Metabolic acidosis - mitundu, zizindikiro ndi momwe muyenera kuchitira

Acid-base usawa mu thupi lathanzi limasungidwa mosalekeza, magazi amakhala ndi ofooka amchere. Ikasinthira ku acidization, metabolic acidosis imayamba, alkalization - zamchere. Kuthamanga kwa acidic mbali kumakhala kofala kwambiri, madokotala a akatswiri onse amakumana nayo.

Acidosis palokha siyimakhalapo; imakhala nthawi zonse chifukwa chamatenda kapena matenda. Pali zifukwa zambiri za acidosis: kuyambira matenda a shuga mpaka bongo wa ascorbic acid. Nthawi zonse, njira zomwe zimachitika mthupi zimachitika mofananamo: kusintha kwachilengedwe kumachepetsa, mapuloteni amasintha kapangidwe kake. Matendawa ndi oopsa, mpaka kufooka kwa ziwalo ndi kufa.

Metabolic acidosis - ndi chiyani?

Mapuloteni amapezeka mu khungu lililonse la thupi lathu. Amapezeka m'mahomoni, ndi ma enzymes, komanso chitetezo cha m'thupi. Mapuloteni ndi amphoteric, ndiye kuti, ali ndi mphamvu ya ma acid komanso besi. Amagwira ntchito yawo m'malo opapatiza pH: 7,37 - 7,43. Ndikupatuka kwina kulikonse, mapuloteni amasintha kapangidwe kake. Zotsatira zake, ma enzymes amataya ntchito, njira za ion zimawonongeka, ma membala am'magazi amasiya kugwira ntchito zawo, ma receptor amalephera, ndipo kufalitsa kwa mitsempha kumasokonekera.

Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale

• Matenda a shuga -95%
• Kuthetsa kwa mitsempha thrombosis - 70%
• Kuthetsa kwa kugunda kwamtima kwamphamvu -90%
• Kuthana ndi kuthamanga kwa magazi - 92%
• Kuwonjezeka kwa mphamvu masana, kukonza kugona usiku -97%

Kuchokera pazotsatira zoyipa ngati izi, thupi limadziteteza lokha mothandizidwa ndi pulogalamu ya buffer yamagulu angapo. Yaikulu ndi bicarbonate. Mchere wa carbonic acid ndi ma bicarbonate amapezeka nthawi zonse m'magazi, omwe, ndi kuchuluka kwa asidi m'magazi, nthawi yomweyo amawasokoneza. Zotsatira zake, izi zimapangidwa, zomwe zimapanga kaboni dayoksidi ndi madzi.

Kuphatikizika kwa bicarbonates wamagazi kumasungidwa ndi impso, njira yotsutsana imachitika: ayoni owonjezera a hydrogen amatsanulidwa mu mkodzo, ndipo bicarbonate imabwezeretsedwa m'magazi.

Ngati ma acids ochulukirapo amachokera kunja kapena amapangidwa m'thupi, acidosis imayamba. Imadziwika ndi dontho mu PH mpaka 7.35 ndipo pansipa. Zomwe zimasunthira mulingo wa asidi-asidi zimatha kuchuluka kwa kaboni dayokisaidi, kusokonezeka kwa impso ndi kuthetsedwa kwa ntchito yawo yobwezeretsa nkhokwe zam'madzi am'madzi, kuchotsera kwambiri mazikowo kudzera m'mimba. Zitha kuyambitsa acidization ndi zosokoneza kagayidwe kachakudya, momwe metabolic acidosis imachitika.

Zolinga ndi zomwe zikukula

Kuchiza acidosis, sikokwanira kuyambitsa mabicarbonate akusowa m'magazi. Komanso, nthawi zina, mawu awo oyambira akhoza kukhala owopsa. Kuti muchepetse acidosis, ndikofunikira kumvetsetsa motsogozedwa ndi zomwe zidayamba kukhazikitsa.

