Ọrịa mamịrị ketoacidosis na ọnọdụ hyperosmolar na ọrịa shuga

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Ọrịa mamịrị ketoacidosis (DKA) bụ ọrịa metabolism na-arịa ọrịa shuga, na-egosipụta mmụba dị elu nke glucose na ịba ụba nke ketone n'ime ọbara, ọdịdị ha na mmamịrị, n'agbanyeghị ogo nke onye ọrịa, yana ịchọ ụlọ ọgwụ mberede.

Ugboro DKA na mba ndị dị na Europe dị ihe dị ka 0.0046 maka onye ọrịa kwa afọ (na-enweghị nkewa n'ime ụdị nke m na ọrịa shuga II), na nkezi nkezi na DKA bụ 14%. Na mba anyị, ugboro ugboro DKA maka ụdị nke ịrịa ọrịa shuga bụ 0.2-0.26 maka ndị ọrịa kwa afọ (data nke 1990-1992). Ihe na - akpata oke ọrịa mamịrị ịba ọcha n'anya bụ ihe zuru oke (yana ụdị ọrịa shuga m) ma ọ bụ onye ikwu akpọrọ (ya na ụdị shuga II) ụkọ insulin. Ihe ndị na-akpata ya bụ: ụdị ọrịa shuga a na-achọpụta (ọrịa insulin-dabere), ihe mberede ma ọ bụ ụma kwụsịtụ ọgwụ insulin maka ụdị ọrịa shuga m, ọrịa ọnya, arụmọrụ, mmerụ, wdg n'ihe banyere ọrịa shuga nke ụdị abụọ ahụ, mbelata nke abụọ nke insulin n'ụdị ụdị ọrịa shuga II (nke na-abụghị insulin), iji insulin antagonists (cortisone, diuretics, estrogens, gestagens) na ndị ọrịa nwere ọrịa mellitus (DM) nke ụdị abụọ ahụ, yana ọrịa pancreatectomy na ndị na-arịabeghị mbụ. SD

Ezigbo insulin zuru oke na-ekwukwa na ọ na-eduga na mmụba dị ukwuu n'ọbara glucagon, hormone na-emegide insulin. Ebe ọ bụ na insulin anaghịzi egbochi usoro glucagon na-akpali imeju, imeju glucose site na umeji (ngụkọta nsị nke nkwụsị nke glycogen na usoro gluconeogenesis) na-abawanye n'ike n'ike. N'otu oge, itinye ume na umeji nke imeju, akwara na anụ ahụ na-adị n’ire n’oge na-enweghị insulin na-ebelata nke ọma. Ihe si na usoro ndị a pụta bụ hyperglycemia siri ike. Nke ikpeazụ a na-eto n'ihi ụba mkpụrụ nke homonụ mgbochi - cortisol, adrenaline na uto uto.

Na enweghi insulin, protin catabolism nke aru na-abawanye, ihe amino acid na-ebute abunyekwara na gluconeogenesis na imeju, na-eme ka hyperglycemia dị elu. Nnukwu akwara na -eme ka uru anụ adị na-adị, na -emekwa ụkọ insulin, na-ebute mmụba dị ukwuu na mkpokọta abụba efu (FFA) n'ime ọbara. N'ihe banyere insulin erughi ala, ahụ na-enweta 80% nke ike site na oxidizing FFA, nke na-eduga ná nchịkọta nke ngwaahịa sitere na ire ere ha - "anụ ketone" (acetone, acetoacetic na beta-hydroxybutyric acid). Ọnụego nguzobe ha dị elu karịa etu ha si eme ihe na mpụta izizi ha, n'ihi nke ịta nke anụ ketone n'ime ọbara na-abawanye. Mgbe mkpụkọ nke ihe ndozi akụrụ, akụrụngwa nke acid na - agbagha, metabolic acidosis na - eme.

