PANDUAN PRAKTIK KLINIS SMF ILMU KESEHATAN ANAK RSUD Dr. MOEWARDI MOEWARDI 2012 - 2014 KETOASIDOSIS DIABETIK Ket$a"i%$"i" Ket$a"i%$"i" %ia&eti' KAD# "e&agai "e&agai a'i&at a'i&at %e!i"ien"i %e!i"ien"i in"()in in"()in *er(+a'an *er(+a'an 1.
Pengert ertian D De!in !ini"i# "i#
'e%ar(ratan +a%a %ia&ete" *e)it(" DM# ti+e I. De!ini"i KAD a%a)a, a%ana 'a%ar g()a %ara,.)e&i, %ari 200 *g%)/ 'et$ne*ia/ 'et$n(ria %an a"i%$"i" +H/2 %anata( 'a%ar &i'ar&$nat13 *EL# 1. A%ana A%ana ri5aat ri5aat %ia&ete" %ia&ete" *e))it("6 *e))it("6 +$)i( +$)i(ria/ ria/ +$)i%i+" +$)i%i+"ia ia %an +$)i!ag +$)i!agia ia/
2.
Ana*ne"i"
n$'t(ria/ en(re"i" %an ana' )e*a, *a)ai"e# 2. 7e8a)a-ge8a)a 7e8a)a-ge8a)a a"i%$"i a"i%$"i"" "e+erti "e+erti na!a" 9e+at 9e+at %an %an %a)a* K("*a())# K("*a())# %an %an &a( +erna!a"an a"et$n. . Pen( Pen(r( r(na nan n &er &erat at &a%a &a%an n 4. Neri Neri +er(t +er(t// *(nta, *(nta, *(a)/ *(a)/ tan+a tan+a %iare %iare 1. 7e8a)a-ge8a)a 7e8a)a-ge8a)a a"i%$"i" a"i%$"i" "e+erti na!a" 9e+at 9e+at %an %a)a* K("*a( K("*a())# ))# %an &a(
.
Pe*eri'"aan !i"i'
4.
Kriteria %i %iagn$"i"
3. <.
Diagn$"i" Diag$"i" &an%ing
.
=.
Pe*eri'"aan +en(n8ang Tera+i
+erna!a"an a"et$n 2. Neri +er(t "e+erti a'(t a&%$* a&%$*en/ en/ *(a)/ *(a)/ *(nta, *(nta, tan+a %iare . Tan%a Tan%a : tan%a tan%a %e,i%ra %e,i%ra"i "i "e%ang "e%ang "a*+ai "a*+ai &erat %engan %engan tan+a tan+a "$' 4. Pen(r( Pen(r(nan nan 'e"a%a 'e"a%aran ran "a*+ai "a*+ai '$*a '$*a 3. Pr$% Pr$%(' ('"i "i (rin (rin tingg tinggii 1. Hi+erg)i'e* Hi+erg)i'e*ia/ ia/ %itan%ai %itan%ai %engan %engan 'a%ar 'a%ar g()a %ara,.)e %ara,.)e&i, &i, %ari %ari 200 *g%) *g%) 2. A"i%$"i"/ A"i%$"i"/ %ara, %ara, ;ena ;ena /2 /2 %an ata( ata( &i'ar&$ &i'ar&$nat nat 13 *EL +H . Ket$ne Ket$ne*ia *ia// %itan%ai %itan%ai %enga %engan n +en(r(n +en(r(nan an &erat &erat &a%an &a%an 4. Ket$n(ria Ket$a"i%$"i" %ia&eti' KAD# A"i%$"i" *eta&$)i' e9 "e&a& )ain 1. Ka%a Ka%arr g() g()aa %ar %ara, a, 2. Ket$ne*ia . Ana) Ana)i" i"aa ga" ga" %ara %ara, , 4. Urin rina)i"i" 3. E)e'tr$)it E)e'tr$)it %ara,/ ,a+("an ,a+("an %ara, %ara, te+i/ !(ng"i gin8a) <. K()t(r K()t(r %ara, %ara, %anata( %anata( (rin &i)a %i%a+at'an %i%a+at'an in!e'"i in!e'"i Da"ar tera+i a%a)a,6 1.
tera+i 9airan
2.
in"()in
.
'$re'"i gangg(an e)e'tr$)it
4.
+e*anta(an
3.
+enanganan in!e'"i
1. Terapi rapi cair cairan an
Prin"i+-+rin"i re"("ita"i 9airan6 -
Ata"i Ata"i "$' "$' &i)a &i)a ter8a% ter8a%ii "$' "$' %engan %engan 9air 9airan an Na>) Na>) 0/?@ 0/?@ 20 99'g 99'g %a)a* %a)a* 1 8a* "a*+ai "$' terata"i.
-
Re"( Re"("i "ita" ta"ii "e)an "e)an8( 8(tn tnaa %i&e %i&eri' ri'an an "e9ara "e9ara +er)a +er)a,a ,an n %a)a* %a)a* <-4= <-4= 8a*
&er%a"ar %era8at %e,i%ra"i. -
Se)a*a &e)(* "ta&i) 'a%ar &i'ar&$nat 13 *E)/ g()a %ara,200 *g%)/ +H/# +a"ien %i+(a"a'an.
