Ọrịa mamịrị ketoacidosis

Ọ bụrụ na onye ọrịa ahụ nwere usoro ketoacidosis nke ọrịa mamịrị, a na-echekwa mmụọ ahụ, enweghị usoro iwu siri ike, mgbe ahụ enwere ike duzie ya na ngalaba endocrinological ma ọ bụ ọgwụgwọ. N’ezie, ọ bụrụ na ndị ọrụ nke ngalaba a maara ihe ekwesịrị ime.

Ọrịa shuga na-arịa ọrịa ketoacidosis

Usoro ọgwụgwọ insulin na-anọchi anya Ketoacidosis bụ naanị ọgwụgwọ nwere ike ịkwụsị usoro anụ ahụ nke na-ebute mmepe nke ọrịa shuga a. Ebumnuche nke ọgwụ insulin bụ iji bulie ogo insulin ọkwa 50-100 mcU / ml.

Maka nke a, usoro nlekọta nke “obere” insulin 4-10 kwa elekere, nkezi nke 6 nkeji kwa elekere. A na-akpọ usoro ndị dị otú ahụ maka ọgwụgwọ insulin “ọgwụ dị ala”. Ha na-egbochi mmebi nke abụba na imepụta ahụ ketone, na-egbochi iwepụta glucose n'ọbara, ma na-eso na njikọ nke glycogen.

Ya mere, a na-ewepụ njikọ ndị kachasị na usoro mmepe nke ketoacidosis ọrịa mamịrị. N'otu oge ahụ, usoro insulin na usoro “obere ala” nwere obere ihe ọghọm nke ọrịa ma na-enye ohere ịchịkwa shuga ọbara karịa usoro nchịkwa “elu-elu”.

N ’ụlọ ọgwụ, onye ọrịa na-arịa ọrịa ketoacidosis na-arịa ọrịa shuga na-anata insulin n’ụdị nke na-aga n’ihu n’afọ. Nke izizi, a na-enye insulin ahụ na-adị mkpụmkpụ n'ime oge bolus (jiri nwayọ) na “mbido” nke 0.15 PIECES / n'arọ, na nkezi ọ na - apụta 10-12. Mgbe nke a gasị, onye ọrịa nwere njikọ na infusomat nke mere na ọ na-anata insulin site na ịgbakọ inflatter na-aga n'ihu na 5-8 nkeji kwa elekere, ma ọ bụ nkeji 0.1 / awa / n'arọ.

Na plastik, adsorption nke insulin ga-ekwe omume. Iji gbochie ya, a na-atụ aro ka ịgbakwunye mkpụrụ osisi album mmadụ na ihe ngwọta. Ntuziaka maka ịkwadebe ngwakọta infusion: gbakwunye 50 ml nke 20% albumin ma ọ bụ 1 ml ọbara nke onye ọrịa na nkeji 50 nke insulin “dị mkpụmkpụ,” weta mkpokọta mkpokọta na 50 ml site na iji 0.9% NaCl saline.

Inyocha ọgwụ insulin na-agba agba na ụlọ ọgwụ na-enweghị ọgwụ infusomat

Ugbu a, anyị na-akọwa ụzọ ọzọ maka ọgwụgwọ insulin na-abanye n'ime, ọ bụrụ na enweghi infusomat. Enwere ike ijikwa insulin na-adị mkpụmkpụ otu oge kwa elekere site na bolus, jiri nwayọ, yana sirinji, banye na chịm nke sistem.

Iri insulin kwesịrị ekwesị (dịka ọmụmaatụ, nkeji 6) kwesịrị ijupụta ntụtụ 2 ml, wee tinye 2 ml jiri nnu nnu 0.9% NaCl mee ihe. N'ihi nke a, olu nke ngwakọta na sirinji na-abawanye, ọ ga-ekwe omume ịbanye insulin nwayọ, n'ime nkeji 2-3. Ofme insulin dị mkpụmkpụ iji belata shuga dị n'ọbara dịruru otu awa. Yabụ, enwere ike ịtụle ugboro ole nchịkwa nke 1 oge kwa elekere dị irè.

