Laporan Kasus: PPOK Eksaserbasi Akut Grup E disertai Diabetes Melitus Tipe II dan Infeksi Saluran Kemih pada Pasien Geriatri
DOI:
https://doi.org/10.53366/jimki.v12i3.1039Keywords:
Asidosis Metabolik, Eksaserbasi Akut, Infeksi Saluran Kemih, Geriatri, PPOK Grup E,Abstract
Pendahuluan: Pemicu sistemik non-respirasi pada eksaserbasi akut PPOK (AECOPD) sering terabaikan. Laporan ini membahas manajemen kompleks PPOK Grup E eksaserbasi akibat Infeksi Saluran Kemih (ISK) disertai krisis metabolik.
Ilustrasi Kasus: Laki-laki 73 tahun, riwayat PPOK, datang dengan sesak memberat dan disuria. Pemeriksaan menunjukkan malnutrisi berat (IMT 15,2 kg/m²), wheezing, hiperglikemia, hiponatremia, dan asidosis metabolik terkompensasi. Diagnosis ditegakkan sebagai AECOPD Grup E dipicu ISK, DM Tipe II baru, dan malnutrisi. Terapi meliputi antibiotik, kortikosteroid, bronkodilator, insulin, dan cairan. Perbaikan klinis signifikan respirasi dan urinaria tercapai pada hari ketiga.
Diskusi: Kasus ini menunjukkan ISK sebagai pemicu eksaserbasi melalui inflamasi sistemik. Temuan asidosis metabolik dengan pCO2 rendah mengindikasikan kompensasi sepsis, bukan retensi CO2 klasik. Tantangan terapeutik meliputi penyeimbangan kortikosteroid dengan kontrol gula darah ketat, serta intervensi nutrisi untuk memutus lingkaran setan antara malnutrisi dan kegagalan napas.
Simpulan: Deteksi pemicu non-respirasi seperti ISK dan koreksi gangguan metabolik krusial pada manajemen AECOPD geriatri. Pendekatan multidisiplin diperlukan untuk mengoptimalkan luaran klinis.
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