Tata Laksana Ketoasidosis Diabetik pada Penderita Gagal Jantung

Dicky Febrianto, Esti Hindariati

Abstract

Ketoasidosis diabetik (KAD) merupakan kegawatdaruratan pada diabetes melitus (DM) yang didefinisikan sebagai trias hiperglikemia, ketonemia, dan asidosis. Ketoasidosis diabetik menyebabkan tingkat morbiditas dan mortalitas yang tinggi meskipun terapi diabetes telah berkembang. Aspek krusial dari tata laksana KAD meliputi pemberian cairan dan elektrolit, terutama kalium, dalam jumlah adekuat, dan pemberian insulin secara kontinu.

Status hidrasi penderita dengan KAD dan gagal jantung dapat dinilai dengan pemeriksaan fisik, seperti kesadaran, tanda-tanda vital, capillary refill time, turgor kulit, tekanan vena jugularis, dan tanda-tanda edema paru. Metode invasif dan non-invasif dapat pula menilai kecukupan cairan pada rehidrasi penderita dengan KAD dan gagal jantung. Metode invasif meliputi tekanan vena sentral dan tekanan arteri pulmonal, sementara metode non-invasif meliputi ekokardiografi, bioimpedance vector analysis (BIVA), dan brain natriuretic peptide (BNP). Dengan penilaian status hemodinamik yang tepat di unit perawatan intensif, pasien gagal jantung yang mengalami KAD dapat diberikan cairan dalam jumlah adekuat sehingga terhindar dari dehidrasi ataupun overhidrasi.

Kata Kunci: Gagal jantung, ketoasidosis diabetik, penilaian status hidrasi

Management of Diabetic Ketoacidosis in Patient with Heart Failure

Diabetic ketoacidosis (DKA) is diabetes mellitus emergency which is defined by the biochemical triad of hyperglycemia, ketonemia, and acidemia. Diabetic ketoacidosis continues to have high rates of morbidity and mortality despite advances in the treatment of diabetes. Crucial aspects of DKA management involve adequate replacement of fluids and electrolytes, particularly potassium, and the continuous administration of insulin.

Hydration status in patients with DKA and heart failure can be assessed by physical examination, such as consciousness, vital signs, capillary refill time, skin turgor, jugular venous pressure, and signs of pulmonary edema. Invasive and non-invasive methods can also assess fluid adequacy in rehydration of patients with DKA and heart failure. Invasive methods include central venous pressure (CVP) and pulmonary artery pressure, while non-invasive methods include echocardiography, bioimpedance vector analysis (BIVA), and brain natriuretic peptide (BNP). By assessing hemodinamic status properly in an intensive care setting, a patient with heart failure who develops DKA can be administered adequate quantities of fluid to avoid dehydration or overhydration.

Keywords

Diabetic ketoacidosis, heart failure, hydration status assessment

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