Authorsfọdụ ndị na - ede akwụkwọ na - atụ aro kama ịnwe ụdị usoro a iji tinye insulin “nke na - adị mkpụmkpụ” na nkeji isii kwa elekere. Ma enweghị ihe akaebe na usoro a ga-arụ ọrụ nke ọma agaghị adị njọ karịa nchịkwa mgbochi. Ọrịa ketoacidosis na-arịa ọrịa shuga na-esokarị ya, na -eme ka mkpokọta insulin, nke na-achịkwa intramuscularly, na nke ukwuu.

A na-agbanye agịga dị mkpirikpi n'ime sirinji insulin. Ọ gaghị ekwe omume ugboro ugboro iji gbaa ya ọgwụ mgbochi intramuscular. Notghara ikwu eziokwu ahụ bụ na enwere nsogbu ndị ọrịa na ndị ọrụ ahụike ọzọ. Ya mere, maka ịgwọ ọrịa ketoacidosis nke na-arịa ọrịa shuga, a na-atụ aro nchịkwa intravenous insulin.

Ekwesịrị inye insulin subcutaneously ma ọ bụ intramuscularly naanị na ọkwa dị nwayọ nke ketoacidosis ọrịa shuga, ọ bụrụ na onye ọrịa ahụ anọghị n'ọnọdụ dị njọ ma ọ dịghị mkpa ịnọ na ngalaba nlekọta ahụike yana nlekọta kpụ ọkụ n'ọnụ.

Ntughari insulin

A na-ahazi usoro insulin nke “dị mkpụmkpụ” dabere na ụkpụrụ shuga dị ugbu a, nke a ga-atụle kwa awa. Ọ bụrụ na n’ime awa mbụ atọ na ọkwa ọkwa glucose n’ọbara anaghị ebelata ma ọnụego saturation nke anụ ahụ nwere mmiri zuru oke, mgbe ahụ ike ịba insulin ugboro abụọ.

N'otu oge ahụ, ịtalata shuga dị n'ọbara enweghị ike belata ngwa ngwa karịa 5.5 mmol / l kwa elekere. Ma ọ bụghị ya, onye ọrịa nwere ike nwee ụbụrụ ụbụrụ dị ize ndụ. Maka nke a, ọ bụrụ na ọnụego shuga dị n'ọbara abịala n'okpuru 5 mmol / l kwa elekere, mgbe ahụ, ọkara ọgwụ ọzọ na-agbakọta. Ma ọ bụrụ na ọ gafere 5 mmol / l kwa elekere, mgbe ahụ, injection insulin na-apụtakarị, mgbe ọ na-aga n'ihu ịchịkwa shuga ọbara.

Ọ bụrụ na, n’okpuru ikike insulin ọgwụ, shuga ọbara na-agbada n’ụzọ nwayọ karịa site na 3-4 mmol / l kwa elekere, nke a nwere ike igosipụta na onye ọrịa ahụ ka na-akpọnwụ akpọnwụ ma ọ bụ na akụrụ na-agwụ ike. N'ọnọdụ dị otu a, ịkwesịrị ịtụle olu nke na-ekesa ọbara ma mee nyocha nke ogo creatinine n'ime ọbara.

N’ụbọchị mbụ n’ụlọ ọgwụ, ọ bụ ihe amamihe dị na ya belata shuga ọbara na-erughị 13 mmol / L. Mgbe ọkwa a ruru, a na-enye glucose 5-10%. N'ime 20 g glukos ọ bụla, a na-etinye 3-4 nkeji nke insulin mkpirikpi n'ime chịngọm. 200 ml nke 10% ma ọ bụ 400 ml nke 5% ngwọta nwere gram 20 nke glucose.

A na-enye glucose naanị ma ọ bụrụ na onye ọrịa ahụ enweghị ike iri nri nke aka ya, ọ na-afọkwa obere iwepu insulin. Nlekọta glucose abụghị ọgwụgwọ maka ketoacidosis na-arịa ọrịa mamịrị kwa se. Emere ya iji gbochie hypoglycemia, yana ichekwa osmolarity (njuputa nke mmiri di n’ime ahu).

Ọrịa mamịrị ketoacidosis - gịnị ka ọ bụ?

