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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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