-
Per,it(ngan 'e&(t(,an 9airan re"("ita"i t$ta) "(%a, ter*a"(' 9airan (nt(' *engataa"i "$'.
-
A+a&i)a %ite*('an ,i+ernatre*ia *a'a )a*a re"("ita"i 9airan %i&eri'an "e)a*a 2 8a*.
-
Beni" 9airan re"("ita"i a5a) a%a)a, Na>) 0/?@. A+a&i)a 'a%ar g()a %ara, "(%a, t(r(n *en9a+ai 230 *g%) 9airan %iganti %engan %e'"tr$"a 3@ %a)a* Na>) 0/43@.
2. Terapi insulin
-
%i&eri'an "ete)a, "$' terata"i
-
%ig(na'an rapid (reguler) insulin "e9ara intra;ena %engan %$"i" in"()in 0/03-0/1 U'gCC8a*. C$)(" in"()in ti%a' +er)( %i&eri'an.
-
Pen(r(nan 'a%ar g()a &erta,a+ ti%a' )e&i, 9e+at %ari 3-100 *g%)8a*.
-
In"()in intra;ena %i,enti'an %an a"(+an +er $ra) %i*()ai a+a&i)a "e9ara *eta&$)i' "(%a, "ta&i). Se&e)(* in"()in %i,enti'an a"(+an +er $ra) %i&eri'an %engan *ana*&a, %$"i" in"()in "e&agai &eri'(t6 *a'anan ringan %$"i" in"()in %igan%a'an 2 'a)i "e)a*a *a'an "a*+ai 0 *enit "ete)a, "e)e"ai *a'anan &e"ar %$"i" in"()in %igan%a'an 'a)i "e)a*a *a'an "a*+ai <0 *enit "ete)a, "e)e"ai.
-
Se)an8(tna in"()in reg()er %i&eri'an "e9ara "(&'(tan %engan %$"i" 0/3-1/0 U'g CC,ari %i&agi 4 %$"i" ata( (nt(' +a"ien )a*a %a+at %ig(na'an %$"i" "e&e)(*na.
-
Unt(' tera+i in"()in "e)an8(tna %ir(8(' 'e %$'ter a,)i en%$'rin$)$gi ana'.
3. Koreksi elektrolit
-
tent('an 'a%ar natri(* %engan *engg(na'an r(*(" 1/< 'a%ar g()a %ara, -100# Ka%ar Na ter'$re'"i Na
--------------------------------100
ni)ai g()a %ara, %a)a* "at(an *g%)# -
+a%a ,i+ernatre*ia g(na'an 9airan Na>) 0/43@
-
'a)i(* %i&eri'an "e8a' a5a) re"("ita"i 9airan 'e9(a)i +a%a an(ria. D$"i" 'a)i(* 3 *Eg'g CC +er ,ari %i&eri'an %engan 'e'(atan
)ar(tan 20-40 *EL %engan 'e9e+atan ti%a' )e&i, %ari 0/3 *E'g8a*. -
A"i%$"i" *eta&$)i' ti%a' +er)( %i'$re'"i.
4. Pemantauan
-
+e*anta(an na%i/ 'e9e+atan +erna!a"an/ te'anan %ara,/ +e*eri'"aan ne(r$)$gi"/ 'a%ar g()a %ara,/ &a)an" 9airan/ "(,( &a%an. Ket$n (rin ,ar(" "a*+ai negati!.
-
Pen(r(nan 'e"a%aran %a)a* 24 8a* +erta*a tera+i "e&agai tan%a a5a) e%e*a "ere&ri. Bi'a 9(riga e%e*a "ere&ri &eri'an *anit$) 1-2 gra*'gintra;ena tete"an 9e+at.
-
Tandatanda !a"a#a a. Ceri'(t ini *er(+a'an tan%a-tan%a &a,5a +enanganan +en%erita
*en8a%i )e&i, "()it &. De,i%ra"i &erat %an ren8atan 9. A"i%$"i" &erat %an "er(* K ang ren%a,/ ,a) ini *en(n8(''an K
-
t$ta) ang "angat '(rang %. Hi+ernatre*ia *en(n8(''an 'ea%aan ,i+er$"*$)ar ang *e*&(r(' e. Hi+$natre*ia !. Pen(r(nanan 'e"a%aran "aat +e*&erian tera+i ang *en(n8(''an a%ana e%e*a "ere&ri Edema sere!ri Hernia"i 'arena e%e*a "ere&ri *er(+a'an '$*+)i'a"i tera+i +a%a DKA/ "i!atna a'(t %an ti%a' %a+at %i+re%i'"i "e&e)(*na. Cia"ana ter8a%i %a)a* 24 8a* +erta*a +eng$&atan. Se*(a +en%erita ,ar(" %i*$nit$r a'an 'e*(ng'inan +ening'atan te'anan intra'rania) $&"er;a"i ge8a)a ne(r$)$gi"#. Pen%erita ang &eri"i'$ tinggi (nt(' *enga)a*i e%e*a "ere&ri a%a)a,6 - Pen%erita %engan ("ia 3 ta,(n - Pen%erita &ar( - Pen%erita %engan ge8a)a ang "(%a, )a*a %i%erita - A"i%$"i" &erat/ +>O2 ren%a, %an CUN tinggi Ci)a ter8a%i ,ernia"i $ta'/ 5a't( +enanganan ang e!e'ti! "angat)a, +en%e'. Ci)a rag(-rag( "egera &eri'an *anit$) 1-2 gra*'gCC
%engan IG %ri+ 9e+at. Ci)a *(ng'in )a'('an CT-scan $ta'. 3. Pe*&erian anti&i$ti' "e9ara e*+iri" ata( "e"(ai ,a"i) '()t(r %ara, %an ata( (rin
?.
