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All Journal journal of internal medicine Indonesian Journal of Global Health research Bali Medical and Wellness Journal Indonesian Journal of Endocrinology Metabolism and Diabetes (InaJEMD)
Dewi Catur Wulandari
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HUBUNGAN ANTARA PRODUK KALSIUM X FOSFAT SERUM DENGAN PENYAKIT ARTERI PERIFER PADA PASIEN HEMODIALISIS REGULER DI RSUP SANGLAH DENPASAR Wulandari, Dewi Catur; Raka Widiana, I G; SL, Jodi; Sudhana, I W; Suwitra, Ketut
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (199.171 KB)

Abstract

Peripheral Arterial Occlusive Disease (PAOD) is common among patients undergoing hemodialysis (HD). In the generalpopulation, DM, male, cigarette smoking, advanced age, hypertension and dyslipidemia are the most important risk factorsfor PAOD. Recently, some studies in patients with regular HD found evidences that PAOD associated with increase of calciumand phosphate serum level and increase of Ca.P product due to secondary hyperparatiroidism. A cross-sectional study was doneon 46 regular HD patients to evaluate prevalence of PAOD among patients who are undergoing regular HD and their associationbetween Ca.P product. Morning fasting plasma were taken for lipid profile, blood sugar, blood urea nitrogen, serum creatinin,albumin level, Ca, inorganic P. Ankle-brachial index (ABI) of blood pressure as measured after dialysis session using Va-SeraVS-100. Fourty six (26 males, 20 females) regular HD patients, age 50.95 ± 9.90 years, duration of HD 27.7 ± 22 months wereincluded in this study. Using ABI < 0.9 as cut off value for the presence of PAOD, 15.2% had PAOD. Means of Ca serum levelwas 9.04 ± 0.76 mg/dl, phosphate serum level was 56.48 ± 23.90 mg/dl. Using 55 or more as cut off value for abnormal concentrationof Ca.P product, 47.7% patients had abnormal Ca.P product. Three of 21 patients with Ca.P 55 had PAOD and 4 of 23patients with Ca.P < 55 had PAOD ( OR 0.79 with 95% CI : 0.15 ? 4.04 for patients with Ca.P < 55 ). Using logistic regression tocontrol Ca and P levels, Ca.P 55 tend to associate with increased risk of PAOD (OR 6.22 ; 95% CI : 0.23 ? 167.71)More than fifteen percent of patients with regular HD had PAOD. More than fourty seven percent of patients had abnormal Ca.P.Patients with Ca.P 55 tend to associated with increased risk of PAOD (OR 6.22 ; 95% CI : 0.23 ? 167.71)
Urinary Tract Infections and Inadequate Insulin Therapy as a Precipitating for Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A Case Report Astari, Anak Agung Ayu Mita; Wulandari, Dewi Catur
Bali Medical and Wellness Journal Vol. 1 No. 1 (2024): Bali Medical and Wellness Journal
Publisher : PT BMW Journal Sejahtera

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71341/bmwj.v1i1.5

Abstract

Background: Diabetic ketoacidosis (DKA) is a severe acute metabolic complication associated with diabetes mellitus. It is particularly prevalent in patients with Type 1 diabetes, where inadequate insulin therapy can lead to significant morbidity and mortality. Case: We present the case of an 18-year-old girl diagnosed with Type 1 diabetes mellitus. She arrived at the hospital exhibiting shortness of breath and was found to have a C-peptide level of 0.33, which, alongside her history of irregular insulin injections, indicated poor adherence to insulin therapy. Upon physical examination, the patient appeared lethargic, had apathetic consciousness, a tachycardic heart rate of 127 beats per minute, and an elevated axillary temperature of 37.8°C. Notably, Kussmaul breathing was also observed. Results: Laboratory findings revealed elevated white blood cell count (15,950/μL), hyperglycemia (blood sugar level of 379 mg/dL), and severe metabolic acidosis, as indicated by arterial blood gas analysis (pH 6.89, HCO3 1 mmol/L). Urinalysis demonstrated the presence of albumin (+1), glucose (+2), ketones (+3), leukocytes (+3), and bacteria. The patient required intensive care monitoring for five days before being transitioned to the general ward for an additional three days of treatment. Conclusion: DKA is characterized by hyperglycemia, hyperketonemia, and metabolic acidosis, all of which are indicative of insufficient insulin therapy in patients with Type 1 diabetes. This case highlights the critical importance of adherence to insulin therapy for achieving optimal glycemic control. Effective management and discipline in treatment are essential to prevent DKA and reduce its associated mortality.
Thyroid Storm in A Patient with Graves’ Disease and Tubo-Ovarian Abscess: A Clinical Case Report Dewi, Ni Nyoman Gita Kharisma; Wulandari, Dewi Catur
Indonesian Journal of Global Health Research Vol 7 No 5 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i5.6623

