Isifo sikashukela se-ketoacidotic coma yisimo lapho kusongela khona impilo yeziguli. Kuyinkimbinkimbi yesifo sikashukela. Okuqukethwe kwe-insulin kuba yinto encane ngokweqile ngenxa yokwelashwa okukhethwe ngokungafanele, okuholela ekuphazamisweni okuyingozi ekusebenzeni komzimba.
Iyini i-ketoacidotic coma?
I-Ketoacidosis yisimo esibonakaliswa ukuntuleka kwe-insulin, amazinga kashukela aphakanyisiwe kanye nokungeqile kwemizimba ye-ketone egazini nomchamo wesiguli. Uma ungamsizi umuntu ngokushesha, isimo sakhe sizoshuba ngokushesha. Imvamisa iphela ekufeni.
I-Ketoacidosis yisimo esibonakala ngokushoda kwe-insulin, ushukela wegazi ophezulu.
Izizathu
Amaphutha ekwelashweni kungaba yimbangela. Umuntu angaletha umthamo ongafanele wesidakamizwa, enze umjovo ngaphandle kwesikhathi, weqa umuthi noma akhohlwe ukufaka i-insulin. Ukuthuthuka okungenzeka ngenxa yokulawulwa ngokucophelela kwamazinga kashukela.
Inkinga ivame ukuvela ngenxa yokuphazamiseka kokudla. Ukuze ugweme ukwakhiwa komthambo, kuyadingeka ukwenqaba ukudla ukudla okuqukethe inani elikhulu lama-carbohydrate angagayishwa kalula. Enye imbangela yale nkinga ukusetshenziswa kabi kotshwala.
Mhlawumbe ukukhula lapho kukhona isifo okuxakayo inkambo yesifo sikashukela. Ama-pathologies anjalo afaka i-stroke, infarction ye-myocardial, izinqubo zokuvuvukala, ama-tumic amabi kanye nama-benign tumors, nabanye.
Imvamisa, ukuthuthukiswa kuyaphawulwa phambi kwe-endocrine pathologies, lapho kukhiqizwa khona ama-hormone akhulisa ushukela wegazi. Umphumela ofanayo kungenzeka ngenxa yokusetshenziswa kwezidakamizwa ezikhulisa ukugcwala kwe-glucose.
Izingcindezi ezinkulu zokuxineka, ukuhlukunyezwa okungapheli kwezinzwa, ukungenelela kokuhlinzwa kwamuva nje, nokulimala kunomthelela ekubonakala kwezinkinga.
Izimpawu zesifo se-ketoacidotic coma
I-pathogenesis yalesi simo ibonakala ngentuthuko kungakapheli izinsuku ezimbalwa. Ngezikhathi ezithile, ukukhohlisa kungenzeka phakathi nosuku, ukuthuthukisa ngokushesha. Izimpawu zemitholampilo zincike ekutheni yisiphi isigaba sentuthuko.
Ekuqaleni, kukhona ukwehla kwenani le-insulin. Ngaphezu kwalokho, ukuhlanganiswa kwamahomoni aphikisayo kuyathuthukiswa. Kulesi sigaba, isifiso esijwayelekile sokuchama siyimpawu. Isiguli sizwa ukoma okuqinile okungadluleli ngisho nangemva kokuphuza isilinganiso esikhulu soketshezi. Kunokwehla kwe-glucose engena kwezicubu nezitho zomzimba, ngenxa yokuthi akukho ukusetshenziswa okwanele kwalolutho, futhi kwenzeka ukukhula kwe-hyperglycemia. I-Glycolysis esibindini ivinjelwe.
Ngemuva kwalokho i-hypovolemia iyaphawulwa. Ama-electrolyte e-potassium, sodium, phosphates ashiya umzimba. Ukwehla komzimba kwenzeka. Izimpawu zokuphelelwa amandla ziyangezwa: isikhumba esomile, ikhanda, i-turgor enciphile.
Izimpawu ezijwayelekile zokudakwa ziyaphawulwa. Kukhona isicanucanu, ukugabha, ubuthakathaka. Indoda idinwa ngokushesha. Isimo esivamile se-asthenic sici. Isifiso siphukile. Ubuhlungu emilenzeni kuyaphawulwa. Ukuphefumula kuyaphulukisa, kuba yize. Isigqi sezinkontileka zenhliziyo siyaphazamiseka ngenxa yokwehla kwegazi lokujikeleza kwegazi emzimbeni. Ngesikhathi esifanayo, inani lokuchama kulesi sigaba lehliswa kakhulu, kwesinye isikhathi kuba ukungabikho komchamo ngokuphelele.
