The difference in severity and management between children and adult ’ s cases of COVID-19

mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. 2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac

mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. http://journal.um-surabaya.ac.id/index.php/qanunmedika Case Report 2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.
Cedera otak berat traumatis adalah cedera fatal, dengan tingkat kematian hingga 50%. Sekitar 1,5 juta orang mengalami cedera otak berat di Amerika Serikat. Terdapat lebih dari 50.000 kematian dan 500.000 insiden gangguan neurologis permanen. Sekitar 85% kematian terjadi dalam 2 minggu pertama setelah cedera. Salah satu komplikasi dari cedera otak yang parah adalah diabetes insipidus. Tidak ada data pasti tentang kejadian diabetes insipidus pada pasien dengan cedera otak traumatis mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. http://journal.um-surabaya.ac.id/index.php/qanunmedika berat di Indonesia sejauh ini. Pada laporan kasus ini, seorang pria, 45 tahun, dibawa ke Instalasi Rawat Darurat (IRD) setelah mengalami kecelakaan lalu lintas 12 jam sebelum dirawat di rumah sakit. Setelah operasi, tanda-tanda diabetes insipidus ditandai dengan adanya poliuria produksi urin 300cc / jam dan hipernatremia 149 mmol / L, meskipun segera diberikan desmopresin, kondis klinis dan hemodinamik pasien tidak menunjukkan perbaikan. Pasien meninggal pada hari kelima perawatan di Unit Perawatan Intensif (ICU). Perawatan utama untuk diabetes insipidus pada cedera otak berat traumatis adalah rehidrasi dan pemberian desmopresin yang adekuat. Koreksi hipovolemik, poliurik, dan hipernatremia yang adekuat adalah kunci keberhasilan pengobatan diabetes insipidus. Diabetes insipidus dalam kasus cedera otak membutuhkan perawatan yang rumit. Karena itu, jika ditangani dengan tidak tepat, bisa menyebabkan kematian. a mortality rate of up to 50%. About 1.5 million people with severe brain injury in the United States have more than 50,000 deaths and 500,000 permanent neurological sequelae (Agha and Thompson, 2006). Approximately 85% of mortality occurs in the first 2 weeks after the injury, which exhibits the initial impact of systemic hypotension and intracranial hypertension (Benvenga et al., 2000). One of the complications of a severe brain injury is diabetes insipidus. (Agha and Thompson, 2006;Hannon et al., 2012). Diabetes insipidus is a disease caused by the lower production, Hormone (ADH). Kidney abnormalities were marked by the unresponsiveness of physiological ADH stimulation, which is characterized by excessive thirst (polydipsia) and large amounts of urine (polyuria). There is no definitive data on the incidence of diabetes insipidus in patients with severe brain injury Diabetes insipidus in cases of brain injury requires complicated treatment. Diabetes insipidus can lead to death when handled improperly. Therefore, the authors are A 45-year-old man was taken to the Emergency Hospital (IRD) Dr. Soetomo after a motorcycle traffic accident 12 hours before being hospitalized. The patient is unconscious since previous health facility; RSUD Tuban, thus the patient was referred to IRD Dr. Soetomo. The patient has attached a collar brace at the Soetomo. Responding to pain, with the examination of anisocoria round pupils 4/3 mm, both eye light reflexes were decreased. Spontaneous breathing 30 times per minute presented with an additional gurgling breath with oxygen saturation of 92% using an oxygen mask of 5 liters per minute. Blood pressure 110/75 mmHg (MAP 86), pulse 120 times per minute. Tip of the extremity were warm, dry and red with an examination of capillary refill time <2 seconds. The right parietooccipital hematoma was found. The patient was Jackson Reese 10 liters per minute, a two-lane intravenous line was attached and 30° headup position. The patient was prepared to be intubated using ETT No.7 and the lip border

