Hiki i ka Hyperglycemic coma ke hele mai i loko o ka mea maʻi me ka maʻi maʻi inā e mālama maikaʻi ʻia ʻo ia, a ma muli o kēia, ke piʻi nui ke kahe koko. Wahi a nā kauka i ke kuhikuhi koko i ke koko "glycemia." Inā hoʻāla ʻia ka nui o ke koko, a laila ʻōlelo lākou ua loaʻa i ka mea maʻi "hyperglycemia".
Inā ʻaʻole ʻoe e lawe i ke kō i ke koko ma lalo o ka mālama ʻana i ka manawa, a laila hiki mai kahi hyperglycemic coma
ʻO ka comper Hylyglycemic - kahi ʻike luhi ma muli o ke koko koko kiʻekiʻe. Hele mua ia i nā maʻi kuʻuna o nā poʻe maʻa i ʻole e kaohi i ko lākou koko koko.
ʻO ka coma Hyperglycemic i nā keiki ke hele nei, ma ke ʻano he kānāwai, i ka hui pū me ka ketoacidosis.
ʻO ka coma Hyperglycemic a me ke ketoacidosis maʻi
ʻO ka coma Hyperglycemic hele pinepine me ka ketoacidosis. Inā loaʻa i ka hapa nui o ka maʻi diabetes, a laila ʻaʻole i lawa nā nui o ka nui o ka glucose a hiki ke hoʻololi i ka meaʻai me nā mālama momona. A wāwahi ʻia ka momona, hoʻoulu ʻia nā kino ketone, me nā acetone. ʻO kēia kaʻina ka mea i kapa ʻia ketosis.
Inā nui nā kino ketone e hūnā i ke koko, a laila hoʻonui lākou i kona aila, a hele i luna ma ke ʻano o ka physiological. Aia ke hoʻololi i ka pale o ka acid-base o ke kino i ka hoʻonui ʻana i ka acidity. Hoʻopilikia loa kēia hanana, a ua kapa ʻia he acidosis. Hoʻoikaika ʻia, ka ketosis a me ka acidosis i kapa ʻia ʻo ketoacidosis.
I kēiaʻatikala, e kūkākūkā mākou i nā kūlana i hele mai ai kahi comglycemic coma me ka loaʻa ʻole o ka ketoacidosis. ʻO kēia ka mea he nui ke kō koko koko, akā i ka manawa like, ʻaʻole loli ke kino o ka maʻi maʻi maʻi i ka meaʻai me kāna mau momona. ʻAʻole hua ʻia nā kino Ketone, a no laila ke noho mau nei ka paʻakai koko i nā palena maʻamau.
ʻO kēia ʻano hoʻohālikelike o ke ʻano maʻi maʻi i kapa ʻia ʻo ka "hyperosmolar syndrome." ʻAʻole ia i emi iki ma mua o ka ketoacidosis maʻi. ʻO ka Osmolarity kahi manaʻo o kahi mea i ka hopena. ʻO ka maʻi Hyperosmolar - ʻo ia ka manaʻo o ka mānoanoa nui loa o ke koko ma muli o nā kiʻekiʻe o ka glucose i loko.
Naʻi hoʻolika
Ke komo nei ka mea maʻi i ka comg hyperglycemic coma i ka haukapila, ʻo ka mea mua i hana ai e nā kauka ke hoʻoholo inā he ketoacidosis a i ʻole. No ka hana ʻana i kēia, hana i kahi hōʻike hōʻike ʻana i ka urine no ke kahe ʻana o nā kino ketone e hoʻohana ana i kahi ʻano hoʻāʻo, a hōʻiliʻili pū kekahi i nā ʻike ʻē aʻe.
Pehea e mālama ai i ka coma hyperglycemic me ka ketoacidosis i wehewehe ʻia i ka ʻōlelo kikoʻī o ka ʻatikala "ketoacidosis Diabetic". A eia mākou e kūkākūkā ai pehea e hana ai nā kauka inā ʻaʻole i hele pū ʻia ka coma maʻi me ka ketoacidosis. ʻOiai e loaʻa ana ka mea maʻi me ka hyperglycemic coma i ke ʻano ikaika, pono e mālama pono ʻia kāna mau hōʻailona koʻikoʻi. Ke nānā nei kā lākou nānāʻana e like me ka papa hana like me ka mālama ʻana i ka ketoacidosis.
ʻO ka coma Hyperglycemic, me kaʻole ʻole o ka ketoacidosis, hiki ke hōʻemi ʻia e ka lactic acidosis, i.e., kahi hoʻomehana i ka waikika lactic i loko o ke koko. Ka nui o ka acidact lactic e hoʻopilikia nui loa i ka hoʻomaʻamaʻa ʻana o nā hopena hopena. No laila, he mea kūpono e ana i ke kūpaʻa o ka lactic acid i ke koko o ka mea maʻi.
