Nsogbu nke nyocha na ọgwụgwọ nke ketoacidosis nke ọrịa mamịrị n'ime ụmụaka na ndị nọ n'oge uto

Ọrịa siri ike nke nwere nnukwu nsogbu nke ịrịa ọrịa dị oke njọ ụdị ọrịa shuga mellitus (DM I) n’ebe ụmụaka na ndị nọ n’oge uto gụnyere ketoacidosis (DKA) na ọrịa mamịrị (DK). N'agbanyeghị ọganihu ndị dị ugbu a na njikwa ndị ọrịa nwere ụdị ọrịa shuga, DKA ka bụ isi ihe na-akpata ụlọ ọgwụ, nkwarụ na ọnwụ nke ụmụaka na ndị nọ n'afọ iri na ụma nwere ọrịa shuga.

Dabere na data e bipụtara, na ụwa 21-100% ọnwụ na ọrịa ketoacidosis na 10-25% nke nkwarụ na mmepe nke DKA na ụmụaka na ndị nọ n'afọ iri na ụma nwere ụdị ọrịa shuga bụ nsonazụ ọrịa ụbụrụ. Ọ bụkwa ọrịa ụbụrụ nke bụ isi ihe na-akpata ọnwụ na nkwarụ nke ụmụaka na ndị na-eto eto na mmepe nke nnukwu hypoglycemia na hypoglycemic coma.

Dabere na akwụkwọ na nkwupụta anyị, otu n'ime ihe na-akpata ọnwụ na ụmụaka site na ọrịa shuga bụ oge nchọpụta. Ihe fọrọ nke nta ka ọ bụrụ 80% nke ụmụaka na-arịa ụdị ọrịa shuga dị na ketoacidosis!

Dịka iwu, nke a bụ n'ihi enweghị atụ nke ngosipụta nke ụlọ ọgwụ site n’aka nne na nna (polydipsia, polyuria). Site na agụụ ma ọ bụ karịa nwere ike ịbawanye ụba (nke bụ ihe maka mpụta mbụ nke DM I), a na-ahụ ụlọ ọgwụ a dị ka whim, nsonaazụ nke ihu igwe na-ekpo ọkụ, ọnọdụ ọjọọ (mgbe ọ nwesịrị nrụgide, wdg)

Ọrịa gbasara ọrịa shuga mellitus M na-adabere na ịmara banyere ndị ọrịa gbasara ihe ịrịba ama nke mpụta mbụ ọrịa shuga mellitus:

polyuria na polydipsia (!),
ifelata bu ezigbo agụụ,
ogologo oge asthenization mgbe ọrịa,
omume pụrụ iche nke nwatakịrị n'ihi adịghị ike siri ike (otu n'ime ndị ọrịa anyị si n'oche daa, enweghị ike iguzo ma nọdụ karịa ihe karịrị nkeji ole na ole),
nsogbu mbụ gara aga.

Ya mere, ọnọdụ dị mkpa maka nchọpụta oge bụ agụmakwụkwọ na ibu ọrụ ndị nne na nna. O yighị ka a ga - enwe onye na - ahụ maka ụmụaka nke "kpochapụrụ" mkpesa nke polydipsia na polyuria.

Ọrịa na - akpata nnukwu ọrịa gụnyere hypoglycemia na hypoglycemic coma (n'oge ọgwụgwọ).

Ketoacidosis na-arịa ọrịa shuga bụ nsonaazụ insulin zuru oke, nke na-etolite na ngosipụta nke ọrịa shuga mellitus nke m, yana mmụba na mkpa insulin (nrụgide, ọrịa, nsogbu iri nri), nsogbu insulin onyunyo (nwa agbọghọ ahụ chọrọ ifelata, kwụsị iri nri ma belata ọgwụ ahụ n'onwe ya) , onye ọrịa ahụ na-ajụ insulin na-eme ogologo oge, ọ bụrụ na nke imebi iwu nke nchịkwa insulin insulin.

Oria insulin nke abuo kwekwara omume na mmụba nke mkpokọta homonụ nke mgbochi (nrụgide, trauma, sepsis, ndakpọ nke eriri afọ na afọ ọsịsa na vomiting).

Site na erughi insulin, a na-ebelata glucose site na akwara anụ ahụ (ọkachasị akwara na abụba), na mmeju gluconeogenesis na-ekerekwa na ịbawanye ọkwa glucose. Site na mmụba na mbido ụlọ gbasara aha, glucosuria na-etolite ma osmotic diuresis pụtara. Usoro a na - ebute polyuria - akara izizi nke ọrịa shuga.

Ọnwụ nke mmiri na electrolytes na mmamịrị ahụ, nke arụghị ụgwọ ọrụ ha, na-eduga ná akpịrị ịkpọ nkụ na ọbara ọgbụgba (oke ọbara), nke na-eduga na enweghi ike nke mgbasa ọbara oke, n'ihi oke mbelata nke olu na-emegharị ọbara (ujo). Otu ihe njiri mara jijiji na DKA bu hypotension arterial, nke na-ebute mbelata ọbara ọbara gbasara akụrụ (oge ụfọdụ ruo oke ọrịa anuria).

Tissue anoxia na-eduga n'ịgbanwe metabolism na mpaghara anaerobic glycolysis, na-eme ka mmụba nke mkpokọta lactate n'ime ọbara. Na DKA, mkpokọta acetone n'ime ọbara na-abawanye nke ukwuu, nke na-esote njupụta nke metabolos acidosis (omimi iku ume miri emi nke Kussmaul), nke bụ otu n'ime akara ngosipụta nke ọrịa ketoacidosis.

Mgbe ketonemia gafere n'ọnụ ụlọ nke akụrụngwa, ketones na-apụta na mmamịrị. Mmetụta ha site na akụrụ na-ebelata ihe ndị dị n'ime ala, nke na-eduga n'iwepụ sodium ọzọ. Nke a pụtara imebi “akwara” nke “extracellular fluid” nke ionic, si otua belata ike nke mmiri ịchekwa mmiri.

Enweghị insulin na iji glucose na-akpata nsogbu na-eduga n'ịbelata njikọta protein, mgbakasị ahụ na-akawanye akwara, karịchaa na akwara. N'ihi nke a, enwere ọghọ nke nitrogen, ntọhapụ nke potassium ion na ihe ndị ọzọ na - apụtakarị ihe n'ime ọbara, akụrụ na - esochi mkpụrụ nke potassium site na akụrụ. Ọnwụ mmiri na - aga n'ihu na - eduga na mmiri ọgbụgba n'ime intracellular, nke na - akwalite usoro catabolic na mgbasa nke electrolytes n'ime mmiri extracellular. Ọ bụrụhaala na diuresis dịgide, anụ ahụ potassium ọzọ ga-efunahụ gị, nke nwere ike ibute ndụ egwu.

Na DKA siri ike, nguzogide insulin na-apụta. Treatmentgwọ DKA ọbụlagodi na obere insulin na-eduga n'ịba ụba na ya na ọbara. Ihe kpatara ya bu uzo di elu nke mmanu mmanu n’ime obara, onodu nke acidosis, oke omuma nke mgbochi homonu. Ya mere, anyị nwere ike ikwubi: ịnweghị ike iji nnukwu insulin na ọgwụgwọ nke DKA!

Ọrịa mamịrị ketoacidosis na mmepe ya na-ekewa ụzọ atọ (ogo). Ntọala nke nkewa a na omume ụlọ bụ ogo nke mmetụ arụ ọrụ:

M digrii - obi abụọ (nsogbu ụra),
Uzo nke abuo - nzuzu,
Ngosi nke ato - n’ezie ipu ogwu.

Enwere mmekọrịta n'etiti ogo nke mmụọ ịmachaghị ihe na ịdị omimi nke acidosis. A na-enyocha ogo acidosis site na ụkọ isi (BE).