INTRODUCTION
The COVID-19 (Coronavirus Disease 2019) pandemic situation consists of a collection of severe acute respiratory diseases that threaten human health in the world (Rothan and Byrareddy 2020). Covid-19 infection in children under 15 years old is less than that of the adult, and the symptoms are milder. The epidemiological evidence stated that the number of deaths in pediatric cases is also lower than the adult, and there is a biological difference between children and adults (Sighn et al., 2017).
The case number  in the world at the date of 27 November 2020 has reached 60.264.241 cases with many deaths of 1.420.306 patients (World Health Organization (WHO), 2020). The Indonesian Ministry of Health reported 522.581 cases of COVID-19 on 27 November 2020 (KEMENKES, 2020). COVID-19 case in children is fewer than in adults. 72.314 recorded positive  in China, with 2% of the patients under 19 years old. Italy is one of the countries that experienced the pandemic's impact, with 1,2% of all children. Italy also has higher cases than China (7,2% vs 2,3%), but there is no mortality rate for children (Liguoro et al., 2020). It is recorded that 535 out of 113.368 COVID-19 cases are infected children under 18 years old in Spain (Melgosa et al., 2020). Not only in Italy, China, and Spain but also in children and Africa and America. From March until April 2020, there are 5,2% cases of children infected by SARS-CoV-2 out of 474 recorded cases (Bandi et al., 2020).
The number of deaths caused by COVID-19 in China is 2,3% (1.023 death cases out of 44.672 confirmed cases). There were no cases of death in 9 years old group and younger, but the case was found in 70 until 79 years old group, which has a death rate of 8.0%, and the case in 80 years old group or older has a death rate of 14,8% (Wu dan McGoogan, 2020 (Satgas COVID-19, 2020;IDAI, 2020). However, the number of the adult is still higher in Indonesia, reach 79,9 % and 20,1% cases for children (Kementerian Kesehatan RI, 2020;SATGAS COVID-19, 2020).
The SARS-CoV-2 is included as one of the beta coronavirus genus, and many reports of phylogenetic stated that SARS-CoV-2 has the same subgenus with SARS virus component, which included as Sarbecovirus genus (Zhu et al., 2020). The SARS-CoV-2 also has similarity with SARS-CoV-2 gained from a bat and isolated, so there was a suspicion that SARS-CoV-2 is from mutated bats and infected humans (Zhou et al., 2020).
The computer test stated that the SARS-CoV-2 virus has a 3 dimension structure, including protein spike receptor-binding, and has a very strong affinity for angiotensin-convertingenzyme 2 (ACE2) (Zhang et al., 2020).
The SARS-CoV-2 has S-protein or spike protein mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. http://journal.um-surabaya.ac.id/index.php/qanunmedika Case Report 2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.
The case of children in China until N reached 2143 positive cases. The asymptomatic case in children (94), mild case (1091), moderate case (831), severe case (112), and critical case (13) (Dong et al. 2020). The severe case found in China and Italy reached 19% and 26% for adults older than 60 years old (Istituto Superiore di Sanità 2020a; Wu and McGoogan 2020). The death rate of children in Indonesia until mid-July 2020 is 2,06% for 0-5 years old and 0,50% for 6-17 years old (Setiabudi 2020).
From the report mentioned above, the number of adult's cases are higher than pediatric cases.