10. 11.
E%('a"i
Pr$gn$"i" Ting'at e;i%en"
1.
Per8a)anan +ena'itna %an tin%a' )an8(t
2.
K$*+)i'a"i +ena'it %an +eng$&atanna
.
Min(* $&at terat(r %an !$))$5 (+ r(tin
4. D(&ia a% &$na* III
Men8e)a"'an tata)a'"ana "e)an8(tna
12. 1 14
Ting'at re'$*en%a"i Pene)aa, 'riti" In%i'at$r *e%i"
C SSD En%$'rin$)$gi ana' Pe*eri'"aan %an tera+i 1. UKK En%$'rin$)$gi Ana' %an Re*a8a IDAI. Data regi"tra"i %ia&ete" *e))it(" ti+e 1 ta,(n 200?. 2. UKK En%$'rin$)$gi Ana' %an Re*a8a IDAI. K$n"en"(" na"i$na) +enge)$)aan %ia&ete" *e))it(" ti+e-1 %i In%$ne"ia. Ba'arta6 PP IDAI 200?. . Diet S. R("ta*a %''. Da)a*6 Cat(&ara BRL/ Tri%8a8a C/ P()(ngan AC/ +en(nting. C('( a8ar en%$'rin$)$gi ana'. e% 1. Ba'arta6 Ca%an Pener&it IDAI 2010. ,.123-?. 4. W$)!"%$r! B/ >raig ME/ Dane*an D/ D(nger D/ E%ge B/ Lee WRW/ %''. Dia&eti9 'et$a9i%$"i". Pe%iatrDia&ete". 2006=62=-42. 3. A("tra)ian Pae%iatri9 En%$9rine 7r$(+ !$r t,e De+art*ent $! Hea)t, an% Ageing. Dia&eti9 'et$a9i%$"i" in A("tra)ian >)ini9a) Pra9ti9e 7(i%e)ine"6 T+e 1 %ia&ete" in 9,i)%ren an% a%$)e"9ent" %ia'"e" +a%a tangga) 1Maret 2003.
Di(n%(,
%ari
,tt+6555.n,*r9.g$;.a(+(&)i9ati$n"J!i)e"9+102.+%! <. Si)in' M. APE7 ,an%&$$' $n 9,i)%,$$% an% a%$)e"9ent %ia&ete"6 *anage*ent $! %ia&eti9 'et$a9i%$"i". NSW6 7$;ern*ent Printing
13
Ke+("ta'aan
Ser;i9e 1??<. . P(g)ie"e MT/ F$rt P/ Li!",it F. Treat*ent $! %ia&eti9 'et$a9i%$"i". Da)a*6 Li!",i!t F/ +en(nting. Pe%iatri9 en%$9rin$)$g - a 9)ini9a) g(i%e. 2n% e%. Ne5 $r'6 Mar9e) De''er1??0. ,. 43-<<. =. Kita&9,i AE/ U*+ierre 7E/ M(r+, MC/ Carrett EB/ Krei"&erg RA/ Ma)$ne BI/ %''. H+erg)9e*i9 9ri"e" in +atient" 5it, %ia&ete" *e))it(". Dia&ete" >are. 20062<6S10?-S11. ?. D(nger DC/ S+er)ing MA/ A9erini >L/ C$,n DB/ Dane*an D/ Danne T+A/ %''. ESPELWPES 9$n"en"(" "tate*ent $n %ia&eti9 'et$a9i%$"i" in 9,i)%ren an% a%$)e"9ent". Ar9, Di" >,i)%. 20046=?61==-?4. 10. Harri" 7D/ Fi$r%a)"i I/ Fin&erg L. Sa!e *anage*ent $! %ia&eti9 'et$a9i%$"i". B Pe%iatr. 1?==116<3-. 11. R(9'er DW. Dia&eti9 Ket$a9i%$"i". eMe% B. 200124611-3. 12. O5en OE/ Li9,t BH/ Sa+ir D7. Rena) !(n9ti$n an% e!!e9t" $! +artia) re,%rati$n %(ring %ia&eti9 'et$a9i%$"i". Dia&ete". 1?=106310-=. 1. >$(rt B. T,e Manage*ent $! Dia&ete" Me))it(". Da)a*6 Cr$$' >7D/ +en(nting. >)ini9a) +ae%iatri9 en%$9rin$)$g. E% 'e-. O!$r%6 C)a9'5e)) S9ien9e 1??3. ,. <33-. 14. S*it, >P/ Firt, D/ Cennett S/ H$5ar% >/ >,i",$)* P. Ket$a9i%$"i" $99(rring in ne5) %iagn$"e% an% e"ta&)i",e% %ia&eti9 9,i)%ren. A9ta Pae%iatr. 1??==63-41.