M - ọbara pH 7.15-7.25, BE (–12) - (-18)
II - ọbara pH 7.0-7.15, BE (-18) - (–26)
III - ọbara pH erughị 7.0, Bụrụ More (–26) - (- 28)

Dika odi, ogo nke DKA ya na mmepe nke coria mamria na akara ndi ozo na abawanye. Nleba anya nke oria shuga (DC):

DC digri - ụra, tachypnea, hyporeflexia, hypotension, tachycardia, ọgbụgbọ, ọgbụgbọ, mgbu afọ, isi nke acetone site n'ọnụ, polyuria, pollakiuria,
Grade II DC - nzuzu, iku ume Kussmaul, umeji umeji, hyporeflexia, tachycardia, ụda nke obi, ụda hypotension, vomiting ugboro ugboro, isi nke acetone na-anya n’ebe dị anya, ụlọọgwụ nwere “nnukwu ọrịa afọ”, polyuria nwere ike ọ gaghị enwe,
Grade DK III - nsụhọ adịghị, mkpụmkpụ mkpụmkpụ, mbibi, ngwa ngwa filiform, akpịrị nkọ, "marbling" ma ọ bụ ụcha awọ, cyanosis, anụ ahụ na ọzịza nke ụkwụ, vomiting nke agba kọfị, oligoanuria, Kussmaul ma ọ bụ Chain-Stokes na-eku ume.

O kwesiri icheta na otu ihe na-ebute mmepe nke ọrịa shuga bụ nnukwu ọrịa na-efe efe. Na mgbakwunye, megide ndabere nke nrụgide metabolic siri ike, ọrịa etiologies na ebe dị iche iche na-etolite mgbe mgbe, nke chọrọ ọgwụ mgbochi.

Isi ihe dị na ọgwụgwọ nke ọrịa mamịrị ketoacidosis:

mmee mmiri
ọgwụ insulin
hypokalemia mgbazi,
mweghachi nke nguzogide acid,
ọgwụ mgbochi nje.

Ekwesịrị iji mmiri na - eme ka mmiri na - emegharị mmiri nke ọma n'ihi nsogbu nke ọrịa ụbụrụ, a ga - eme ka azịza ya dị ọkụ ruo 37 Celsius. Olu nke mmiri a na-agbanye n’ọkụ ekwesịghị gafere ụkpụrụ iwu: afọ 0-1 - 1,000 ml kwa ụbọchị, afọ 1-5 - 1,500 ml, afọ 5-10 - 2,000 ml, afọ 10-15 - 2,000-3,000 ml.

N'ikwu ya n'ụzọ dị mfe,, ọnụọgụ mmiri agwara n'ime DKA ka a na-agbakọ dị ka ndị a: maka nwatakịrị na-erughị kilogram 10 - 4 ml / n'arọ / h, maka nwatakịrị dị kilogram 11-20 - 40 ml + 2 ml / kg / h maka kilogram nke ọ bụla n’agbata kilogram 11 na 20, ya na nwatakiri di ihe kariri kilogram 20 - 60 ml + 1 ml / kg / h maka kilogram obula kariri 20 n'arọ.

Iji chọpụta nha kwa ụbọchị nke mmiri injection, mkpa physiological, erughi mmiri (ogo nke mmiri mmiri), na ọgha n’ihu kwesịrị iburu n’uche. Needbọchị ọmụmụ ahụ kwa ụbọchị maka ịgbakọ oke nke anụ ahụ dabere na afọ nwatakịrị ahụ bụ: afọ 1 - 120-140 ml / n'arọ, afọ 2 - 115-125 ml / n'arọ, afọ 5 - 90-100 ml / n'arọ, afọ 10 - 70- 85 ml / n'arọ, afọ 14 - 50-60 ml / n'arọ, afọ 18 - 40-50 ml / n'arọ.

N'ime mkpa anụ ahụ gbakọrọ agbakwụnye, a na-agbakwunye 20-50 ml / kg / ụbọchị, dabere na mmiri akpịrị, ma na-aga n'ihu na mfu ndị ahụ.

Ihe ngwọta dị ukwuu nke ngwakọta bụ kristal. Na ụmụaka, agbanyeghị hyperglycemia, ojiji nke mmiri ọgwụ glucose na mmiri mgbe niile bụ ihe mmachi. Ijikwa glucose na - aga n'ihu dị mkpa iji gbochie mbelata ogo na ụbụrụ nke ụbụrụ n'oge ọgwụgwọ.

Ta oke glucose dị na ihe ngwọta na-adabere n'ọkwa glucose dị na plasma:

2,5% - nke nwere glucose dị elu karịa 25 mmol / l,
5% - ya na glucose ogo 16-25 mmol / l,
7.5-10% na glucose dị n'okpuru 16 mmol / L.

Ojiji nke saline n'ahụ ụmụaka na mmalite ọgwụgwọ ezighi ezi, ebe ọ bụ na enwere nnukwu ihe ize ndụ nke ịmalite ọrịa hypernatremia na ọrịa hyperosmolarity yana egwu nke ụbụrụ. Nyocha nyocha nke sodium dị n’ọbara dị mkpa.

Isi ihe ọzọ dị mkpa bụ mkpochapu ụkọ potassium. Na ụmụaka, a na-ahụkarị ọkwa potassium dị ala na - adị ala, nke na-agbada ngwa ngwa n'oge ọgwụgwọ (ọgwụ infusion, insulin). Ọ dị mkpa iji weghachite ụkọ potassium na ozugbo (na mbụ potassium), ma ọ bụ awa 2 mgbe mmalite nke infusion ọgwụgwọ na a dose nke 3-4 mmol / l / n'arọ nke ahụ dị ezigbo arọ kwa ụbọchị yana lita ọ bụla (1 ml nke 7.5% KCl kwekọrọ na 1 mmol / l).

N'ihe banyere ntinye nke sodium bicarbonate, a choro iwebata potassium ozo na onu ogugu 3-4 mmol / l / kg.

Endfọdụ endocrinologists (Moscow) kwenyere na iwebata ihe ngwọta nke potassium kwesịrị ịmaliteworị na mmalite ọgwụgwọ (yana diuresis dị mma), mana na obere ịta: 0.1-0.9 meq / kg / h, wee mụbaa 0.3— 0,5 meq / n'arọ / h Igosiputa bu ihe egwu di uku nke hypokalemia na eziokwu na umuaka ndi no n’onodu oria n’azu n’onodu igba ogwu n’ogwe nkpuru osisi nke potassium n’iru otutu ihe ana achoputara na adighi ike, ma obu ihe n’erughi oke a n’eme ngwa ngwa n’oge ogwugwo.

Ofkpụrụ nke usoro ọgwụgwọ insulin: hyperglycemia, kama ọ bụ naanị ma ọ bụrụ na ọkwa glucose anaghị agafe 26-28 mmol / l ma ọ bụrụ na ọ nweghị ihe iyi egwu na ndụ onye ọrịa. Igwe glucose dị mma (nke dị nchebe) bụ 12-15 mmol / L. Ọkwa dị n'okpuru 8 mmol / L megide ndabere nke ketoacidosis siri ike maka mmepe nke steeti hypoglycemic, nke ejikọtara ya na nnukwu ohere nke ọrịa ụbụrụ.

Nmalite insulin bụ 0.1 U / n'arọ nke ahụ dị ezigbo nwatakịrị ahụ kwa elekere, na ụmụaka, ọgwụ a nwere ike ịbụ 0.05 U / n'arọ. Mbelata nke glycemia n'oge awa mbụ kwesịrị ịbụ 3-4 mmol / l kwa elekere. Ọ bụrụ na nke a emeghị, ọgwụ insulin na-abawanye site na 50%, yana mmụba nke glycemia - site na 75-100%.

Ọ bụrụ na ọkwa glucose na-agbadata n'okpuru 11 mmol / L, ma ọ bụ na-agbada ngwa ngwa, ọ dị mkpa iwelie mkpokọta nke glucose na-achịkwa 10% ma ọ bụ karịa. Ọ bụrụ na ọkwa nke glycemia na-adịgide n'okpuru 8 mmol / l, n'agbanyeghị ntinye nke glucose, ọ dị mkpa iji belata ego insulin na-elekọta, mana ọ bụghị ihe na-erughị 0.05 U / kg kwa awa.