Pathogenesis and pathophysiology of coronavirus in pediatric and adults
The SARS-CoV-2 passes the respiratory tract and is attached to Angiotensin-Converting Enzym-2 (ACE-2) using the spike protein structure of SARS-CoV-2. The ACE-2 receptor can also recognize SARS-CoV (Dhochak et al., 2020;Hoffmann et al., 2020). The ACE-2 can be found in many organs, including oral mucosa, nasal, nasopharynx, lung, stomach, small intestine, large intestine, skin, thymus, bone marrow, spleen, liver, kidney, brain, pulmonary alveolar epithelial cells, small Table 1. SARS-CoV-2 confirmed patient cases in children and adults. Source: CDC COVID-19 Response Team, 2020;IDAI, 2020;Lu et al., 2020;Wu & McGoogan, 2020;SATGAS COVID-19, 2020 Pathogenesis and pathophysiology of coronavirus in pediatric and adults. mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. a mortality rate of up to 50%. About 1.5 million people with severe brain injury in the United States have more than 50,000 deaths and 500,000 permanent neurological sequelae (Agha and Thompson, 2006). Approximately 85% of mortality occurs in the first 2 weeks after the injury, which exhibits the initial impact of systemic hypotension and intracranial hypertension (Benvenga et al., 2000). One of the complications of a severe brain injury is diabetes insipidus. (Agha and Thompson, 2006;Hannon et al., 2012). Diabetes insipidus is a disease caused by the lower production, Hormone (ADH). Kidney abnormalities were marked by the unresponsiveness of physiological ADH stimulation, which is characterized by excessive thirst (polydipsia) and large amounts of urine (polyuria). There is no definitive data on the incidence of diabetes insipidus in patients with severe brain injury intestinal enterocyte cells, endothelial cells venous arteries, and smooth muscle cells (PDPI, 2020).
The SARS-CoV-2 enters the cell facilitated by proteolytic breakdown ACE-2 by transmembrane serine protease-2 (Dhochak et al., 2020;Hoffmann et al., 2020). Inside the cell, the RNA genome virus is released to the cytoplasm and then translated into two polyprotein and structural proteins. After being translated, the virus genome begins to multiply itself. The new glycoproteins which are formed on the virus's surface, started to go inside the endoplasm reticulum membrane and the virus started to grow and forms nucleocapsid. In the last stage, the vesicles that already contain the virus start to combine with plasm membranes that have the purpose of releasing the new virus components (Susilo et al., 2020;de Wit et al., 2016).
Patients infected by SARS-CoV-2 experiencing a decrease of ACE-2 regulation that results in increased vascular permeability and inflammation. The ACE-2 activity in children is very high to give protection Figure 1 The clinical symptoms of pediatric and adult cases from SARS-CoV-2 infection manifestation and reduce the severity level case (Cristiani et al. 2020;Dhochak et al. 2020;de Wit et al. 2016). The result from recent studies, it is still hard to predict that ACE-2 activity in the lungs is more important than SARS-CoV-2 because the infection of SARS-CoV-2 is more severe clinically in infants rather than the older children (Dhochak et al. 2020).
The difference between adults and children case is related to living habits and host factors.
Children are tended to play at home and are taken care of by the parents, so they have a lower chance of infected by the pathogens. Meanwhile, adults have a responsibility to work, etc., which have a higher chance of infected by the pathogens. Children are also less sensitive to SARS-CoV-2 because of the maturity, function, and number of the ACE-2. Besides the ACE-2 factor, children often experience respiratory tract infections that might have a higher antibody level to the virus, and the immune of children still develops and might recognize the pathogens differently than adults (Dong et al. 2020).

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.

Case Report
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.

COVID-19 classification in pediatric
The clinical symptoms of pediatric and adult cases The clinical symptoms of children infected by SARS-CoV-2 now are milder than the adult infected by SARS-CoV-2. More studies in pediatric SARS COV-2 was conducted; it is now clear that children of any age can be infected. But the case is more difficult to detect since they are likely to be asymptomatic and the possibility to get tested is small (Dong et al., 2020;Lu et al. 2020;Sighn et al. 2017).

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. a mortality rate of up to 50%. About 1.5 million people with severe brain injury in the United States have more than 50,000 deaths and 500,000 permanent neurological sequelae (Agha and Thompson, 2006). Approximately 85% of mortality occurs in the first 2 weeks after the injury, which exhibits the initial impact of systemic hypotension and intracranial hypertension (Benvenga et al., 2000). One of the complications of a severe brain injury is diabetes insipidus. (Agha and Thompson, 2006;Hannon et al., 2012). Diabetes insipidus is a disease caused by the lower production, Hormone (ADH). Kidney abnormalities were marked by the unresponsiveness of physiological ADH stimulation, which is characterized by excessive thirst (polydipsia) and large amounts of urine (polyuria). There is no definitive data on the incidence of diabetes insipidus in patients with severe brain injury

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.