Manaʻo ʻia nō hoʻi e hana i nā hōʻike koko no ka manawa prothrombin a hoʻoiho hou ʻia i ka manawa part thromboplastin manawa (APTT). No ka mea, me ka maʻi hyperosmolar i ʻoi aku ka pinepine ma mua o ka ketoacidosis maʻi, ulu a DIC, i.e., hoʻopau ka pilina o ke koko ma muli o ka hoʻokuʻu nui o nā mea thromboplastic mai nā kiko.
ʻO nā maʻi me ka hyperglycemic hyperosmolar syndrome e nānā pono ʻia i ka huli ʻana i ka foci o nā maʻi, a me nā maʻi e hoʻoiho ai i nā nīnoho lymph nū. No ka hana ʻana i kēia, pono ʻoe e nānā:
- kaʻaila paranasal
- ka waha e pili ana
- nā ʻāpana ʻōpala
- ʻōpū o ka pūpū, me nā ʻāpana
- nā pōpō
- palpate nā ʻapo lymph
- ... a ma ka manawa like i ka loiloi i nā pōkole cardiovascular.
Nā kumu o kahi maʻi Hyperosmolar Diabetic Coma
ʻO ka Hyperosmolar hyperglycemic coma e pili ana i kahi manawa 6-10 mau manawa ma mua o ka ketoacidosis maʻi maʻi. Me kēia hoʻopiʻi kūlohelohe nui loa, e like me ke ʻano he kānāwai, ua komo ka poʻe kahiko me ka maʻa type type 2 i ka haukapila. Akā ʻokoʻa nā mea ʻokoʻa i kēia kānāwai ākea.
ʻO ka mīkini hana hoʻonāuki i ka hoʻomohala ʻana o ka maʻi hyperosmolar ka mea maʻamau i hoʻonui ʻia i ka pono o ka insulin a alakaʻi i ka dehydration. Eia ka papa inoa o lākou:
- nā maʻi ʻeha, ka poʻe nui me nā maʻi kiʻekiʻe, ka luaʻi a me nā ʻōpū ʻana (ʻo ke kinalā);
- myocardial infarction;
- embolism pulmonary;
- maʻi nui pancreatitis (hana o ka pancreas);
- pōpilikia ʻana;
- he poho;
- pālahalā nui;
- kahe nui;
- pilikia ʻole, dialitis peritoneal;
- nā hana endocrinological (acromegaly, thyrotoxicosis, hypercortisolism);
- nā mea hōʻeha, nā hana hoʻoweliweli;
- nā hopena kino (wela wela, hypothermia a me kekahi);
- ka lawe ʻana i kekahi mau lāʻau lapaʻau (steroid, sympathomimetics, somatostatin analogues, phenytoin, immunosuppressants, beta-blockers, diuretics, calcium antagonists, diazoxide).
ʻO ka Hyperglycemic coma ke hopena pinepine o ka mea maʻi ma ka mea maʻi ma ke ʻano he wai liʻiliʻi e inu. Hana nā poʻe maʻi i kēia, e hoʻāʻo e hōʻemi i kā lākou huehue. Mai kahi ʻanoʻike lapaʻau, ʻoi aku ka ʻōlelo aʻo e kaupalena i ka inu ʻana i ka wai i loko o ka cardiovascular a me nā maʻi ʻē aʻe he pololei a me ka pilikia.
Nā hōʻailona o ka comg hyperglycemic coma
Hoʻoulu pinepine ka maʻi Hyperosmolar i ka nāo diabetes ketoacidosis, ma loko o kahi mau lā a i ʻole hebedoma paha. ʻOi aku ka paʻakikī o ka maʻi pākuʻi ʻana me ka ketoacidosis. Ma ke ʻano ʻole i nā kino ketone, ʻaʻohe ʻano ʻatikala o ka ketoacidosis: ka ʻūhū ʻana o ka hanu ʻana a Kussmaul a me ka ʻalā o ka acetone i ka ea hanu.
I nā lā mua o ka hoʻomohala ʻana o ka maʻi hyperosmolar, hoʻomaka pinepine nā mea maʻi i ka urinate. Akā i ka manawa e hele ai i ke haukapila, ʻoi aku ka palupalu o ka urine a i ʻole ʻoki loa ʻia, no ka dehydration. I ka ketoacidosis maʻi maʻi, he nui ka piʻi ʻana o nā kino ketone e hoʻomaʻamaʻa pinepine i ka luaʻi. Me ka maʻi maʻi hyperosmolar, he ʻakaʻaka ka make, ke ʻole kekahi kumu ʻē aʻe.
Hoʻokumu ka piko Hyperglycemic i kahi ma kahi o 10% o nā mea maʻi me ka maʻi hyperosmolar. Aia ia i ke ʻano o ka mānoanoa o ke koko a me ka nui o ka ʻike o ka sodium i loko o ka cerebrospinal fluid ua hoʻonui. Ma kahi o ka lethargy a me ka coma, hiki i ka ʻikeʻike ʻole ke hōʻike iā ia iho i ke ʻano o ka agitation psychomotor, delirium a me nā hallucinations.
