Matenda a shuga a ketoacidotic ndimkhalidwe womwe umawopseza moyo wa wodwalayo. Ndi zovuta za matenda ashuga. Zomwe zili ndi insulin zimakhala zochepa kwambiri chifukwa cha mankhwala osankhidwa bwino, zomwe zimabweretsa zovuta zowopsa pakugwira ntchito kwa thupi.
Kodi ketoacidotic coma ndi chiani?
Ketoacidosis ndi mkhalidwe wodziwika ndi kuperewera kwa insulin, kuchuluka kwa shuga komanso kuchuluka kwa matupi a ketone m'magazi ndi mkodzo wa wodwala. Mukapanda kuthandiza munthu nthawi yomweyo, vuto lakelo limayamba kuwonongeka. Nthawi zambiri zimatha ndikumwalira.
Ketoacidosis ndi chikhalidwe chodziwika ndi kuperewera kwa insulin, shuga yayikulu yamagazi.
Zifukwa
Zolakwika pamankhwala zingakhale zomwe zimayambitsa. Munthu angayambitse mlingo woyipa wa mankhwalawo, kupanga jakisoni nthawi, kulumpha mankhwalawo kapena kuyiwala jakisoni. Kukula kotheka chifukwa cha kusamala mosamala muyezo wama glucose.
Vutoli limayamba nthawi zambiri chifukwa chamadwala. Popewa kukula kwa chikomokere, ndikofunikira kukana kudya zakudya zokhala ndi chakudya chamafuta ambiri. Chinanso chomwe chimapangitsa mavutowo ndi kumwa mowa kwambiri.
Mwina chitukuko pamaso pa matenda complic njira ya shuga. Ma pathologies amenewa amaphatikizapo stroke, myocardial infarction, kutupa njira, zilonda zapakhosi ndi zotupa, ndi ena.
Nthawi zambiri, chitukuko chimadziwika pamaso pa endocrine pathologies, momwe mumakhala kuchuluka kowonjezera kwamahomoni komwe kumawonjezera shuga. Zofanana ndizotheka chifukwa cha kugwiritsa ntchito mankhwala omwe amapangitsa kuti shuga azikhala kwambiri.
Kupsinjika kwakukulu, nkhawa zosalekeza, kuchitapo kanthu pochita opaleshoni yaposachedwa, komanso kuvulala kumathandizira kuoneka ngati zovuta.
Zizindikiro za ketoacidotic chikomokere
Pathogenesis yamakhalidwe awa imadziwika ndi chitukuko m'masiku ochepa. Nthawi zina, kukomoka kumatha kuchitika masana, kukulitsa msanga. Zizindikiro zamankhwala zimatengera gawo la chitukuko cha matenda.
Poyamba, pali kuchepa kwa kuchuluka kwa insulin. Kuphatikiza apo, kapangidwe ka mahomoni otsutsana timalimbikitsidwa. Pakadali pano, chidwi chofuna kukodza ndi chakhalidwe. Wodwalayo amakhala ndi ludzu lamphamvu lomwe silidutsa ngakhale atamwa madzi ambiri. Pali kuchepa kwa glucose olowa m'matupi ndi ziwalo, chifukwa chosagwiritsidwa ntchito mokwanira ndi chinthu ichi, ndipo hyperglycemia yomwe imakula mofulumira. Glycolysis m'chiwindi ndi choletsa.
Kenako hypovolemia amadziwika. Ma electrolyte a potaziyamu, sodium, phosphates amachoka m'thupi. Kuthetsa madzi kumachitika. Zizindikiro za kuchepa madzi m'thupi zimawonjezeredwa: khungu lowuma, kupweteka mutu, kuchepera turgor.
Zizindikiro zambiri za kuledzera zimadziwika. Pali mseru, kusanza, kufooka. Mwamuna amatopa msanga. Mkhalidwe wamba wa asthenic ndi wodziwika. Chilango chasweka. Zowawa m'miyendo zimadziwika. Kupuma kumafulumira, kumakhala kopanda. Mlengalenga wa contractions ya mtima imasokonekera chifukwa cha kuchepa kwa magazi kuzungulira magazi. Nthawi yomweyo, kuchuluka kwamikodzo pagawo lino kumachepetsedwa kwambiri, nthawi zina pamakhala kusowa kwathunthu kwamkodzo.
