Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Background: diabetic ketoacidosis (DKA) is a potentially lethal complication of diabetes mellitus (DM). There is no study in Indonesia that compares the much-preferred capillary beta hydroxybutirate (β-OHB) measurement to urine acetoacetate in monitoring therapeutic response of DKA in adolescents. Methods: a prospective study of 37 adolescents and children with DKA in Cipto Mangunkusumo Hospital was done between June 2006 and March 2011. The patients were followed until the time of DKA resolution. Hourly measurement of random blood glucose, capillary β-OHB concentration, and urine ketones were done, while blood gas analysis and electrolyte were measured every four hours. Results: median time to resolution was 21 (9-52) hours. Compared to urine ketones, capillary β-OHB concentration showed stronger correlation with pH (r= -0,52, p= 0,003 vs r= -0,49, p= 0,005) and bicarbonate level (r=-0,60, p=0.000 vs r= -0.48, p=0.007) during the median time of DKA resolution. All capillary β-OHB measurement yielded negative results at median time of DKA resolution, while urine ketones were still detected up to 9 hours after resolution. Conclusion: blood ketone concentration showed better correlation with pH and bicarbonate level, as a tool to monitor therapeutic response in DKA in adolescent, compared to traditional urine ketones test in adolescents.

Abstrak :
Latar Belakang. Mortalitas KAD sebagai komplikasi akut DM di negara berkembang seperti Indonesia masih tinggi. Karena itu, diperlukan model prediksi untuk menapis pasien-pasien KAD yang memiliki risiko mortalitas tinggi. Tujuan. Mendapatkan model prediksi mortalitas 72 jam pasien KAD di IGD RSUPN Cipto Mangunkusumo. Metode. Penelitian dengan desain kohort retrospektif menggunakan rekam medik pasien KAD di IGD RSUPN Cipto Mangunkusumo periode Januari 2011 - Juni 2017 dengan metode sampling konsekutif. Hubungan mortalitas 72 jam dengan prediktor yaitu, usia, tingkat kesadaran, jenis DM, riwayat KAD, jumlah komorbid dan parameter laboratorium kadar bikarbonat, kalium, anion gap, ?-hidroksibutirat, laktat dan fungsi ginjal akan dinilai dan dilanjutkan dengan pembuatan model prediksi. Seluruh analisis dilakukan menggunakan program SPSS Statistics 20.0. Hasil. Sebanyak 86 subjek 28,57 dari 301 subjek yang dianalisis meninggal dalam waktu 72 jam. Prediktor yang berhubungan bermakna dengan mortalitas pada analisis multivariat p 4 mmol/L HR 5,585; IK 95 2,966 - 10,519 . Keempat prediktor dilanjutkan ke dalam sistem skor dan didapatkan model prediksi mortalitas 72 jam pasien KAD RSCM yang memiliki performa baik dengan probabilitas mortalitas sebesar 15,41 untuk skor 0 - 2, 78,01 untuk total skor 3 - 4 dan 98,22 untuk total skor 5 - 6. Simpulan. Mortalitas 72 jam pasien KAD di RSUPN Cipto Mangunkusumo adalah 28,57 . Model prediksi mortalitas memiliki performa yang baik dan terdiri dari komorbid, riwayat KAD, tingkat kesadaran, dan kadar laktat.Kata Kunci. Model Prediksi, Mortalitas, Ketoasidosis Diabetikum. ......Mortality rate of DKA as acute complication of DM in Indonesia is still high. Therefore, a mortality prediction model is needed to screen high risk mortality DKA patients. Aim. To identify prediction model of 72 hours mortality in diabetic ketoacidosis patients at emergency unit Cipto Mangunkusumo General Hospital. Methods. This was a retrospective cohort study with consecutive sampling method. Subjects were adult DKA patients in emergency unit Cipto Mangunkusumo General Hospital from January 2011 to June 2017. Data were obtained from medical records. Association of predictors age, type of DM, history of DKA, comorbidities, level of consciousness, bicarbonate, potassium, anion gap, lactate, hydroxybutirate and renal function and 72 hours mortality was analyzed and submitted to prediction model. All analysis was done using SPSS Statistics 20.0. Results. A total of 86 subjects out of 301 subjects did not survive in 72 hours since hospital admission. Comorbidities HR 2,407 95 IC 1,181 - 4.907 , level of consciousness HR 10,345 95 IC 4,860 - 22,019 , history of DKA HR 2,126 95 IC 1,308 - 3,457 and lactate level HR 5,585 95 IC 2,966 - 10,519 were significant predictors and submitted to scoring system. A prediction model was derived with a good performance. Subjects with 0 - 2 points were at 15,41 risk of mortality, 3 - 4 points were 78,01 and 5 - 6 points were 98,22 risk of mortality. Conclusion. Seventy two hours mortality rate in Cipto Mangunkusumo General Hospital was 28,57. The mortality prediction model had a good performance, consisted of comorbidities, history of DKA, level of consciousness dan lactate level.