Case Report
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.

Laboratory findings on adult and pediatric of COVID-19 cases
The laboratory findings of child cases in Indonesia have been compared with laboratory findings in Wuhan China. There are 4 studies conducted on lymphocyte range and two studies reported that there is a decrease in lymphocytes for 10 of 214 cases. Based on two other studies which reported there was an increase in lymphocytes for 18 of 43 cases. Besides changes in the number of lymphocytes, there was also a change in the amount of C-Reactive protein that increased (> 5mg/L) in 70 of 271 pediatric cases infected with SARS-CoV-2 (Lee-Archer and von Ungern-Sternberg, 2020).

Blood test findings in adult cases infected
with SARS-CoV-2 include lymphocyte range, neutrophil count, total cell T, total CD4 + , CD8 + , total cell B, total cell NK (Natural Killer), and CRP total (C-Reactive Protein). Based on some studies conducted in Wuhan, it is found that there is a decreased amount of white blood cells is (< 4x10 9 ) from 10 of 40 adult cases. Not only the decrease amount of white blood cells, but there is also a decrease amount of lymphocytes in adults from 26 of 40 cases reported the number of lymphocytes is <1.0x10 9 /L (Huang et al., 2020). Other studies also compared the immune profile between children and adults that in adults is found a lower amount of cell T, cell T CD8 + , and cell B (Chen et al., 2020). Neutrophil (x10 9 /L) 5,6-6,6 3,3-8,9 Lymphocyte range (x10 9 /L) 4,33-6,13 0,6-1,1  Chen et al., 2020;Huang et al., 2020;Liu et al., 2020 8 QANUN MEDIKA

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. a mortality rate of up to 50%. About 1.5 million people with severe brain injury in the United States have more than 50,000 deaths and 500,000 permanent neurological sequelae (Agha and Thompson, 2006). Approximately 85% of mortality occurs in the first 2 weeks after the injury, which exhibits the initial impact of systemic hypotension and intracranial hypertension (Benvenga et al., 2000). One of the complications of a severe brain injury is diabetes insipidus. (Agha and Thompson, 2006;Hannon et al., 2012). Diabetes insipidus is a disease caused by the lower production, Hormone (ADH). Kidney abnormalities were marked by the unresponsiveness of physiological ADH stimulation, which is characterized by excessive thirst (polydipsia) and large amounts of urine (polyuria). There is no definitive data on the incidence of diabetes insipidus in patients with severe brain injury

Radiological findings in adult and pediatric with COVID-19
Radiological examinations that are often conducted on children infected with COVID-19 are chest x-rays and chest CT scans, both of which often reveal unilateral or bilateral cloudiness. Based on the chest x-rays showed abnormalities in 24 of 46 cases. These abnormalities were in the form of unilateral changes that occurred in 15 of 46 pediatric cases and there were also bilateral changes in 7 of 46 pediatric cases. Besides chest x-rays, there are also chest CT-scans. Based on this examination, it is reported normal from 89 of 267 cases and there were unilateral changes in 63 of 267 cases, and 112 of 267 cases had bilateral changes. Wuhan Children Hospital reported that from 20 pediatric cases of COVID-19, all of them reported sub-pleural changes on chest CT-scans (Lee-Archer dan von Ungern-Sternberg, 2020; Xia et al., 2020).
Some studies also mentioned chest CT-scans and chest x-rays changes reported from 6 of 8 cases that showed bilateral pneumonia and unilateral pneumonia. The changes of image showed there is more than one shadow like a patch in 7 of 8 cases, Ground-Glass opacity in 6 of 8 cases, pleural effusion in 1 of 8 cases, and a white pulmonary appearance was found in 1 of 8 cases (Sun et al., 2020). Based on these results, it is recommended to conduct a CT-scan examination for children infected COVID-19 (Lee-Archer and von Ungern-Sternberg 2020; Xia et al. 2020).
The radiological findings in adult COVID-19 cases were the same as in cases of children. The examinations that are often conducted on adults are x-rays and CT-scans, in 101 cases there were abnormalities on CT-scans such as GGO (86,1%), mixed GGO and consolidation (64%), dilation of blood vessels in the lesion (71,3%), and bronchiectasis (52.5%). There is some lesion that found in CT-scan image in an adult patient that is the peripheral distribution (87%), bilateral (82,2%), and also found multifocal (54,5%) (Zhao et al., 2020).