Ngati chithandizo chakanthawi sichinaperekedwe, kudandaula komwe kumadziwika. Choyamba, chisokonezo, ulesi, komanso kuchepa kwa ntchito yodziwa zinthu kudzachitika. Ngati njira zopulumutsira wodwala sizinatengedwe, munthuyo amadzazindikira ndikufa pakapita kanthawi.
Ngati njira zopulumutsira wodwala sizinatengedwe, munthuyo amadzazindikira ndikufa pakapita kanthawi.
Kupuma kwa Kussmaul ndizachikhalidwe: kupuma pafupipafupi pakapita nthawi kumakhala kaphokoso komanso kosowa. Pali kununkhira kwa acetone.
Kupeza Matenda
M'mayambiriro oyamba, kekeacidotic chikomokere chitha kuganiziriridwa ndi zomwe zimadziwika. Dokotala adzafunsa wodwalayo, kuti adziwe kuti zizindikirazo zidayamba liti. Ndipofunikanso kuti mupereke chidziwitso pazomwe zachitika posachedwa: mankhwala omwe adasowa, mavuto azakudya, komanso ma pathologies omwe adapezeka. Kuphatikiza apo, mayeso a labotale adzachitika. Mlingo wa matupi a ketone, shuga amatsimikiza. Ma sampu amkodzo amatengedwa kuti awunikidwe kuti adziwe kupezeka kwa matupi a ketone mwa iwo.
Ndikofunikira kudziwa kukhalapo kwa ma electrolyte, creatinine, urea, bicarbonate, chloride, ndi milingo ya lactate. Kuphatikizika kwa magazi, magazi amadzi am'madzi awa, kuwululidwa.
Momwe mungaperekere chithandizo choyambachi
Panthawi imeneyi, chisamaliro chadzidzidzi ndichofunikira. Ndikofunikira kuyitanitsa madokotala nthawi yomweyo: wodwalayo amatha kuchiritsidwa pokhapokha kuchipatala. Kenako yang'anani kuthamanga kwa mtima ndi kupuma, kuthamanga kwa magazi. Nthawi ndi nthawi ndikofunikira kuyambiranso miyeso kuti mupereke chidziwitso kwa madokotala akafika. Kuti muwone momwe wodwalayo alili, muyenera kufunsa za china chake chomwe chikufunika kuyankhidwa. Ndikulimbikitsidwanso kupukutira khutu la m'makutu, nthawi ndi nthawi kumayendetsa wodwalayo kumaso, kuti asamuletse.
Akatswiri asanafike, mutha kuyimira palokha yankho la sodium chloride (0,9%).
Akatswiri asanafike, mutha kuyimira palokha yankho la sodium chloride (0,9%). Jakisoni wotereyu athandizira kubwezeretsanso ma elekitironi omwe atayika. Kuphatikiza apo, insulin imayendetsedwa, poyesa kale kuchuluka kwa shuga ndi glucometer. Ndikofunikira kugwiritsa ntchito magawo 8-16. Ndikosatheka kusiya wodwalayo yekha: ndikofunikira kuwunika momwe aliri kuti achitepo kanthu ngati pakufunika kutero.
Wodwala ayenera kuyikidwa pambali pake. Chifukwa chake, lilime silipangitsa kuvuta kupuma. Zovala zolimba, zovala zolimba zimayenera kukhala zopanda kukhazikika kapena kuchotsedwa. Ndikofunikira kuti munthu azitha kulandira mpweya mwaulere.
Ndi chithandizo chiti chomwe chikufunika?
Thandizo limafunikira kuchipatala. Ndikofunikira kuti muyambe kudziwa kuchuluka kwa zosokoneza pakugwira ntchito kofunikira mthupi. Kenako pamachitika zinthu zowakonza. Kuphatikiza apo, ndikofunikira kuchepetsa kuledzera. Madokotala amayesa kudziwa chomwe chinayambitsa kukomoka: izi zithandizira kulinganiza chithandizo moyenera. Kubwezeretsa kachitidwe ka zinthu zolimbitsa thupi kunyumba sikungatheke.
Miyezo yamadzi
Chifukwa cha kuchepa mphamvu kwa madzi m'thupi, zizindikiro za kuledzera zimachuluka. Kusintha momwe wodwalayo alili, ndikofunikira kusintha mkodzo, kuti apange madzi amadzimadzi.
Kubwezeretsa madzi ndi dontho, njira ya sodium chloride imayambitsidwa.