S(ra'arta/ K$*ite Me%i' Wa'i) Ket(a
Ket(a SMF Ana'
Dr. D8$'$ S("iant$/ S+.M NIP.1?33003 1?=12 1 001
Dr.En%ang De5i L/ S+.AK#/ MPH NIP. 1?3?1201 1?=<0 2 00=
Dire't(r RSUD Dr M$e5ar%i
Drg. Ca"$e'i S$etar%8$/ MMR NIP.1?3=101= 1?=<0 1 00?
PANDUAN PRAKTIK KLINIS SMF ILMU KESEHATAN ANAK RSUD Dr. MOEWARDI 2012 - 2014 $IPOTI%OID KO&'E&ITA( Hi+$tir$i% a%a)a, 'ea%aan ang %i"e&a&'an $)e, '(rangna +r$%('"i ,$r*$n tir$i% ata( 'e)ainan a'ti;ita" re"e+t$r ,$r*$n tir$i%. Di"e&(t ,i+$tir$i% '$ngenita) a+a&i)a 'e)ainan !(ng"i tir$i% ter8a%i "e&e)(* ata( "aat )a,ir. Cer%a"ar'an +ene&a&na %a+at %i&agi ,i+$tir$i% +ri*er/ "e'(n%er 1.
Pengertian De!ini"i#
%an ter"ier. Pri*er a+a&i)a 'e)ainan +a%a 'e)en8ar tir$i%/ "e'(n%er +a%a 'e)en8ar ,i+$!i"i"/ %an
ter"ier
+a%a ,i+$ta)a*(". Pa%a +a"ien ini
'e*(ng'inan +ene&a&na a%a)a, +ri*er ait( 'e)ainan +a%a 'e)en8ar tir$i%. Hi+$ta)a*(" %an ,i+$!i"i" %a)a* 'ea%aan n$r*a)/ %i&('ti'an %engan a%ana +ening'atan TSH a'i&at (*+an &a)i' negati! negative feed back 2.
Anan*ne"i"
mechanism# 'arena ren%a,na 'a%ar !T4. 1. Pa%a &ai &ar( )a,ir "a*+ai ("ia = *ingg( 'e)(,an ti%a' "+e"i!i' 2. Retar%a"i +er'e*&angan . 7aga) t(*&(, ata( +era5a'an +en%e' 4. Letargi/ '(rang a'ti! 3. K$n"ti+a"i <. Ma)a" *enete' . S(ara *enangi" "era' =. P(9at ?. Cai %i)a,ir'an %i %aera, %engan +re;a)en" 'retin en%e*i' 10. %an %aera, 'e'(rangan $%i(* 11. Cia"ana )a,ir *at(r ata( )e&i, &()an post-mature# 12. Ri5aat gangg(an tir$i% %a)a* 'e)(arga/ +ena'it i&( "aat
1. ,a*i)/ $&at antitir$i% ang "e%ang %i*in(*/ %an tera+i "inar
.
Pe*eri'"aan !i"i'
1. U&(n-(&(n &e"ar )e&ar ata( ter)a*&at *en(t(+ 2. Dull face . Li%a, &e"ar 4. K()it 'ering 3. Hernia (*&i)i'a)i" <. Mottling / '(ti" *ar*$rata . Pen(r(nan a'ti;ita" =. K(ningi'teri' ?. Hi+$t$nia 10. Pa%a "aat %ite*('an +a%a (*(*na ta*+a' +(9at 11. Se'i)a" "e+erti "in%r$* D$5n/ teta+i +a%a "in%r$* D$5n &ai )e&i, a'ti!. 12. Hi+$tir$i% '$ngenita) )e&i, "ering ter8a%i +a%a &ai %engan &erat &a%an )a,ir '(rang%ari 2000 g ata( )e&i, %ari 4000 g 1. Se'itar -@ &ai ,i+$tir$i% '$ngenita) &ia"ana %i"ertai %engan 'e)ainan &a5aan )ainna ter(ta*a %e!e' "e+t(* atri(* %an ;entri'e)
1. 2. .
Ana*ne"i" Pe*eri'"aan Fi"i' In%e'" Ne$nata) Hi+$tir$i% 'e)ala klinis
4.
Kriteria %iagn$"i"
1. 7angg(an *a'an
1
2. K$n"ti+a"i . Ti%a' a'ti! 4. Hi+$t$ni
1 1 1
3. Hernia (*&i)i'a)i"
1
<. Ma'r$g)$"ia
1
. K(ti" *ar*$rata
1
=. K()it 'ering ?. F$ntane))a +$"t )e&ar 0/3 9*# 10. Fa"ie" ',a"
1/3 1/3
Total
13
Interpretasi skor* $ipotiroid Kon+enital &ormal
3. <.