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.

Case Report
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.

Immunological response in adult and pediatric cases to COVID-19
1β, IL α genes

Immunological response in adult and pediatric cases to COVID-19
SARS-CoV-2 can be high in the lower respiratory tract in early stage. Inflammatory signaling molecules are released by infected cells and alveolar macrophages in addition to recuited T lymphocytes, monocytes and neutrophils. SARS-CoV-2 induce host immune response (Wiersinga, Rhodes, Cheng, Peacock, & Prescott, 2020). Immunization is a way to increase the innate immune function, aiming to make the condition more active after fighting antigens (infection or vaccination) by increasing the Krebs cycle and epigenetic changes such as the transcription of IL-1β, IL-6, and TNF-α genes. The process can affect the progenitor cell lines from myeloid cells and monocyte also local cells such as macrophages in the lungs and dendrite cells (Netea et al., 2020).
Some countries with a BCG vaccination program routinely were reported to have lower morbidity and mortality rates (Aaron et al., 2020; Dhochak et al., 2020). The BCG vaccination is often associated with a decrease in acute upper respiratory tract infection in adults and decreased child mortality, but the BCG effect can only stay in 1-2 years (Dhochak et al., 2020;Wardhana et al., 2011). The immunization conducted in children is measles, rubella, and influenza can give them protection to SARS-CoV-2 infection (Dhochak et al., 2020).
The adaptive immune response also has an essential effect on the patient infected with COVID-19. The number of lymphocytes in pediatric cases COVID-19 were reported varied, it can be decreased or increased, and healthy children had more lymphocytes than adults. The level of lymphocytes can be found more in children's cases who are often infected with viruses and result in a robust immune system (Cristiani et al. 2020).
It was found that the total lymphocytes, CD4 + and CD8 + , T cells helper and T cells memory of patients with severe cases decrease significantly, and as well as severe cases in adults. There is an increase in the number of cytokines, namely IL-2, IL-6, IL-10, and the neutrophil amount, indicating the dysfunctional and excessive adaptive immune response that causes damage to the lungs (Dhochak et al., 2020).

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. a mortality rate of up to 50%. About 1.5 million people with severe brain injury in the United States have more than 50,000 deaths and 500,000 permanent neurological sequelae (Agha and Thompson, 2006). Approximately 85% of mortality occurs in the first 2 weeks after the injury, which exhibits the initial impact of systemic hypotension and intracranial hypertension (Benvenga et al., 2000). One of the complications of a severe brain injury is diabetes insipidus. (Agha and Thompson, 2006;Hannon et al., 2012). Diabetes insipidus is a disease caused by the lower production, Hormone (ADH). Kidney abnormalities were marked by the unresponsiveness of physiological ADH stimulation, which is characterized by excessive thirst (polydipsia) and large amounts of urine (polyuria). There is no definitive data on the incidence of diabetes insipidus in patients with severe brain injury

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.

