Hubungan Terapi Manitol 20 % dengan Fungsi Ginjal pada Penderita Stroke Perdarahan Intraserebral dengan Peningkatan Tekanan Intrakranial

Abstract

Background : Intracerebral hemorrhage can increase intracranial pressure. Treatment of increased ICP is one of the most important and most common problems. Mannitol has been seen as one of the first choices in the immediate-treatment of increased ICP. The most common complications of mannitol therapy are fluid and electrolyte imbalances, hypersensitivity reactions and might also cause renal failure even in therapeutic doses. However the influence of osmotherapy on renal function in patients treated with mannitol due to increased intracranial pressure was not so far well described. Method : This was a cross sectional study of 39 subjects in Haji Adam Malik General Hospital. Subjects were patients who diagnosed with stroke caused by intracerebral hemorrhage with increasing of intracranial pressure based on neurological examination and head CT scan examination and treated with mannitol 20% dose 0,5 g/kg body weight for 3 days. Renal function were measured before and after mannitol 20% administration. Results : Of 39 patients (21 males, 18 females), mannitol 20% administration showed changes of renal function parameter on the 3rd day. There were increasing of serum creatinine level 0,21+0,51 mg% (p=0,014), increasing of serum ureum level 18,44+25,7 mg% (p=0,000), increasing of serum osmolality 8,64+17,95 mmol/kgH2O (p=0,005) and decreasing of serum sodium level 3,03+6,68 mEq/L (p=0,007). Increasing of serum potassium level and decreasing of serum chloride level were also found (p>0,05). None of patients developed anuria or oliguria. There was decreasing of GFR 14,87+36,42 mL/menit (p=0,015), but none of patients developed acute renal failure. There was a significant relationship between creatinine level and serum osmolality on the 3rd day (r=0,415, p=0,009). Conclusion : Mannitol 20% administration for stroke caused by intracerebral hemorrhage with increasing of intracranial pressure showed changes of serum creatinine, ureum, osmolality and natrium level significantly (p<0.05) and also decreased of glomerular filtration rate (p<0.05)

Latar Belakang : Peningkatan tekanan intrakranial sering terjadi pada penderita stroke perdarahan intraserebral. Penanganan peningkatan tekanan intrakranial merupakan hal yang penting dan manitol 20% telah menjadi salah satu pilihan utama dalam penanganan peningkatan tekanan intrakranial yang cepat. Terapi manitol 20% dapat menyebabkan terjadinya gangguan cairan dan elektrolit, reaksi hipersensitivitas, bahkan gagal ginjal meskipun dalam dosis terapi. Akan tetapi hubungan antara fungsi ginjal dengan pemberian manitol 20% pada peningkatan tekanan intrakranial masih belum jelas diketahui. Metode : Penelitian ini merupakan studi kasus potong lintang dengan 39 subyek yang dilakukan di Rumah Sakit Umum Haji Adam Malik. Subyek merupakan pasien yang didiagnosis dengan stroke perdarahan intraserebral dengan peningkatan tekanan intrakranial berdasarkan pemeriksaan neurologis dan CT scan kepala dan diterapi dengan manitol 20% dosis 0,5 g/kg berat badan selama 3 hari. Kadar kreatinin serum, ureum serum, osmolalitas serum, urin output dan elektrolit serum diperiksa sebelum dan setelah pemberian manitol 20%. Hasil : Dari 39 penderita (21 pria, 18 perempuan), selama pemberian manitol 20% ditemukan perubahan kadar parameter fungsi ginjal pada hari ke-3 setelah pemberian manitol 20%. Terdapat peningkatan kadar kreatinin serum 0,21+0,51 mg% (p=0,014), peningkatan kadar ureum serum 18,44+25,7 mg% (p=0,000), peningkatan kadar osmolalitas serum 8,64+17,95 mmol/kgH2O (p=0,005) dan penurunan kadar natrium serum 3,03+6,68 mEq/L (p=0,007). Selain itu, juga terdapat peningkatan kadar kalium serum dan penurunan kadar klorida serum (p>0,05). Tidak subyek yang mengalami anuria maupun oliguria. Terdapat penurunan GFR 14,87+36,42 mL/menit (p=0,015), namun tidak ada subyek yang mengalami gagal ginjal. Terdapat korelasi positif lemah yang signifikan antara kreatinin serum dengan osmolalitas serum pada hari ketiga setelah pemberian manitol 20% (r=0,415, p=0,009). Kesimpulan : Pemberian manitol 20% pada penderita stroke perdarahan intraserebral dengan peningkatan TIK menunjukkan adanya perbedaan kadar kreatinin, ureum, osmolalitas dan natrium serum secara signifikan (p<0,05) serta penurunan GFR (p<0,05) dibandingkan dengan sebelum pemberian manitol 20%