Terapi Pengganti Ginjal pada Sepsis disertai dengan Status Hiperosmolar Hiperglikemia dan Cedera Ginjal Akut
Acute kidney injury was a complication recently occurred in critical ill patients of ICU. A 64-years-old man came to emergency department with chief complain of lump originated at colli dextra accompanying with difficult of breathing symptom. Patient was diagnosed with septic shock due to deep neck abcess complicated with AKI and uremic encephalopathy, diabetes mellitus type 2 with hyperosmolar hyperglycemia state. Patient was treated to manage dehydration, high blood glucose, and source control of infection, then patients was transferred to ICU with support of mechanical ventilator. The major problem of this patient were decrease of consciousness and difficulty in treating AKI stage because there were increase in serum ureum and creatinine level even though urine production was excessive. Patients condition was improved and could be extubated after performing renal replacement therapy on the sixth day. On patient with sepsis and AKI, renal replacement therapy was one of the modalities considered to support management in critically ill patients in ICU.
Cedera ginjal akut atau Acute Kidney Injury (AKI) merupakan komplikasi yang sering terjadi pada pasien kritis di ICU. Pada kasus ini, seorang laki-laki 64 tahun dibawa ke IGD RS Hasan Sadikin dengan keluhan benjolan di leher kanan yang terasa nyeri dan disertai sesak nafas. Pasien didiagnosis dengan syok sepsis yang disebabkan abses leher dan diabetes mellitus tipe 2 dengan status hiperosmolar hiperglikemia dengan komplikasi AKI dan ensefalopati uremikum. Pada pasien sudah dilakukan rehidrasi, regulasi gula darah, insisi drainase abses dalam anestesi umum, dan selanjutnya dilakukan perawatan di ICU dengan terapi ventilasi mekanik. Permasalahan selama perawatan di ICU adalah kesadaran pasien yang semakin menurun disertai peningkatan ureum dan kreatinin serum, meskipun produksi urin berlebih. Setelah dilakukan terapi pengganti ginjal pada hari ke-6, kesadaran pasien semakin membaik dan dapat dilakukan ekstubasi. Pada pasien dengan sepsis dengan AKI, terapi pengganti ginjal merupakan salah satu modalitas yang perlu dipertimbangkan untuk menunjang perawatan di ICU.
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