Endocrine 14.ppt
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Transcript of Endocrine 14.ppt
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Endocrine
IGD RSSA
Tim IGD RSSA 14
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Glucose
Dibutuhkan untuk metabolisme sel
Otak membutuhkannya, sama pentingnya dengan kebutuhan akan oksigen.
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Insulin
Hormone
Diproduksi oleh Pulau - pulau Langerhans di pancreas
Dibutuhkan glucose untuk masuk kedalam kebanyakan sel
Sel Otak tidak butuh Insulin dalam mempergunakan glucose.
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Pancreas
Terletak pada ruang retroperitoneal
Memproduksi, melepaskan Enzym-enzym
pencernaan kedalam duodenum
Insulin, glucagon kedalam darah
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Pulau – pulau Langerhans
Alpha cells Glucagon Meningkatkan kadar
gula
Beta cells Insulin Menurunkan kadar gula
Delta cells
• Somatostatin.• Menghambat glucagon
dan Insulin
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Diabetes Mellitus
Penyakit metabolik
Ditandai dengan penurunan sampai absent produksi Insulin
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Type I Diabetes
Tidak ada produksi Insulin
Perlu Insulin dari luar.
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Type II Diabetes
Produksi insulin yang tidak adekuat Peningkatan resistensi jaringan terhadap
Insulin Dikendalikan dengan
Diet Oral Anti Diabetes:
Diabeta, Diabinese, Dymelor, Glucotrol, Micronase, Orinase, Tolinase, Glucophage
Injeksi Insulin diperlukan saat penyakit bertambah parah.
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Masalah pada Diabetes
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Kadar Gula darah yang tidak seimbang
Hyperglycemia
Diabetic ketoacidosis (DKA)
Hyperosmolar coma
Hypoglycemia
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Hyperglycemia
Penyebab
Gagal “mengambil” insulin
Makan berlebihan, salah makan
Stress (demam, infeksi, stres emosi)
New-onset diabetics biasanya tampil dengan episode hyperglycemia
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Diabetic Ketoacidosis
Umumnya Type I diabetic (no insulin) Peningkatan kadar gula darah Ginjal berusaha mengeluarkan kelebihan
glucosa Terjadi peningkatan produksi urine (polyuria) Pasien “menjadi’ dehidrasi
Haus (polydypsia) Tachycardia Hypotension Kulit dan mucus membran menjadi kering .
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Diabetic Ketoacidosis
Sel tak dapat membakar glucosa lapar (polyphagia) Sel membakar lemak sebagai energi alternative Acidic ketone bodies terbentuk. Pasien berusaha mengkoreksi acidosis; dengan
mengeluarkan CO2
Pernafasan cepat dan dalam (Kussmaul respirations) Pengeluaran ketone bodies lewat udara pernafasan
tercium sebagai pembersih kuku.
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Diabetic Ketoacidosis
Dehidrasi
Ketone body mengakibatkan acidosis (ketoacidosis)
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Hyperosmolar Hyperglycemia State / HHS Umumnya Type II diabetic (inadequate
insulin) Peningkatan kadar Gula Ginjal berusaha mengeluarkannya . Produksi urine meningkat (polyuria) Pasien menjadi dehidrasi
Thirst (polydypsia) Tachycardia Hypotension Dry skin, mucous membranes
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HHS
Sel terus “membakar” glucosa Acidic ketone bodies tidak terbentuk Tidak tercium bau aceton ( pembersih cat
kuku).
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HHS
Dehidrasi berat Tidak terdapat produksi keton
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Hyperglycemia
Tatalaksana
Support ABC’s
Atasi hypovolemic shock
Transport
Bila ragu beri Gula !
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Hypoglycemia
Penyebab :
Insulin overdose
Pemakaian insulin Normal ,tapi tidak disertai asupan karbohidrat yang memadai.
Exercise / kegiatan fisik yang berlebihan.
