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Laporan Kasus: Tantangan Pengelolaan Krisis Hiperglikemia Pasien Penyakit Ginjal Kronik (PGK) Tahap Akhir dalam Hemodialisa Rutin Davin Takaryanto; Maya Kusumawati; Nenny Agustanti; Rudi Supriyadi; Ervita Ritonga; Nanny N. M. Soetedjo; Hikmat Permana
Jurnal MedScientiae Vol. 2 No. 1 (2023): April
Publisher : Fakultas Kedokteran dan Ilmu Kesehatan Ukrida

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Introduction Hyperglycemic crisis is a life threatening medical emergency which occur in any individuals, including end stage renal disease (ESRD). The altered renal, glucose, electrolyte, and body fluid dysregulation seen in ESRD patients affects the management. Objective: Hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA) are life threatening hyperglycemic emergencies that warrant immediate and adequate management. The incidence of hyperglycemic crises among ESRD patients who undergo routine hemodialysis remains unknown. Furthermore, several available studies reported in case reports. Methods: We hereby report a case of hyperglycemic crisis of 61years old woman with medical history of type 2 diabetes mellitus (DM) and ESRD as the complication, she undergoes routine hemodialysis. Results: The patient was admitted with decreased consciousness that was preceded by dyspnea, active cough and fever. Then, the patient treated for the hyperglycemic crisis as in ESRD patient and for the with septic shock due to pneumonia. Conclusion: The management of hyperglycemic crises consist of fluid, potasium corection and insulin administration, however there were some adjustment in ESRD patients. At present therere were no spesific guidelines to manage hyperglicemic crisis and ESRD which is challenging.

Laporan Kasus: Tantangan Pengelolaan Krisis Hiperglikemia Pasien Penyakit Ginjal Kronik (PGK) Tahap Akhir dalam Hemodialisa Rutin Davin Takaryanto; Maya Kusumawati; Nenny Agustanti; Rudi Supriyadi; Ervita Ritonga; Nanny N. M. Soetedjo; Hikmat Permana
Jurnal MedScientiae Vol. 2 No. 1 (2023): April
Publisher : Fakultas Kedokteran dan Ilmu Kesehatan Ukrida

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jmedscientiae.v2i1.2800

Introduction Hyperglycemic crisis is a life threatening medical emergency which occur in any individuals, including end stage renal disease (ESRD). The altered renal, glucose, electrolyte, and body fluid dysregulation seen in ESRD patients affects the management. Objective: Hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA) are life threatening hyperglycemic emergencies that warrant immediate and adequate management. The incidence of hyperglycemic crises among ESRD patients who undergo routine hemodialysis remains unknown. Furthermore, several available studies reported in case reports. Methods: We hereby report a case of hyperglycemic crisis of 61years old woman with medical history of type 2 diabetes mellitus (DM) and ESRD as the complication, she undergoes routine hemodialysis. Results: The patient was admitted with decreased consciousness that was preceded by dyspnea, active cough and fever. Then, the patient treated for the hyperglycemic crisis as in ESRD patient and for the with septic shock due to pneumonia. Conclusion: The management of hyperglycemic crises consist of fluid, potasium corection and insulin administration, however there were some adjustment in ESRD patients. At present therere were no spesific guidelines to manage hyperglicemic crisis and ESRD which is challenging.

Transition of Care of Disorders of Sexual Development: A Twist of Two Cases with Ambiguous Genitalia Marshell Tendean; Nanny Natalia. M Soetedjo; Maya Kusumawati; Ervita Ritonga; Hikmat Permana
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 1 (2024): InaJEMD Vol. 1, No. 1
Publisher : PP PERKENI

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Disorders of sexual development (DSD) is a congenital condition that requires an alteration in the development of chromosomal, gonadal, and anatomical sex is atypical. A report showed most of the patients in the 46XX DSD had congenital adrenal hyperplasia (CAH) at 69.23% followed by unknown under-virilization in the 46XY DSD group at 60.09%. Patient 1 diagnosed as DSD 46XX/non-classic congenital adrenal hyperplasia (NCAH) presented with primary amenorrhea, short stature, over-virilization (Prader 2), and 46XX karyotype. Laboratory examination showed elevated 17-hydroxyprogesterone (17OHP): 166.7 ng/ml (2.83 ng/ml), without salt wasting feature. Patient 2 diagnosed with DSD 46XY/type 2 5α -reductase deficiency (SAD) presented with cryptorchidism, under-masculinization (sinecker stage 3b), and 46XY karyotype. Laboratory examination showed elevated testosterone 613 ng/dL (4.6-38.3 ng/dL), decreased dihydrotestosterone (DHT) 11 ng/dL (>20 ng/dL), and elevated testosterone T/DHT ratio 55.73 (8-16). A deep understanding of pathophysiology, and approach to disease in each stage of life is important and warrants special treatment. Comprehensive multidisciplinary team management (MDT) is warranted in DSD management. Disease prognosis varies among each disorder: early detection, treatment compliance, and continuity of care are important to improve patient outcomes.

