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All Journal Jurnal Anestesiologi Indonesia Jurnal Komplikasi Anestesi
Andriani, Ika Jati Setya
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Health Professions Medicine & Pharmacology Public Health

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The Blood Glucose Regulation in Intensive Care Unit (ICU) Andriani, Ika Jati Setya; Jufan, Ahmad Yun
Jurnal Komplikasi Anestesi Vol 10 No 3 (2022)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v10i3.12390

Abstract

Glucose control among ICU patients has been a topic of debate over the past 20 years. Harmful effects posted by uncontrolled hyperglycemia and hypoglycemia among critically-ill patients have been acknowledged widely. Previous researches had proven that a tight glucose control is not only of no benefit, but instead harmful due to the increased risk of developing a significant hypoglycemia. Current guidelines suggest a moderate approach of intravenous insulin therapy initiation towards critically-ill patients with blood glucose level above 180 mg/dL. The most integral factor that underlies the glycemic management of patients in the ICU is the prevention of hypoglycemia. A robust glucose monitoring and insulin protocol strategies need to be implemented in achieving this goal. Keywords: glucose control, hyperglycemia and hypoglycemia, ICU
Management of Adult-Onset Still's Disease Patients in Intensive Care Unit: a Case Report Andriani, Ika Jati Setya; Rakhmatjati, Pradana Bayu; Wisudarti, Calcarina Fitriani Retno; Widodo, Untung
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 1 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.65781

Abstract

Background: Adult-onset Still's disease (AOSD) is a rare inflammatory disorder characterized by the classic triad of fever, arthritis, and evanescent rash. AOSD is a multi-systemic disorder with unclear etiology. Glucocorticoids are the first line treatment for AOSD, and disease-modifying anti-rheumatic drugs (DMARDs) are often used in some patients with a poor response to glucocorticoids. Parenchymal lung involvement in AOSD is rare (only 5% of AOSD), one of them is acute respiratory distress syndrome (ARDS), where ARDS is the most severe complication. Management of such conditions in the intensive care unit (ICU) is crucial.Case: A 25-year-old woman came with unresolved fever for one week which was preceded by joint pain and reddish spots on the skin. The patient was diagnosed as AOSD complicated with ARDS due to pneumonia which kept the patient in the ICU for 24 days.Discussion: AOSD is a multigenic auto-inflammatory disorder involving the innate and adaptive immune systems. Based on Yamaguchi's criteria, the patient was diagnosed with AOSD where there was a high fever that lasted more than a week, arthritis, salmon rash, leucocytosis, sore throat, splenomegaly, alanine aminotransferase (ALT) abnormalities, and negative antinuclear antibodies (ANA) test. The first-line therapy given was methylprednisolone, doses were tapered gradually. As the patient didn't respond to therapy, she was then given immunosuppressive therapies such as cyclosporine, hydroxychloroquine and underwent therapeutic plasma exchange (TPE). The patients responded to treatments and showed good laboratory results.Conclusion: This case report describes a patient with AOSD that was diagnosed based on clinical manifestations and Yamaguchi criteria. The patient improved clinically with high dose administration of corticosteroids, immunosuppressive agents, and TPE. Making a correct diagnosis and starting an appropriate treatment as soon as feasible is crucial in this case as the patient suffers complications.
Co-Authors Calcarina Fitriani Retno Wisudarti Jufan, Ahmad Yun Rakhmatjati, Pradana Bayu Untung Widodo, Untung