.
=.
Diagn$"i" Diag$"i" &an%ing
Pe*eri'"aan +en(n8ang
Tera+i
Skor
, 4 -2
Hi+$tir$i% K$ngenita) Sin%r$*a D$5n 1. Pe*eri'"aan %ara, r(tin%ara, +eri!er )eng'a+ 2. !(ng"i tir$i% TSH/ !T4/ T/ TC7# . anti*i'r$"$*a) anti&$%i AMA# %an Antitir$g)$&()in anti&$%i ATA# 4. Ra%i$)$gi"6 a. !$t$ t$ra'"6 'ar%i$*ega)i. &. !$t$ (*(r t()ang ter)a*&at/ %i"gene"i" e+i!i"ea) t()ang. 3. US7 %a+at %i'eta,(i a%ana 'e)en8ar tir$i%. Prin"i+ Tata)a'"ana6 1. 2. . 4. 3. 1.
Me%i'a*ent$"a Ce%a, Pr$*$ti! S(+$rti! Pe*anta(an edikamentosa Replacement therapy "e(*(r ,i%(+ *engg(na'an +re+arat L-tir$'"in6
(e/otiroksin . 2. Beda" Ti%a' a%a tin%a'an &e%a, +a%a 'a"(" ini. 3. Promoti0
S'rining ,i+$tir$i% +a%a ne$nate" %engan ge8a)a : ge8a)a %iata" %a)a*
4= : 2 8a* "ete)a, 'e)a,iran. 4. Suporti0 a. Peng$&atan ane*ia ang *enertai ,i+$tir$i% &. Re,a&i)ita"i *e%i' ata( !i"i$tera+i 9. Peni)aian I %. R(8('an 'e "+e"ia)i" THT (nt(' *e*eri'"a !(ng"i +en%engaran . Pemantauan a. Tan%a : tan%a ,i+ertir$i% &. Pe*eri'"aan TSH %an !T4 "e9ara &er'a)a 9. E!e' "a*+ing tera+i6 ,i+era'ti!/ 'e9e*a"an/ ta'i'ar%ia/ +a)+ita"i/
tre*$r/ %e*a*/ &erat &a%an *en(r(n %. T(*&(, 'e*&ang6 +ert(*&(,an )inier/ &erat &a%an/ +er'e*&angan
?.
10 . 11. 12 . 1 14 13
E%('a"i
1.
*$t$ri' %an &a,a"a/ "erta 'e*a*+(an a'a%e*i" Per8a)anan +ena'itna %an tin%a' )an8(t
2.
K$*+)i'a"i +ena'it %an +eng$&atanna
.
Min(* $&at terat(r %an !$))$5 (+ r(tin
4.
Men8e)a"'an tata)a'"ana "e)an8(tna
Pr$gn$"i"
D(&ia a% &$na*
Ting'at e;i%en"
III
Ting'at re'$*en%a"i
C
Pene)aa, 'riti" In%i'at$r *e%i" Ke+("ta'aan
SSD En%$'rin$)$gi ana' Pe*eri'"aan %an tera+i 1. Cr$5n RS. T,e t,r$i%. Da)a*6 Cr$$' >7D/ >)at$n PE/ Cr$5n RS/ +en(nting. Cr$$'" 9)ini9a)+e%iatri9 en%$9rin$)$g. E%i"i 'e-<. UK6 Wi)e-C)a9'5e))200?. ,.230-=2. 2. Fi",er DA/ 7r(eter" A. Di"$r%er" $! t,e t,r$i% in t,e ne5&$rn an% in!ant. Da)a*6 S+er)ing MA/+en(nting. Pe%iatri9 en%$9rin$)$g. E%i"i 'e-. P,i)a%e)+,ia6 Sa(n%er"-E)"e;ier200=. ,.1?=-22<. . Lar"en PR/ Da;ie" TF/ Terr FD. H+$t,r$i%i"* an% t,r$i%iti". Da)a*6 Lar"en PR/ Kr$nen&erg HM/Me)*e% S/ P$)$n"' KS/ +en(nting.
Wi))ia*"
tet&$$'
$!
en%$9rin$)$g. E%i"i
'e-10.
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S(ra'arta/ K$*ite Me%i' Wa'i) Ket(a
Ket(a SMF Ana'
Dr. D8$'$ S("iant$/ S+.M NIP.1?33003 1?=12 1 001
Dr.En%ang De5i L/ S+.AK#/ MPH NIP. 1?3?1201 1?=<0 2 00=
Dire't(r RSUD Dr M$e5ar%i
Drg. Ca"$e'i S$etar%8$/ MMR NIP.1?3=101= 1?=<0 1 00?
