ABSTRACT

Improving Timely Detection and Management of Shock Septic with

Chronic Kidney Disease and Diabetic Mellitus
Cerah Purba, Funny Chandra
Intensive Care Unit Sahid Sahirman Memorial Hospital

Background :
Infection is a major cause of mortality in Chronic Kidney Disease (CKD). Pneumonia is one
of the most common sources of infection morbidities in CKD. Microbial infection may result
in bacteremia, trigging exaggerated inflammation and sepsis. Sepsis is a life threatening
organ dysfunction caused by a dysregulation host response to infection. Septic shock is
defined as a subset of sepsis in which underlying circulatory and cellular metabolism
abnormalities are profound enough to substantially increase mortality. It has been widely
reported that reducing the time to diagnosis of sepsis is a critical component of reducing
mortality from sepsis related multiple organ dysfunction. In Indonesia’s incidence of sepsis
is still high 8,7 to 30,29% with death rate 11,56 to 49,9%. Quick Sequential [Sepsis-
related] Organ Failure Assessment (qSOFA) is can be represented as organ dysfunction.
qSOFA provides simple bedside criteria because is better known and simple to identify
patient with suspected infection.

Objective :
The aim of this case report is to describe early detection and management of sepsis.

Case :
Male 55 years old was entered to ICU with decrease of consciousness. Had been
complaint continuous cough with greenish yellow sputum for three days. A history of fever.
A hemodialysis patient. Awareness somnolent with TD 84/43 mmHg, HR 125x/min, RR 30
x/min, Sat.O2 88%, Temp 37,3C with cold peripheral and oliguria. Thorax rhonchi +/+,
wheezing -/-, slam +. Cor regular heart sound, murmur (-). Laboratory examination founds
Hb 11,5 g/dL, leucocytosis 13.200/uL, Ur/Cr 65/2,46 mg/dL, AST/ALT 129/140 U/L, PCT
2,21 ng/mL, lactate acid 3,7 mmol/L, BGA acidosis metabolic, ECG sinus tachycardia,
imaging showed : bronchopneumonia with lungs edema and pleural effusion bilateral.

Discussion
Patient treated in ICU with ventilator installation, colloid administration in rapid infusion,
vasopressor, antibiotics, feeding diet, fluid balance, urine output observation. The patient's
hemodynamic state was stable, increased Ur/Cr 87/3.12 mg/dL and planned hemodialysis.
Found improvement of bronchopneumonia from imaging, Ur/Cr has begun to decline
94/0,7, leukocytes had fallen by 11.000/uL. Planned extubation on 5th day, hemodynamic
patient stabilized with spontaneous breath after extubation and given oxygen with nasal
cannula 2 L/min, and on 7th day planned to moved into ward after hemodialysis.

Conclusion :
Early detection of sepsis and septic shock followed by rapid and proper resuscitation and
management will results in good outcomes. After treatment in ICU 7 days, the patient
moved into the ward. There has therefore been increasing pressure for front line staff in all
departments to ensure rapid detention and management of patient with chronic disease
and suspected sepsis.