Zomwe zimayambitsa metabolic acidosis:

1. Kuperewera kwa insulin kapena kukana kwambiri insulin. Chifukwa cha izi, zimakhala kuti sizimalandila chakudya ndipo zimakakamizidwa kugwiritsa ntchito mafuta omwe amaphulika kuti apange ma acid.
2. Kuchulukitsa kwa lactic acid mu matenda a chiwindi, kuperewera kwa insulin mu shuga, kusowa kwa oxygen m'matumbo chifukwa cha matenda amitsempha yamagazi, mapapu, mtima.
3. Mowa wadzaoneni, limodzi ndi kusanza komanso nthawi yothamanga.
4. Kusala kudya kwanthawi yayitali kapena mafuta ochulukirapo pazakudya.
5. Kulowetsedwa kwa thupi pakudya: ethylene glycol - mowa, chinthu china chopatsa mphamvu; salicylic acid wamkulu kuposa 1.75 g pa kg iliyonse ya kulemera kwake; methanol.
6. Poizoni ndi nthenga za toluene, zomwe zimapezeka penti, varnish, glue, solvent.
7. Kuchepetsa aimpso glomerular ntchito chifukwa nephropathy, pyelonephritis, nephrosulinosis, mankhwala enaake: anti-kutupa mankhwala; amphotericin - mankhwala antifungal; tetracycline ndi antiotic; Kukonzekera kwa lithiamu - psychotropics; acetazolamide (diacarb); spironolactone (Veroshpiron) - okodzetsa.
8. Kutayika kwa ma hydrocarbons kuchokera m'mimba yogaya chifukwa cha m'mimba, fistulas yakunja.
9. Mankhwala osokoneza bongo a metformin, mankhwala osankhidwa a shuga omwe amadalira insulin. Kulandila kwa Metformin kwa odwala omwe ali ndi vuto la chiwindi kapena impso.
10. Kupanda kukwana kwa adrenal cortex kwa aldosterone kapena deoxycorticosterone.
11. Kuchuluka kwa potaziyamu kuphwanya mawonekedwe ake ndi impso.
12. Kukhazikitsidwa kwa ma acid mu zakudya za makolo kapena chloride ammonium kuti muchepetse kutupa.
13. Chachikulu minofu necrosis chifukwa chokhalitsa kupsinjika, kuwotcha, myopathy, trophic zilonda komanso kusintha kwazovuta matenda ashuga mellitus.

Mitundu yamatenda

Kutengera zomwe zimapangitsa kuchuluka kwa asidi m'magazi, acidosis imagawidwa m'mitundu:

Kuphatikizika kwa acidosis kumachitikanso, makamaka kwa odwala omwe ali ndi vuto la metabolic. Mwachitsanzo, chiopsezo cha acidosis chifukwa cha shuga yambiri m'matenda a shuga chimachulukitsidwa kwambiri chifukwa chomwa mowa komanso matenda ashuga a shuga.

Malinga ndi kuchuluka kwa malipiro, acidosis imagawidwa m'mitundu itatu:

• kulipidwa acidosis: Zizindikiro ndizosowa, acidity ili pafupi ndi malire ochepera abwinobwino, okhazikika. Chithandizo chapadera sichofunikira, ndikofunikira kuzindikira ndikuchotsa chomwe chimayambitsa kuphwanya;
• subcompensated acidosis: malire amalire, kuyang'anira pamafunika;
• mawonekedwe a metabolic acidosis - pH ya magazi imatsitsidwa kuzinthu zowopsa kapena ikupitilirabe. Kuthamangitsidwa kuchipatala, kukonza acidity ndi njira zapadera kumafunika, nthawi zina njira zotsitsimutsa. Popanda chithandizo, acidosis yowonongeka imayambitsa kukomoka ndikupangitsa kuti wodwalayo afe.

Momwe mungadziwire kuchuluka kwa metabolic acidosis:

Zizindikiro zake

Kuchokera pakuwona pathophysiology, acidosis ndi njira yofananira yomwe imatsatana ndi zizindikiro wamba. Acidosis yolipidwa imatha kuzindikiridwa pokhapokha kusintha kwamakanidwe amkati ndi mkodzo. Zizindikiro mu wodwala pakadali pano ndizodalira kwathunthu kumatenda omwe amayambitsa acidity.

Vutoli likamakulirakulira, chizindikiro choyamba cha mitundu yonse ya acidosis chikuwoneka - kuwonjezeka, kupuma pafupipafupi. Zimafotokozedwa ndikuwonjezereka kwa zomwe zili mu kaboni m'magazi panthawi yogwira ntchito machitidwe a ziwalo zamagetsi. Pamene kuperewera kwa mpweya wa minyewa kumayamba, kupuma movutikira kumachitika, kupuma kumakhala kwachilengedwe - kumakhala kaphokoso, kupuma pakati pa kupuma kumafupikitsidwa, kenako ndikutha.