Uma usizo olungenasikhathi alunikezwanga, kuphawulwa ukudangala okubonakalayo kokwazi. Okokuqala, ukudideka, ukubekeka phansi, kanye nokwehla kwemisebenzi yokuqonda kuzokwenzeka. Uma izinyathelo zokusindisa isiguli zingathathwanga, umuntu uzolahlekelwa ukwazi futhi afe ngemuva kwesikhathi esithile.
Uma izinyathelo zokusindisa isiguli zingathathwanga, umuntu uzolahlekelwa ukwazi futhi afe ngemuva kwesikhathi esithile.
Ukuphefumula kukaKussmaul kuyisimo esijwayelekile: Ukuphefumula ngokujulile okungaxhunyiwe emuva kwesikhashana kuba nomsindo futhi kungavamile. Kunephunga le-acetone.
Ukuxilongwa Kwezinkinga
Esikhathini sokuqala, i-ketoacidotic coma ekhulayo ingasolwa ngezimpawu zomuntu. Udokotela uzobuza isiguli, athole ukuthi izimpawu zavela isikhathi esingakanani. Futhi kuzodingeka ukuthi unikeze imininingwane ngezehlakalo zakamuva: umuthi ophuthelwe, ukuphazamiseka kokudla, kanye nama-pathologies atholakele. Ngaphezu kwalokho, kuzokwenziwa izivivinyo zaselebhu. Izinga lemizimba ye-ketone, ushukela kunqunywa. Kuthathwa amasampula omchamo ukuze kuhlaziwe ukuze kutholakale ubukhona bezidumbu ze-ketone kuzo.
Kuyadingeka ukuthola ukuthi kukhona ama-electrolyte, i-creatinine, i-urea, i-bicarbonate, i-chloride, kanye namazinga e-lactate. Ukwakheka kwegesi kwegazi, i-acidity yalolu ketshezi lwezinto eziphilayo, kuyambulwa.
Ungayinikeza kanjani usizo lokuqala lwe-coma
Kulesi simo, ukunakekelwa okuphuthumayo kubalulekile. Kuyadingeka ukubiza odokotela ngokushesha: isiguli singalashwa kuphela esimweni sesibhedlela. Bese uhlola ukushaya kwenhliziyo nokuphefumula, umfutho wegazi. Ngezikhathi ezithile kuyadingeka ukuthi kabusha kwenziwe izilinganiso ukunikeza ulwazi kodokotela lapho befika. Ukuhlola isimo sesiguli, kufanele ubuze ngokuthile okudinga ukuphendulwa. Kunconywa nokuhlikihla amacici endlebe, ngezikhathi ezithile uzungeze isiguli ebusweni, ukuze ungamvumeli ukuba angazi.
Ngaphambi kokufika kochwepheshe, ungangena ngokuzimela ikhambi le-sodium chloride (0.9%).
Ngaphambi kokufika kochwepheshe, ungangena ngokuzimela ikhambi le-sodium chloride (0.9%). Umjovo onjalo uzosiza ukubuyisela amanye ama-electrolyte alahlekile. Ngaphezu kwalokho, i-insulin iyabhalwa, ngemuva kokulinganisa izinga leshukela nge-glucometer. Kuyadingeka ukusebenzisa amayunithi ayi-8-16. Akunakwenzeka ukushiya isiguli sisodwa: kubalulekile ukubheka isimo sakhe ukuze uthathe izinyathelo ezidingekayo uma kunesidingo.
Isiguli kufanele sibekwe eceleni kwakhe. Ngakho-ke ulimi ngeke ludale ubunzima bokuphefumula. Izingubo eziyisishiyagalombili, eziqinile kudingeka zingaqiniswa noma zisuswe. Kuyadingeka ukuthi umuntu akwazi ukufinyelela mahhala emoyeni.
Yikuphi ukwelashwa okudingekayo
Usizo luyadingeka endaweni yesibhedlela. Kuyadingeka ukuthi kuqala unqume izinga lokuphazamiseka ekusebenzeni kwezinhlelo ezibalulekile zomzimba. Ngemuva kwalokho kuthathwa izinyathelo zokuzilungisa. Ngaphezu kwalokho, kuyadingeka ukunciphisa ukudakwa. Odokotela bazama ukuthola isizathu esidale i-coma: lokhu kuzosiza ukuhlela ukwelashwa ngempumelelo. Ukubuyisela izinhlelo ze-buffer ngokomzimba ekhaya akunakwenzeka.