Ọrịa mamịrị ketoacidosis bụ nsogbu dị egwu nke ọrịa shuga, nke nwere ike ibute ọrịa mamịrị ma ọ bụdị ọnwụ. Ọ na - eme mgbe anụ ahụ na - enweghị ike iji shuga (glucose) dị ka isi iyi ume, n'ihi na anụ ahụ anaghị enwe insulin homonụ zuru ezu. Kama anụ ahụ, anụ ahụ na-amalite iji abụba dị ka isi iyi nke ike ịgbakwunye ume.

Mgbe abụba gbajiri, ihe mkpofu a na-akpọ ketone na-amalite ịgbakọ n'ime ahụ ma mebie ya. Ketones n'ọtụtụ buru ibu na-egbu egbu nye ahụ.

Enweghị nlekọta ahụike mberede na ọgwụgwọ maka ketoacidosis na-arịa ọrịa shuga nwere ike ibute nsonaazụ na-enweghị atụ.

Ebu ụzọ kọwaa ọrịa nke ọrịa ketoacidosis na 1886. Tupu mepụta insulin na 20s. na narị afọ gara aga, ketoacidosis fọrọ nke nta ka ọ kpatara ọnwụ. Ugbu a, onwu erughi 1% n’ihi nhọpụta nke ọgwụgwọ zuru oke na oge.

Ọrịa ndị a nwere ụdị ọrịa shuga mellitus nke mbụ bụ ọrịa a na-emetụta, karịsịa ụmụaka na ndị nọ n'afọ iri na ụma nke nwere ọrịa mellitus na-adịghị akwụ ụgwọ. Ketoacidosis dị ụkọ na ụdị ọrịa shuga 2.

Withmụaka nwere ọrịa shuga na-emetụta ketoacidosis.

Ọgwụgwọ ketoacidosis na-abụkarị n'ụlọ ọgwụ, n'ọnọdụ ụlọ ọgwụ. Mana ị ga - egbochi ịga ụlọ ọgwụ ma ọ bụrụ na ị mara ihe ịdọ aka na ntị ya, ma lelee mmamịrị na ọbara gị maka ketones kwa ụbọchị.

Ọ bụrụ na agwọghị ketoacidosis n'oge, ketoacidotic coma nwere ike ime.

Ihe kpatara ketoacidosis

Enwere ike iche ihe ndị na-esote usoro nke ịrịa ketoacidosis mamịrị:

1) N’inwe ụdị insulin na-akpata ọrịa shuga nke mbụ achọpụtara, ketoacidosis nwere ike ịpụta n’ihi eziokwu ahụ na mkpụrụ ndụ beta pancreatic beta na-akwụsị imepụta insulin na-agwụ ike, si otú a na-abawanye shuga ọbara ma mepụta enweghi insulin n’ime ahụ.

2) Ọ bụrụ na edepụtara inje insulin ọ bụla, ketoacidosis nwere ike ịpụta n'ihi ọgwụgwọ insulin na-adịghị mma (a na-edenye insulin ọgwụ dị ntakịrị) ma ọ bụ imebi usoro ọgwụgwọ (mgbe ị na-ahapụ injections, na-eji insulin emebiela).

Mana ọtụtụ oge, ihe kpatara ketoacidosis na-arịa ọrịa shuga bụ mmụba dị elu na mkpa insulin na ndị ọrịa nwere ọrịa shuga na-akpata ọrịa shuga mellitus:

• ọrịa na-efe efe ma ọ bụ malitere ịrịa (flu, tonsillitis, nnukwu akụkụ okuku ume na nje virus, sepsis, oyi baa, wdg),
• ọrịa endocrine ndị ọzọ na ahụ (thyrotoxicosis syndrome, Ọrịa Hisenko-Cushing, acromegaly, wdg),
• infarction myocardial, ọrịa strok,
• ime
• ọnọdụ nrụgide, ọkachasị n’oge ndị ntorobịa.

Uzo esi agbanwe ya na insulin insulin nke mara

Igwu insulin na-abanye n'ime ya ekwesịghị igbu oge. Mgbe ọnọdụ onye ọrịa dara, ọbara ọgbụgba kwụsịrị, a na-edozi shuga ọbara n'ogo nke ọ na-akarịghị nke 11-12 mmol / L na pH> 7.3 - ị nwere ike ịgbanwee gaa na nchịkwa insulin. Site na usoro onunu ogwu nke 10-14 nkeji kwa awa anọ. A na-agbanwe ya dabere na nsonaazụ nchịkwa nke ọbara ọbara.

