ʻO ka maʻi diabetes mellitus he pathology, ka hōʻike nui a ka nui o ka hoʻonui i ke kōhi koko. ʻO nā hōʻailona nui o ka maʻi e pili pū me ka hyperglycemia, a ma o kāna uku ʻana, hiki ke wānana ʻia ka loaʻa ʻana o nā maʻi maʻi maʻi maʻi.
Hoʻopilikia ka hoʻāla nui o ka glucose i ka paia o ka vascular a alakaʻi i ka hiki ʻana o nā maʻi o ka pūpū, ka retina, ka hoʻopuni ʻōnaehana peripheral, ka wāwae maʻi maʻi, ka angioeuropathies o nā ʻano like ʻole.
ʻO ka hoʻopiʻi hewa ʻana i ka maʻi mellitus a i ʻole ka hele ʻana o nā maʻi concomitant koʻikoʻi hiki ke hoʻonā i nā maʻi i loko o ke kōʻai koko me ka hoʻomohala ʻana i kahi kohu maʻi maʻi maʻi, e koi ai i ka mālama maʻi olakino.
ʻO nā kumu o ka hyperglycemia i ka maʻi diabetes
ʻO ka hoʻonui ʻana o ke kō o ke koko i ka maʻi diabetes huki 1 e pili ana me ka hema ʻole o ka nui o ka insulin. Hoʻopau ʻia nā hua beta i ka pancreas ma muli o ka ulu ʻana o kahi ʻano hopena autoimmune. ʻO nā maʻi, nā mea huʻala, nā lāʻau lapaʻau, hoʻonāukiuki i ka hoʻonāukiuki o ke ʻano pale ʻole. Aia kahi maʻi ma nā maʻi maʻi genetically predisposed.
Ma ke ʻano ke aniani type 2, ʻaʻole e ʻokoʻa ka neʻe ʻana o ka insulin i ka maʻamau, akā ʻaʻole i pane mai nā ʻaeʻana o ka insulin i kēia hormon. ʻO ka mea nui i ka hoʻomohala ʻana i ka maʻi hika he nui i ke kuapo ʻana o ka predisposition hoʻoilina. Hōʻike ka lua o ke ʻano maʻi maʻi me ka nele o ka wina o ka insulin.
Me ka nele o ka insulin a hewa ʻole, ʻaʻole hiki i ka glucose ke komo i loko o nā ʻāpana a ua hoʻōla ʻia e hana i ka ikehu. No laila, ke waiho nei i loko o ka lumen o ka moku, e hōʻeha i ka nui o ke kahe mai nā kiko, no ka mea, he mea utakou osmotically. Hoʻoulu ka lepo i ke kino, ʻoiai ke kīpē ana nā keiki i kahi maʻi maʻi me nā glucose.
E like me ka paʻakikī o hyperglycemia, ua manaʻo ʻia ka papa o ka maʻi diabetes.
- Kahiahi: ka wikiwiki o ka glycemia ma lalo o 8 mmol / l, ʻaʻohe glucoseosuria a i ʻole he alahele o ka glucose i loko o ka urine. Hoʻonohonoho ʻia e ka meaʻai, ka angiopathy hana.
- Ma kahi o ka hōʻemi maʻalahi: ka wikiwiki o ka hoʻokeʻo a hiki i 14 mmol / l, glucosuria i kēlā me kēia lā ʻaʻole i kiʻekiʻe ma mua o 40 g, ka ketoacidosis e hana i kekahi manawa. Ma muli o ka lāʻau me nā papa ʻaila a i ʻole insulin (a hiki i nā ʻāpana 40) i ka lā.
- Maikaʻi ʻokoʻa: glycemia ma luna o 14 mmol / l, glucosuria kiʻekiʻe, mālama ʻia ka insulin i nā koina nui, aia ka maʻi ngioneuropathies diabetes.
No laila, inā he 16 koko koko a he pōʻino paha ia no kahi maʻi maʻi, e hiki wale ke pane i ka nīnau like like me ka maikaʻi, no ka mea, pili kēia hōʻailona i ke ʻano nui o ka maʻi maʻi.
Hiki i kēia kūlana ke ulu i kahi hoʻopiʻi koʻikoʻi o ka maʻi maʻi - diabetes ketoacidosis maʻi.