A na-elekọta insulin n'ime mmekọrịta (nhazi insulin nke mmadụ na-adị obere oge ma ọ bụ analogues insul na-eme obere ihe). Ọ dị mkpa idebe ụkpụrụ nke usoro "obere". Ọnụego nchịkwa ekwesịghị gafere 0.12 U / kg / h, nke sitere na 1-2 ruo 4-6 U / h, dabere na afọ nwata ahụ. Kwesighi ịbawanye insulin nke ukwuu, ma ọ bụrụ na n'oge awa mbụ ọkwa glucose adịghị ebelata, enwere ihe ize ndụ nke hypoglycemia, yana edeba akụkụ ụbụrụ.

Na mgbakwunye na ndị isi infusion, a na-atụ aro ka a nyefee heparin na 150-200 IU / kg / ụbọchị, cocarboxylase 800-1200 mg / ụbọchị, ascorbic acid ruo 300 mg / ụbọchị, panangin ruo 40-60 ml / ụbọchị. Ọ bụrụ na ọ dị mkpa, calcium, magnesium sulfate nke 25% - 1.0-3.0 ml (agbakwunyere na infusion ọkara mgbe a na-ebelata ọkwa glucose na 16 mmol / L ma ọ bụ dị ala iji mee ka ọ̀tụ̀tụ̀ osmotic ọbara ahụ sie ike).

Dịka ọmụmaatụ, iwebata ngwakọta glucose-nnu. Otutu mgbe, uzo ihe abuo ndi ozo di iche.

Ngwọta Nke 1:

Glucose, 2.5-5-10%, 200 ml (dabere na ọkwa nke glucose na plasma).
Potassium chloride, 4-5%, 15-30 ml (dabere na ọkwa nke K + na ọbara).
Heparin, 5000 IU / ml, 0.1-0.2 ml.
Inyocha insulin, nkeji 2-6-8 (ọ dabere na ịdị arọ nwata na ogo glucose na plasma).

Ngwọta Nke 2:

Ngwọta nnu - 200 ml.
Glucose, 40%, 10-20-50 ml (dabere na ọkwa nke glucose na plasma).
Panangin, 5-10-15 ml.
Potassium chloride, 4-5%, 10-30 ml (dabere na ọkwa nke K + na ọbara).
Sulfate magnesium, 25%, 0,5-2 ml.
Heparin, 5000 IU / ml, 0.1-0.2 ml.
Inyocha insulin, nkeji 2-6-8 (ọ dabere na ịdị arọ nwata na ogo glucose na plasma).

A na-enyocha glucose Plasma ọbụlagodi 1 oge kwa elekere ruo mgbe ọnọdụ ahụ ga-adị mma (awa isii mbụ), ma emesia ọ bụla awa 2-3 A na-enyocha ala-acid nke ọbara na ọkwa electrolyte kwa awa 3-6, nyocha ọbara ọbara. - awa 6 kwa awa (ya na hypokalemia - awa 2-3 obula).

Site n'ihe egwu nke ụbụrụ akụkụ, dexamethasone 0.4-0.5 mg / kg / ụbọchị ma ọ bụ prednisone 1-2 mg / n'arọ / ụbọchị na-achịkwa na usoro 4. Achọpụtaghị Hydrocortisone site na njigide sodium na hypokalemia nwere ike ịdị. Na ntinye, a na-atụ aro iwebata mannitol, albumin, diuretics (furosemide). Jide n'aka na ịchọrọ ọgwụ mgbochi oke!

N'agbanyeghị ọnụnọ acidosis, a naghị ejikwa nchịkwa intraven na mmalite ọgwụgwọ. Acidosis siri ike bụ ọnọdụ a na-atụgharị n'oge ọgwụgwọ ọzọ na mmiri na insulin: ọgwụgwọ insulin na-egbochi orụ keto acid ma na-akwalite metabolism ya na nguzobe nke bicarbonate.

Treatmentgwọ hypovolemia na-eme ka mmanụ anụ ahụ na arụ ọrụ akụrụngwa na-arụ ọrụ, si otú a na-eme ka mkpụrụ ndụ nke Organic na-eto. N'akụkụ a, a na-eji bicarbonates eme ihe naanị n'ọnọdụ dị oke njọ, mgbe pH ọbara na-ada n'okpuru 6.9 na ọnụego 1-2 mmol / kg nke ịdị arọ ahụ n'ezie, a na-etinye nwayọ nwayọ nwayọ karịa 60 nkeji. Ọzọkwa, a na-ewebata potassium na ọnụego nke 3-4 mmol / L potassium chloride kwa 1 n'arọ nke ịdị ahụ mmadụ kwa 1 liter nke mmiri mmiri.

Nsogbu nke usoro ọgwụgwọ DKA bụ nsonaazụ mmiri na-ezughi oke na mmepe nke hypoglycemia, hypokalemia, hyperchloremic acidosis na akụkụ ụbụrụ. Yabụ, ịchọpụta ọnọdụ ndị a n'oge na ọgwụgwọ zuru oke ga-enyere aka ịme usoro ndị kwesịrị ekwesị iji kwụsị ha.

Acidosis n’okpuru ọnọdụ ọnọdụ metabolic

Ketoacidosis nwere ike ịmalite n’etiti ndị ọrịa nwere ọrịa shuga na ọrịa metabolic ndị ọzọ, bụ nke a na-eji enweghị mkpụrụ ndụ na-emepụta insulin na-enyere aka ịgbari shuga.

Mgbe ngụgụ anaghị ewepụtarịrị carbon dioxide n'ọbara, ọnọdụ acidosis nke iku ume nwere ike ime.. Aku na ahụ nwere oke acid, na-egbochi ọrụ nke akụkụ ahụ ma nwee ike ibute oke ụjọ, yana ịkpasu mmebi iku ume.

Osdị metabolic acid ọzọ dị iche iche na - abụkarị akpịrị na - ebute site na afọ ọsịsa ọ na - ebute n'ihi ọnwụ nke nnukwu sodium bicarbonate.

Akwa lactic acid nwere ike ibute acidosis, nke na - eme mgbe ụfọdụ n’ihi ị alcoholụ mmanya, nsị imeju, enweghị oxygen, na site na oke ọzụzụ.

Mgbe ọnọdụ a na-ahụ maka anụ ahụ na-adị ogologo oge, akụrụ na-ejikwa nhazi acid mgbe ụfọdụ ma wepụ ihe ndị ọzọ na-emerụ ahụ.

Isi ihe mgbaàmà nke ketoacidosis

Acidosis ngwa ngwa

Etodị oke nke ketoacidosis na-eku ume ọkụ na - akpatakarị nchịkọta carbon dioxide ngwa ngwa. Usoro akụrụ agaghị egbochi usoro a yiri nke ahụ. A na-etolite acid a na - ahụ anya ma ọ bụ ketone n’oge a na - enwe ọrịa mamịrị.

Ha bụ nnabata nke agbajikwa sel sel, ọ bụghịkwa nke shuga a na-akpọ glucose, nke enweghị ike ị beụ ya n’enweghi mmekorita nke insulin.

Njirimara Ọrịa

Ketoacidosis - gịnị ka ọ bụ?

Ketoacidosis na-arịa ọrịa shuga nwere njirimara ndị a

mbelata ọrụ na ọdịdị nke adịghị ike,
akọwapụtara iku ume
mgbu afọ,
akpịrị ịkpọ nkụ mgbe niile.

Enwere ike ịga n'ihu na ndepụta a, mana ogo nke akara ndị fọdụrụ adịbeghị oke. Ketoacidosis na mellitus nke ọrịa shuga chọrọ nlekọta ahụike ngwa ngwa, ebe onye ọrịa ahụ nwere ike ịmalite coma.

Ọ bụrụ na onye ọrịa nwere ọrịa siri ike, mgbe ahụ iguzogide insulin a gbanyere mkpọrọgwụ malitere ịmalite n’ahụ ya. Withgwọ obere ọgwụ were obere ọgwụ na-eduga n'ịba ụba oke dịka iwu ruru ugboro ise ruo ugboro iri na anọ. Nlegide insulin bu n'ihi otutu ihe, tinyere:

ịta abụba n'ime ọbara,
ọrịa mamịrị ketoacidosis,
ọdịnaya dị elu nke ndị na - emegide ọgwụ insulin (homonụ ibu, catecholamines, wdg).