Case Report
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. http://journal.um-surabaya.ac.id/index.php/qanunmedika berat di Indonesia sejauh ini. Pada laporan kasus ini, seorang pria, 45 tahun, dibawa ke Instalasi Rawat Darurat (IRD) setelah mengalami kecelakaan lalu lintas 12 jam sebelum dirawat di rumah sakit. Setelah operasi, tanda-tanda diabetes insipidus ditandai dengan adanya poliuria produksi urin 300cc / jam dan hipernatremia 149 mmol / L, meskipun segera diberikan desmopresin, kondis klinis dan hemodinamik pasien tidak menunjukkan perbaikan. Pasien meninggal pada hari kelima perawatan di Unit Perawatan Intensif (ICU). Perawatan utama untuk diabetes insipidus pada cedera otak berat traumatis adalah rehidrasi dan pemberian desmopresin yang adekuat. Koreksi hipovolemik, poliurik, dan hipernatremia yang adekuat adalah kunci keberhasilan pengobatan diabetes insipidus. Diabetes insipidus dalam kasus cedera otak membutuhkan perawatan yang rumit. Karena itu, jika ditangani dengan tidak tepat, bisa menyebabkan kematian. a mortality rate of up to 50%. About 1.5 million people with severe brain injury in the United States have more than 50,000 deaths and 500,000 permanent neurological sequelae (Agha and Thompson, 2006). Approximately 85% of mortality occurs in the first 2 weeks after the injury, which exhibits the initial impact of systemic hypotension and intracranial hypertension (Benvenga et al., 2000). One of the complications of a severe brain injury is diabetes insipidus. (Agha and Thompson, 2006;Hannon et al., 2012). Diabetes insipidus is a disease caused by the lower production, Hormone (ADH). Kidney abnormalities were marked by the unresponsiveness of physiological ADH stimulation, which is characterized by excessive thirst (polydipsia) and large amounts of urine (polyuria). There is no definitive data on the incidence of diabetes insipidus in patients with severe brain injury Diabetes insipidus in cases of brain injury requires complicated treatment. Diabetes insipidus can lead to death when handled improperly. Therefore, the authors are A 45-year-old man was taken to the Emergency Hospital (IRD) Dr. Soetomo after a motorcycle traffic accident 12 hours before being hospitalized. The patient is unconscious since previous health facility; RSUD Tuban, thus the patient was referred to IRD Dr. Soetomo. The patient has attached a collar brace at the Soetomo. Responding to pain, with the examination of anisocoria round pupils 4/3 mm, both eye light reflexes were decreased. Spontaneous breathing 30 times per minute presented with an additional gurgling breath with oxygen saturation of 92% using an oxygen mask of 5 liters per minute. Blood pressure 110/75 mmHg (MAP 86), pulse 120 times per minute. Tip of the extremity were warm, dry and red with an examination of capillary refill time <2 seconds. The right parietooccipital hematoma was found. The patient was Jackson Reese 10 liters per minute, a two-lane intravenous line was attached and 30° headup position. The patient was prepared to be intubated using ETT No.7 and the lip border RR 16, PC 15, trigger 2, I: E 1: 2, FiO2 50%.

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.

Case Report
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. a mortality rate of up to 50%. About 1.5 million people with severe brain injury in the United States have more than 50,000 deaths and 500,000 permanent neurological sequelae (Agha and Thompson, 2006). Approximately 85% of mortality occurs in the first 2 weeks after the injury, which exhibits the initial impact of systemic hypotension and intracranial hypertension (Benvenga et al., 2000). One of the complications of a severe brain injury is diabetes insipidus. (Agha and Thompson, 2006;Hannon et al., 2012). Diabetes insipidus is a disease caused by the lower production, Hormone (ADH). Kidney abnormalities were marked by the unresponsiveness of physiological ADH stimulation, which is characterized by excessive thirst (polydipsia) and large amounts of urine (polyuria). There is no definitive data on the incidence of diabetes insipidus in patients with severe brain injury