Ibhalansi yamanzi
Ngenxa yokuphelelwa ngamandla komzimba, izimpawu zokudakwa ziyanda. Ukulungisa isimo sesiguli ngokwejwayelekile, kuyadingeka ukuthi ijwayele ukuvezwa komchamo, ukwenza ukulahleka kwamanzi.
Ukubuyisela ibhalansi yamanzi nge-dropper, kwethulwa isixazululo se-sodium chloride.
Ukubuyisa ibhalansi yamanzi, isiguli kufanele kuqala sisindwe. Isikhombi siyadingeka ukubala inani elidingekayo lekhambi. Uketshezi uphathwa ngaphakathi nge-dropper. Ngekhilogremu ngayinye yesisindo, kufanele kuphathwe i-10 ml yesisombululo se-chodium chloride. Uma ukulahlekelwa uketshezi kukhulu kakhulu, umthamo ukhuphuka amahlandla ama-2. Ngokunyuka kwevolumu yokujikeleza kwegazi, ukwehla kweshukela kwenzeka. Lapho umchamo uqala ukuthululwa, izidumbu ze-ketone zithunyelwa ngawo, umthamo uyancishiswa. Usuku luvunyelwe ukungangeni ngaphezu kwama-8 amalitha.
Ukululama kwe-Electrolyte
Ukubuyisela izinga lama-electrolyte, kwethulwa izidakamizwa ezikhethekile. Ukuntuleka kwe-potassium kuyingozi kakhulu. Baqala ukwethula le-microelement noma ngesilinganiso esijwayelekile, ngoba lapho i-dilating yegazi nekhambi elingenayo, ukuhlushwa kuzoncipha. Izidakamizwa zilawulwa ngokuhlinzwa.
Ukuvuselelwa kwe-Acid-base
Ukuze kube ngokwejwayelekile i-acidity yetshezi lomzimba, kusetshenziswa i-sodium bicarbonate. Isidakamizwa siyasetshenziswa uma inkomba yehlela ku-7.0. Ingasetjenziswa ngehle kuze kufike ku-7.1, uma kukhona ukwephula isigqi sezinkontileka zenhliziyo, ukwehla komfutho wegazi, kanye ne-coma ejulile.
Kufanele kukhunjulwe ukuthi ukubuyiselwa kwenkomba kuqala lapho kusetshenziswa i-insulin nokubuyisela ibhalansi yamanzi. Kulokhu, i-ketogenesis iyacindezelwa, ukugcwala kwama-ion hydrogen egazini kuyancipha, amandla ezinso okubuyisela i-babsarbates bicarbonates ayabuyiselwa.
Ukusetshenziswa kwe-sodium bicarbonate kungadala izinkinga, ngakho-ke kungcono ukwenqaba ukuyisebenzisa ngaphandle kwezinkomba ezikhethekile. Ngaphandle kwalokho, i-alkalosis ye-metabolic ihlala ikhula.
Kuyadingeka ukuphatha i-insulin ngokwenyuka okunamandla kwamazinga kashukela ngokushesha.
Ukwelashwa kwe-insulin
Kuyadingeka ukuphatha i-insulin ngokwenyuka okunamandla kwamazinga kashukela ngokushesha. Uma amanani enkomba engemikhulu kakhulu, kuqapheleka ukomisa kakhulu, le ndlela isetshenziswa isikhashana ngemuva kokuqala kokujwayelekile kokulingana kwamanzi.
I-insulin emfushane isetshenzisiwe. Kwezinye izimo, ukuphathwa kwama-unit angama-16 ukuya kwe-intramuscularly kunqunywa ngokushesha. Uma isilinganiso esinjalo singadingeki, umthamo ukhethwa ngawodwana. Ngokwesilinganiso, kufinyelela amayunithi ayi-6 ngehora. Ukuze into ingene emthanjeni ngokushesha, kusetshenziswa isisetshenziswa esikhethekile - i-infusomat.
Lapho umuntu ethola futhi amandla okudla ngokuzimela, i-hormone iqala ukuphathwa ngokungaziphathi. Isikhathi eside, umuntu ongazi ukuthi unqunyelwe ukuphathwa kanyekanye kwe-insulin neglucose: lokhu kusiza ukubuyisa ukuntuleka kwamandla.