Kuti abwezeretse madzi bwino, wodwalayo ayenera kuyamba kulemedwa. Chizindikiro ndichofunikira kuwerengera kuchuluka kwa yankho. Madzimadzi amaperekedwa kudzera m'mitsempha ndi dontho. Pa kilogalamu iliyonse yakulemera, 10 ml ya sodium chloride solution iyenera kuperekedwa. Ngati madzi am'madzi atayika kwambiri, mlingo wake umachulukitsidwa nthawi ziwiri. Ndi kuwonjezeka kwa kuchuluka kwa magazi ozungulira, kuchepa kwa shuga kumachitika. Mkodzo ukayamba kuchotseredwa, matupi a ketone amuchotsedwaponso, mlingo umachepetsedwa. Tsiku limaloledwa kulowa osaposa malita 8.
Electrolyte bwino kuchira
Kubwezeretsa mulingo wamagetsi, mankhwala apadera amabweretsedwa. Kuperewera kwa potaziyamu ndi kowopsa kwambiri. Amayamba kuyambitsa ma microelement awa ngakhale pamulingo wabwinobwino, popeza mukamapaka magazi ndi yankho lomwe likubwera, ndende imachepa. Mankhwala amaperekedwa.
Acid-base kuchira
Pofuna kuteteza acidity yamadzi am'magazi, sodium bicarbonate imagwiritsidwa ntchito. Mankhwalawa amagwiritsidwa ntchito ngati chizindikiro chikatsikira mpaka 7.0. Itha kugwiritsidwa ntchito ndi kuchepa mpaka 7.1, ngati pali kuphwanya mtundu wa kugunda kwa mtima, kuchepa kwa magazi, komanso kukomoka kwambiri.
Tiyenera kukumbukira kuti kuchira kwa chizindikirocho kumayamba mukamagwiritsa ntchito insulin ndikubwezeretsa madzi. Pankhaniyi, ketogenesis imapanikizika, kuchuluka kwa ma ioni a haidrojeni m'mwazi kumachepa, kuthekera kwa impso kubwezeretsanso bicarbonates kumabwezeretsedwa.
Kugwiritsira ntchito sodium bicarbonate kumatha kuyambitsa zovuta, chifukwa chake ndibwino kukana kugwiritsa ntchito popanda zisonyezo zapadera. Kupanda kutero, metabolism ya metabolism imayamba.
Ndikofunikira kuperekera insulin ndi kuchuluka kwamphamvu kwa glucose nthawi yomweyo.
Mankhwala a insulin
Ndikofunikira kuperekera insulin ndi kuchuluka kwamphamvu kwa glucose nthawi yomweyo. Ngati zisonyezo sizili zazikulu kwambiri, kuchepa madzi m'thupi kumadziwika, izi zimagwiritsidwa ntchito kwakanthawi pambuyo pakuyambira kwa mawonekedwe a madzi.
Insulin yochepa imagwiritsidwa ntchito. Nthawi zina, kuyendetsa mayunitsi 16-20 intramuscularly nthawi yomweyo amapatsidwa. Ngati muyeso wotere sukufunikira, mlingo umasankhidwa payekha. Pa avareji, mpaka magawo 6 amaperekedwa pa ola limodzi. Kuti thupilo lilowe m'mitsempha nthawi yomweyo, chinthu chofunikira chimagwiritsidwa ntchito - infusomat.
Munthu akayambanso kudya pawokha, mahomoniwo amayamba kutumikiridwa mosakakamiza. Kwa nthawi yayitali, munthu amene samazindikira amapatsidwa mankhwala amtundu wa insulin komanso shuga: izi zimathandizira kubwezeretsanso mphamvu.
Zakudya pambuyo kuchotsedwa kwa ketoacidotic chikomokere
Mukatha kuseka, muyenera kutsatira zakudya zapadera. Kwa sabata, magwero onse a mafuta amayenera kupatula pakudya. Nthawi zina, chiletso chimatenga nthawi yayitali.
Zakudya zopatsa thanzi ziyenera kulimbikitsidwa ndi potaziyamu. Kugwiritsa ntchito madzi amchere amchere kumaloledwa.
Mapuloteni amatha masiku atatu. Nthawi yomweyo, chakudya chamafuta chimaphatikizidwa ku menyu. Shuga ndi oletsedwa. Iyenera m'malo ndi xylitol kapena sorbitol, yomwe imalepheretsa kuwonjezeka kwa matupi a ketone.