A na-agbanye insulin nke dị mkpụmkpụ maka “mkpụmkpụ” mkpụmkpụ ruo 1-2 awa ọzọ mgbe ọ gbasịrị ọgwụ nke mbụ Subcutaneous, ka enweghị ihe nkwụsị ọ bụla n'ọrụ insulin. Ugbua n’ụbọchị mbụ nke iruu ọgwụ subcutaneous, enwere ike iji insulin arụ ọrụ ogologo oge n’otu oge. Ọgwụ nke mbụ ya bụ nkeji 10-12 ruo ụbọchị 2. Etu esi edozi ya ka akọwara n’isiokwu bụ “Dosage Calculation and Technique for Insulin Administrator”.

Fọghari na ketoacidosis na-arịa ọrịa shuga - mkpochapu nke mmiri akpịrị

Ọ dị mkpa ịgbalị ime ka ọkara nke ụkọ mmiri dị n’ahụ onye ọrịa abanyelarị n’ụbọchị mbụ ọgwụgwọ. Nke a ga - enyere aka belata shuga dị n’ọbara, n’ihi na a ga-eweghachi ọbara ọbara akụrụ, ahụ ga-ewepụkwa glucose dị na mmamịrị.

Ọ bụrụ na ọkwa nke sodium dị na ọbara ọbara nkịtị (= 150 meq / l), jirizie hypotonic mee ihe na ntinye uche NaCl nke 0.45%. Ọnụego nchịkwa ya bụ 1 lita na elekere nke mbụ, 500 ml ọ bụla na awa nke abụọ na nke atọ, mgbe ahụ na 250-500 ml / awa.

A na-ejikwa ọ̀tụ̀tụ̀ ịgba mmiri nwayọọ nwayọọ karị: lita 2 n'ime awa anọ ndị mbụ, lita 2 ọzọ n'ime awa asatọ sochirinụ, mgbe ahụ 1 lita maka awa asatọ ọ bụla. Nhọrọ a weghachite ọkwa bicarbonate ngwa ngwa ma kpochapụ ọdịiche anionic. Nnọkọ nke sodium na chlorine na plasma ọbara na-arịwanye elu.

N'ọnọdụ ọ bụla, a na-ahazi ọnụọgụ mmiri ịgba mmiri ka ọ dabere na isi mgbanye etiti (CVP). Ọ bụrụ na erughi 4 mm aq. Art. - 1 liter kwa elekere, ma ọ bụrụ na HPP sitere na 5 ruo 12 mm aq. Art. - 0,5 lita kwa awa, karie 12 mm aq. Art. - 0.25-0.3 lita kwa elekere. Ọ bụrụ na onye ọrịa nwere akpọnwụ akpịrịkpa, mgbe ahụ, maka elekere ọ bụla ị nwere ike itinye mmiri mmiri n'ime olu na-erughị 500-1000 ml karịa mmamịrị nke ewepụtara.

Etu esi egbochi mmiri mmiri karịrị akarị

Onu ogugu mmiri nke etinyere n’awa iri na abuo nke ọgwụgwọ ketoacidosis kwesiri ikwekọ karịa pasent 10 nke ogo onye ọrịa. Loadbara oke ọkụ na-ebulite ohere nke ọrịa akpịrị, ya mere a ga-enyocha CVP. Ọ bụrụ na ejiri hypotonic mee ihe n'ihi ụba ọdịnaya sodium dị n'ọbara, mgbe ahụ, a na-ahụ ya na obere olu - ihe dịka 4-14 ml / n'arọ kwa elekere.

Ọ bụrụ na onye ọrịa nwere hypovolemic ujo (n'ihi mbelata olu nke ọbara na-erugharị, ọbara mgbali elu “sịrị”) ga-akwụsi ike n'okpuru 80 mm Hg ma ọ bụ CVP erughị 4 mm Hg), mgbe ahụ ka akwadoro iwebata colloids (dextran, gelatin). N’ihi na n’ọnọdụ a, iwebata usoro 0.9% NaCl nwere ike ọ gaghị ezu iji kwado ọbara mgbali elu ma weghachite inye ọbara n’arụ.

