o'a$ e"de'al Pela)a"a" Med&k Dekes RI( hal 515:

:1


32/34



Aelmelk 7( L)""( A( The a#se o* ses&s> %a$e'&al ell omo"e"$ $ha$

$'&!!e' $he )$ok&"e asade( I"> Dha&"a#$ F( Th&+s L( Pa'k G( ;epti0

s9o0= Lo"do"> 7 Sa#"de's o. 2000( 21:

7alk RA( Se,e'e ses&s a"d se$& shok( de*&"&$&o"( e&dem&olo!) a"d l&"&al

ma"&*es$a$&o"( Crit Care Clin( 2000. 15-2/> 182

7oed&a'so"o( 2011( Ses&s &" a"e'( Hematolog 7n0olog Medi Update=

S#'a%a)a RSUD D' Soe$omo

7'o" G7( Ala" ( 2001( S&m,as$a$&" a"d N&a&"( a"$&o=&da"$ ,&$am&"s( o' $he

om%&"a$&o" *o' $he 'e,e"$&o" o* o'o"a') d&sease( N ng ! "ed

2001.:43.22>139:131

hama")( S( Ta%ae&( 7P 2010( ha$e' 9 E&dem&olo!) I"# $rinciples o% Diabetes

"ellitus eds Po'e$sk)( L( 2"d ed( Ne Co'k> S'&"!e'( 11520

olled!e( NR 2008( A!e&"! a"d D&sease I"> Davidson&s $rinciple and $ractice o%

"edicine eds' NA( )oom( NR( Colledge( )R( *alker ( 20$h ed( USA>

h#'h&ll L&,&"!s$o"e

Ga"o"!( F( 2003( &'#la$&o"( I" > &ll&am F Ga"o"!( Revie+ o% "edical

$hysiology( Ed 22"d( USA > The MG'a H&ll oma")( 101110

Gla#se'( MP( Pa$oh)s&olo!) %as&s o* ses&s> o"s&de'a$&o" *o' *#$#'e s$'a$e!&es

o* &"$e',e"$&o"( Crit Care "ed ( 2000.29-S#l/>S29

Hak( E( Th&+s( L( Role o* &"*lamma$o') med&a$o's &" ses&s( I"> Dha&"a#$ F(

Th&+s( L( Pa'k( G( Septic shock ( Lo"do"> 7 Sa#"de's o. 2000 P 41

128

&"dal( N( Holle"%e'!( SM( Dell&"!e'( RP( Pha'maolo!& &ss#es &" $he

ma"a!eme"$ o* se$& shok( Crit Care Clin( 2000.15-2/>2::4

oh"s$o"( 7( Ha'e'( MG( La"de*eld( S 2005( Ge'&a$'& Med&&"e( In# Current

"edical Diagnosis and ,reatment ( eds LM( T&e'"e)( S( MPhee( MA(

Paadak&s( 43$h ed( USA> M G'a H&ll

:2


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Laakso( M 2009( E&dem&olo!) o* T)e 2 D&a%e$es I"> ,ype - Diabetes#

$rinciple and $ractice eds Golds$e&"( 7( &ela"d( DM( 2"d ed( Ne

Co'k> I"*o'ma Heal$h a'e( 110

L)so"s( L( 7oh"s$o"( 7( o,&"sk)( KE( Res"&k( NM 2001( Ge'&a$'&

Med&&"e( In# Current "edical Diagnosis and ,reatment ( eds LM(

T&e'"e)( S( MPhee( MA( Paadak&s( 40$h ed( USA> M G'a H&ll

Ma"!o"&( A. a"se"( P( akso"( S 200( l&"&al Pha'maolo!) o* A!&"! I">

$rescribing %or lderly $atients eds S( akso". P( a"se". A( Ma"!o"&(

Lo"do"> oh" &le) Y So"s

Ma)es( PA( 7o$ham( KM( 200:( 7&oe"e'!e$& Y The Me$a%ol&sm o*

a'%oh)d'a$e Y L&&ds( In> Ro%e'$ K M#''a)( Da')l K G'a""e'( Pe$e'

AMa)es( .arper&s Ilustrated )iochemistry= Ed 25$h ( USA > MG'a

H&lls oma"&es( 90 X 93

M&lle'( S 2000( Ge'&a$'& D'#! The'a)( I"> ,e/tbooks o% ,herapeutics Drug

and Disease "anagement ( eds ET( He'*&"dal( DR( Go#'le)( 8$h ed(

Lo"do"> L&&"o$$ &ll&ams a"d &lk&"s

Mosa L e$ al( 1( G#&de $o 'e,e"$&,e a'd&olo!) *o' ome"(

A.A0ACC0Scienti%ic statement# Consensus $anel Statement 1.2491

2493

M#ldoo" MF( Ma"#k S7( Ma$he KA( 10( Loe'&"! holes$e'ol

o"e"$'a$&o" a"d mo'$al&$)> A Z#a"$&$a$&,e 'e,&e o* '&ma') 'e,e"$&o"

$'&als( )"! 10.:01>:0:14

Neal M&hael ( 2003( "edical $harmacology at a 1lance( Ed 4$h( USA >

7lakell P#%l&sh&"! oma")( 424:

Ol)ae&( A( 7e""e$( M 200 D'#! Dos&"! a"d Re"al To=&&$) &" Elde'l) Pa$&e"$(

American Society o% Nephrology( 18

$edoman $engelolaan $enderita "asuk Rumah Sakit dengan Demam di

)agian Ilmu $enyakit Dalam( Ed&s& 2004( 7a!&a" Ilm# Pe")ak&$ Dalam

RSUD D' Soe$omo @ FK UNAIR( S#'a%a)a

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34/34



R&,e's( E( N!#)e"( 7( Ha,s$ad( S( e$ al( Ea'l) !oald&'e$ed $he'a) &" $he

$'ea$me"$ o* se,e'e ses&s a"d se$& shok( N ng ! "ed = 2001(:43>1:59

88

S$a'"e'( I( G'a)( SL( G#a)( DRP( Ha++a'( ER( Ha"dle'( SM( Ha"lo"( T 2009(

Ge'&a$'&s( I"> $harmacotherapy A $athophysiological Approach( eds

S$okle)( I,a" H( 200:( Stockley&s Drug Interaction= Lo"do" > Ro)al

Pha'mae#$&al o* G'ea$ 7'&$a&"

Tal%e'$ LR( 2009( H)e'l&&dem&a , In > oseh T D&&'o( Ro%e'$ L Tal%e'$ e$ al(

$harmacotherapy # A pathophysiologic approaches( 8$h ed&$&o"( USA >

The MG'a H&ll om I"( :93:8

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