Nā kumu o ka ketoacidosis i ka maʻi diabetes
Ke kū nei ka hoʻomohala ʻana o ka ketoacidosis me kahi kiʻekiʻe glycemia a me ka hoʻonui nui ʻana o ka nui o nā kino ketone i ke koko. ʻO ke kumu ke kaohi ʻana o ka insulin. Hiki i ka ʻano maʻi maʻi mua me ka ketoacidosis i ka hopena o ke ake ʻana, a i loko o ke ʻano maʻi maʻi type 2 i loaʻa ia i nā hopena o hope o ka maʻi, i ka wā i pau ai nā kumu waiwai o ka pancreas.
ʻO ka hoʻowahāwahā a ʻole hoʻi e hōʻole ʻole i ka insulin, nā maʻi concomitant a me nā hōʻeha, nā hana, ka lawe ʻana i ka hormone a me ka diuretics, a me ka hoʻoneʻe ʻana i ka pancreas e alakaʻi ana hoʻi i ka hyperglycemia kiʻekiʻe a me ke ketoacidosis.
ʻO ka hemahema o ka insulin e alakaʻi i ka hoʻonui i ka pae o ka momona, ka ulu ʻana o ka hormone, cortisol a me adrenaline i ke koko, kahi e hoʻoulu ai i ka wāwahi o ka glycogen i loko o ka ate a me ka hoʻokumu ʻana o ka glucose i loko. Ke alakaʻi nei kēia i kahi hoʻonui i ka glycemia. Hoʻopili ia, me ka lawe ʻole o ka insulin, e hoʻomaka ka hakakā o nā protein a me nā momona i ka piʻi nui o ka pae o nā waikawa amino a me nā momona momona i ke koko.
No ka mea ua nele ka glucose i loko o nā hana, hoʻomaka ke kino e loaʻa ka ikaika mai nā momona. ma ke kaʻina o nā hopena i hana ʻia nā kino ketone - acetone a me nā aʻala kūlohelohe. Ke piʻi nui ko lākou kiʻekiʻe ma mua o nā keiki, hiki i ka ketoacidosis i ke koko. ʻAʻole nā māka momona i nā meaʻai i ʻai i ka ketogenesis.
Hoʻopili ʻia kēia ʻano me ka huhū kaumaha. Inā ʻaʻole hiki i ka mea maʻi ke inu i ka wai nui, a laila hiki ke lilo i ka 10% o ke kaumaha o ke kino, kahi e hiki ai i ka dehydration maʻamau o ke kino.
ʻO ke ʻano lua o ke maʻi maʻi me ka decompensation e hele pinepine ʻia e kahi kūlana hyperosmolar. Mai ka hoʻokaʻawale ʻana o ka insulin i ka hoʻokumu ʻana i nā kino ketone, akā no ka mea ʻaʻohe hopena o ia ʻano, hoʻonui ka hyperglycemia. Hoʻomaopopo o nā hōʻailona o ka hoʻēmi hyperosmolar:
- Ka hopena urine nui loa.
- Ka makewai ʻole.
- Kahula
- Kau ka momona kino kino.
- He koko koko nui.
- ʻO nā pae kiʻekiʻe o ka sodium i loko o ke koko.
Hiki i nā kumu kumu o ka kūlana hyperosmolar i ka dehydration me ka nui o nā lāʻau diuretic nui, holo aihua, a i ʻole hōʻeha ʻana.
Aia pū kekahi pū hui o ketoacidosis a me ka hoʻōla a hyperosmolar.
ʻO nā hōʻailona o ka ketoacidosis
Hōʻike ʻia ka maʻi diabetes mellitus e ka hoʻonui lohi i nā hōʻailona o ka hyperglycemia. Hoʻoulu ʻo Ketoacidosis i loko o hoʻokahi lā a oi aʻe paha, ʻoiai e hoʻonui ka waha maloʻo, inā paha e inu ka mea maʻi i ka wai nui. Ma ka manawa like, malaise, ʻeha, ka maʻi ʻawaʻawa ma ke ʻano o ka maʻi maʻi maʻi maʻi constipation a constipation, ʻeha o ka ʻōpū a me kekahi manawa e hoʻopiʻi hou ʻia i nā maʻi.
ʻO ka nui o ka hyperglycemia alakaʻi i ka ʻike luhi, ke ʻano o ka walaʻau a me ka hanu pinepine ʻana, e manaʻo nei ka ʻūhū a wela, ka ʻā o ka acetone mai ka waha, a i ka wā e paʻi ʻia ai ka pale i ka maka, hōʻike ʻia ko lākou nāʻalulu.