DISCUSSION
The differences in severity in children's cases compared to adult were the number of ACE-2 receptor, ACE-2 activation, immunization, and the immune system. The number of ACE-2 receptors in children is lower than adult, and activation of ACE-2 in pediatric stimulation of cytokines stroms (Lymphocytes B, T and natural killer cell) is very high than in adult cases it can protect against the virus (Dhochak et al. 2020). Immunizations given to children can increase the immune system and provide better ability to work against different pathogens (Cristiani et al. 2020) There were fewer cases of children than adults, with milder symptoms in children (CDC COVID-19 Response Team, 2020). Laboratory tests have shown that the number of white blood cells in children is more than normal. Whereas, in adult patients, there is a decrease in the number of white blood cells (Huang et al., 2020;Liu et al., 2020), and the number of T cells and B cells in children is better than in adult cases (Chen et al., 2020).
COVID-19 in children is often caused by infection from family members who live in one house (70-80%) (Setiabudi, 2020). Infected cases are divided into high-risk close contact cases and low-risk close contact cases. The high-risk close contact cases if you have been in contact with a patient OF COVID-19 and the close low-risk contact if you have been in contact with a patient under surveillance (Andarini, 2020).
The treatment given to patients with confirmed of COVID-19 depends on the severity of the case and for cases of children with confirmed of COVID-19, there are several differences where negative pressure isolation, IFN nebulization, and antibiotics and antivirals based on WHO (Andarini, 2020). Treatment antiviral in adult can be given Chloroquine phosphate with dose 500 mg/12 hours orally for 5 days but in children can be given Oseltamivir with dose according to age and weight. Treatment in the critical case may be different with other classification cases.
In the critical cases, we should recognize septic shock and ARDS (Acute Respiratory Distress Syndrome); children with critical cases should

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.

Case Report
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.
There are more positive confirmed  in children in Indonesia with a higher mortality rate than other countries in Asia in particular and the world in general (IDAI, 2020

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. a mortality rate of up to 50%. About 1.5 million people with severe brain injury in the United States have more than 50,000 deaths and 500,000 permanent neurological sequelae (Agha and Thompson, 2006). Approximately 85% of mortality occurs in the first 2 weeks after the injury, which exhibits the initial impact of systemic hypotension and intracranial hypertension (Benvenga et al., 2000). One of the complications of a severe brain injury is diabetes insipidus. (Agha and Thompson, 2006;Hannon et al., 2012). Diabetes insipidus is a disease caused by the lower production, Hormone (ADH). Kidney abnormalities were marked by the unresponsiveness of physiological ADH stimulation, which is characterized by excessive thirst (polydipsia) and large amounts of urine (polyuria). There is no definitive data on the incidence of diabetes insipidus in patients with severe brain injury

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. http://journal.um-surabaya.ac.id/index.php/qanunmedika

Case Report
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.

JURNAL KEDOKTERAN FKUM SURABAYA
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death.
a mortality rate of up to 50%. About 1.5 million people with severe brain injury in the United States have more than 50,000 deaths and 500,000 permanent neurological sequelae (Agha and Thompson, 2006). Approximately 85% of mortality occurs in the first 2 weeks after the injury, which exhibits the initial impact of systemic hypotension and intracranial hypertension (Benvenga et al., 2000). One of the complications of a severe brain injury is diabetes insipidus. (Agha and Thompson, 2006;Hannon et al., 2012). Diabetes insipidus is a disease caused by the lower production, Hormone (ADH). Kidney abnormalities were marked by the unresponsiveness of physiological ADH stimulation, which is characterized by excessive thirst (polydipsia) and large amounts of urine (polyuria). There is no definitive data on the incidence of diabetes insipidus in patients with severe brain injury Diabetes insipidus in cases of brain injury requires complicated treatment. Diabetes insipidus can lead to death when handled improperly. Therefore, the authors are A 45-year-old man was taken to the Emergency Hospital (IRD) Dr. Soetomo after a motorcycle traffic accident 12 hours before being hospitalized. The patient is unconscious since previous health facility; RSUD Tuban, thus the patient was referred to IRD Dr. Soetomo. The patient has attached a collar brace at the Soetomo. Responding to pain, with the examination of anisocoria round pupils 4/3 mm, both eye light reflexes were decreased. Spontaneous breathing 30 times per minute presented with an additional gurgling breath with oxygen saturation of 92% using an oxygen mask of 5 liters per minute. Blood pressure 110/75 mmHg (MAP 86), pulse 120 times per minute. Tip of the extremity were warm, dry and red with an examination of capillary refill time <2 seconds. The right parietooccipital hematoma was found. The patient was Jackson Reese 10 liters per minute, a two-lane intravenous line was attached and 30° headup position. The patient was prepared to be intubated using ETT No.7 and the lip border