Abstract

Thyroid storm is a rare, life-threatening complication of thyrotoxicosis, involving multi-organ dysfunction. This study aims to identify risk factors for thyroid storm and evaluate effective management strategies to reduce mortality. This study is a descriptive case report. Data were collected through patient interviews, physical examinations, and supporting tests at Wangaya Hospital. The data were analyzed qualitatively and presented in a narrative format based on case report guidelines. This paper reports the case of a 24-year-old female with a history of hyperthyroidism on methimazole and an intrauterine device (IUD) presented with abdominal pain that started in the epigastric region and migrated to the lower quadrants. She developed ocular prominence, vomiting, palpitations, generalized weakness, and non-bloody diarrhea. She also experienced persistent lower abdominal pain (pain score: 6/10), dysuria, and fever. A Burch-Wartofsky Point Scale (BWPS) score > 45 confirmed thyroid storm. She was admitted to the ICU and treated with propylthiouracil (PTU), hydrocortisone, digoxin, propranolol, and antibiotics for suspected infection. Her condition improved, and she was discharged after seven days. Thyroid storm is commonly triggered by Graves' disease. The diagnosis is clinical, based on BWPS or the Japanese Thyroid Association criteria, especially in patients with a history of hyperthyroidism and a precipitating factor. PTU is preferred due to its rapid onset and ability to inhibit the conversion of T4-to-T3. Successful management of thyroid storm requires prompt, comprehensive therapy to suppress thyroid hormone levels and treat triggering factors such as infection.
Diabetic Ketoacidosis in Pregnancy Caused by Multiple Risk Factors: A Case Report Pratiwi, Made Sindy Astri; Wulandari, Dewi Catur
Indonesian Journal of Global Health Research Vol 7 No 4 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i4.6283

Abstract

Pregnant patients with diabetes are susceptible to diabetic ketoacidosis (DKA) but this condition is still underreported. Unknown risk factors during pregnancy will increase morbidity and mortality of DKA. The interaction between multiple risk factors will certainly increase the burden of health care. This report aims to discuss the management of DKA in pregnancy with multiple risk factors, from diagnosis to prevention of complications. This study is descriptive study with case report design. Data were obtained from anamnesis, physical, and supporting examinations at Wangaya Hospital. Data were analyzed qualitatively and presented narratively according to case report format. This paper reports DKA in 39-year-old female with 24 weeks gestational age with shortness of breath. This was her fourth pregnancy. The patient had no history of diabetes and had never undergone pregnancy control. The patient had increased blood pressure and Kussmaul's breathing. Supporting examinations showed leukocytosis, hyperglycemia, bacteriuria, ketonuria, proteinuria, metabolic acidosis, low potassium, while chest x-ray showed pneumonia. The patient was diagnosed DKA with severe preeclampsia, pneumonia, urinary tract infection, and hypokalemia. Unfortunately, the patient experienced IUFD. After aggressive fluid replacement, intravenous insulin, electrolyte correction, treat the causes, and maternal monitoring, the patient showed significant improvement. Various adaptations during pregnancy can lead to DKA. Missed glucose homeostasis screening, oxidative stress, aging of β cells, inflammatory environment with various cytokines, to vascular dysfunction can be pathways for DKA in pregnancy. DKA in pregnancy is a challenge that requires proper risk factor screening. Optimal management and close monitoring are needed to achieve good prognosis.
Hyperemesis Gravidarum with Gestational Transient Thyrotoxicosis Inducing Thyrotoxic Periodic Paralysis in Diabetes Mellitus and Hypertension: A Case Report Yovita Gotama; Dewi Catur Wulandari
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
Publisher : PP PERKENI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v2i1.38