Ya mere, gluconeogenesis (na nsonaazụ ya, hyperglycemia) na ketogenesis (na nsonaazụ ya, ketoacidosis) bụ nsonaazụ nke ihe glucagon na imeju, nke ewepụtara n'okpuru ọnọdụ insulin insulin. N’aka ozo, ihe mbu bidoro mebe aru nke ketone na DKA bụ enweghi insulin, nke n’eduba na-abawanye abụba n’inwe ike ha. Abụba ndị a nwetara na nri adịghị etinye aka na nkwalite ketogenesis. Ọkụ glucose, mmiri osmotic diuresis, na-eduga n'iwe mmiri na-eyi ndụ. Ọ bụrụ na onye ọrịa enweghị ike ị drinkụ mmiri kwesịrị ekwesị, mgbe ahụ, mmiri nke mmiri nwere ike ịdị ihe ruru lita 12 (ihe dị ka 10-15% nke ahụ, ma ọ bụ 20-25% nke ngụkọta nke mmiri dị na ahụ), nke na-eduga na intracellular (ụzọ abụọ n'ime ụzọ atọ nke ya ) na extracellular (otu ụzọ n'ụzọ atọ) akpọnwụ akpọnwụ na hypovolemic ọbara ekesa. Dịka mmeghachi mmeghachi omume nke na-eme ka ịchekwa olu nke plasma na-ekesa, ịmị mkpụrụ nke catecholamines na aldosterone na-abawanye, nke na-eduga na igbu oge na sodium ma na-enyere aka iwelie uto nke potassium na mmamịrị. Hypokalemia bụ akụkụ dị mkpa nke nsogbu nke metabolic na DKA, na-eme ka ngosipụta ụlọ ọgwụ kwekọrọ. Na njedebe, mgbe ọdịda akwara na-eduga na mkpụkọ akwara gbasara arụ, mmamịrị mbelata, na-ebute ọnụ ngwa ngwa n'ọbara nke glucose na ahụ ketone n'ime ọbara.

Enweghị ike insulin na-arịa siri ike (ụdị shuga II) nwere ike ibute ụdị hyterosmolar nke decompensation pụrụ iche, ruo na hyperosmolar. N'otu oge, insulin dịnụ zuru ezu iji chịkwaa lipolysis, na-egbochi mmepe nke ketoacidosis. Ahụ Ketone adịghị etolite, yabụ enweghị ụdị akara akụrụngwa dị ka vomiting, iku ume Kussmaul na isi acetone. Ihe ịrịba ama nke steeti hyperosmolar bụ hyperglycemia, hypernatremia na akpịrị ịkpọ nkụ. Ihe nkwalite ahụ nwere ike ịbụ, ọmụmaatụ, ị intụ ọgwụ na-achịkwaghị achịkwa, afọ ọsịsa, ọgbụgbọ, wdg. A na-ahụkarị steepụ agwakọta, dịka. DKA nwere ihe ịtụnanya hyperosmolarity ma ọ bụ steeti hyperosmolar nwere ketosis dị nwayọọ (transient acetonuria).

Isi ihe na-enye aka na mmepe DKA bụ omume na-ezighi ezi nke ndị ọrịa: ịpụpụ ma ọ bụ kagbuo injections insulin (gụnyere ndị nwere ebumnuche nke onwe ha), ezughi oke nyocha nke metabolism, ịhapụ irube isi n'iwu maka nnwere onwe na-abawanye na insulin n'ihe banyere ọrịa na-efe efe, na enweghị nlekọta ahụike zuru oke.

Mgbe ọ bụla onye ọrịa na-arịa ọrịa shuga mellitus tolitere otu ma ọ bụ karịa ihe mgbaàmà ndị a - ọgbụgbọ, ọgbụgbọ, ọnya afọ - ịkwesịrị ikpebi glycemia na acetonuria ozugbo. Mgbe achoputara DKA: shuga di elu (kariri 16-17 mmol / l, ma otutu mgbe karie ya) na aru ketone na mmamiri ma obu serum (site na "++" rue "+++"). Ọ bụrụ na enweghị ike inweta mmamịrị maka ọmụmụ ihe ahụ (anuria), a na-achọpụta ketosis site na nyocha nke ọbara nke onye ọrịa: a na-etinye dobe ọbara na-adịghị edozi na mpempe ule maka mkpebi ngwa ngwa glucose ọbara (dịka ọmụmaatụ, Glucochrome D) na ntinye nke enwetara na-atụnyere ọnụ ọgụgụ agba. Ntinyeghi glycemia na onye ọrịa ọ bụla nọ n'ọnọdụ amaghị ihe bụ mmehie dị oke njọ ma na - edugakarị nchọpụta ezighi ezi nke "ihe mberede ụbụrụ", "coma of etiology amaghi", ebe onye ọrịa nwere DCA. O di nwute, ọgbụgbọ, dị ka ihe mgbaàmà nke DKA, na-elegharakarị anya. Na DKA, a na-ahụkarị ihe a na-akpọ "ọrịa mamịrị pseudoperitonitis, nke na-eme ka mgbaàmà nke" afọ na-arịa ọrịa ", mgbe ụfọdụ yana mmụba n'otu oge na serum amylase na ọbụna leukocytosis, nke nwere ike ibute njehie nchọpụta, n'ihi nke onye ọrịa nwere DKA n'ụlọ ọgwụ na ngalaba na-efe efe ma ọ bụ nke ịwa ahụ.