N'ime ụmụaka na ndị na-eto eto, ohere nke ọrịa ụbụrụ na-abawanye ụba mgbe a na-agwọ ketoacidosis ọrịa mamịrị. A na-adụ ha ọdụ ka ha gbanye mmiri mmiri iji kpochapụ akpịrịkpa na ọnụego 10-20 ml / kg na elekere nke 1st. N'ime oge awa anọ mbụ nke ọgwụgwọ, mkpokọta olu mmiri mmiri a na-achịkwa agaghị agafe 50 ml / n'arọ.

Mmezi nke ọgba aghara electrolyte

Ihe dị ka 4-10% nke ndị ọrịa nwere ketoacidosis na-arịa ọrịa shuga nwere hypokalemia n’elu nnabata, i.e., ụkọ potassium n’ahụ. Ha na-amalite ọgwụgwọ site na ntinye nke potassium, a na-eyigharịkwa ọgwụ insulin ruo mgbe potassium n'ime plasma ọbara na-agbago ma ọ dịkarịa ala 3.3 meq / l. Ọ bụrụ na nyocha ahụ gosipụtara hypokalemia, mgbe ahụ nke a bụ ihe ngosipụta maka ịkpachapụ anya na nchịkwa nke potassium, ọbụlagodi na mmamịrị mmamịrị nke onye ọrịa adịghị ike ma ọ bụ na-anọghị ya (oliguria ma ọ bụ anuria).

Ọ bụrụgodi na ọkwa ọgwụ potassium dị n'ọbara bụ oke etu o kwesiri, mmadụ nwere ike ịtụ anya mbelata ya n'oge ọgwụgwọ ọrịa ketoacidosis. A na - ahụkarị ya awa 3-4 mgbe mmalite nke normalization nke pH. N'ihi na ntinye nke insulin, mkpochapu akpukpọ mmiri na mbelata ọ̀ka shuga dị n'ọbara, a ga-etinye potassium n'ụba ọnụ yana glucose na sel, yana amịrị na mmamịrị.

Ọ bụrụgodi na ọrịa ọgwụ potassium dị na mbụ onye ọrịa, ọ na-eburu ibu nke potassium na - ebido na mmalite insulin ọgwụ. N'otu oge, ha na-achọ ịgbado ụkpụrụ nke plasma potassium site na 4 ruo 5 meq / l. Ma ị gaghị abanye karịa 15-20 g nke potassium kwa ụbọchị. Ọ bụrụ na ịbanyeghị na potassium, mgbe ahụ, ebumnuche nke hypokalemia nwere ike ịbawanye mmegide insulin ma gbochie ịdị elu nke shuga ọbara.

Ọ bụrụ na amabeghị ọkwa nke potassium na plasma ọbara, mgbe ahụ iwebata potassium na-ebido mgbe awa abụọ gasịchara ọgwụ insulin, ma ọ bụ tinye mmiri 2 lita. N'okwu a, a na-enyocha ECG na ọnụego mmịpụta mmịpụta (diuresis).

Ọnụego nchịkwa potassium na ọrịa shuga na-arịa ọrịa shuga *

* Tebụl ahụ dabeere n'akwụkwọ 'Ọrịa shuga. Ọrịa siri ike na nke na-adịghị ala ala ”ed. I.I.Dedova, M.V. Shestakova, M., 2011
** na 100 ml nke 4% KCl ngwọta nwere 1 g nke potassium chloride

Na ketoacidze na-arịa ọrịa shuga, nchịkwa phosphate adịghị arụ ọrụ n'ihi na ọ naghị emezi nsonaazụ ọgwụgwọ. Onu ogugu n’edeputa ihe enyere n’ibu nke foduru phosphate nke otutu 20-30 meq / l infusion. Ọ gụnyere:

• akpọ hypophosphatemia,
• anaemia
• oke obi ike.

Ọ bụrụ na enyere phosphates, mgbe ahụ ọ dị mkpa ijikwa ọkwa nke kalsel dị n’ọbara, n’ihi na enwere ihe ize ndụ nke ọdịda ya gabigara ókè. Na ọgwụgwọ nke ọrịa ketoacidosis nke ọrịa mamịrị, a naghị edozi ọkwa magnesium.