PANDUAN PRAKTIK KLINIS SMF ILMU KESEHATAN ANAK RSUD Dr. MOEWARDI 2012 - 2014 DIABETES E(ITS TIPE1 Dia&ete" *e)it(" DM# a%a)a, +ena'it *eta&$)i' ang %itan%ai %engan ,i+erg)i'e*ia 'r$ni' a'i&at a%ana gangg(an +a%a "e're"i in"()in/ 'er8a in"()in ata( 'e%(ana. Ha)
ini
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Pengertian De!ini"i#
+an'rea" %a+at ter8a%i a'i&at +r$"e" a(t$i*(n *a(+(n +ene&a& )ain ang ti%a' %i'eta,(i i%i$+ati'#. Ha) ini ti%a' ter*a"(' 'er("a'an -+an'rea" ang %i"e&a&'an $)e, 'ea%aan ',("(" "e+erti 9"ti9 !i&r$"i" %an %e!e' *it$'$n%ria. Se9ara g)$&a) DMT1 %ite*('an +a%a ?0@ %ari "e)(r(, %ia&ete" +a%a ana' %an re*a8a. Di In%$ne"ia in"i%en" ter9atat "e*a'in *ening'at %ari ta,(n 'eta,(n/ ter(ta*a %a)a* 3 ta,(n tera',ir. B(*)a, +en%erita &ar( *ening'at %ari
2.
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4.
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Pe*eri'"aan !i"i'
Kriteria %iagn$"i"
2 $rang +er ta,(n %i ta,(n 2003 *en8a%i 4= $rang +er ta,(n %i ta,(n 200?. 1. P$)i%i+"i 2. P$)i(ri . P$)i!agi 4. Pen(r(nan &erat &a%an ang nata %a)a* 5a't( 2-< *ingg( %i"ertai 3. 1. 2. . 4. 3. <. . =. ?. 1. 2. . 4.
'e)(,an )ain ang ti%a' "+e"i!i' M(%a, )e)a, P$)i%i+"i P$)i(ri P$)i!agi Pen(r(nan &erat &a%an 'r$ni' Irrita&)e %an +en(r(nan +re"ta"i "e'$)a, In!e'"i '()it &er()ang Kan%i%ia"i" ;agina ter(ta*a +a%a ana' 5anita +re+(&erta" 7aga) t(*&(, Cer&e%a %engan DMT2 ang &ia"ana 9en%er(ng ge*('/ ana'-ana' DMT1 &ia"ana '(r(" Ana*ne"i" Pe*eri'"aan Fi"i' Ka%ar g()a %ara, "e5a't( 200 *g%L 11/1 **$)L# Ka%ar g()a %ara, +(a"a 12< *g%L ang %i*a'"(% +(a"a a%a)a, ti%a'
a%a a"(+an 'a)$ri "e)a*a = 8a*# 3. Ka%ar g()a %ara, 2 8a* +a"9a t$)eran"i g)('$"a 200 *g%L 11/1 3. <. .
Diagn$"i" Diagn$"i" &an%ing Pe*eri'"aan
**$)L# Dia&ete" *e)it(" ti+e 1 DMT1# - IDDM Dia&ete" *e)it(" ti+e 2 DMT2# - NIDDM 1. Ka%ar g()a %ara, "e5a't(/ 'a%ar g()a %ara, +(a"a/ 'a%ar g()a %ara, 2 8a*
+a"9a t$)eran"i g)('$"a 2. Ka%ar >-+e+ti%a (nt(' *e)i,at !(ng"i "e) re"i%( ait( "e) ang *a"i, *e*+r$%('"i in"()in %a+at %ig(na'an a+a&i)a "()it *e*&e%a'an %ia&ete"
+en(n8ang
ti+e 1 %an 2. . H&A19 %i)a'('an r(tin "etia+ &()an. Pe*eri'"aan H&A19 &er*an!aat (nt(' *eng('(r 'a%ar g('$"a %ara, "e)a*a 120 ,ari ang )a)( "e"(ai ("ia eritr$"it#/*eni)ai +er(&a,an tera+i =-12 *ingg( "e&e)(*na/ %an *eni)ai +engen%a)ian +ena'it DM %engan t(8(an *en9ega, ter8a%ina
=.
Tera+i
'$*+)i'a"i %ia&ete". Dia&ete" *e))it(" ti+e 1 *e*er)('an +eng$&atan "e(*(r ,i%(+. Ke+at(,an %an 'eterat(ran +eng$&atan *er(+a'an '(n9i 'e&er,a"i)an. Prin"i+ Tata)a'"ana6 1. 2. . 4. 3. 1.