DKA bụ ihe ngosipụta maka ụlọ ọgwụ mberede. Na ọkwa prehospital, n'oge njem nke onye ọrịa n'ụlọ ọgwụ, a na-etinye ọgwụ mgbochi intanvenia nke 0.9% sodium chloride solution na ihe dịka 1 l / h, nkeji 20 nke insulin na-eme ihe dị mkpirikpi (ICD) na-abanye intramuscularlyly.

N’ụlọ ọgwụ, njikwa ụlọ nyocha bụ isi nyochara shuga ọbara, ozu ketone na mmamịrị ma ọ bụ ọbara, sodium, potassium, serumine, nyocha ọbara zuru oke, nyocha ọbara gas venous, na pH ọbara. N'oge ọgwụgwọ, ekwesịrị ịtụle nyocha nke glycemia, sodium na potassium serum kwa oge, ọ bụ nyocha nke gas.

Usoro ọgwụgwọ akọwapụtara nwere ihe anọ dị mkpa - ọgwụgwọ insulin, nhugharị mmiri, mgbazi nke nsogbu elektrolyte na mgbazi nke acidosis.

Ọgwụ insulin insulin bụ naanị ọgwụgwọ etiological maka DKA. Naanị homonụ anabolic a nwere ike ịkwụsị usoro nnukwu catabolic usoro na-akpata site na enweghị ya. Iji mezuo ọkwa insulin nke na-arụ ọrụ nke ọma (50-100 microed / ml), chọrọ insulin na-aga n'ihu nke 4-12 insulin kwa elekere. Ntinye uche nke insulin n'ime ọbara na-egbochi mmebi nke abụba na ketogenesis, na-akwalite njikọ nke glycogen ma na-egbochi mmepụta nke glucose, si otú ahụ kpochapụ njikọ abụọ kachasị mkpa na pathogenesis nke DKA. A na-akpọ usoro insulin na-eji ụdị ọgwụ ndị a 'usoro dị ala'. Na mbu, a na-eji insulin dị elu karịa. Agbanyeghị, ekwuputala na ọgwụ insulin na usoro dị ala na-esonye n'ihe egwu dịkarịsịrị ala nke nsogbu karịa na usoro nchịkwa dị elu. A na-atụ aro ka usoro ọgwụgwọ dị ala maka ọgwụgwọ DKA, n'ihi na: a) nnukwu insulin insulin (16 ma ọ bụ karịa n'otu oge) nwere ike belata glucose ọbara oke ike, nke nwere ike ibute hypoglycemia, ọrịa ụbụrụ, na ọtụtụ nsogbu ndị ọzọ, b) mbelata nke ukwuu na glucose ịta ahụ so O nweghi ntule ngwa ngwa kariri mkpokota ahihia na ahihia, yabụ mgbe ị na - eji insulin buru ibu, ihe egwu ginokalemia na - abawanye ike.

N ’ụlọ ọgwụ, a ga-ebu ọgwụ insulin ọgwụ DKA mgbe niile n’ụdị ọgbụgba dị ogologo. Na mbu, a na-edozi otu ụdị "itinye" ọnụọgụ ọbara - 10-14 nkeji nke ICD (nke ka nke mmadụ mma), emesia ha tụgharịrị na ntinye nke ICD site na ntinye na-aga n’ihu na onye na-emebi iwu na ọnụego 4-8 nkeji kwa awa. Iji gbochie adsorption insulin na rọba, enwere ike ịgbakwunye albumin mmadụ na ngwọta. A kwadebere ngwakọta a dị ka ndị a: 2 ml nke ihe ngwọta 20% nke albumin na-agbakwunye na nkeji 50 nke ICD ma na-agbanwe ụda olu dum na 50 ml na 0.9% nke sodium chloride.

