2. Patient Identity
• Name : Mrs. HM
• Age : 40 years old
• Sex : Female
• Occupation : House Wife
• Education : Senior High School
3. A 40 year-old Woman was admitted to R.D.
Kandou Hospital at IMC ward on
September, 26th 2022
Chief complaint: shortness of breath
4. Present Medical History
• The patient was referred from Wahyu Slamet Bitung Navy hospital
and was admitted this morning with complaints of shortness of
breath since last night, which initially along with cough and fever.
• Cough was felt 3 days ago without any sputum and bloody strep
• Also, the patient has felta fever three days ago before
hospitalised. The fever went down with an antipyretic drug and
went up again
• Nausea (+), vomit (-)
• Currently, there was no complaints of urine and defecation
5. Past Medical History
• The patient and family has denied a history of T2DM,
hypertension, renal disease, heart disease
29. Problem List
• DKA
• Septic shock ec pneumonia
• Pneumonia with ARDS recovery
• Partly compensated metabolic acidosis
• Hyponatremia
• AKI dd/ CKD
30. no Problem list Pharmacological and Non
Pharmacological Intervention
Output and Outcome
1. DKA IVFD NaCl 0.9% 500 ml/8 hours, change
D5% 500cc / 8 hours if RBG <200.
IVFD Novorapid 50 unit in NaCl 0.9% 50
ml (titrasi doses)
IVFD KCL 50 meq drips in NaCl 0.9%
500 ml/6 hours KCL 25 meq drips in
NaCl 0.9% 500 ml/6 hours
Monitoring urine output/24 bours
Monitoring blood glucose/hour
Check Na/K/Cl, BGA, urinalysis/6 hours
Check HbA1C, lipid profile
Consult ICU —> the patient and family
were refusing to intubate
Titrate with target decrease 50-
75 mg/dl per hour. Target 140-
200 mg/dl
Diagnostic
Care Plan
31.
32. no Problem list Pharmacological and Non
Pharmacological Intervention
Output and Outcome
2. Septic shock ec
pneumonia
IVFD Norepinefrin 80 mg in NaCl 0.9%
100 ml, doses titrasi according BP
(STOP)
MAP <65 mmHg
Care Plan
33.
34. no Problem list Pharmacological and Non
Pharmacological Intervention
Output and Outcome
3. Pneumonia with ARDS
improved
Oxygen adequate
Levofloxacin 1x750 mg IV ST
Paracetamol 3x500 mg via NGT
SpO2 >96%
WBC 4000-10000
Fever (-) T 36.0-37.5
Care Plan
35. no Problem list Pharmacological and Non
Pharmacological Intervention
Output and Outcome
4. Partly Compensated
Metabolic acidosis
BGA/6 hours PH 7.35-7.45
HCO3 22-26
PCO2 35-45
Diagnostic
Care Plan
36.
37. no Problem list Pharmacological and Non
Pharmacological Intervention
Output and Outcome
5. Hyponatremia IVFD NaCl 0.9% 500cc/8 hours
Check Na, K, Cl control/6 hours
Na 135-153
Diagnostic
Care Plan
38. Natrium Correction
– Na deficit: (135-119)x0.5x50 = 400 meq
– Na daily: 2-3 meq/kgBB = 100 -150 meq
– Total Na = 500 – 550 meq
– Max Na / day = 8x0.5x50 = 200 meq
– NaCl 0,9% = 200/154 *1000 = 1.298 ml/day
– Duration = 550/200 x 24 hours = 66 hours
– Osmolality = 2 x 119 + (976/18) + (68/6) = 292
40. no Problem list Pharmacological and Non
Pharmacological Intervention
Output and Outcome
6. AKI dd/ CKD. IVFD NaCl 0.9% 500 ml/8 hours
Monitoring urine output/24 hours
Urinalysis/6 hours
Rehydrate
UO 0.5-1cc/kgbw/day
Diagnostic
Care plan
41.
42.
43.
44.
45. Conclusion
• Has been reported the case of a 40-year-old woman who
was admitted to R. D. Kandou Hospital at IMC ward with
the chief complaint of shortness of breath. After a
thorough history-taking, physical examination, and
laboratory-radiology workup, patient was diagnosed with
DKA, Septic shock ec pneumonia, Pneumonia with ARDS
recovery, Partly compensated metabolic acidosis,
Hyponatremia, AKI dd/ CKD