Pe*&erian in"()in Pengat(ran *a'an O)a,raga E%('a"i Home monitoring +e*ant(an *an%iri# Pem!erian insulin - Har(" %i+er,ati'an6 8eni"/ %$"i"/ 'a+an +e*&erian/ 9ara +en(nti'an
-
"erta +eni*+anan. Beni" in"()in &er%a"ar )a*a ()tra+en%e'/
+en%e'/*enenga,/
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-
(*&i)i'(" "e9ara &ergantian. In"()in re)ati! "ta&i) +a%a "(,( r(angan a"a) ti%a' ter+a+ar +ana" ang &er)e&i,an. In"()in "e&ai'na %i"i*+an %i %a)a* )e*ari e" +a%a "(,( 4-= 0> &('an %a)a* !reeer. P$ten"i in"()in &ai' %a)a* ;ia) ata( +en!i)) ang te)a, %i&('a/ *a"i, &erta,an &()an &i)a %i"i*+an %i
)e*ari e" "ete)a, *e)e5ati *a"a ter"e&(t in"()in ,ar(" %i&(ang. 2. Pen+aturan makan - T(8(an6 *en9a+ai '$ntr$) *eta&$)i' ang &ai'/ tan+a *enga&ai'an 'a)$ri ang %i&(t(,'an (nt(' *eta&$)i"*e &a"a)/ +ert(*&(,an/ +(&erta" ata(+(n (nt(' a'ti;ita" ang %i)a'('an. - B(*)a, 'a)$ri ang %i&(t(,'an6 1000 ("ia ta,(n# 100# 'a)$ri +er ,ari. K$*+$"i"i 'a)$ri ang %ian8(r'an a%a)a, <0-<3@ &era"a) %ari 'ar&$,i%rat/ 23@ &era"a) %ari +r$tein %an "(*&er energi %ari
-
)e*a' 0@. Ba%5a)6 'a)i *a'an (ta*a %an 'a)i *a'anan 'e9i). Ti%a' a%a +engat(ran *a'an ',("(" ang %ian8(r'an +a%a ana'/ teta+i +e*&erian *a'anan ang *engan%(ng &ana' "erat "e+erti &(a,/ "a(ran/ %an "erea) a'an *e*&ant( *en9ega, )$n8a'an 'a%ar g)('$"a
%ara,. 3. Ola"ra+a - O)a,raga ti%a' *e*+er&ai'i '$ntr$) *eta&$)i'/ a'an teta+i *e *&ant( *ening'at'an 8ati%iri ana'/ *e*+erta,an'an &erat &a%an i%ea)/ *ening'at'an
'a+a"ita"
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-
%$"i" in"()in. A"(+an 9airan +er)( %iting'at'an "e&e)(*/ "ete)a,/ %an "aat $)a,raga
4. Edukasi - Per8a)anan +ena'itna %an tin%a' )an8(t. - K$*+)i'a"i +ena'it %an +eng$&atanna. - Min(* $&at terat(r %an !$))$5 (+ r(tin. - Men8e)a"'an tata)a'"ana "e)an8(tna. . Home monitoring pemantuan mandiri O)e, 'arena DM ti+e 1 *er(+a'an +ena'it 'r$ni' %an *e*er)('an
+eng$&atan "e(*(r ,i%(+/ *a'a +a"ien "erta 'e)(argana ,ar(" %a+at *e)a'('an +e*anta(an 'a%ar g)('$"a %ara, "erta +ena'itna %i r(*a,. Ha) ini %i+er)('an 'arena "angat *en(n8ang (+aa +en9a+aian n$r*$g)i'e*ia. Pe*anta(an %a+at %i)a'('an "e9ara )ang"(ng %ara,#. Dia&ete" *e))it(" ti+e 1 *er(+a'an "(at( )i!e )$ng %i"ea"e. Ke&er,a"i)an (nt(' *en9a+ai n$r*$g)i'e*ia "angat &ergant(ng %ari 9ara %an gaa ,i%(+ +en%erita'e)(arga ata( %ina*i'a 'e)(arga "e,ingga +engen%a)ian (ta*a *eta&$)i' ang i%ea) tergant(ng +a%a +en%erita "en%iri. E%('a"i %a)a* ,a) ini
?.
E%('a"i
10. 11. 12. 1 14 13
1. Per8a)anan +ena'itna %an tin%a' )an8(t. 2. K$*+)i'a"i +ena'it %an +eng$&atanna. . Min(* $&at terat(r %an !$))$5 (+ r(tin. 4. Men8e)a"'an tata)a'"ana "e)an8(tna. Pr$gn$"i" Cai' Ting'at e;i%en" III Ting'at re'$*en%a"i C Pene)aa, 'riti" SSD En%$'rin$)$gi ana' In%i'at$r *e%i" Pe*eri'"aan %an tera+i Ke+("ta'aan 1. UKK En%$'rin$)$gi Ana' %an Re*a8a IDAI. Data regi"tra"i %ia&ete" *e))it("
*e)i+(ti 6
ti+e 1 ta,(n 200?. 2. UKK En%$'rin$)$gi Ana' %an Re*a8a IDAI. K$n"en"(" na"i$na) +enge)$)aan
%ia&ete" *e))it(" ti+e-1 %i In%$ne"ia. Ba'arta6 PP IDAI 200?. . A*eri9an Dia&ete" A""$9iati$n. T+e 2 %ia&ete" in 9,i)%ren an% a%$)e"9ent". Dia&ete" >are. 200026=1-?. 4. Cang"ta% HB. In"()in treat*ent. Pe%iatr Dia&et. 2006=6==:102. 3. A("tra)ian Pae%iatri9 En%$9rine 7r$(+. >)ini9a) +ra9ti9e g(i%e)ine"6 t+e 1 %ia&ete" in 9,i)%ren an% a%$)e"9ent". A("tra)ian 7$;ern*ent : Nati$na) Hea)t, an% Me%i9a) Re"ear9, >$(n9i) 2003. <. S+er)ing MA. Dia&ete" Me))it(". Da)a*6 S+er)ing MA/ +en(nting. Pe%iatri9 en%$9rin$)$g. P,i)a%e)+,ia6 Sa(n%er" 2002. ,. 2-<0. . Nan9 A>/ La5ren9e MD. De!initi$n/ %iagn$"i"/ an% 9)a""i!i9ati$n $! %ia&ete" in $(t,. Da)a*6 Da&e)ea D/ B K)ingen"*it, 7/ +en(nting. E+i%e*i$)$g $! +e%iatri9 an% a%$)e"9ent %ia&ete". Ne5 $r'6 In!$r*a Hea)t,9are 200=. ,.1-1?. =. >raig ME. ISPAD >)ini9a) +ra9ti9e 9$n"en"(" g(i%e)ine" 200<:2006 %e!initi$n/ e+i%e*i$)$g/ an% 9)a""i!i9ati$n. Pe%iatr Dia&et. 200<64: 31.