Ọ bụrụ na mmanụ adịghị mkpa, infusion nke agbanwe agbanwe na ọgwụ ndị ọzọ ka a na-eme site na usoro infusion ot. A na-agbanye ICD otu oge kwa elekere, jiri nwayọ, banye “chịngọm” nke sisitem, mana n’enweghi isi n’ime vial ngwọta, ebe ọtụtụ insulin (8-50% nke dose) ga-agba n’elu iko ma ọ bụ plastik. Maka ịdị mfe nke nchịkwa, a na-anakọta ụfọdụ ọnụ ọgụgụ ICD (dịka ọmụmaatụ, 4-8) na ntụtụ 2 ml ruo ihe dị ka 2 ml gbakwunyere na ntụpọ isotonic sodium chloride. N'otu oge, olu nke ngwakọta a gbanyere mkpọrọgwụ na-abawanye, nke na-enye gị ohere ịbanye insulin nwayọ - na nkeji 2-3.

Ọ bụrụ na n'ihi ihe ụfọdụ, ọ gaghị ekwe omume ịmalite ịchịkwa insulin ngwa ngwa, mgbe ahụ, agwara mbu ya ka a na-eme intramuscularly. Ọ gaghị ekwe omume ịdabere na ihe insulin na-abanye n'ime insulin na DKA, karịsịa na precom ma ọ bụ coma, ebe ọ bụ na microcirculation ahụ na-echegbu onwe ya, itinye ya n'ime ọbara na, yabụ, nsonaazụ ahụ ezughi oke.

Doe insulin kwekọrọ na shuga ọbara dị ugbu a. Na-achịkwa kwa oge site na ụzọ awara awara, ekwesịrị ibelata ya ọsọ ọsọ karịa 5.5 mmol / l kwa elekere. Mbelata nke glycemia ngwa ngwa na-eduga n'ịmepụta gradient osmotic dị n'etiti oghere intracellular na extracellular na ọrịa nke osmotic ahaghị nhata na edema, ọkachasị na akụkụ ụbụrụ. N'ụbọchị mbụ ọgwụgwọ, ọ dị mma belata ọkwa nke glycemia karịa ihe 13-14 mmol / l. Ozugbo enwere ogo a, ihe dị n’iru iwebata insulin na-amalite ibido 5% gluuze gwọọ. Iwebata glucose abughi usoro eji agwọ DKA dika nke a, a na-eme ya iji gbochie hypoglycemia megide mmalite nke iwebata insulin, ma ọ bụrụ na onye ọrịa ahụ enweghị ike iri nri. Achọrọ glucose na onye ọrịa naanị dị ka isi iyi ike, glucose dị na ọbara enweghị ike mejupụta mkpa a: mbelata shuga ọbara, dịka ọmụmaatụ, site na 44 mmol / l ruo 17 mmol / l na-enye ahụ ahụ naanị gram 25 nke glucose (= 100 kcal). Anyị na-ekwusi ike ọzọ na a na-achịkwa glucose n'oge mbụ karịa ọkwa nke glycemia na-agbadata 13-14 mmol / l, ya bụ, mgbe ọ fọrọ nke nta ka a kwụsị ikpo insulin.

Mgbe mweghachi nke nsụhọ, onye ọrịa ekwesịghị idobe ọgwụ infusion maka ọtụtụ ụbọchị. Ozugbo ọnọdụ ya adịla mma, glycemia kwụsiri ike n'ogo nke ọ na-erughị 11-12 mmol / l, ọ kwesịrị ịmalite ịmalite iri nri (carbohydrates - poteto maskin, achịcha mmiri, achịcha), n'oge na-adịghị anya enwere ike ibuga ya na ọgwụ insulinaneous insulin. nke ka mma. N’ebido, a na-ekenye ICD na mbido, 10-14 nkeji kwa 4 awa, na-agbazi ọnụọgụ dabere na ọkwa nke glycemia, wee gbanwee ịgbanye ojiji nke ICD na insulin action insulin (IPD). Acetonuria nwere ike ị nọgide ruo oge ụfọdụ yana ezigbo ọnụọgụ carbohydrate metabolism. Maka mkpochapu ya kpamkpam, o na-ewe ubochi ato ozo, kari ime ka insulin buru nnukwu ibu maka ebumnuche a.

Friza. Na na mbụ nkịtị ọbara Na + larịị (

Ihe ị ga-eme

A na-adụ ndị na-arịa ọrịa shuga ume ịzụta glucometer maka ịhazi shuga na mpempe ule iji chọpụta ahụ ketone na mmamịrị. Ọ bụrụ na ngosipụta abụọ ahụ dị elu, yana mgbaama egosipụtara n’elu, ịkwesịrị ịkpọ ụgbọ ihe mberede. A ga-eburu onye ọrịa ahụ n'ụlọ ọgwụ ma ọ bụrụ na onye ahụ nwere nnukwu adịghị ike, mmiri gwụ, ma nweekwa mmụọ.