Ndi metabolic acidosis, pamakhala kutulutsa kochedwa kwa adrenaline ndi otsogola ake, motero, ntchito yamtima imathandizira, chifukwa chomwe zimachitika zimafulumira, kutulutsa magazi kumawonjezeka panthawi iliyonse, ndipo kupanikizika kumakula. Pang'onopang'ono, mapuloteni am'magawo a cell amataya zina mwa ntchito zawo, ma hydrogen ion amalowa m'maselo, ndipo potaziyamu amawasiya. Kashiamu imachoka m'mafupa; hypercalcemia imachitika m'magazi. Chifukwa cha kuchuluka kwa ma electrolyte amwazi, Zizindikiro zimasinthira mbali: kukakamiza kumatsika, arrhasmia imachitika. Zizindikiro zotere zikuwonetsa kuti acidosis yadutsa pagawo lovuta.

Mwa zina zomwe zimakonda kuchitika, kusanza komanso kutsegula m'mimba kumatha kusiyanitsidwa. Amayambitsidwa chifukwa cha kuledzera ndi ma ketones, zinthu zomwe zimatengedwa kunja kapena kuwonjezeka kwa kamvekedwe ka mitsempha, zomwe zimapangitsa kuti timinyewa tam'mimba tambiri komanso kupindika.

Zizindikiro zimayang'anidwanso kuchokera kumbali yamanjenje yapakati: wodwalayo akamizidwa mu malo osweka, ogona, akumva kupweteka. Kusakonda kungasinthane ndikusokonekera komanso kukwiya. Ndi kuwonjezeka kwa acidosis, wodwalayo amataya chikumbumtima.

Zizindikiro zamitundu ina ya metabolic acidosis:

• kwa ketoacidosis, fungo la acetone kuchokera pakhungu la wodwala ndi pakamwa limakhala ngati, kupweteka kwambiri pamimba, kusokonezeka kwa khoma lam'mimba. Ndi matenda a shuga, ketoacidosis imangoyambira ndi shuga wambiri, yomwe imayendetsedwa ndi ludzu, polyuria ndi ziwalo zowuma za mucous;
• Zizindikiro zoyambirira za acidosis zomwe zimachitika pakumwa mankhwala zimaphatikizanso kuchepa kwa mphamvu yawo;
• Pamene metabolic acidosis imayendera limodzi ndi kuledzera kwambiri, wodwalayo amatha kupuma mosakhazikika - mopitilira muyeso;
• ngati acidosis imayambitsidwa ndi matenda a impso, makamaka kulephera kwa impso, zizindikiro za hypocalcemia zimawonedwa nthawi zambiri: mtima fibrillation, minofu kukokana. Mpweya wa wodwalayo ukhoza kukhala ndi fungo la ammonia;
• kuchuluka kwa lactic acid pa lactic acidosis kumawonetsedwa ndi kupweteka kwamisempha, kukulitsidwa ndi katundu pa iwo. Ngati chifukwa cha lactic acidosis chinali zovuta zam'mapapo, khungu la wodwalayo limayamba kutuwa, pang'onopang'ono limasanduka lofiira ndikuphimba ndi thukuta.

Kuzindikira kwa acidosis

Kuzindikira kwa acidosis kumachitika magawo awiri. Choyamba chimazindikira ngati pali kusintha kwa magazi acidity ndi mtundu wake. Chachiwiri chikuwulula zomwe zimayambitsa metabolic acidosis.

Asidi-base state, kapena pH ya magazi, zomwe zimakhala ndi mpweya ndi kaboni m'mo mwake zimatha kutsimikiziridwa mu labotale pogwiritsa ntchito kusanthula kwa mpweya. Mwazi umatengedwa kuchokera kumitsempha yama radial, nthawi zina kuchokera ku capillaries pa chala. Kusanthula sikumatha zoposa 15 mphindi.

Kuti mudziwe mtundu wa acidosis nthawi zambiri, maphunziro pamlingo wa glucose komanso mkaka wa m'magazi, matupi a ketone mumkodzo ndi okwanira:

Pa nthawi ya chithandizo, ndikofunikira kuti muchepetse kuphwanya komwe kunayambitsa acidosis. Kuti muzindikire, maphunziro ambiri amatha kuchitika, kutengera matenda omwe adapezeka kale ndi wodwala komanso chithunzi cha chipatala.