Pono nā hoʻokolohua diagnostic e hōʻoia ana i ka ketoacidosis ma nā hōʻike mua o ka hyperglycemia. I loko o kahi hōʻike koko, ke piʻi nei ka nui o ke kōpaʻa ma mua o 16-17 mmol / l, e loaʻa ana nā kino ketone i ke koko a me ka urine. I loko o kahi hale hila, e hana ʻia nā hoʻokolohua:
- ʻO Glycemia - hoʻokahi hola.
- ʻO nā kino ketone i loko o ke koko a me ka waiʻa - i kēlā me kēia mau hola 4.
- I nā electrolytes o ke koko.
- ʻO ka helu koko piha.
- Nā mea hana koko.
- Nā manaʻo o ke koko pH.
Hoʻolālā ʻana i ka hyperglycemia a me ketoacidosis
Hāʻawi ʻia kahi mea maʻi me nā hōʻailona o ka ketoacidosis i kahi dropper me ka paʻakai physiological a me nā ʻāpana he 20 o ka insulin hana pōkole e lawelawe ʻia intramuscularly.
A laila, hoʻomau ʻia ka insulin i ka intravenously a i ʻole me ka musika ma ka nui o nā 4-10 mau paona i hoʻokahi hola, e pale ana i ka wāwahi o ka glycogen e ka lepa a pale i ka ketogenesis. I mea e pale ai i ka hoʻonele ʻana o ka insulin, e mālama ʻia ana ka albumin i ka pahu like.
Pono e hōʻemi iki ʻia ka Hyperglycemia, no ka mea hiki i ka hāʻule wikiwiki i ke kōpaʻa hiki ke alakaʻi i ka edema osmotic, inā paha i ka edema utak. I ka lā e pono ai ʻoe e hōʻea i ka pae o 13-14 mmol / l. inā ʻaʻole hiki i ka mea maʻi ke ʻai i ka ʻai ma kāna ponoʻī, a laila ua kuhikuhi ʻia ʻo ia i 5% glucose i kumu waiwai.
Ma hope o ka ʻike hou ʻana i ka mea maʻi, a ua hoʻomau ʻia ka glycemia i ka pae o ka 11-12 mmol / l, ua ʻōlelo ʻia ʻo ia: inu wai hou aku, hiki iā ʻoe ke ʻai i ka cereals wai, nā palupalu, nā mea ʻai, a i ʻole ka mea hū i ka ʻai. Me kēlā glycemia, ke hoʻomalu ʻia nei ka insulin i ka hapa mua, a laila e like me ke ʻano maʻamau.
Ke lawe nei i kahi maʻi mai kahi noho o ka ketoacidosis maʻi, hoʻohana ʻia nā lāʻau lapaʻau e like me kēia:
- ʻO Sodium klorida 0.9% i ka nui o 7-10% o ke koʻikoʻi o ke kino ma nā hola 12 mua.
- Hoʻopili nā Plasma me ka systolic pressure ma lalo o 80 mm Hg. ʻAniā.
- Mālama ʻia ka paʻakai pākawahele e nā pae koko. I ka mua, loaʻa i ka mea maʻi i ka infusion o ka pāhana, a laila hoʻomākaukau ka pākia kalapula i nā papa no ka pule.
- Loaʻa pinepine ʻia ka infusion ʻo Soda e hoʻoponopono i ka waʻa acidosis.
Hoʻohana ʻia kahi pahuhopu sodium 0.45% e mālama i ka maʻi hyperosmolar a ʻaʻole i hoʻohana ʻia ka insulin a i kuhikuhi ʻia ma nā wahi liʻiliʻi loa. Ke hōʻike nei i nā mea maʻi e hoʻomaopopo: inu nui i ka wai, lawe ʻia ka ʻai, hoʻokaʻawale ʻia nā mea kākara maʻalahi. I mea e pale ai i ka trombosis, ʻōlelo ʻia nā poʻe maʻi maʻi heparin.
I mea e pale ai i ka hoʻonui ʻia o ke kō koko a me ka hoʻomohala ʻana i ka ketoacidosis i ka mellitus maʻi diabetes, hiki wale ke nānā aku me ka mālama mau ʻana i ka pae o ka glycemia, e pili ana i ka ʻai me ka palena o nā mea ʻaloe kūlohelohe, lawe ka wai nui, hoʻoponopono ʻia ka nui o ka insulin a i ʻole papa no nā maʻi hoʻopulapula, heʻano kūlohelohe kino, ʻuhaneʻeha.
Hōʻike ʻia ka ʻike ma hyperglycemia i ke wikiō ma kēia ʻatikala.