Abstract

Hyperemesis gravidarum (HG) is often associated with gestational transient thyrotoxicosis (GTT) due to elevated human chorionic gonadotropin (hCG) levels, affecting approximately 60% of HG patients. GTT is generally self-limiting, resolving by the first or early second trimester without requiring pharmacological treatment. We present the case of a 38-year-old pregnant woman, in her third pregnancy, who experienced severe nausea and vomiting at 6 weeks of gestation, with a Pregnancy-Unique Quantification of Emesis/Nausea (PUQE) score of 12. Laboratory findings indicated low thyroid-stimulating hormone (TSH) and high free thyroxine (FT4), consistent with GTT, while thyroid ultrasound showed no abnormalities. The patient had a history of chronic hypertension since her first pregnancy and diabetes mellitus diagnosed a year earlier. Three weeks later, she was readmitted and diagnosed with thyrotoxic periodic paralysis (TPP) secondary to GTT. Treatment included intravenous fluids, potassium supplementation, antiemetics, vitamins, antithyroid drugs, and continued management of her diabetes and hypertension. HG, which is most common in the first trimester, is often linked to thyroid dysfunction due to hCG stimulation. While GTT is typically self-limiting, complications like TPP can arise, adding complexity to patient management, especially with coexisting conditions like diabetes and hypertension. Treatment strategies focused on symptom control, fluid rehydration, and careful adjustments of medications for thyroid, glycemic, and blood pressure management. Unfortunately, the patient did not return for follow-up, limiting further evaluation of her thyroid function in the second trimester. This case highlights the need for accurate diagnosis and timely intervention to prevent severe maternal and fetal outcomes, particularly in complex cases with multiple comorbidities.
Efficacy of Levothyroxine (LT4) and Liothyronine (T3) Combination Therapy vs. LT4 Monotherapy for Hypothyroidism: A Meta-Analysis Pratama, Gede Made Cahya Trisna; Wulandari, Dewi Catur
Bali Medical and Wellness Journal Vol. 3 No. 1 (2026): Bali Medical and Wellness Journal
Publisher : PT BMW Journal Sejahtera

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71341/bmwj.v3i1.56

Abstract

Background: Levothyroxine (LT4) monotherapy is the standard treatment for hypothyroidism, using serum thyroid-stimulating hormone (TSH) as the primary indicator of therapeutic adequacy. However, many patients remain symptomatic despite achieving normal TSH levels. Objectives: This meta-analysis evaluates the biochemical and metabolic efficacy of adding liothyronine (T3) to LT4 compared to standard monotherapy. Method: A systematic search was conducted to identify randomized controlled trials (RCTs) comparing LT4+T3 combination therapy with LT4 monotherapy in adults. TSH was the primary outcome, while secondary outcomes included free T4 (fT4), total T3, lipid profiles, and body weight. Results: Seven RCTs involving 355 participants were analyzed. Biochemical outcomes showed no significant difference in TSH suppression (P=0.40) or total T3 levels (P=0.38) between groups. Notably, LT4 monotherapy resulted in significantly higher fT4 levels (MD=0.27; 95%CI: 0.13, 0.40; P=0.0001). Regarding metabolic outcomes, combination therapy significantly improved LDL cholesterol (MD=4.79; 95%CI: 1.63, 7.96; P=0.003) with zero heterogeneity (I2=0%). A borderline significant trend toward weight reduction was also observed in the combination group (MD=-2.26; 95%CI: -4.52, 0.01; P=0.05). Conclusion: Compared to monotherapy, LT4+T3 combination therapy provides significant metabolic advantages, particularly in LDL reduction, while maintaining biochemical euthyroidism.
Co-Authors Astari, Anak Agung Ayu Mita Dewi, Ni Nyoman Gita Kharisma I Gde Raka Widiana I Wayan Sudhana Jodi SL Ketut Suwitra Pratama, Gede Made Cahya Trisna Pratiwi, Made Sindy Astri Yovita Gotama