N'ịchọpụta ihe ndị bụ isi, ndị ọkachamara kwubiri na nkwubi insulin na nke a bụ n'ihi ion hydrogen. Mgbe afọ nyocha gasịrị, achọpụtara ya:

Mbelata ma ọ bụ mkpochapu insulin na-eguzogide ọgwụ ma ọ bụrụ na iwebata sodium bicarbonate.
Mmepe ngwa ngwa nke nguzogide insulin mgbe iwebata ammonium chloride. Emere nnwale ahụ na oke oke.

Acidosis na - egbochi ọrụ insulin, na - ebute nsogbu na njikọta homonụ-receptor. Sodium bicarbonate bụ ihe nnwale na-ewepụ ọrịa metabolic na okirikiri nke ọrịa ahụ. Enwere ike iji ogige a na-agwọ ketoacidosis, ihe mgbaàmà nke ama ama ama.

Isi ihe kpatara ọrịa ahụ:

Usoro ọgwụgwọ insulin na-ezighi ezi (mbelata / mmụba na usoro onunu ogwu, ị ofụ ọgwụ gbagburu agbagha, mebie ya na iwebata insulin (sirinji, wdg)).
Site na ntinye hormone mgbe niile n'otu ebe, mmepe nke lipodystrophy na-amalite, mmịnye nke insulin.
Diabetesdị ọrịa shuga a chọpụtabeghị.
Ọrịa na-efe efe na-emetụta ahụ.
Exacerbation nke ọrịa dị iche iche na-adịghị ala ala.
Oge ịwa ahụ na mmerụ ahụ gara aga.
Ime
Achọpụtara ọrịa ndị dị elu nke ọrịa obi (akwara ọbara, nkụchi obi).
Nlekọta nke homonụ a na - ahụ maka ọrịa shuga 2.
Ogologo oge iji ọgwụ mgbochi alụso ọrịa ọgụ.
Nchegbu na iji ọgwụ ọjọọ.

Acidzọ acidosis siri ike

Redị ketoacidosis dị ụkọ na-esite na nsị akụrụ. Renal acidosis na - eme ka ikike pere mpe nke nephron tubular mee ihe iji mee ka ihe ndị na - egbu egbu nke acid wepụtara. Ọrịa ogbu na nkwonkwo na ọrịa imeju, nwere ike ịmalite na ketoacidosis.

Enweghị bicarbonate n'ime ọbara, ma ọ bụ uru sodium chọrọ, na-eduga n'ụfọdụ ketoacidosis metụtara akụrụ.

Gịnị bụ ọrịa ketoacidosis na-arịa ọrịa shuga

Ọnọdụ a bụ nnukwu ọrịa nke ọrịa shuga n'ihi ụkọ insulin. Ọtụtụ mgbe, ndị ọrịa nwere ụdị 1 na-arịa ketoacidosis. Nnukwu ketoacidosis na-eduga na coma, nke nwere ike ịbụ ngosipụta mbụ nke shuga dị n'ọbara. Nke a bụ ọkachasị n’ebe ụmụaka na ndị nọ n’oge uto nọ.

Site na mbibi nke pancreas, ihe ịrịba ama ndị ahụ na - apụta n'oge mgbe naanị 10-15% nke mkpụrụ ndụ na - emepụta insulin na - arụ ọrụ. Ha enweghị ike ịchọpụta ojiji nke glucose na nri. Ọrịa shuga dị oke mkpa chọrọ ọgwụ insulin. Ihe karịrị 16% nke ndị ọrịa nwere ụdị ọrịa shuga 1 na-anwụ site na ketoacidosis na nsonaazụ ya.

Thedị nke abụọ, ọnọdụ ketoacidotic apụtaghị ugboro ugboro ma na-ejikọkarị ya na enweghị ọgwụgwọ. Onye ọrịa ahụ nwere ike ịkwụsị ị theụ ọgwụ ahụ n'onwe ya n'ihi atụmatụ mgbasa ozi nke ndị na-emepụta nri nri, ma ọ bụ kwenye na ịgbaso nri zuru oke iji kwụọ ụgwọ ọrịa ahụ.

Ihe egwu nke ketoacidosis na-echere ndị ọrịa agadi nwere ogologo “ahụmịhe” nke ọrịa ahụ. N'ime oge, pancreas na-agbari, n'ihi na iji merie ihe na-emegide insulin emepụtara, ọ ga-arụ ọrụ na ọnọdụ ọ kawanye arụ. Oge na-abịa mgbe ọrịa shuga na-enweghị insulin na-agbanwe ghọọ insulin chọrọ. Ọrịa mamịrị chọrọ n'ọnọdụ ndị a, na mgbakwunye na mbadamba nkume, ga-anata insulin.

Na ebe a bu ihe ozo banyere nkenke isi nke oria shuga.

Ihe kpatara mmepe

Ketoacidosis nwere ike ime na enweghị ọgwụ insulin n'ihi amaghị nke ọrịa shuga, mana na omume ọ na - ejikọkarị ya na njehie ọgwụgwọ:

onye ọrịa na-anara inje injection, mgbe ụfọdụ ọ na - eri nri n'ihi agụụ na ọgbụgba n'ihi ụba glucose ọbara ma ọ bụ ọrịa na ọnya,
akwadoghị inje injection ma ọ bụ mbadamba na-akwadoghị. Site n'ọrịa shuga 2dị nke abụọ, a chọpụtara na onye ọrịa ahụ were ọtụtụ ọnwa (ma ọ bụ ọbụna ọtụtụ afọ) ị medicationaghị ọgwụ ma ghara ịtụ glycemia,
nnukwu ọnya nke ime,
nsogbu nke adrenal gland, pituitary, thyroid gland,
usoro nri, ị systemụbiga mmanya ókè,
nchịkwa na-ezighi ezi nke obere insulin (ọhụụ dị ala, mkpi na-ezighi ezi, mgbapụta insulin),
nsogbu ọgbụgba - nkụchi obi, ọnya afọ,
ogwugwo ogwu, mmerụ ahụ,
ọgwụ a na-achịkwaghị achịkwa nke nwere homonụ, diuretics.

Usoro mmepe nke ketoacidosis

Enweghị insulin zuru oke n'ụdị shuga 1 ma ọ bụ mebie uche ya (enweghị ụkọ) na ntinye nke abụọ nke usoro:

A na-abawanye ọ̀tụ̀tụ̀ glucose ọbara, sel ndị ahụ na-enwekwa agụụ.
Ahụ mmadụ na-achọpụta erughị ala nri dịka nrụgide.
Ntọhapụ nke homonụ na-egbochi ọrụ insulin - contrarainlar na-amalite. Ahụhụ nke pituitary gandoro somatotropin, adrenocorticotropic, gren adrenal - cortisol na adrenaline, na pancreas - glucagon.
N'ihi ọrụ nke ihe ndị na - eme ka ọ pụta ìhè, ịmepụta glucose ọhụrụ n'ime imeju, mmebi nke glycogen, protein na abụba, na - abawanye.
Site na imeju, glucose na-abanye n'ọbara ọbara, na-abawanye ọkwa glycemia dị elu.
Nchịkọta shuga dị elu na-eduga n'eziokwu ahụ na mmiri mmiri si na anụ ahụ dị ka iwu nke osmosis si banye na arịa.
A na-eme ka akpụkpọ ahụ nwee nkụ, ha nwere ihe ndị na-enye protein potassium.
A na-ewepụ glucose site na akụrụ (mgbe ọ mụbara glycemia ruo 10 mmol / l), na-ewepụ mmiri, sodium, potassium.
Akwa mmiri ozuzo, enweghi echiche elektrik.
Mkpuchi ọbara, agbatị ọbara.
Mbelata ọbara na-eruga na ụbụrụ, akụrụ, obi, aka na aka.
Ọbara ọbara gbasara akụrụ dị ala na-eme ka njedebe nke mmamịrị na nnukwu akwara ghara ịba uru shuga.
Agụụ oxygen na-akpata usoro nke glucose na-egbu egbu (anaerobic glycolysis) na ị nweta acid lactic.
Ojiji nke abụba kama glucose maka ike na-esonyere ntinye ketones (hydroxybutyric, acetoacetic acid na acetone). Enweghị ike ịpịpụ ha nke ọma n'ihi mmụba mmamịrị akụrụ dị obere akụrụ.
Ahụ Ketone na-eme ka ọbara (acidosis) na-emebi mmiri, na-akpasu etiti iku ume (oke iku ume Kussmaul), eriri afọ na peritoneum (mgbu na-egbu mgbu), na-akpaghasị ọrụ ụbụrụ (coma).

