Laporan Kasus Silent Hypoxemia pada Penderita COVID-19 dengan Komorbid Diabetes Melitus

Abstract

Coronavirus disease 2019 atau COVID-19 menjadi pandemi yang masih menjadi ancaman global sampai saat ini. Gejala klinis bervariasi mulai dari demam, batuk, lemas, mialgia, dan diare. Derajat keparahannya pun bervariasi dari asimptomatik, gejala ringan, sampai gejala berat. Hipoksemia pun menjadi tanda prognosis buruk pada pasien COVID-19. Namun, banyak penderita COVID-19 datang dengan kandungan oksigen yang sangat rendah tetapi tanpa ada keluhan sesak. Kejadian tersebut sering disebut silent hypoxemia. Kejadian ini berhubungan dengan hiperkoagulasi yang dapat diperberat dengan komorbid penderita, salah satunya diabetes melitus. Pada laporan kasus ini, seorang wanita usia 47 tahun datang ke Instalasi Gawat Darurat Rumah Sakit Hermina Grand Wisata dengan keluhan demam sejak 5 hari sebelum masuk rumah sakit. Keluhan disertai batuk, mual, pusing, dan lemas, tetapi tanpa sesak. Pemeriksaan fisik didapatkan kesadaran kompos mentis dengan tekanan darah 120/70 mmHg, frekuensi nadi 120 kali per menit, frekuensi napas 21 kali per menit, suhu 37.8⁰C, dan saturasi oksigen perifer 67% dengan suplemen oksigen nasal kanul 4 liter per menit. Pasien ditatalaksana ventilasi mekanik setelah pemberian non-rebreathing mask 15 liter per menit tidak menunjukkan perbaikan. Hasil pemeriksaan swab PCR untuk COVID-19 positif, disertai dengan d-dimer 1.2 dan HbA1C 8.2. Pasien ditatalaksana antikoagulan enoxaparin sejak awal admisi. Pada hari kelima perawatan hasil pemeriksaan foto toraks ulang menunjukkan perbaikan, tetapi pemeriksaan d-dimer ulang menunjukkan hasil d-dimer meningkat menjadi 1.8. Silent hypoxemia pada penderita COVID-19 dengan komorbid diabetes melitus menunjukkan kondisi hiperkoagulasi yang sulit ditangani.

Kata Kunci: COVID-19; silent hypoxemia, diabetes, hiperkoagulasi

Coronavirus disease 2019 or COVID-19 became pandemy and still be a global threat. Symptoms varies from fever, cough, fatigue, myalgia, and diarrhea. Severity of the disease also varies from asymptomatic, mild, to severe disease. Hypoxemia is a sign of poor prognosis in COVID-19 patients. Unfortunately, many patients were admitted with very low blood oxygen content but without dyspnea symptom. This event is called silent hypoxemia. This event also related to hypercoagulation which is intensified by patient’s comorbidities, such as diabetes melitus. In this case report, a forty-seven years old woman was admitted to Emergency Department in Grand Wisata Hermina Hospital. The patient complained fever since 5 days before admission. Fever was accompanied by cough, nausea, dizziness, and fatigue. But, there was no dyspnea complained by patient. Patient was alerted with blood pressure 120/70mmHg, pulse rate 120 per minute, respiratory rate 21 per minute, temperature 37.8C, and peripheral oxygen saturation 67% with 4 litre per minute with nasal cannule. The patient was admitted with mechanical ventilation after therapy with 15 liter per minute with non-rebreathing mask show no sign of improvement. The patient was positive for COVID-19 after PCR swab test in a day after admission, with d-dimer result was 1.2 and HbA1C is 8.2. Patient was already given enoxaparin as anticoagulant in time of admission. In 5^th day after admission, thorax photo showed improvement but d-dimer showed worsening result as the result increase from 1.2 to 1.8. Silent hypoxemia in COVID-19 patient with diabetes melitus as comorbidity shows hypercoagulation which is hard to control.

Key words: COVID-19; silent hypoxemia, diabetes, hypercoagulation