Ezi ebumnuche iji kpọọ ụgbọ ihe mberede:

Mgbu n’azụ sternum
Vomiting
Ihe mgbu
Okpomoku di elu (site na 38.3 ° C),
Ọkwa shuga dị elu, ebe onye gosipụtara anabataghị ihe achọrọ n'ụlọ.

Cheta na emegaghị ma ọ bụ ọgwụgwọ adịghị egbu egbu na-egbukarị.

Diagnostics

Tupu itinye onye ọrịa n'ụlọ ọgwụ, a na-eme nyocha ngwa ngwa maka ọkwa nke glucose na ketone n'ime ọbara, mmamịrị. Mgbe ị na-achọpụta nyocha, nsonaazụ nke nnwale ọbara iji chọpụta ọkwa nke electrolytes (potassium, sodium, wdg). Emere atụmatụ ọbara pH.

Iji chọpụta ọnọdụ ọrịa ndị ọzọ, mee usoro nchọpụta ọrịa ndị a:

Nnyocha nyocha
ECG
X-ray.

Oge ụfọdụ ịkwesịrị ime nyocha nke ụbụrụ. Ọ dị mkpa ikpebi ogo ketoacidosis na ọdịiche dị iche na ọnọdụ ndị ọzọ:

Agụụ "ketosis,
Lactic acidosis (ngafe nke lactic acid),
Mmanya ketoacidosis,
ọgwụ aspirin,
nsị ethanol, methanol.

N'ọnọdụ ndị a na-enyo enyo na ọria, mmepe nke ọrịa ndị ọzọ, a na-eme nyocha ndị ọzọ.

Ọgwụgwọ oria nke ogbo nke ketosis na-ebido na mkpochapu ihe ndị na-akpasu ya iwe. Nchịkọta menu na-egbochi abụba. Emere onye ọrịa ahụ ihe ọkalụ alụ alkaline (mmiri soda, mmiri alkaline ịnweta, Regidron).

Ha na-atụ aro ị enụ enterosorbents, hepatoprotector. Ọ bụrụ na ahụ adịchaghị onye ọrịa ahụ mma, a na-edenye insulin ọzọ “ngwa ngwa”, usoro ịgba ọgwụ insulin ike na-enyekwa aka.

Usoro ọgwụgwọ Ketoacidosis

A na-eme ọgwụgwọ nke ketoacidosis n'ụlọ ọgwụ. Ebumnuche bụ isi bụ ịhazi ọkwa insulin. Usoro ọgwụgwọ gụnyere 5 nkebi:

Usoro ọgwụgwọ insulin
Njikwa akpịrị ịkpọ nkụ
Ntughari nke enweghi ahihia, sodium,
Symptomatic ọgwụ nke acidosis,
Ọgwụ nke concomitant pathologies.

A na-elekọta insulin n'ime intraven, na-eji usoro nke obere usoro, nke kachasị nchebe. Ọ mejupụtara n'oge nlekọta insulin na elekere n'ime nkeji 4-10. Obere usoro na-enyere aka belata usoro ọgbụgba, na-egbu oge iwepụ glucose n'ime ọbara, ma melite nguzobe nke glycogen. Ọ dị mkpa ilegide ọkwa shuga anya mgbe niile.

A na-eme ntụpọ sodium chloride, a na-achịkwa potassium mgbe niile (ego kwa ụbọchị ekwesịghị gafere 15-20 g).Ihe ngosi ọkwa nke potassium kwesịrị ịdị 4-5 meq / l. N’ime awa iri na abụọ izizi, ngụkọta nke mmiri a gbanyere n’arịa ekwesịghị ịbụ ihe dị ka 10% n’arụ nke onye ọrịa, ma ọ bụghị n’ihe ize ndụ nke mbufụt ure na-abawanye.

Site na iji ọgbụgbọ na-arụ ọrụ, a na-eme larịị gastric. Ọ bụrụ na mmịpụta ahụ apụta, a na-ejikọta onye ọrịa ahụ na onye na-ekuru ikuku. Nke a ga - egbochi imerime umeji.

A na-eme ọgwụgwọ maka iwepụ acidity ọbara, agbanyeghị, a na-enye sodium bicarbonate naanị ma ọ bụrụ na pH ọbara na-erughị 7.0. Iji gbochie ọbara ọgbụgba, a na-atụgharị heparin maka ndị agadi.