ʻO kahi hiʻohiʻona o ka maʻi hyperosmolar ka maʻi maʻamau a me nā ʻano like ʻole o ka hōʻino ʻana o ka nūnaehana. ʻO kā lākou papa inoa he:
- nahoa
- haunaele ʻōlelo;
- ka neʻe ʻana o ka wikiwiki o ka hoʻouluulu ʻana o nā makamae (nystagmus);
- nā nāwaliwali o nā hana neʻe (paresis) a i ʻole oki i ka lolo o nā pūpū;
- nā hōʻailona neurological ʻē aʻe.
He ʻano ʻokoʻa kēia mau hōʻailona a ʻaʻole i kūpono i loko o kahi ʻōmaʻomaʻo maopopo. Ma hope o ka wehe ʻana i ka mea maʻi mai ke kūlana hyperosmolar, maʻa mau lākou.
Kōkua me ka hyperglycemic coma: ʻike kikoʻī ʻike no ke kauka
Ke lawe ʻia nei ka lāʻau lapaʻau no ka maʻi hyperosmolar a me ka hyperglycemic coma ma luna o nā kumu like e like me ka mālama ʻana i ka ketoacidosis maʻi. Akā he mau hiʻohiʻona e kamaʻilio ana mākou ma lalo nei.
No nā hihia ʻaʻole e hoʻemi ʻia nā pae koko koko ma mua o 5.5 mmol / L no kēlā me kēia hola. ʻO ka osmolarity (density) o ka serum koko ʻaʻole e emi wikiwiki i mua o ka 10 mosmol / l i kēlā me kēia hola. ʻO ka emi ʻana o kahi mea i hōʻemi ʻia i kēia mau ʻōuli e paʻa loa, no ka mea, e hoʻonui ana i ka ulu o ka edema pulmonary a me ka edema cerebral.
I ka hoʻohui ʻana o Na + i ka plasma> 165 meq / l, ua hoʻokomo ʻia ke hoʻolilo ʻana i nā hopena paʻakai. No laila, ua hoʻohana ʻia kahi kūmole glucose 2% e like me ka wai e hoʻopau ai i ka hoʻoheheʻe. Inā ka nui o ka sodium e 145-165 meq / l, a laila hoʻohana i kahi oho momona 0.45% o NaCl. Ke hoʻemi nei ka pae sodium <145 meq / l, hoʻomau ʻia ka rehydration me ka paʻakai physiological 0.9% NaCl.
I ka hola mua, ua kahiki ʻia ka wai o 1-1.5 lita, ma ka 2 a me 3 hoʻi - 0.5-1 lita, a laila 300-500 ml i hoʻokahi hola. Hoʻohālikelike ʻia ka helu rehydration ma ke ʻano like me ka maʻi ketoacidosis maʻi, akā ʻoi aku kāna kīhāpai mua ma ka hihia o ka hyperosmolar syndrome.
I ka hoʻomaka ʻana o ke kino o ka mea maʻi i ka saturated me ka wai, i.e., ua hoʻopau ʻia ka hoʻoheheʻe, ʻo ia iho i alakaʻi i ka emi ʻana o ke kaʻe o ka glucose i loko o ke koko. I kahi comg hyperclycemic com, e hoʻonui pinepine ʻia ka naʻau o ka insulin. I kēia mau kumu, ma ka hoʻomaka ʻana o ka maʻi lapaʻau, ʻaʻole i lawelawe ʻia ka insulin a i lawelawe ʻia paha ma nā koina liʻiliʻi, e pili ana i 2 mau pūʻulu o "insulin" pōkole i kēlā me kēia hola.
Ma hope o 4-5 mau hola mai ka hoʻomaka ʻana o ka maʻi infusion, hiki iā ʻoe ke neʻe i ka regimen dosing insulin e wehewehe ʻia ma ka ʻāpana "Ka mālama ʻana i ka ketoacidosis maʻi", akā inā kiʻekiʻe wale ke koko koko a me ka hoʻoliʻiliʻi ʻana o nā sodium i loko o ke koko koko.
Ma kahi maʻi hyperosmolar, ʻoi aku ka nui o ka potassium e hoʻoponopono ʻia i ka hapa potassium ma ke kino o ka mea maʻi ma mua o ka maʻi ketoacidosis maʻi. ʻO ka hoʻohana ʻana i ka alkalis, me ka pena hou ʻana i ka paoa palaoa, ʻaʻole i hōʻike ʻia no ka ketoacidosis, a ʻoi aku hoʻi no ka maʻi hyperosmolar. Hiki i ka pH ke hōʻemi inā ulu ka acidosis me ka hoʻohui o nā kaʻina purulent-necrotic. Akā i kēlā me kēia mau hihia, ʻokoʻa loa ka pH ma lalo o 7.0.
Ua hoʻāʻo mākou e hana i kēia ʻatikala e pili ana i ka hypoglycemic coma a me ka maʻi hyperosmolar i hoʻohana pono no nā maʻi. Manaʻo mākou hiki i nā kauka ke hoʻohana iā ia me he mea "hoʻopunipuni pepa" maʻalahi.