Ihe mgbochi nke nsụhọ na ketoacidosis metụtara akpọnwụ nke sel ụbụrụ, ụkọ oxygen n'ihi njikọta nke haemoglobin na glucose, ọnwụ nke potassium na thrombosis zuru ebe nile (agbasa coagulation intravascular).

Ọga ọkwa

N’agba nke mbu, a na-akwụghachi ketoacidosis site na excretion nke ketone ahu na mmamịrị. Yabụ, enweghị akara nke nsị anụ ahụ ma ọ bụ na ha pere mpe. A na-akpọ ọkwa nke mbụ ụgwọ ketosis. Ya, ka ọnọdụ ahụ siwanyere njọ, na-aga n'ime acidosis decompensated. Na-emegide ihe dị na ọkwa nke acetone na acid, nsụhọ na mbụ na-agbagha, onye ọrịa na-eji nwayọ emeghachi omume na gburugburu ebe obibi. N'ime ọbara, ahụ glucose na ketone ahu na-abawanye nke ọma.

Ekem precoma, ma ọ bụ ketoacidosis siri ike. A na-echekwa nsachapụ uche, mana mmeghachi omume onye ọrịa na-akpali ihe mpụga bụ adịghị ike. Ihe onyonyo a gunyere ihe banyere ihe ndi ozo di ike. Na ọkwa nke anọ, Coma na - etolite, na enweghị enyemaka mberede, ọ na - eduga n'ọnwụ.

Na omume, a gaghị enwe ike ịkewa ndị nke ikpeazụ ikpe, yabụ, a na-ahụta mbelata nke ọkwa dị ka ketoacidosis nke na-arịa ọrịa shuga, chọrọ ịmalitegharị.

Ọrịa nkwarụ na ndị okenye na ụmụaka

Ihe ịrịba ama nke mmụba na shuga ọbara na-abawanye nke nta nke nta. Nke a bụ nnukwu ọdịiche dị n'etiti coma hyperglycemic ọ bụla na hypoglycemic coma, nke na-amalite ngwa ngwa. Dị ka ọ na-adịkarị, glycemia na-abawanye na ketoacidosis ma ọ dịkarịa ala ụbọchị 2-3 ma naanị megide ndabere nke nnukwu ọrịa ma ọ bụ nnukwu mgbasa mgbasa, oge a na-ebelata ka awa 16-18.

Ihe ịrịba ama mbụ nke ketosis gụnyere:

agụụ maka nri,
ọgbụgbọ, vomiting,
akpịrị ịkpọ nkụ a na-apụghị inyochapụta
ihe mmamịrị riri oke
ọkpọ na nkụ nke anụ ahụ, akpụkpọ anụ mucous,
igba azu
ifelata
isi ọwụwa
anwụghị anwụ
ntakịrị isi nke acetone (yiri apụl a gbanyere mkpọrọgwụ).

N’ime ụfọdụ ndị ọrịa, akara ndị a niile anaghị adị ma ọ bụ na -eme ha anya na-emegidekarị shuga dị n’ọbara. Ọ bụrụ n ’ime mkpebi siri ike nke ketones na mmamịrị n’oge a, ule ahụ ga-adị mma. Ọ bụrụ n’itinyeghị glycemia ọbụlagodi otu ugboro n’ụbọchị, mgbe ahụ ị nwere ike ịpụpụ agba mbụ nke coma.

N'ọdịnihu, ọganihu nke ketoacidosis ka amara:

ụda anụ ahụ na akwara na-ebelata
ọbara mgbali elu
usu ahụ na - eme ngwa ngwa
mbelata mmamịrị,
ọgbụgbọ na ọgbụgbọ na-aga n'ihu, ọgbụgbọ na-acha aja aja,
na-eku ume miri emi, na-eme mkpọtụ, na-eme ugboro ugboro, ísì ọjọọ nke acetone na-apụta,
a na-achapu aja na-apụta na ihu n'ihi ezumike nke mgbidi capillaries.

Diagnostics

Ọ bụrụ na amara na onye ọrịa ahụ nwere ọrịa shuga, yabụ nchọpụta a ga-ekwe omume ugbua na ọkwa nke nyocha mbụ. Ọ bụrụ na enweghị ozi dị otú ahụ ma ọ bụ onye ọrịa ahụ amaghị ihe ọ bụla, mgbe ahụ, dọkịta na-elekwasị anya n'ihe ịrịba ama nke akpịrị ịkpọ nkụ (akpụkpọ akpọnwụ, ude dị nro, nku anya dị nro anaghị agbatị ogologo oge), isi acetone, iku ume.

Maka nyocha ọzọ, achọrọ ụlọ ọgwụ ozugbo na nyocha ọbara na mmamịrị. Ihe mgbaàmà ndị a na-akwado echiche nke ketoacidosis na-arịa ọrịa shuga:

glucose ọbara karịrị 20 mmol / l, na-apụta na mmamịrị,
ụba ketone ahu (site na isii ruo 110 mmol / l), acetone na mmamịrị,
wedata n'ọbara pH ruo 7.1,
Mbelata alkaline nke ọbara, potassium na sodium ion,
ntakịrị mmụba na osmolarity ruo nkeji iri atọ (na ọnụego 300),
urea ba uba
mkpụrụ ndụ ọbara dị elu karịa nke nkịtị, ịgbatị usoro na aka ekpe,
hematocrit dị elu, hemoglobin yana sel ọbara.

Lee vidio banyere mpempe akwụkwọ nnwale Glukotest:

A na-enyocha onye ọrịa, a na-enyocha ule ụlọ nyocha na oge ndị a:

glucose - Kwa nkeji 60-90 ruo 13 mmol / l, mgbe ahụ kwa awa 4-6,
electrolytes, gas mejupụtara ọbara na acidity - ugboro abụọ n'ụbọchị,
mmamịrị maka acetone - site na ụbọchị 1 ruo 3 n’ime awa iri na abụọ ọ bụla, mgbe ahụ kwa ụbọchị,
ECG, nyocha ọbara na mmamịrị n'ozuzu ya - ụbọchị ọ bụla maka ụbọchị 7 mbụ, mgbe ahụ dabere n'ihe ngosipụta.

Nsogbu ndị nwere ike ibilite

Agba ikpeazụ nke ketoacidosis bụ coma, nke nsụhọ na-anọghị. Ihe ama ya:

iku ume ugboro ugboro
isi acetone
lecha na acha ọbara ọbara na ntì ya na ntì ya,
oke akpukpo aru - akpukpo ahihia, olu nkpa aru na anya,
ike ugboro ugboro, adịghị ike, hypotension,
nkwụsị mmamịrị,
ibelata ma ọ bụ enweghị mgbanwe,
ụmụ akwụkwọ dị warara (ma ọ bụrụ na ha anaghị anabata ọkụ, mgbe ahụ nke a bụ ihe ịrịba ama nke mmebi ụbụrụ na ịkọwa ihe na-adịghị mma maka Coma),
imeju imeju.

Ketoacidotic coma nwere ike ime na ọnya nwere ọnya:

akwara obi na arịa ọbara - daa na mbelata nke mgbali, ọbara nke akwara ọbara (nkụchi obi), aka na aka, akụkụ ahụ, akwara ume (thromboembolism na okuku ume),
traktọ diges - vomiting, oke nke ime, nnukwu eriri afọ, pseudoperitonitis,
akụrụ - nnukwu ọdịda, ụba creatinine na urea n'ime ọbara, protein na cylinders na mmamịrị, enweghị urination (anuria),
ụbụrụ - ọ na-abụkarị ndị agadi na-arịa ọrịa atherosclerosis. Ọkpụkpụ ọbara ọgbụgba, mbelata nke mmiri, acidosis na-esonyere akara ngosipụta nke mmebi ụbụrụ - adịghị ike nke aka, imerụ okwu, ọgbụgba, olu ike.

