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The number of women who have a pre-existing cardiovascular disease (CVD) or develop cardiac problems during pregnancy is increasing, and it is the leading cause of non-obstetric mortality during pregnancy. Heart disease complicates approximately 1–3% of pregnancies and is responsible for 10 to 15% of maternal mortality. The rheumatic heart disease remains the number one worldwide cause of maternal cardiac complications in pregnant. It is important that obstetric, anesthesiologists, cardiologist, remain aware of the disease, its complications and management of valvular lesions throughout the birthing process.

ABSTRACK Introduction: The Hyperosmolar Hyperglycemic State (HHS) is rare case and the most serious acute hyperglycemic emergency in patients with type 2 diabetes, are characterized by severe hyperglycemia, hyperosmolality, and dehydration in the absence of ketoacidosis. Immediately treatment is necessary to reinstate hemodynamic stability, as mortality rates for HHS are exceptionally high and can have multiple complications. Case Presentation: In this case report, a 63-year-old man with a chiefly complaint from the body became weaker. Patients present with compos mentis, blood pressure 100/70 mmHg, regular pulse rate 110 times per minute with sufficient content and respiration 20 times per minute, and temperature 37,90C. Physical examination shows signs of dehydration. Investigation found white blood cell 12.580 103/mm3, plasma glucose 741 mg / dL, and a negative urine ketone. Conclusion: Case has been reported, a 63-year-old man with a diagnosis of HHS, the trigger factor for HHS in these patient are the discovery of infections as bronchopneumonia, elderly, and irregular diabetes treatment. The importance of treatment in this case is because the patient is elderly, treatment must be right because where too rapid rehydration may precipitate heart failure but insufficient may fail to reverse acute kidney injury. Keywords: Diabetes Mellitus, Hyperosmolar Hyperglycemic State, Hyperglycemia   ABSTRAK Latar Belakang : Hyperosmolar Hyperglycemic State (HHS) merupakan kasus yang jarang dan komplikasi emergensi akut dari pasien diabetes melitus tipe 2, dengan karakteristik hiperglikemi, hiperosmolar dan dehidrasi atau tidak adanya ketoasidosis. Tatalaksana segera penting dilakukan untuk menstabilkan hemodinamik, mortalitas dari HHS tinggi dan dapat menyebabkan banyak komplikasi. Presentasi Klinis : Pada laporan kasus ini, seorang laki-laki berusia 63 tahun dengan keluhan utama badan semakin lemas. Pasien datang dengan kesadaran kompos mentis, tekanan darah 100/70 mmHg, nadi teraba 110 kali per menit kuat regular dengan isi cukup dan respirasi 20 kali per menit, dan suhu 37,90C . Pemeriksaan fisik didapatkan tanda-tanda dehidrasi. Pemeriksaan penunjang dijumpai sel darah putih 12.580, glukosa plasma 741 mg/dL, dan keton urine negatif. Kesimpulan : Telah dilaporkan kasus, laki-laki usia 63 tahun dengan diagnosa HHS, faktor pencetus terjadinya HHS pada pasien ini yaitu ditemukannya infeksi berupa bronkopneumonia, usia lanjut, pengobatan diabetes yang tidak teratur. Pentingnya perawatan dalam kasus ini adalah karena pasien berusia lanjut, pengobatan harus benar karena ketika rehidrasi yang terlalu cepat dapat memicu gagal jantung tetapi tidak cukup dapat gagal untuk membalikkan cedera ginjal akut. Kata Kunci : Diabetes Melitus, Hyperglycemic Hyperosmolar State, Hiperglikemi

The number of women who have a pre-existing cardiovascular disease (CVD) or develop cardiac problems during pregnancy is increasing, and it is the leading cause of non-obstetric mortality during pregnancy. Heart disease complicates approximately 1–3% of pregnancies and is responsible for 10 to 15% of maternal mortality. The rheumatic heart disease remains the number one worldwide cause of maternal cardiac complications in pregnant. It is important that obstetric, anesthesiologists, cardiologist, remain aware of the disease, its complications and management of valvular lesions throughout the birthing process.