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The Journal of Society Medicine (JSOCMED)
Published by PT. CoinReads Media Prima
ISSN : -     EISSN : 29645565     DOI : https://doi.org/10.47353/jsocmed.v2i1
Core Subject : Health, Science,
Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience
The Journal of Society Medicine (JSOCMED) | ISSN (e): 2964-5565 is a leading voice in the Indonesia and internationally for medicine and healthcare. Published continuously, JSOCMED features scholarly comment and clinical research. JSOCMED is editorially independent from and its The Editor-in-Chief (EIC) is Prof. dr. Aznan Lelo, PhD, SpFK. JSOCMED offers many attractive features for authors, including free online access to all research articles, online publication ahead of print, and online responses to articles published as Quick Comments. In addition, as befitting a publication of the Journal of Society Medicine, JSOCMED implements best practice in scientific publishing with an open peer review process, declarations of competing interests and funding, full requirements for patient consent and ethical review, and statements of guarantorship, contributorship, and provenance.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 5 Documents
 1 
Search results for , issue "Vol. 4 No. 11 (2025): November" : 5 Documents clear
Management of Severe Head Injury Patients with Concurrent Metabolic Disorders, Hyperkalemia, Stage III Acute Kidney Injury, and Suspected Alcohol Intoxication Using Renal Replacement Therapy in ICU Irawati, Dian; Pradian, Erwin
Journal of Society Medicine Vol. 4 No. 11 (2025): November
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i11.239

Abstract

Introduction: Severe head injury (SHI) presents complex challenges, particularly when complicated by metabolic disorders, hyperkalemia, acute kidney injury (AKI), and suspected alcohol intoxication. These conditions necessitate comprehensive management in the Intensive Care Unit (ICU), often incorporating renal replacement therapy (RRT) to address life-threatening complications. This case highlights the multidisciplinary approach required to optimize outcomes in such critical scenarios. Case Description: A 45-year-old male presented to the ICU with SHI following a motor vehicle accident, exhibiting a Glasgow Coma Scale score of 6. Clinical evaluation revealed hyperkalemia (potassium 6.8 mmol/L), stage III AKI (serum creatinine 4.2 mg/dL), and metabolic acidosis. Suspected alcohol intoxication was noted based on clinical history and odor of alcohol. Initial management included neuroprotective measures, mechanical ventilation, and fluid resuscitation. Continuous renal replacement therapy (CRRT) was initiated to manage hyperkalemia and AKI, stabilizing electrolyte imbalances within 48 hours. Neuroimaging confirmed diffuse axonal injury, prompting anticonvulsant therapy and intracranial pressure monitoring. Multidisciplinary care involving neurology, nephrology, and critical care teams facilitated tailored interventions, resulting in gradual improvement in renal function and consciousness over two weeks. Conclusion: Effective management of SHI with concurrent metabolic disorders, hyperkalemia, AKI, and suspected alcohol intoxication requires integrated ICU care and RRT. Early intervention, precise monitoring, and multidisciplinary coordination are critical for improving patient outcomes in such complex cases.
Management of Myasthenic Crisis in the Intensive Care Unit Putra, Angga Permana; Zulfariansyah, Ardi
Journal of Society Medicine Vol. 4 No. 11 (2025): November
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i11.241

Abstract

Introduction: Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by muscle weakness and fatigability due to impaired neuromuscular transmission. Approximately 15–20% of patients develop myasthenic crisis requiring endotracheal intubation and mechanical ventilation. Management is challenging in the presence of comorbidities, necessitating careful selection of immunomodulatory therapy. Case Description: A 39-year-old woman was admitted to the General Intensive Care Unit of Dr. Hasan Sadikin Hospital with progressive dyspnea and generalized weakness. She was diagnosed with myasthenic crisis complicated by bradyarrhythmia, hypercoagulable state (elevated D-dimer, prolonged PT/INR/APTT), and electrolyte imbalance. Intravenous immunoglobulin (IVIG) was chosen over plasma exchange due to its non-invasive administration, avoidance of large-bore vascular access, more favorable hemodynamic profile, and lower risk of arrhythmia or hypotension. Potential arrhythmogenic effects from fluid shifts and hypotension associated with plasma exchange (reported in ~3% of cases) were considered contraindications in this patient. IVIG was administered at 0.4 g/kg/day for 5 consecutive days. Significant clinical improvement was observed, allowing successful extubation on day 8 and transfer to the High Care Unit on day 9. Conclusion: This case demonstrates the efficacy and safety of IVIG as first-line immunomodulatory therapy in myasthenic crisis with complex comorbidities. A comprehensive multidisciplinary approach combined with appropriate selection of IVIG resulted in rapid clinical recovery and favorable outcome.
Intensive Care Management of Non-Ischemic Dilated Cardiomyopathy with Morbid Obesity in a Parturient Undergoing Cesarean Section Darmoko, Aris; Kestriani , Nurita Dian
Journal of Society Medicine Vol. 4 No. 11 (2025): November
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i11.242