N'ime usoro mkpochapu nke ketoacidosis, ihe ndị a nwere ike ime:

akụkụ ụbụrụ ma ọ bụ akụkụ akwara umeji,
coagulation intravascular
nnukwu ọrịa okirikiri,
na-egbu egbu n'ihi oke afọ nke ihe dị n'ime.

Ọnọdụ mberede

Ekwesịrị ịtọhapụ onye ọrịa ahụ ma mee ka ọ banye na ikuku dị ọcha, yana mbelata nke okpomoku - mkpuchi. Mgbe a na-agbọọ, a gha atụgharị isi n’otu akụkụ. Na ọkwa mbụ (tupu ọ gaa ụlọ ọgwụ), iwebata ọgwụ na-akpata infusion, wee banye insulin, amalite. Ọ bụrụ na onye ọrịa maara, a na-atụ aro ka ị drinkụọ nnukwu mmiri ịnweta mmiri n'enweghị gas, wee sachaa afọ gị.

Lelee vidiyo na nlekọta mberede maka ọrịa shuga:

Ọrịa mamịrị ketoacidosis

N'ụlọ ọgwụ, usoro ọgwụgwọ na-ewere ọnọdụ ndị a:

nchịkwa nke insulin na obere ọrụ, na mbụ, intravenously, na mgbe ọ ruru 13 mmol / l - subcutaneously,
onye na-eji mmiri eji mmiri eme ihe, nke nwere nnu 0.9%, ma ihe okpukpu nke 5% glucose, potassium, (a na-eji sodium bicarbonate eme ihe na-anaghị ahụkebe),
Ọgwụ nje dị iche iche iji gbochie mbufụt nke akpa ume na akụrụ (Ceftriaxone, Amoxicillin),
anticoagulants maka igbochi thrombosis (heparin na obere doses), karịsịa na ndị ọrịa agadi ma ọ bụ kọmị miri emi.
ndị ọrụ cardiotonic na ọgwụgwọ oxygen iji wepu ọdịda nke cardiopulmonary,
echichi nke catheter na eriri urinary na ọkpọ afọ iji wepu ihe ndị dị n’ime afọ (n’onweghị mmụọ).

Ozi izugbe

Ọrịa mamịrị ketoacidosisbụ ihe pụrụ iche gbasara metabolic acidosis - ịgbanwee na nguzozi acid-ahu n’arụ na-abawanye acidity (site na Latin acidum - acid). Acid mekota ahihia - ketonesnke n'oge metabolism na-adịghị ike ịnwe ike ma ọ bụ mbibi zuru ezu.

Ọnọdụ ọrịa na - ebilite n'ihi enweghi ike na - eme ka ọ na - akpata ike nri insulin - homonụ nke na - enyere mkpụrụ ndụ aka ịmịkọta glucose. Ọzọkwa, n'ọbara ọbara, nchịkọta nke glucose na ketone ma ọ bụ n'ụzọ ọzọ acetone ozu (acetone, acetoacetate, beta-hydroxybutyric acid, wdg) dị elu karịa ụkpụrụ physiologically nkịtị. Nzoputa ha putara n'ihi mmebi siri ike nke metabolism na abụba. Enweghị enyemaka oge, mgbanwe na-eduga n'inwe mmepe ketoacidotic mamịrị coma.

Ọrịa glucose bụ ihe ume dị n’ụwa niile maka ọrụ nke mkpụrụ ndụ niile na ahụ ụbụrụ, na-enweghị ụbara ọbara, mmebi nke ihe glycogen(glycogenolysis) na mmezi nke glucose njikọ (gluconeogenesis)Ka ịgbanwee akwara na isi mmalite ọzọ - ịkwanye abụba n'ime abụba ọbara na-ahapụ hepatic acetyl coenzyme A ma na - abawanye ọdịnaya nke ozu ketone - site na ngwaahịa nke ịchacha ihe, nke a na - ejikarị obere ego ma bụrụ ihe na - egbu egbu. Ketosis ọ naghị ebute ọgba aghara electrolyte, mana na usoro nke decompensation, metabolic acidosis na acetonemic syndrome na-etolite.

Ndabere nke imebi carbohydrate metabolism bụ ụkọ insulin, nke na-eduga n'ịba ụba nke mkpokọ glucose na ọbara - hyperglycemiamegide ụzụ ike nke mkpụrụ ndụ, yana osmotic diuresismbelata nke olu mmiri extracellular na-eme ka mbelata ọbara ọbara akụrụ, ọnwụ plasma electrolytes na akpịrị ịkpọ nkụ. Na mgbakwunye, rụọ ọrụ na-apụta. lipolysis na ịba ụba ego efu glycerin, nke, yana ịba ụba nke glucose endogenous n'ihi nsonaazụ neoglucogenesis na glycogenolysis, na-eme ka ọkwa hyperglycemia dịkwuo elu.

N'ọnọdụ ume ume belata akwara anụ ahụ na imeju, ọ na-eme ka ọ dịwanye mma ketogenesismana anụ ahụ enweghị ike iji ọtụtụ ketones dị ole ma enwere mmụba ketonemia. Nke a gosipụtara onwe ya n'ụdị nku ume acetone na-adịghị ahụkebe. Mgbe superconcentrations nke ozu ketone gafere ihe mgbochi gbasara akwara na ndị ọrịa, ketonuria na mgbakwunye nke cations. Mwepu nke alkaline a na - eji egbochi acetone ogige na - akpata mmepe nke acidosis na ọnọdụ pathologies buru ụzọ, hypotension na mbelata ọbara ọgbụgba.

Homonụ Contrineulin na - ekere òkè na pathogenesis: daalụ adrenaline, cortisol nahomonụ na-eto Ọkpụkpụ insulin na-eji ọgwụ glucose eme ihe na-egbochi uru ahụ, usoro nke glycogenolysis, gluconeogenesis, lipolysis na-eme ka ọ dịkwuo mma ma na-ebelata usoro mkpụkọ insulin.

Nkewa

Na mgbakwunye na ketoacidosis mamịrị, zoro ezo na-anaghị arịa ọrịa shugama obu ọrịa acetonomic, nke a na-ahụkarị na ụmụaka ma gosipụta ya dịka oge ihe ọgbụgbọ na-esote, oge na-esochi oge nnabata ma ọ bụ mfu nke mgbaàmà. Ọrịa ahụ bụ ihe mmụba n'ọbara plasma nke ahụ ketone. Ọ nwere ike ịmalite n’enweghị ihe kpatara ya, megide ọrịa ma ọ bụ n’ihi njehie nri - ọnụnọ nke agụụ agụụ na-agụ ogologo oge, oke abụba na nri.

Ọ bụrụ na mmụba na ịta nke ketone ahụ n'ọbara abụghị nke akpịrị nsụ na-esiteghị na mmiri ịmụba na-esoghị, ha na-ekwu maka ihe dị ka mamịrị ketosis na-arịa ọrịa shuga.

Ketoacidosis na-egosipụta site na ọnọdụ uche bụ ihe mberede mere ka ọ bụrụ nhụsianya zuru oke ma ọ bụ nke enweghị nsogbu insulin, toro ihe karịrị ọtụtụ awa na ụbọchị, yabụ na ebumnuche na-abụkarị:

Nchọpụta na-enweghị atụ na ebumnuche ọgwụgwọ ụdị shuga 1 - insulin dabere, dabere na onwu mkpụrụ ndụ isuo mara mma nke Langerhans,
iji insulin eme ihe na-adịghị mma, ọtụtụ mgbe ezughị iji kwụọ ụgwọ ọrịa shuga na-akpata insulin,
imebi usoro nke usoro ọgwụgwọ insulin zuru ezu - nchịkwa na-elezighị anya, ọjụjụ ma ọ bụ ojiji nke insulin nke adịghị mma.
nguzogide insulin - wedata uche nke anụ ahụ na nsonaazụ insulin,
ị insụ ọgwụ insulin ma ọ bụ ọgwụ na - emebi metabolism. corticosteroids, nnabata ọmiko, thiazidespsychotropic bekee nke ọgbọ nke abụọ,
pancreatectomy - mwepu nke pancreas.