Mkpochapu Acidosis

Acidosis bụ ntụgharị na ọkwa nke acid na-ebute ịrị elu nke acidity. Ọ na - etolite mgbe, n'ihi ụkọ insulin, ahụ ketone na-abanye n'ọbara. Site na enyemaka nke ọgwụ insulin zuru oke, a na-ebelata mmepụta nke ozu ketone. Kpochapu akpukpo ahihia n’enye aka na pH, n’ihi na o na - eme ka obara gbasaa, tinyere akụrụ, nke ketones dị na ya.

Ọbụna ma ọ bụrụ na onye ọrịa ahụ nwere acidosis siri ike, ịta ahụhụ nke bicarbonate nke pH nkịtị kwesịrị ịdị ogologo oge na sistemụ etiti. Ozokwa na eriri akpa nwa (cerebrospinal fluid), a na-edobe ọkwa nke ketone dị ala karịa na plasma ọbara.

Iwebata alkalis nwere ike ibute nsogbu ndi ozo:

• ụba ụkọ potassium,
• abawanye na acidosis intracellular, ọ bụrụgodị na pH nke ọbara bilitere,
• ihu abụọ
• jiri nwayọ wedata ketosis (mmepụta nke aru ketone),
• mmebi nke usoro nkewapu nke oxygenhemoglobin na hypoxia na - esochi (enweghị oxygen),
• hypotension akwara,
• acidosis nke paradoxical, nke nwere ike itinye aka na akụkụ ụbụrụ.

Ekwuputara na nhọpụta nke sodium bicarbonate anaghị belata ọnwụ nke ndị ọrịa nwere ọrịa ketoacidosis. Yabụ, ihe ngosi maka mbido ya ga-ebelata warara. Iji soda eme ihe mgbe nile na-ada mbà nke ukwuu. Enwere ike inye ya naanị n ’pH ọbara nke na-erughị 7.0 ma ọ bụ uru bicarbonate na-erughị 5 mmol / L. Karịsịa ma ọ bụrụ na achọpụta vaskụla vaskụla ma ọ bụ ọgwụ potassium gabigara n'otu oge, nke bụ ihe na-egbu ndụ.

Na pH nke 6.9-7.0, a na-ewebata 4 g nke sodium bicarbonate (200 ml nke ihe ngwọta 2% intravenously jiri nwayọ karịa 1 awa). Ọ bụrụ na pH dị ala, a na-ewebata 8 g nke sodium bicarbonate (400 ml nke otu 2% ngwọta na awa abụọ). A na-ekpebi ọkwa nke pH na potassium n'ime ọbara. Ọ bụrụ na pH erughị 7.0, mgbe ahụ ịkwesịrị ịmeghachi nchịkwa ahụ. Ọ bụrụ na mgbanye potassium dị ala karịa 5.5 meq / l, ekwesịrị ịgbakwunye 0.75-1 g nke potassium chloride maka 4 g nke sodium bicarbonate ọ bụla.

Ọ bụrụ na ọ gaghị ekwe omume ịchọpụta ihe ngosipụta nke ala acid, mgbe ahụ ihe egwu dị na ntinye nke alkali ọ bụla “na-enweghị isi” dị elu karịa uru a na-erite. A naghị atụ aro ya ịkọtara ndị ọrịa ihe ọ ofụ sodaụ soda na-a sodaụ mmanya, ma ọ bụ maka ị orụ ihe ọ orụallyụ ma ọ bụ n'akụkụ (site na ikensi ukwu). Enweghị mkpa ị toụ mmiri alkaline ịnweta. Ọ bụrụ na onye ọrịa nwere ike ị drinkụ mmiri nke aka ya, tii na-enweghị mmiri ma ọ bụ mmiri nkịtị.

Ọrụ ndị siri ike

Ekwesịrị ịba arụ ọrụ iku ume. Site na PO2 dị n'okpuru 11 kPa (80 mmHg), a na-enye usoro ọgwụgwọ oxygen. Ọ bụrụ na ọ dị mkpa, a na-enye onye ọrịa ọrịa a na-ahụ n'anya. Bụrụ na nke ọnwụ - guzobe eriri afọ maka agụụ ihe na-aga n'ihu (mgbapụta) nke afọ. A na-etinye katati n'ime eriri akpa ume iji nwee nyocha zuru oke gbasara nguzo mmiri.