Parathyroid Carcinoma with Hungry Bone Syndrome Complication After Parathyroidectomy: A Case Report Muhammad Iman Pratama Putra; Nanny Natalia Mulyani Soetedjo; Maya Kusumawati; Ervita Ritonga; Yohana Azhar; Hasrayati Agustina; Hikmat Permana
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
Publisher : PP PERKENI

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Riedel's thyroiditis is a rare fibrotic condition involving damage to the thyroid gland and infiltration of surrounding structures. Synonyms of Riedel's thyroiditis include Riedel's goiter, fibrous goiter, ligneous goiter, or chronic invasive fibrous thyroiditis. The inflammatory thyroid condition of Riedel's thyroiditis is a local manifestation of a systemic fibrous or autoimmune process and chronic sclerosis or productive thyroiditis. A 59-year-old man came to the Endocrinology Clinic at Wahidin Sudirohusodo Hospital and was consulted by an oncology surgeon colleague with complaints of a lump in his neck for 2 years before coming to the hospital. Initially the lump was the size of a marble then it got bigger, felt hard, and not painful. The patient had a history of biopsies by surgical colleagues 2 times, the first in May 2022 Fine Needle Aspiration Biopsy with Malignancy (Papillary) results at Bhayangkara Hospital, then the patient was referred to a surgical oncology colleague at Wahidin Sudirohusodo Hospital and a 1-month incision biopsy was performed before going to the endocrine polyclinic with the results of Riedel's Thyroiditis. The patient was then given therapy with Tamoxifen 20 mg per 24 hours orally, and Methylprednisolone 16 mg per 8 hours orally with tapering doses every 7 days. In the treatment during control there were no complaints but complaints of a lump in the neck tended to shrink so the treatment was continued for 2 months then the patient returned to control with a clinical lump in the neck shrinking (Improvement). Riedel's thyroiditis is a disease characterized by an overgrowth of connective tissue that can invade surrounding structures. This connective tissue growth may extend into the recurrent laryngeal nerve. This thyroid inflammatory condition is suspected as a local manifestation of a systemic fibrotic process or an autoimmune process. Commonly used therapies such as glucocorticoids and immunosuppressant agents such as tamoxifen. Steroid treatment is usually given at a dose of 100 mg of prednisolone daily.

Rhabdomyolysis in Thyroid Crisis Soetedjo, Nanny Natalia Mulyani; Loe, Luse; Kusumawati, Maya; Ritonga, Ervita; Permana, Hikmat
Majalah Kedokteran Indonesia Vol 72 No 5 (2022): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.72.5-2022-829

Introduction: Hyperthyroidism might lead to rhabdomyolysis. Rhabdomyolysis in thyroid crisis is very rare, currently there are only 7 cases in the world. This is the eight cases in the world that had been reported.Cases: We reported a case of a 46-year-old man with Graves’ Disease who presented with thyroid crisis and rhabdomyolysis.Discussion: The patient came with shortness of breath and palpitations for 10 hours before admission. Tachycardia, tachypnea, thyroid enlargement, motoric weakness, and bilateral lung crackles were noted. The Burch-Wartofsky Point Scale was 60 and the Japan Thyroid Association grade was TS2 first combination. Laboratory showed hyperkalemia (7.7 meq/L), increase in urea (144 mg/dl), creatinine (1.92 mg/dl), fT4 ( greater than 5.0), TSHs (0.06 uIU/ml) creatine kinase (3645 U/L), positive TRAb and Anti-TPO. The patient was treated with thyroid crisis management (propylthiouracil, lugol, dexamethasone) and supportive treatment (dobutamine, digoxin, furosemide, antibiotics, hyperkalemia therapy). After hospitalized for 11 days, the patient was discharged with resolution clinical symptom and levels of CK, urea, and creatinine. Conclusion: Hyperthyroidism might lead to rhabdomyolysis. This condition needs to be recognized and becomes a differential diagnosis in non-traumatic rhabdomyolysis accompanied by acute kidney injury. Therefore, can lead to appropriate and prompt management.

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