Enwere ike ịhụwanye mmụba nke anụ ahụ insulin n'ihi ihe nzuzo nke homonụ ndị dị otú a adrenaline, glucagon, catecholamines, cortisol, STH wee zụlite:

na-efe efe na-efe efe, ọmụmaatụ, na sepsis, oyi baa, meningitis, sinusitis, periodontitis, cholecystitis, pancreatitis, paraproctitis na usoro mkpali nke akụkụ okuku ume na elu traktị,
n'ihi nsogbu endocrine concomitant - thyrotoxicosis, Ọrịa Cushing, acromegalypheochromocytomas
ya na myocardial infarction ma obu ọrịa strok na-abụkarị asymptomatic
ya na ogwu ogwu glucocorticoids, estrogengụnyere nnabata mgbochi homonụ,
n'ọnọdụ ndị na-akpata nchekasị na n'ihi mmerụ ahụ,
n'oge ime mere afọ ime,
n’oge uto.

Na 25% nke ikpe idiopathic ketoacidosis - ebilite n’enweghị ihe kpatara ya.

Ihe mgbaàmà nke ọrịa ketoacidosis nke ọrịa mamịrị

Ejiri mara ọrịa ketoacidosis - ọrịa deellensus deellensus decompensated bụ:

adịghị ike
ifelata
akpịrị ịkpọ nkụ - polydipsia,
uba urination - polyuria na urination ngwa ngwa,
nri riri
nkuzi, uda na ura,
ọgbụgba, mgbe ụfọdụ ya na ọgbụgbọ, nke nwere agba aja aja na-adị ka "ahịhịa kọfị",
mgbu na - agbanwegharị - pseudoperitonitis,
hyperventilation, Nku ume Kussmaul - obere, miri emi, mkpọtụ nwere njiri mara nke "acetone".

Ule na nyocha

Iji mee nyocha, o zuru ezu iji mụọ onyonyo nke nyocha. Na mgbakwunye, ketoacidosis dị ka onye na-arịa ọrịa shuga na-agbanwe agbanwe na-egosipụta onwe ya n'ụdị:

elu glycemia ihe karịrị 15-16 millimol / l,
rụzuru glycosuria 40-50 g / l na ndị ọzọ
leukocytosis,
ngafe ketonemia ihe karịrị 5 milimol / l na nchọpụta ketonuria ọzọ (+)
iwetulata pH obara n'okpuru 7.35, yana ego nke ọkọlọtọ ọbara bicarbonate ruru 21 mmol / l na-erughị ya.

Ọgwụ Ketoacidosis

Iji gbochie mmepe nke ketoacidotic ọrịa mamịrị na akara mbụ nke ketoacidosis, enyemaka mbụ na ụlọ ọgwụ dị mkpa.

Ọrịa inpatient na-amalite site na infusion nnu nnuọmụmaatụ Ringer na iwepu ihe na - akpata nsogbu nke metabolic - na - abụkarị nchịkwa ihe mberede na mgbazi nke usoro ahụ, ogo nke usoro insulin. Ọ dịkwa mkpa ịchọpụta na ịgwọ ọrịa ndị kpalitere ọrịa shuga. Na mgbakwunye, a na-atụ aro ya:

ihe ọkalụ alụ alkaline - mmiri alkaline ịnweta, soda mmiri,
ihe na-asacha alkaline enemas,
mejuputara enweghi ntupo nke potassium, sodium na ndi ozo.
n'ikuku enterosorbentsna hepatoprotector.

Ọ bụrụ na onye ọrịa ahụ etolite Coma hyperosmolar, mgbe ahụ gosipụtara ya ntinye nke hypotonic (0.45%) sodium chloride solution (ọsọ anaghị erughị 1 l kwa elekere) yana usoro mmịkọ ọzọ na-esochi, yana hypovolemia - iji colloidal nọchiri plasma.

Ndozi Acidosis

Ọgwụgwọ na-adabere n’ụdị ketoacidosis onye ọrịa na-arịa. A na-eme nnwale ụlọ nyocha nke ihe mejupụtara gas, yana ule mmamịrị maka ọdịnaya electrolyte, iji chọpụta nsogbu njirimara, maka ebumnuche nchọpụta.

Enwere ike idozigharị Ketoacidosis ma chịkwaa ya, ebe onye ọrịa ahụ kwesịrị ịmata ụdịrị akpịrị acidosis ndị dị ka:

ike ọgwụgwụ
gbagwojuru anya
iku ume ike.

Ketoacidosis nwere ọrịa shuga nwere ike ibute ọdịda iku ume, ọnụ akọrọ, mgbu afọ na ọgbụgbọ. Ndị na-egbochi ọrịa nwere nsogbu bụ akwara anụ ahụ na akpịrị ịkpọ nkụ. N'ọnọdụ siri ike, ọnọdụ ahụ nwere ike ibute nsogbu na nlanarị 70%.

Dịka iwu, ngosipụta mbụ nke ọrịa na-amalite naanị mgbe ihe karịrị 80% nke mkpụrụ ndụ beta dị na pancreas bibiri. Mgbaàmà na-eduga bụ njirimara, mana akọwapụtaghị ya (ha nwere ike ime n'ọtụtụ ọrịa na ọnọdụ ndị ọzọ).

Mgbaàmà ndị a gụnyere:

polydipsia (akpịrị kpọrọ nkụ),
polyuria (mmụpụta mmụba),
nocturia (mmamịrị n'abalị),
enuresis (urinary incontinence),
ifelata
vomiting
akpịrị ịkpọ nkụ
isi mmụọ
arụmọrụ belatara.

Ogologo oge nke ihe mgbaàmà ndị a na-abụkarị site na ụbọchị ole na ole ruo ọtụtụ izu.

Ihe ị ga - eme ketoacidosis

Ihe ekpughe ekpughe nke ọrịa a, dabere ogo ha:

Mpempe ọkụ

N'ihe dị ka 30% nke ụmụaka, ngosipụta mbụ na-apụta n'ụdị dị nwayọọ - ihe mgbaàmà na-eduga dị nro, enweghị ọgbụgbọ, nkụ anaghị adị ike. Mgbe nyocha, achọpụtaghị ketones na mmamịrị ma ọ bụ na ha nọ na ọnụọgụ obere. Ọgwụ acid-base nke ọbara ahụ anaghị egosi ọghọm dị mkpa, ọ nweghị ketoacidosis akpọrọ akpọ.

isi acetone site n'ọnụ na mgbe urin,
mgbu na mpaghara ebe
enweghi ịda mba
ọgbụgbọ ma ọ bụ vomiting
Ọnọdụ anụ ahụ na ike ọgwụgwụ,
enweghị agụụ.

Ogo ogo

Site na ogo ogo mmadụ, mmadụ nwere ike ịhụ mgbanwe omume ka nsị nke mmiri:

akpụkpọ anụ mucous achara,
ifesa ire (akwa mkpuchi)
idobe anya
belata na ịdị ọcha nke anụ ahụ.

A na-ahụkwa ihe nwude n’ime mmamịrị - a na-egosipụta ketonuria. Nyochaa ọbara gas na-egosipụtakwa oke arụ dị ka obere mbelata ọbara pH. Ọ bụ ezie na nke a bụ obere n'ihi metabolic acidosis. Formdị ọrịa shuga a na-aputa ihe dị ka 50% ụmụaka..

Ogo siri ike

Ọrịa siri ike gbasara ụmụaka 20%. Ọ na-egosipụta onwe ya n’ụdị ihe atụ nke ketoacidosis nke ọrịa mamịrị.

Ketoocytosis na-arịa ọrịa shuga, bụ nke na-eme mgbe a naghị agbaso usoro nri na ọgwụgwọ maka ọrịa shuga. Ọzọkwa, ọdịdị acetone n'ime mmamịrị na-egosi nsoma nke Coma.
Ibu ọnụ ogologo nri, nri.
Eclamsia.
Enzymatic ụkọ.
Na nsị, nsia na-efe efe.
Ọbara hypothermia.
Ọzụzụ egwuregwu karịrị akarị.
Nchegbu, trauma, nsogbu uche.
Oriri na-ezighi ezi - abụba abụba na protein karịa carbohydrates na eriri.
Ọrịa cancer afọ.