Enwere ike iji obere heparin gbochie thrombosis. Ihe ngosi maka nke a:

• afọ nke onye ọrịa
• miri coma
• akpọrọ hyperosmolarity (ọbara buru oke ibu) - ihe karịrị 380 mọl / l,
• onye ọrịa ahụ na-a drugsụ ọgwụ gbasara obi, ọgwụ nje.

Ekwesịrị ịcribedụ ọgwụ mgbochi ọgwụ ọgwụ ọgwụ, ọbụlagodi ma ọ bụrụ na achọpụtaghị ebe a na-elekwasị anya ọrịa, mana ahụ dị elu nke ahụ. N'ihi na hyperthermia (fever) na-arịa ọrịa shuga ketoacidosis pụtara ọrịa mgbe niile.

Ọrịa mamịrị ketoacidosis n'ime ụmụaka

Ọrịa mamịrị ketoacidosis na ụmụaka na - apụtakarị na nke mbụ ma ọ bụrụ na ha enweghị ike ịchọpụta ụdị shuga nke oge n'oge. Na oge nke ketoacidosis na-adabere n'otú a ga-esi jiri nlezianya na-agwọ ọrịa shuga na onye ọrịa na-eto eto.

Agbanyeghi na ketoacidosis n'ime ụmụaka ka emere ka ọ bụrụ ihe ama ama nke ọrịa shuga 1, ọ nwekwara ike ịmalite n’etiti ndị ntorobịa nwere ọrịa shuga ụdị 2. Omume a bụ ihe a na-ahụkarị n'etiti ụmụaka ndị Spain nwere ọrịa shuga, na ọkachasị n'etiti ndị Africa America.

E mere nnyocha n’etiti ndị ntorobịa Africa-Amerika nwere ọrịa shuga nke 2. Ọ tụgharịrị na n'oge nyocha mbụ, 25% n'ime ha nwere ketoacidosis. Na-esote ya, ha nwere onyonyo a na-ahụkarị gbasara ụdị shuga nke 2. Ndị ọkà mmụta sayensị achọpụtabeghị ihe mere ihe a ji mee.

Ọrịa na ọgwụgwọ nke ketoacidosis na-arịa ọrịa shuga na ụmụaka bụ n'ozuzu ya na ndị okenye. Ọ bụrụ na ndị nne na nna ejiri nlezianya nyochaa nwa ha, ha ga-enwe oge iji mee ihe tupu ya adaba na ọrịa shuga. Mgbe ị na-edepụta usoro insulin, saline na ọgwụ ndị ọzọ, dọkịta ga-eme mgbanwe maka ogo ahụ nwatakịrị ahụ.

Iwu ccessga nke Ọma

Thekpụrụ maka idozi (ọgwụgwọ ọma) nke ketoacidosis na-arịa ọrịa shuga gụnyere ọkwa shuga ọbara nke 11 mmol / L ma ọ bụ nke dị ala, yana mmezi nke opekata mpe abụọ n'ime atọ na-egosi ọnọdụ acid. Nke a bụ ndepụta nke ihe ndị a na - egosi:

• ọbara bicarbonate> = 18 meq / l,
• pHsane ọbara ọbara + = 7.3,
• isi anionic Isiokwu: Nsogbu Diabetes

Ọrịa na akara nke ketoacidosis n’ime ụmụaka na ndị okenye

Ọrịa ketoacidosis na-arịa ọrịa mamịrị na-etolite n'ime awa 24.

Ihe ịrịba ama mbụ (mgbaàmà) nke ọrịa mamịrị detoacidosis bụ ndị a:

• akpịrị ịkpọ nkụ ma ọ bụ ọkpọọ nkụ
• ugboro ugboro
• ọbara mgbali elu
• ọnụnọ nke ọtụtụ ketones na mmamịrị.

Ihe mgbaàmà ndị a nwere ike ịpụta mgbe e mesịrị:

• ike ọgwụgwụ mgbe niile
• akọrọ ma ọ bụ ọbara ọbara nke anụ ahụ,
• ọgbụgbọ, ọgbụgbọ, ma ọ bụ afọ mgbu (vomiting nwere ike ibute ọtụtụ ọrịa, ọ bụghị naanị ketoacidosis. Ọ bụrụ na ọgbụgbọ na-adịgide karịa awa abụọ, kpọọ dọkịta),
• adọgbu onwe ya n'ọrụ na iku ume ugboro ugboro
• mkpụrụ osisi (ma ọ bụ isi nke acetone),
• itinye uche na nsogbu, nsụhọ.