A na-elebara anya na ọgwụgwọ nke ọrịa ndị ọzọ nwere ike ibute mmepe nke coma (trauma, oyi baa, wdg). Iji gbochie ọrịa na-efe efe, a na-eji ọgwụ intramuscular ọgwụ penicillin mee ihe. Site na mmepe nke oria, a na-ejikọ ọgwụ mgbochi kwesịrị ekwesị na ọgwụgwọ ahụ. Ọ bụrụ na ụbụrụ nke etolite etolite, ọgwụgwọ corticosteroid, ọrịa diuretics dị mkpa, a na-arụkwa ikuku ikuku.

Emepụtara ọnọdụ kachasị mma maka onye ọrịa ahụ, nke gụnyere ọnụ ọcha, akpụkpọ ahụ na-agakọ. Ndị ọrịa mamịrị nwere ketoacidosis chọrọ nlere anya oge niile. A na-enyocha ihe ndị a na-egosi:

Nnyocha nyocha nke mmamịrị, ọbara (mgbe a nabatara n'ụlọ ọgwụ, mgbe nke ahụ gasịrị, ụbọchị abụọ ruo ụbọchị 2-3),
Nnwale ọbara dị ngwa maka shuga (kwa awa, na mgbe shuga ruru 13-14 mmol / l - na oge dị ka awa 3),
Nchịkọta urine maka acetone (na ụbọchị abụọ mbụ - 2 p / ụbọchị, mgbe nke a gasịrị - 1 p / ụbọchị),
Mkpebi ọkwa nke sodium, potassium (2 p. / Day),
Nyocha nke ọkwa phosphorus (ọ bụrụ na ọrịa ahụ gwụchara n'ihi nri na-edozi ahụ)
Mkpebi ọbara pH, hematocrit (1-2 p. / Day),
Mkpebi nke nitrogen, creatinine, urea,
Nyochaa oke mmamịrị ewepụtara (kwa awa, ruo mgbe eweghachite usoro mmamịrị nkịtị).
Nnwale nrụgide akwara
Nlegide anya ECG, onodu obi, obara, otutu.

A na-eme ọgwụgwọ nke ketoacidosis n'ime ụmụaka dịka atụmatụ ọzọ si dị, gụnyere: injections insulin nke "ngwa ngwa", iwebata ọgwụgwọ physiological, calcium, alkalization nke ọbara. Mgbe ụfọdụ, a chọrọ heparin. N’omume dị elu, a na-eji ọgwụ mgbochi nje nke nwere ụdị ọfụma eme ihe.

Oriri na-edozi ahụ maka ketocacidosis

Ihe oriri na-edozi ahụ na-emetụta ogo ọnọdụ onye ọrịa ahụ. Ihe oriri maka onye na-arịa ọrịa shuga na steeti predomatous ekwesịghị ịnwe abụba, a na-ewepụ ha maka ụbọchị 7-10. Nri nwere protein bara ụba nwere oke, a na-agbakwunye carbohydrates digestible (mana ọ bụghị shuga). Ejiri sorbitol, xylitol, ha nwere ngwongwo antiketogenic. Ka emechara usoro ahụ, a na-ahapụ ya ka abụba abụba, mana ọ bụghị tupu tupu ụbọchị iri. Ha na-agbanye na menu nke mbụ iji nwayọ.

Ọ bụrụ na onye ọrịa enweghị ike iri nri nke aka ya, parenteral fluid, glucose solution (5%) na-abanye. Mgbe nkwalite gasịchara, menu gụnyere:

1stbọchị nke mbụ: carbohydrates dị omimi (semolina, mmanụ a ,ụ, jam), ihe ọ drinkụ drinkụ buru ibu (ihe ruru 1.5-3 lita), mmiri mmiri alkaline (dịka, Borjomi),
2ndbọchị nke abụọ: oatmeal, poteto achara, mmiri ara ehi, ngwaahịa ara ehi, ngwaahịa achịcha,
3rdbọchị nke atọ: a na-ewebata efere, mashed anụ ọzọ na nri.

N’ụbọchị atọ mbụ ka akpịrị na - apụ, a na - ewepu protein ụmụ anụmanụ na menu. Ha na-aghọrọ nri oriri na-edozi ahụ n'ime otu izu, mana abụba ga - abụrịrịrịrịrị ruo mgbe a ga - enweta ọnọdụ mmegwara.