A na-ahụ oke akpịrị mmiri, isi acetone site n'ọnụ, ọgbụgbọ na ọgbụgbọ. Otutu ogo nke nwere nsogbu nwere ike ime, gụnyere coma. N'ụdị ndị a, a na-ahụkarị ọdịda akụrụ.

Nlekọta ihe mberede na ketoacidosis

N'ime ule ọbara maka gas, a na-ahụta metabolic acidosis nke nwere oke pH dị ala, gụnyere n'okpuru 7.0. Nke a bụ ọnọdụ na-egbu ndụ nke chọrọ ọgwụgwọ kpụ ọkụ n'ọnụ na nleba anya ọrụ.

Ọ dị mma ịmara na ụkpụrụ ọbara shuga dị na ngosipụta mbụ nke ọrịa shuga adịghị emetụta ịdị njọ nke ụlọ nyocha.

Kedu ka esi achọpụta ọrịa ahụ

Maka nyocha ọrịa mbụ, ọ dị mkpa inyocha mmamịrị, yana ọkwa shuga dị n'ọbara. Mgbe nke ahụ gasị, ọ dị mkpa ịgbasa nchọpụta nyocha nke ụlọ nyocha site na inyocha ihe ngosi dị iche iche, dabere n'ọnọdụ onye ọrịa ahụ.

Imirikiti ụlọọgwụ, mgbe ọ gafesịrị nnukwu ọrịa nke ọrịa (nke na-ewe ihe dị ka izu abụọ), a na-enyocha ihe ndị dị ize ndụ.

N'akụkụ a, ọ dị mkpa ịchọrọ profaịlụ nke lipid, homonụ thyroid, ọgwụ mgbochi a kapịrị ọnụ na sel nke agwaetiti. A chọghị nyocha ndị a maka nchọpụta ma ọ bụ maka ịmepụta usoro ọgwụgwọ. Mana ha nwere ike mejupụta nchọpụta nke ọrịa ahụ ma nyere dọkịta aka ịchekwa nke ọma ihe inyeaka.

Ihe nlere nile nke ime ulo ogwu gha aghaghachite ihe mgbaàmà nke oria a - polydipsia, polyuria, oke ibu, oke mmiri.

Kedu ụdị nri a na-anabata

N'iburu egwu nke coma, ọ dị mkpa ịhapụ abụba na protein, ebe ọ bụ na a na-emepụta ahụ ketone site na ha. Carbohydrates n'oge a kwesịrị ịdịkarị mfe, nke na-egbochi onye ọrịa ka ọ bụrụ nri nkịtị maka ndị ọrịa mamịrị:

semolina, osikapa osikapa na mmiri,
akwụkwọ nri
achịcha ọcha
ihe ọ juiceụ fruitụ mkpụrụ osisi
compote na shuga.

Ọ bụrụ na akpọrọ onye ọrịa mamịrị ụlọ ọgwụ na nkụ, mgbe ahụ, a na-ewu nri dịka atụmatụ a si dị:

ụbọchị mbụ - mmiri alkaline, ihe ọ juiceụ fromụ sitere na akwụkwọ nri na mkpụrụ osisi (apụl, karọt, mkpụrụ vaịn, currants ojii, mkpụrụ osisi), beri ma ọ bụ jelii nke mkpụrụ osisi, mkpụrụ osisi a mịrị amị,
2–4 ikp - eghe eghe, eghe na osikapa ma obu osikapa semolina, achicha nke eji achicha ocha, semolina, osikapa osikapa, kefir di obere (obughi ihe kariri 150 ml),
5-9 ikp - tinye chiiz obere obere abụba (ọ dịghị ihe dị elu karịa 2%), azụ a mịrị amị, nke ome steamed sitere na protein, tapawa si na anụ ọkụkọ sie ma ọ bụ iyak esiri esi.

Mgbe ụbọchị iri gasịrị, enwere ike ịgbakwunye akwukwo nri ma ọ bụ bọta na nri ahụ na-erughị 10 g. Nke nta nke nta, a na-agbakwunye nri ahụ na ntughari na nri Nke 9 dị ka Pevzner.

Mgbochi nke ketoacidosis mamịrị

Iji gbochie ọnọdụ ọjọọ a, ị ga-emerịrị:

njirimara nke otu ihe egwu n’etiti ụmụaka nwere ọrịa shuga 1 - ndị nne na nna na-arịa ọrịa shuga ma ọ bụ ọrịa autoimmune, ezinụlọ ahụ nwere nwa nwere ọrịa shuga, n’oge ime nne nne nwere ọrịa rubella. Oftenmụaka na-arịakarị ọrịa, glandia thymus na-abawanye, site na ụbọchị mbụ a na-enye ha nri,
nchoputa n’oge ọrịa shuga - mwepụta nke mmamịrị dị ukwuu mgbe ọrịa butere ya, nrụgide, ịwa ahụ, akwa “ọgbụgba” na nwata, agụụ dị oke ibu, ọrịa na-adịgide na-eto eto.
mmuta nke onye ọrịa na - arịa ọrịa shuga - mmezi dose maka ọrịa ndị na - adịghị mma, na - adịghị edozi ahụ, ịmara ihe ịrịba ama nke ketoacidosis, mkpa nke njikwa glycemic.

Na ebe a bu ihe ozo banyere hyperglycemic coma.

Ketoacidosis na-arịa ọrịa shuga na-apụta na ụkọ insulin. Ọ na-egosipụta onwe ya dị ka mbelata agụụ, agụụ na-agụ na oke urin. N'ihi mmụba nke ọnụ ọgụgụ ketone dị n'ọbara, ọ na-eji nwayọọ nwayọọ ghọọ Coma. Maka nyocha, nchọpụta ọbara, mmamịrị.

A na-eme ọgwụgwọ site n’enyemaka nke insulin, ọgwụgwọ, na mmegharị ọbara. Ọ dị mkpa ịgbaso nri pụrụ iche ma mara otu esi egbochi ọrịa shuga na-emebi emebi.

Dabere n'ụdị coma na-arịa ọrịa shuga, ihe ịrịba ama na mgbaàmà dị iche, na-eku ume. Agbanyeghị, nsonaazụ ya siri ike mgbe niile, ọ na-egbu egbu. Ọ dị mkpa ịnye enyemaka mbụ ozugbo enwere ike. Nchọpụta gụnyere mmamịrị na nyocha ọbara maka shuga.

A na - egbochi nsogbu ịrịa shuga n'agbanyeghị ụdị ya. Ọ dị mkpa na ụmụaka n’oge ime. Enwere nsogbu nke mbụ na nke abụọ, nnukwu nsogbu na ngwụsị ụdị ọrịa shuga 1 na ụdị 2.

Nrụ ụka nke ọrịa shuga nwere ike ibilite n'ihu ọnya ọnya na - akpọ nkụ, mmamịrị nke oke mmamịrị. Nkwụsị nke ọrịa shuga na nwatakịrị nwere ike ime naanị coma. Nyocha General na ule ọbara ga - enyere gị aka ikpebi ihe ị ga - eme. Mana n'ọnọdụ ọ bụla, achọrọ nri.

Site na nchịkwa insulin na-adịghị mma, hyperglycemic coma nwere ike ime. Ihe ndị ọ na-akpata na-ezughị ezu ọ bụla. Ọrịa ndị okenye na ụmụaka na-abawanye nwayọ nwayọ. Ihe enyemaka mbu sitere na omume ziri ezi nke ndị ikwu. Neededkpọ oku ngwa ngwa. Naanị ndị dọkịta maara etu esi agwọ ma insulin chọrọ.

Otutu mgbe omumu site n’aka nne na nna nwere oria shuga na-eduga n’eziokwu na ha na-arịa oria. Ihe ndị kpatara ya nwere ike ịbụ n’ọrịa autoimmune, oke ibu. A na - ekewa ụdị dị iche iche abụọ - nke mbụ na nke abụọ. Ọ dị mkpa ịmata njirimara ndị na-eto eto na ndị na-eto eto iji chọpụta ọrịa ma nye aka n'oge. Enwere mgbochi nke ịmụ nwa na-arịa ọrịa shuga.