Hipoglikemia Persisten pada Pasien Non-Diabetes dalam Kondisi Kritis: Mengungkap Penyebab yang Tidak Terkait dengan Insulin — Laporan Kasus
Laporan Kasus
DOI:
https://doi.org/10.55175/cdk.v53i08.1864Kata Kunci:
Laporan kasus, penyakit kritis, hipoglikemia, hipoglikemia non-insulinAbstrak
Pendahuluan: Hipoglikemia jarang terjadi pada pasien tanpa riwayat diabetes melitus, namun kondisi kritis dapat memicunya melalui gangguan glukoneogenesis dan deplesi cadangan glikogen di hati. Ketika hipoglikemia terjadi tanpa riwayat terapi insulin ataupun diabetes, identifikasi penyebab yang mendasarinya menjadi tantangan diagnostik tersendiri. Kasus: Seorang laki-laki berusia 56 tahun datang dengan penurunan kesadaran yang disebabkan oleh hipoglikemia berat (glukosa 42 mg/dL). Pasien memiliki riwayat kanker prostat stadium IV yang dicurigai bermetastasis dengan PSA yang meningkat secara signifikan sebesar 930,8 ng/mL, anemia berat (Hb 4,9 g/dL), transaminitis (AST 108 U/L), dan HbA1c normal 4,7% tanpa riwayat diabetes melitus. Selama perawatan, pasien juga didiagnosis dengan infeksi saluran kemih berkomplikasi dan pneumonia didapat di rumah sakit (hospital-acquired pneumonia). Pada hari ketiga, hipoglikemia yang persisten berulang muncul meskipun telah diberikan suplementasi glukosa. Pada hari kelima, kondisi pasien memburuk menjadi gagal napas tipe 2 yang memerlukan perawatan di ICU, dan pasien kemudian meninggal dunia. Pembahasan: Hipoglikemia persisten pada pasien ini kemungkinan disebabkan oleh berbagai faktor, yang melibatkan mekanisme terkait tumor, kondisi kritis disertai infeksi, disfungsi hati, dan malnutrisi berkepanjangan, sedangkan nilai HbA1c yang normal dan tidak adanya glikosuria menyingkirkan kemungkinan adanya diabetes melitus dan kehilangan glukosa melalui ginjal sebagai penyebab mendasar. Simpulan: Laporan kasus ini menegaskan bahwa hipoglikemia persisten pada pasien kritis non-diabetik merupakan kondisi yang penting secara klinis namun sering luput dari perhatian diagnostik. Pendekatan multifaktorial - mencakup mekanisme terkait keganasan, disfungsi hati, sepsis, dan deplesi nutrisi - sangat diperlukan untuk pengenalan dini dan tata laksana yang tepat.
Unduhan
Referensi
Mathew P, Thoppil D. Hypoglycemia [Internet]. 2022 [cited 2024 Oct]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534841/.
Cryer PE. Hypoglycemia in type 1 diabetes mellitus. Endocrinol Metab Clin North Am. 2010;39(3):641–54. doi: 10.1016/j.ecl.2010.05.003.
Donnelly LA, Morris AD, Frier BM, Ellis JD, Donnan PT, Durrant R, et al. Frequency and predictors of hypoglycaemia in type 1 and insulintreated type 2 diabetes: a population-based study. Diabet Med. 2005;22(6):749–55. doi: 10.1111/j.1464-5491.2005.01501.x.
Marks V, Teale JD. Drug-induced hypoglycemia. Endocrinol Metab Clin North Am. 1999;28(3):555–77. doi: 10.1016/s0889-8529(05)70088-8.
Koch CA, Petersenn S. Black swans - neuroendocrine tumors of rare locations. Rev Endocr Metab Disord. 2018;19(2):111–21. doi: 10.1007/s11154-018-9473-0.
Gosmanov AR, Gosmanova EO, Kovesdy CP. Evaluation and management of diabetic and non-diabetic hypoglycemia in end-stage renal disease. Nephrol Dial Transplant. 2016;31(1):8–15. doi: 10.1093/ndt/gfv258.
Rayas MS, Salehi M. Non-diabetic hypoglycemia [Internet]. 2024 [cited 2024 Oct]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK355894/.
Bagshaw SM, Bellomo R, Jacka MJ, Egi M, Hart GK, George C. The impact of early hypoglycemia and blood glucose variability on outcome in critical illness. Crit Care. 2009;13(3):R91. doi: 10.1186/cc7921.
Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97. doi: 10.1056/NEJMoa0810625.
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345(19):1359–67. doi: 10.1056/NEJMoa011300.
Ben-Ami H, Nagachandran P, Mendelson A, Edoute Y. Drug-induced hypoglycemic coma in 102 diabetic patients. Arch Intern Med. 1999;159(3):281–4. doi: 10.1001/archinte.159.3.281.