Abstract

Introduction: Dilated cardiomyopathy (DCM) in pregnancy is a rare but life-threatening condition, with reported incidence ranging from 1:4,950 deliveries in Europe to 2.38:1,000 deliveries in Asia. When complicated by morbid obesity, it significantly increases perioperative and critical care challenges, requiring a coordinated multidisciplinary approach to optimize maternal outcomes. Case Description: A 32-year-old primigravida with morbid obesity (BMI 49.5 kg/m²) and non-ischemic dilated cardiomyopathy presented with decompensated heart failure at 29 weeks of gestation. She underwent elective cesarean section under general anesthesia followed by 19 days of intensive care. Management included hemodynamic optimization with dobutamine infusion, restrictive fluid strategy targeting negative balance, stepwise ventilator weaning from mechanical ventilation to nasal cannula, and treatment of complications including electrolyte disturbances and postoperative delirium secondary to obesity hypoventilation syndrome (Pickwickian syndrome). Continuous hemodynamic monitoring using MostCare and invasive arterial pressure enabled precise titration of therapy. Conclusion: Successful maternal outcome in pregnant patients with dilated cardiomyopathy and morbid obesity can be achieved through comprehensive preoperative optimization, carefully selected anesthetic technique, and prolonged multidisciplinary intensive care. This case highlights the importance of integrated hemodynamic, respiratory, and metabolic management in this high-risk population.
Septic Shock Management Using Continuous Renal Replacement Therapy in a Postpartum Patient with Diabetic Ketoacidosis, Acute Kidney Injury, and Ventilator-Associated Pneumonia Putra, Prana Indra; Pradian, Erwin
Journal of Society Medicine Vol. 4 No. 11 (2025): November
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i11.248

Abstract

Introduction: Postpartum sepsis in patients with pregestational diabetes mellitus is a life-threatening condition that may precipitate acute kidney injury (AKI) and diabetic ketoacidosis (DKA). Sepsis frequently leads to multiorgan dysfunction, with the kidneys being particularly vulnerable. Severe AKI in septic shock often requires renal replacement therapy. Continuous Renal Replacement Therapy (CRRT), particularly in hemodynamically unstable patients, is the preferred modality due to its gradual solute and fluid removal, cytokine modulation, and ability to manage complex acid-base disturbances. In this setting, secondary ventilator-associated pneumonia (VAP) further complicates management. Case Description: A 35-year-old woman with pregestational type 2 diabetes mellitus developed septic shock with DKA following spontaneous vaginal delivery. She presented with refractory hypotension, severe metabolic acidosis (pH 6.98), hyperglycemia (301 mg/dL), ketonuria (2+), and oliguria (0.3 mL/kg/h). Serum creatinine rose from 0.85 to 3.61 mg/dL, fulfilling KDIGO stage 3 AKI criteria. During ICU stay, the patient developed VAP, necessitating prolonged mechanical ventilation and targeted antimicrobial therapy. Conclusion: Early initiation of Continuous Veno-Venous Hemodiafiltration (CVVHDF) using bicarbonate-buffered replacement fluid and an oXiris filter effectively corrected severe acidosis (pH 7.255 → 7.359 within 76 hours), removed ketones and inflammatory mediators, stabilized hemodynamics, and facilitated renal recovery while reducing vasopressor requirements. Multidisciplinary management, including strict VAP prevention bundle and culture-directed antibiotics, enabled successful extubation. Timely high-volume CRRT combined with comprehensive critical care is crucial in managing complex postpartum septic shock with DKA and AKI.
Management of Refractory Status Epilepticus and Profoundly Impaired Consciousness in Anti-NMDA Receptor Autoimmune Encephalitis Alam, Mohamad Deny Saeful; Indriasari, Indriasari
Journal of Society Medicine Vol. 4 No. 11 (2025): November
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i11.249

Abstract

Introduction: Autoimmune encephalitis is a major cause of non-infectious encephalitis and remains challenging to diagnose based solely on clinical presentation. Confirmation is particularly difficult in antibody-negative cases despite strong clinical suspicion, requiring comprehensive diagnostic workup. Case Description: A 25-year-old male presented with progressive altered mental status and seizures preceded by behavioral changes for 10 days. EEG showed no epileptiform activity, cerebrospinal fluid analysis excluded infection, and brain CT was unremarkable. Serum and CSF HSV IgG/IgM were non-reactive. Anti-NMDA receptor antibodies in CSF were strongly positive. The patient developed refractory status epilepticus requiring mechanical ventilation, deep sedation with propofol, and multiple anti-seizure medications including phenytoin. Empirical acyclovir was administered for 10 days without improvement. High-dose methylprednisolone (1 g/day for 5 days) was given as first-line immunotherapy but yielded no neurological recovery. On day 14, plasma exchange was initiated for three sessions, resulting in marked clinical improvement with recovery of consciousness and seizure control. Conclusion: This case highlights the critical importance of considering autoimmune encephalitis even when initial antibody results are pending or imaging is normal. Early escalation to second-line immunotherapy, particularly plasma exchange, can be lifesaving in anti-NMDAR encephalitis presenting with refractory status epilepticus and profound coma.

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