S(ra'arta/ K$*ite Me%i' Wa'i) Ket(a
Ket(a SMF Ana'
Dr. D8$'$ S("iant$/ S+.M NIP.1?33003 1?=12 1 001
Dr.En%ang De5i L/ S+.AK#/ MPH NIP. 1?3?1201 1?=<0 2 00=
Dire't(r RSUD Dr M$e5ar%i
Drg. Ca"$e'i S$etar%8$/ MMR NIP.1?3=101= 1?=<0 1 00?
PANDUAN PRAKTIK KLINIS SMF ILMU KESEHATAN ANAK RSUD Dr. MOEWARDI 2012 - 2014 K%ISIS AD%E&A(5$IPE%P(ASIA AD%E&A( KO&'E&ITA( Kri"i"
a%rena)
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Pengertian De!ini"i#
'e&(t(,an !i"i$)$gi" ter,a%a+ ,$r*$n ter"e&(t *e)e&i,i 'e*a*+(an 'e)en8ar a%rena) (nt(' *eng,a"i)'an ,$r*$n ter"e&(t/ ait( +a%a +en%erita %engan 'e'(rangan ,$r*$n 'e)en8ar a%rena) ang 'r$ni" ang ter'ena "tre"" ata( +ena'it. Kri"i" a%rena) 8(ga "ering %ite*('an +a%a +en%erita ,i+er+)a"ia a%rena) '$ngenita) a'i&at %e!i"ien"i eni* 21-,i%r$'"i)a"e ti+e "a)t 5a"ting 3@ 'a"("# ang &i"a &er(8(ng +a%a 'e*atian 8i'a ti%a'
2.
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.
Pe*eri'"aan !i"i'
)a'i 10. Pert(*&(,an tinggi &a%an ang ter)a)( 9e+at 11. Warna '()it ang "e*a'in *eng,ita* 1. Hi+$ter*ia,i+erter*ia 2. 7enita)ia a*&ig(" +a%a &ai +ere*+(an . Pa%a &ai )a'i-)a'i ga*&aran ')ini"na ti%a' &egit( 8e)a". Sering'a)i %ite*('an +e*&e"aran +eni" a'i&at ;iri)i"a"i %an ,i+er+ig*enta"i +a%a %aera, "'r$t(* a'i&at "e're"i A>TH &er)e&i,an/ na*(n ga*&aran 4. 3. <. . =.
')ini" ini "ering ter)e5at'an Letargi Kea%aan (*(* &(r(' Ke"a%aran *en(r(n Ke8ang Pa%a ti+e salt asting 6 +$)i(ria/ %e,i%ra"i/ ,i+$ten"i/ "$' Hi+$ten"i/
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a'"i)a/ %an --ra*&(t %e5a"a )ainna/ a'ne/ &a( &a%an %e5a"a. 10. P,a)(" ang *e*&e"ar6 ')it$r$*ega)i +a%a ana' +ere*+(an/ +ert(*&(,an +eni" ang ter)a)( 9e+at +a%a ana' )a'i-)a'i tan+a %i"ertai +ening'atan ;$)(*e te"ti". 11. Hi+er+ig*enta"i "e)ain +a%a %aera, are$)a %an "'r$t(* 8(ga +a%a &agian e'"ten"$r +er"en%ian/ *('$"a %an g("i. Ha) ini a'i&at "e're"i A>TH ang &er)e&i,an. 12. A'"e)era"i +ert(*&(,an )inier/ ata( gaga) t(*&(, %an gii &(r(' !ai)(re
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HAK
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%ita*&a,'an &i)a %i%a+at'an ,i+$g)i'e*ia Hi%r$'$rti"$n "('"inat %$"i" "tre""# 30-3 *g*2 &$)(" intra;ena/ "e)an8(tna 300-3 *g*2,ari intra;ena %i&agi *en8a%i 4 %$"i". Bi'a
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