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Danny Luhulima dr., Sp.PK

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Diabetic hyperglycemic

hyperosmolar syndrome is acondition of:

- Extremely high blood sugar

glucose! le"els- Extreme lac# of $aterdehydration!

- Decreased consciousness

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DEFINITION

HYPEROSMOLAR NONKETOTIC COMA (HONK)

Se"ere hyperglycemia%&''mg(dL !

)yperosmolarity %*+' msm(L!

Dehydration in the absence ofsignicant #etoacidosis thepresence of #etonuria or mild#etonemia and an arterial p)/.*or serum bicarbonate01 mE2(Ldo not preclude the diagnosis!

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PATHOGENESIS3lood glucose exceeds the renal threshold for glucose

hypovolemia

osmotic diuresis

glucosuria and urinary loss of water,Na,K,Mg,Ca,P

dehydration/hyperosmolality

shock coma/renal failure

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PRECIPITATING FACTORS

ACUTE ILLNESS

4nfections pneumonia, 564, sepsis! 7yocardial infarction 89 ;4 gastroenteritis,pancreatitis! renal failure burns

endocrinehypercortisol ( thyrotoxicosis! surgery

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PRECIPITATING FACTORS

D-adrenergic bloc#ers cyclosporine cimetidine

nalidixic acid6)E< S6

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LABORATORY VALUES

Plasma glucose %&'' mg(dL

?38 increased

789 articially ele"ated

L@6 abnormal

Potassium initially may be high, mayfall dramatically $ith insulin and Auidreplacement

smolarity %*+' msm(L

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LABORATORY VALUES

Leucocyturia

8holesterol(6riglyceride B

3lood gas analysisp),bicarbonate,p+, p8+!

3lood(urine culture

8oagulation studies D48C!

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smolalitas : umlah parti#el =atterlarut per #ilogram air .

osmolaritas : umlah parti#el =atterlarut per liter larutan.

Pada larutan cair spt cairan tubuh,#edua istilah ini dapat di guna#an#arena perbedaannya #ecil.

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sm + F Ga! H 35G(+.I! Hglucose(0I!sm +Ga H K! H glucose(0I!

Gilai normal untu# manusia +/1-+JJ milli-osmoles (#g

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Terimakasi

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Danny Luhulima dr, !pPK

"#

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PENDAHULUAN

Resistensi insulin :

!uatu keadaan terganggunya respon $iologis terhadapinsulin shg ter%adi penurunan sensitivitas insulin

Sensitivitas insulin :

&fektivitas insulin untuk menurunkan glukosa darah

dengan cara '

( memacu uptake glukosa pada otot dan sel lemak,

( meningkatkan simpanan glikogen hepar, serta

( mengurangi produksi glukosa hepatik

")

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"*

Penurunan bermakna dari sensitivitas insulin

resistensi insulin

respon sel terhadap pengaruh insulin kurang

dibutuhkan kadar insulin lebih besar agar tercapaieuglycemic

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Sindroma metabolik

"+

National Cholesterol Education Program (NCEP),

Minimal kriteria sbb:

1. DP ! 11" mg#dL$%. &besitas abdomen 'lingkar perut( ) 1"% cm$* ++ cm,-. serum ! 1/" mg#dL$0.HDL serum ) 0" mg#dL dan * /" mg#dL$

/. D ! 1-"#+/ mmHg

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Studi #linis menggambar#an bah$a

Sindroma metaboli# dapatmening#at#an resi#o resistensi insulin.

"

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Faktor risiko resistensi insulin :

"-

.ri2a3at keluarga D4 tipe %$

.hipertensi$

.pen3akit 5antung koroner$.polycystic ovary syndrome 'P6&7,$

.aktivitas 8isik 3ang kurang$

.usia lan5ut$

.etnis tertentu 3g berisiko tinggi D4 tipe %.pen3akit 5antung koroner

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Beberapa metode ujiresistensi insulin

"

.kadar insulin plasma puasa

.homeostasis model assessment012M34

.tes toleransi insulin,

.tes supresi insulin,

.metode glukosa plasma steady state,.euglycemic hyperinsulinemic clamp,

.tehnik model minimal 5 frequently sampled intravenous

glucose tolerance test (FSIVGTT/FISGT,.perhitungan indeks sensitivitas menggunakan insulin 5

glukosa setelah pem$erian $e$an glukosa oral

Euglycemic-hyperinsulinemic clamp $aku emas '

resistensi insulin 5 akurat, tetapi tidak praktis,sangat mahal

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"6

.Kera insulin dimulai dgn teri#atnyainsulin pdreseptor di permu#aan membran sel

target.

.9er5a utama insulin pengambilan 'uptake)glukosa 3ang cepat pada otot dan sel lemak

.9er5a tambahan insulin( menurunkan glukosa

dalam hepar

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RINGKASAN

#7

Resistensi insulin : terganggunya

respon biologis terhadap insulin

penurunan sensitivitas insulin.

Sensitivitas insulin :

kemampuan utk menurunkan glukosa darahdgn cara memacu uptake glukosa pd otot & sel

lemak, meningkatkan simpanan glikogen hepar

serta mengurangi produksi glukosa hepatik.

Beberapa metode utk resistensi insulin :.Euglycemic-hyperinsulinemic clamp baku

emas.HOM metode yg relati! sederhana

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7/#+/" #"

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