Foto adakarị nke ketoacidosis nke ọrịa mamịrị:

Ọbara ọbara

13.8-16 mmol / L na elu

Glycosuria (ọnụnọ shuga dị na mmamịrị)

Ketonemia (ọnụnọ nke ketones na mmamịrị)

0,5-0.7 mmol / L ma ọ bụ karịa

Ọnụnọ nke ketonuria (acetonuria) bụ ọnụnọ akpọpụtara na mmamịrị nke ketone ahụ, ya bụ acetone.

Ntị! Ketoacidosis bụ ọnọdụ dị njọ na ọrịa shuga mellitus chọrọ ọgwụgwọ ozugbo. N’onwe ya, ọ naghị agafe. Ọ bụrụ n ’ụdị mgbaàmà ọ bụla dị n’elu emee, gakwuru dọkịta ozugbo ma ọ bụ kpọọ ụgbọ ihe mberede.

Ihe enyemaka mbu maka ketoacidosis

Mmụba na ọkwa nke ketones n'ime ọbara dị oke ize ndụ nye onye ọrịa nwere ọrịa shuga. Should kwesịrị ịkpọ dọkịta ozugbo ma ọ bụrụ:

• nyocha nke mmamịrị gị na-egosi ọkwa ketones dị elu,
• ọbụghị na ị nwere ketones n’ime mmamịrị gị, mana shuga ọbara gị dị elu,
• nyocha nke mmamịrị gị na-egosi ọkwa ketones dị elu wee malite ịrịa ọrịa - na-ama ihe karịrị ugboro abụọ na awa anọ.

Ejila onwe gi ogwu ma oburu na enwere ketones n’ime mmamiri, a na-edobe obara shuga di elu, n’okwu a ichoro odi nkpa nke ulo ogwu

Oke ketone dị elu na ọkwa glucose ọbara dị elu pụtara na ọrịa shuga gị enweghị nchịkwa ma ịchọrọ ụgwọ ozugbo.

Ọgwụgwọ ketosis na ketoacidosis na-arịa ọrịa shuga

Ketosis bụ ihe na-akpata ketoacidosis nke na-arịa ọrịa shuga, ya mere ọ chọkwara ọgwụgwọ. Abụba na abụba n'ihe oriri. A na-atụ aro ị drinkụ mmiri alkaline dị ukwuu (mmiri alkaline ịnweta ma ọ bụ mmiri mmiri nwere soda).

N'ime ọgwụ ọjọọ, methionine, essentiale, enterosorbents, enterodesis ka egosipụtara (5 g na-agbaze na 100 ml nke mmiri ọkụ ma drunkụbiga mmanya na 1-2 doses).

N'ime ọgwụgwọ nke ketoacidosis, a na-eji isotonic sodium chloride solution.

Ọ bụrụ na ketosis na-adịgide, ịnwere ike ịbawanye obere insulin insulin (n'okpuru nlekọta dọkịta).

Site na ketosis, a na-enye usoro ọgwụ mgbochi intramuscular kwa izu nke cocarboxylase na splenin.

A na-agwọkarị Ketosis n'ụlọ n'ụlọ onye dọkịta na-elekọta ya ma ọ bụrụ na ọ nweghị oge iji gbanwee ketoacidosis mamịrị.

Site na ketosis siri ike nke nwere ihe ngosipụta doro anya nke ọrịa mellitus decompensated, a chọrọ ịga ụlọ ọgwụ onye ọrịa.

Tinyere usoro ọgwụgwọ ndị a dị n'elu, onye ọrịa ahụ na-agbazi mmegharị insulin, na-amalite inye ọgwụ 4-6 nke insulin dị mfe kwa ụbọchị.

Na ketoacidosis na-arịa ọrịa shuga, a ghaghị inye ọgwụ mgbochi ọgwụ (nke ndị na-ebubata ya mmiri) - a na-ahazi mmiri ọgwụ isotonic sodium chloride (saline solution), na-eburu n'uche afọ na ọnọdụ onye ọrịa.

Lazareva T.S., endocrinologist nke ụdị kachasị elu