Von Mach MA, Meyer S, Omogbehin B, Kann PH, Weilemann LS. Epidemiological assessment of 160 cases of insulin overdose recorded in a regional poisons unit. Int J Clin Pharmacol Ther. 2004;42(5):277–80. doi: 10.5414/cpp42277.
Lacherade JC, Jacqueminet S, Preiser JC. An overview of hypoglycemia in the critically ill. J Diabetes Sci Technol. 2009;3(6):1242–9. doi:10.1177/193229680900300603.
Wilder RM, Allan FN, Power MH, Robertson HE. Carcinoma of the islands of the pancreas. JAMA. 1927;89(5):348–55. doi: 10.1001/jama.1927.02690050014007.
Service FJ, McMahon MM, O'Brien PC, Ballard DJ. Functioning insulinoma-incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc. 1991;66(7):711–9. doi: 10.1016/s0025-6196(12)62083-7.
Kittah NE, Vella A. Management of endocrine disease: pathogenesis and management of hypoglycemia. Eur J Endocrinol. 2017;177(1):R37–47. doi: 10.1530/EJE-16-1062.
Daughaday WH, Emanuele MA, Brooks MH, Barbato AL, Kapadia M, Rotwein P. Synthesis and secretion of insulin-like growth factor II by a leiomyosarcoma with associated hypoglycemia. NEJM. 1988;319(22):1434–40. doi: 10.1056/NEJM198812013192202.
Daughaday WH, Kapadia M. Significance of abnormal serum binding of insulin-like growth factor II in the development of hypoglycemia in patients with non-islet-cell tumors. Proc Natl Acad Sci USA. 1989;86(17):6778–82. doi: 10.1073/pnas.86.17.6778.
Fukuda I, Hizuka N, Ishikawa Y, Yasumoto K, Murakami Y, Sata A, et al. Clinical features of insulin-like growth factor-II producing non-islet-cell tumor hypoglycemia. Growth Hormone IGF Res. 2006;16(4):211–6. doi: 10.1016/j.ghir.2006.05.003.
de Groot JWB, Rikhof B, Van Doorn J, Bilo HJG, Alleman MA, Honkoop AH, et al. Non-islet cell tumour-induced hypoglycaemia: a review of the literature including two new cases. Endocrine-related Cancer. 2007;14(4):979–93. doi: 10.1677/ERC-07-0161.
Iglesias P, Diez JJ. Management of endocrine disease: a clinical update on tumor-induced hypoglycemia. Eur J Endocrinol. 2014;170(4):R147–57. doi:10.1530/EJE-13-1012.
Vihonen H, Kuisma M, Nurmi J. Hypoglycaemia without diabetes encountered by emergency medical services: a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2018;26(1):12. doi: 10.1186/s13049-018-0480-7.
Sako A, Yasunaga H, Matsui H, Fushimi K, Hamasaki H, Katsuyama H, et al. Hospitalization with hypoglycaemia in patients without diabetes mellitus: a retrospective study using a national inpatient database in Japan, 2008–2012. Medicine (Baltimore). 2017;96(25):e7271. doi:10.1097/MD.0000000000007271.
Kayambankadzanja RK, Schell CO, Gerdin Wanberg M, Tamras T, Mollazadegan H, Holmberg M, et al. Towards definitions of critical illness and critical care using concept analysis. BMJ Open. 2022;12(9):e060972. doi: 10.1136/bmjopen-2022-060972.
Kandaswamy L, Raghavan R, Pappachan JM. Spontaneous hypoglycaemia: diagnostic evaluation and management. Endocrine 2016;53(1):47–57. doi: 10.1007/s12020-016-0902-0.
Wang J, Zhu CK, Yu JQ, Tan R, Yang PL. Hypoglycemia and mortality in sepsis patients: asystematic review and meta-analysis. Heart Lung. 2021;50(6):933–40. doi: 10.1016/j.hrtlng.2021.07.017.
Maitra SR, Wojnar MM, Lang CH. Alterations in tissue glucose uptake during the hyperglycemic and hypoglycemic phases of sepsis. (J). Shock 2000;13(5):379–85. doi: 10.1097/00024382-200005000-00006.
Tsujimoto T, Yamamoto-Honda R, Kajio H, Kishimoto M, Noto H, Hachiya R, Kimura A, et al. Prediction of 90-day mortality in patients without diabetes by severe hypoglycemia: blood glucose level as a novel marker of severity of underlying disease. Acta Diabetol. 2015;52(2):307–14. doi: 10.1007/s00592-014-0640-9.
Gonzalez F, Roshan R, Levene R, Miskin B, Vazquez N. Management of severe hypoglycemia at the end of life in non-diabetic patients: a case study and recommendations. J Med Cases. 2015;6(9):413–6. doi:10.14740/jmc2260w.
Unduhan
Diterbitkan
Cara Mengutip
Terbitan
Bagian
Lisensi
Hak Cipta (c) 2026 Kadek Mercu Narapati Pamungkas, I Ketut Suryana
Artikel ini berlisensi Creative Commons Attribution-NonCommercial 4.0 International License.