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Hypoglycemia
A ltera tions in consc iousness ;S e izures; H ea d a che;
U nusua l B eha v ior
B ra in la ck s a d eq ua te g lucose
P a le ; C ool sk in;S w ea ting ; T achyca rd ia ;Increa sed B P ; N a usea
A d rena l G la nd s re lea se E p inep hr ine
B lood S ug ar F a lls
Pale, cool skin; sweating; nausea; tachycardia
Is that why hypoglycemia sometimes is called “Insulin Shock?”
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Hypoglycemia
Insulin shock isn’t really shock
Patient just looks “shocky” because of epinephrine adrenals are releasing
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Hypoglycemia
Dapat terjadi pada penderita diluar DM
Penyebab tersering = alkoholisme
A patient is never, just drunk
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Hypoglycemia Management
Penderita sadar
Beri gula per-oral
Penderita tak sadar
Support ABC’s
Get ALS back-up for IV glucose
Bila ragu, beri Glucose !
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Pertanyaan pada semua penderita DM
Hari ini Anda sudah makan?
Sudah juga minum obat?
Bila ragu , beri Gula!
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Komplikasi lain Diabetes
Atherosclerosis
Myocardial infarction
CVA
Peripheral vascular disease
Buta
Gagal Ginjal
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Komplikasi lain Diabetes
Diabetic Neuropathy
Gangrene
Increased “silent” myocardial infarction risk
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Silent Myocardial Infarction
Acute MI pada penderita diabetes bisa disertai tanpa nyeri
Mungkin mirip “flu”
Jadi perlakukan penderita DM yang sakit kritis sebagai MI, sampai terbukti tidak.
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Abnormal fungsi Thyroid
Hypothyroidism
Terlalu sedikit hormon thyroid
Hyperthyroidism(Thyrotoxicosis / Thyroid Storm)
Terlalu banyak hormon thyroid
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Hypothyroidism
Defisiensi hormon Thyroid ↓kecepatan metabolisme basal. Person is “slowed down”
Penyebab Hypothyroidism: Ablasi dengan Radioactive iodine . Terapi dengan levothyroxine Hashimoto’s thyroiditis - autoimmune
destruction
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Hypothyroidism
Bingung , ngantuk, coma Tidak tahan dingin. Hypotension, Bradycardia Lemah Penurunan respirasi. Gemuk , Constipation Non-pitting peripheral edema Depresi Sembab wajah, rambut
rontok. Kukit kering dan kasar . Gambar Myxedema
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Hypothyroidism
Myxedema Comahypothyroidism berat fatal
Tatalaksana Myxedema ComaKontrol airwaySupport oxygenation, ventilation IV fluidsSelanjutnya
Levothyroxine (Synthroid®)Hydrocortisone
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Hyperthyroidism
↑hormon thyroid hypermetabolic state Person is “sped up”.
Penyebab Hyperthyroidism Pengobatan berlebihan levothyroxine
(Synthroid®) Goiter (enlarged, hyperactive thyroid gland) Graves Disease
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Hyperthyroidism
Gelisah, irritable, tremors, paranoid
Kukit merah ,hangat . Tak tahan panas. Tachycardia - High output CHF Hypertension Tachypnea Diarrhea Weight loss Exophthalmos Goiter
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Hyperthyroidism
Tatalaksana Airway/Ventilation/Oxygen ECG monitor IV access - Cautious IV fluids PTU (propylthiouracil) , lalu Solutio Lugoli
(potassium iodide) Acetaminophen untuk panasBeta-blockers Benzodiazepines untuk gelisah.
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Thyroid Storm/Thyrotoxicosis
Hyperthyroidism berat fatal Acute life-threatening hyperthyroidism
Penyebab ↑ stress pada pasien hyperthyroid.
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Thyroid Storm/Thyrotoxicosis
Severe tachycardia Gagal jantung. Dysrhythmias Shock Hyperthermia Nyeri Abdomen Gelisah, Agitasi, Delirium, Coma
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Thyroid Storm/Thyrotoxicosis
Tatalaksana Airway/Ventilation/Oxygen ECG monitor IV access - cautious IV fluids Propylthiouracil (PTU) , lalu larutan Lugol Control hyperthermia
Active coolingAcetaminophen
Inderal (beta blockers) Benzodiazepines untuk gelisah.
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