Zakudya zopatsa thanzi ndizofunikira. Patsiku loyamba atasiya chikomokere, ngati wodwalayo sangathe kudya payekhapayekha, uchi, kupanikizana, semolina, zakumwa za zipatso, mousses atha kuphatikizidwa mu chakudya chake. Kumwa kumaloledwa amchere amchere amchere. Kuchuluka kwa madzimadzi.
Pa tsiku lachiwiri, amaloledwa kusinthanitsa ndi puree ya zakudya kuchokera ku maapulo kapena mbatata, oatmeal, kefir, mkate, yogati, tchizi cha kanyumba chokhala ndi mafuta ochepa.
Msuzi wophika, nyama yotsika ndiyowonjezereka tsiku lachitatu.
Sabata yotsatira, pamakhala kusintha kosintha pang'onopang'ono ku kachitidwe kakale kagetsi.
Ndikofunikira kutsatira mosamalitsa pamazakudya. Kuphwanya malingaliro a dokotala kungayambitse zovuta.
Zolakwa zamankhwala
Ndi chithandizo cholakwika cha insulin, kuchuluka kwa shuga m'magazi kumatha kutsika kwambiri.
Ngati potaziyamu imayendetsedwa pang'onopang'ono, padzakhala zovuta mu mtima.
Ngati kuthanso kwa thupi sikuthamanga kwenikweni, kudzidzimutsa kumayamba.
Ngati kuchuluka kwa shuga m'magazi sikuwongolera mokwanira, chithandizo sichingasankhidwe molondola. Chifukwa cha izi, wodwalayo amatha kuchuluka.
Ngati potaziyamu imayendetsedwa pang'onopang'ono, padzakhala zovuta mu mtima.
Zovuta zotheka
Ngati sanachiritsidwe, zimachitika. Popanda kuthandizidwa ndi akatswiri, chikomokere sichingathe kuchiritsidwa.
Chimodzi mwamavuto owopsa kwambiri ndi edema ya ubongo. Amakula mkati mwa maola 6-48. Muzochitika ngati wodwalayo samadzindikiranso, sizotheka nthawi zonse kuzindikira izi. Nthawi zambiri zimadziwika chifukwa chosowa kusintha kwa zinthu. Tsimikizani kugwiritsa ntchito ultrasound kapena compended tomography ya ubongo. Kuthekera kwa kufa kumachuluka 2 times. Mwina chitukuko cha ma pathologies mu gawo la mitsempha, zamisala.
Kuponya kwakukulu kumatheka. Nthawi zambiri amapezeka kuti ali ndi vuto la impso kapena mtima, edema. Ngati wodwalayo sakudziwikanso, asphyxia ndiyotheka.
Kupewa ketoacidotic chikomokere
Wodwala yemwe ali ndi matenda ashuga ayenera kuphunzira zinthu zomwe zimayambitsa kupweteka. Izi zikuthandizira kuzindikira panthawi yovutikayi ndikuwonana ndi dokotala. Poyambirira, chithandizo ndichosavuta, chiwopsezo cha zovuta ndizochepa. Wodziwika bwino ndi zovuta zake ayenera kukhala abale ake. Ngati zizindikiro zikupezeka, pitani kuchipatala mwachangu. Wodwala sangakhale yekha.
Ndikofunikira kutsatira zakudya. Ngakhale kupatuka pang'ono kumatha kubweretsa zotsatira zowopsa. Pachifukwa ichi, ndikofunikira kusiya kugwiritsa ntchito maswiti ndi zakumwa zoledzeretsa.
Mankhwala ayenera kumwedwa malinga ndi dongosolo lomwe dokotala wakupatsani. Kudumpha jakisoni ndizosavomerezeka. Alumali moyo wa mankhwala ndikofunikira kuti muziwunika pafupipafupi. Kumwa mankhwala omwe atha ntchito kungakupangitseni kwambiri. Kuphatikiza apo, ndikofunikira kusunga malamulo osungira. Kupanda kutero, mankhwala amatha kukhala osavomerezeka, amakhala osagwira ntchito.
Malangizo onse a dotolo ayenera kutsatiridwa. Ndikofunika kupewa zinthu zopsinja, kuchitira matenda aliwonse munthawi yake, komanso kupewa matenda omwe amapangitsa kuti matenda ashuga akhale.