Akuluakulu amayesedwa mwatsatanetsatane komanso osiyanasiyana osiyanasiyana pamagazi osiyanasiyana, urinalysis.

Kupatuka kotheka:

1. Mapuloteni, maselo a impso, ma cylinders mu mkodzo, komanso kukula kwa magazi a metabolinine kumawonetsa mavuto a impso.
2. Shuga mumkodzo amawonetsa kuchuluka kwambiri m'magazi, nthawi zambiri chifukwa cha matenda ashuga kapena gawo loopsa la kapamba.
3. Kukula kwa magazi m'magazi kumatsimikizira kuti acidosis idachitika chifukwa cha kutupa ndi kusagwira bwino ntchito kwa chimodzi mwa ziwalo zamkati. Ma neutrophils amakwezedwa ndi mabakiteriya, ma lymphocyte omwe ali ndi matenda oyambitsidwa ndi ma virus.
4. Kuwonjezeka kwa kuchuluka kwa bilirubin kapena kuchepa kwa mapuloteni am magazi kumawonedwa ndi kuperewera kwa chiwindi, matenda a chiwindi.

Malinga ndi zotsatira za kusanthula, ultrasound, compute kapena maginito a resonance angathe kulembedwa. Kuchuluka kwa kafukufuku kumatsimikiziridwa ndi dokotala, poganizira zomwe zimayambitsa metabolic acidosis.

Njira zochizira

Choyambirira kuchita ngati zizindikiro zomwe zili pamwambapa ndikuyimbira ambulansi, chifukwa kuchiza metabolic acidosis kunyumba ndikosathandiza komanso koopsa. Nthawi zambiri chithandizo chovomerezeka ndi koloko chimakhala chopanda ntchito. Sodium carbonate ikalowa m'mimba imakhala yosasinthika kwathunthu ndi madzi a m'mimba, osati gramu yomwe ingalowe m'magazi, chifukwa chake, pH yake imakhala yosasinthika.

Mu chipatala chothandizira matenda a acidosis, amayesetsa kuthetsa chomwe chinayambitsa. Mu shuga, shuga m'magazi amachepetsedwa ndi insulin. Kwa ketoacidosis wopanda matenda a shuga, zakudya za makolo kapena shuga zokhala ndi shuga zitha kufunikira. Kuthetsa madzi kumatha chifukwa cha makulidwe a mchere wa volumetric. Ngati kusowa kwa magazi kumachitika pamene potaziyamu ibwerera ku maselo, potaziyamu mankhwala enaake amayamba. Ndi kulephera kwa aimpso ndi poyizoni ndi zinthu zakupha, magazi amayeretsedwa ndi hemodialysis.

Mitsempha yamavuto amtundu wa alkaline imagwiritsidwa ntchito ngati njira yomaliza, chifukwa imalepheretsa kupuma, kuchepetsa kupanikizika, kukulira zotsatira za insulin, komanso bongo wambiri ungayambitse matenda a alkalosis. Nthawi zambiri, sodium bicarbonate ndi trometamol amagwiritsidwa ntchito.

Sodium bicarbonate imagwiritsidwa ntchito kwambiri metabolic acidosis, pamene pH imatsikira ku 7.1, ndipo wodwala amakhala ndi kuthamanga kwa magazi. Itha kugwiritsidwanso ntchito pakuwonongeka kwa ma carbonates kudzera m'mimba yogaya ndi kuchuluka kwa mankhwala osokoneza bongo. Kuchulukitsa kumawerengeredwa ndi njira. Njira yothetsera vutoli imaperekedwa pang'onopang'ono, motsogozedwa ndi kupangika kwa magazi.

Trometamol imatha kumangirira ma ayoni ambiri a hydrogen, osati m'magazi okha, komanso mkati mwa maselo. Mankhwalawa amagwiritsidwa ntchito ngati nthawi yayitali acidosis ingakhale yoopsa pamtima wa wodwala. Chofunikira pakuyambitsa trometamol ndichizolowezi cha impso ntchito.

Ngati mankhwalawa adachitika munthawi yake ndipo zovuta zikanapewedwa, acidosis imachotsedwa tsiku loyamba, ndipo patatha sabata limodzi wodwalayo amatsitsidwa.