Ukudla okungenamsoco ngemuva kokuqedwa kwe-ketoacidotic coma
Ngemuva kokuphumula, kufanele ulandele ukudla okhethekile. Isonto lonke, yonke imithombo yamafutha kuzodingeka ingafakwa ekudleni. Kwezinye izimo, ukuvinjelwa kuhlala isikhathi eside.
Umsoco kufanele uqiniswe nge-potassium. Ukusetshenziswa kwamanzi amaminerali we-alkaline kuvunyelwe.
Amaprotheni akhawulelwe ezinsukwini ezi-3. Ngasikhathi sinye, ama-carbohydrate wokugaya ayengezwa kwimenyu. Ushukela wenqatshelwe. Kufanele ithathelwe indawo nge-xylitol noma i-sorbitol, evimbela ukwanda kokuqoqwa kwezidumbu ze-ketone.
Ukudla okuphephile kuyadingeka. Ngosuku lokuqala ngemuva kokushiya ukhubazekile, uma isiguli sigcina amandla okudla ngokuzimela, uju, ujamu, i-semolina, iziphuzo zezithelo, ama-mousses angafakwa ekudleni kwakhe. Ukuphuza kuvunyelwe amanzi amaminerali we-alkaline. Kudlalelwa amanzi amaningi
Ngosuku lwesibili, kuvunyelwe ukuguqula i-puree yokudla kusuka kuma-apula noma amazambane, i-oatmeal, i-kefir, isinkwa, iyogathi, ukhokho ushizi onokudla okuphansi kwamafutha.
Umhluzi wenyama, i-purean inyama puree yengezwa ngosuku lwesithathu.
Esontweni elizayo, kunokushintshwa kancane kwesistimu yamandla endala.
Kubalulekile ukunamathela ngokuqinile kwimenyu yokudla. Ukwephulwa kwezincomo zikadokotela kungaholela ekwenzekeni kwezinkinga.
Amaphutha wokwelashwa
Ngokulashwa kwe-insulin okungafanele, amazinga kashukela wegazi angawa kakhulu.
Uma i-potassium iphathwa kancane kakhulu, kuzoba nezinkinga ohlelweni lwenhliziyo.
Uma izinga lokuphanjululwa komzimba lingashesha ngokwanele, kuyethuka ukwethuka kwe-hypovolemic.
Uma amazinga kashukela wegazi angalawulwa ngokwanele, ukwelashwa kungenzeka kungakhethwanga kahle. Ngenxa yalokhu, isiguli singase sibe sibi kakhulu.
Uma i-potassium iphathwa kancane kakhulu, kuzoba nezinkinga ohlelweni lwenhliziyo.
Izinkinga ezingaba khona
Uma kungalashwa, kufa. Ngaphandle kosizo lochwepheshe, i-coma ayikwazi ukwelashwa.
Enye yezinkinga eziyingozi kakhulu yi-edema yamakhemikhali. Ikhula kungakapheli amahora ayi-6-48. Kulezo zimo lapho isiguli singaphindi sazi, ngaso sonke isikhathi akwenzeki ukuthola le nqubo ye-pathological. Okuvame ukutholwa kakhulu ngenxa yokuntuleka kwezimpawu zokuthuthuka. Qinisekisa ukusebenzisa i-ultrasound noma i-compact tomography yengqondo. Amathuba okufa anda ngezikhathi ezimbili. Mhlawumbe ukuthuthukiswa kwe-pathologies emkhakheni we-neurology, psychiatry.
Ama-thromboses amakhulu kungenzeka. Imvamisa etholakala ngokulimala kwezinso noma inhliziyo, i-pulmonary edema. Uma isiguli singabuyisi ukwazi, i-asphyxia kungenzeka.
Ukuvimbela iketoacidotic coma
Isiguli esinesifo sikashukela kufanele sitadishe izimpawu zobuthakathaka. Lokhu kuzosiza ukuqaphela ngesikhathi le nkinga futhi uthintane nodokotela. Ezigabeni zokuqala, ukwelashwa kulula, ubungozi bezinkinga buncane. Ukujwayelana nezimpawu zezinkinga kufanele kube yizihlobo zesiguli. Uma kutholakala izimpawu, thintana nodokotela ngokushesha. Isiguli asikwazi ukusala sodwa.
Kuyadingeka ukulandela ukudla. Ngisho nokuphambuka okuncane kungaholela emiphumeleni eyingozi. Ngalesi sizathu, kuyadingeka ukuyeka ukusetshenziswa kwamaswidi kanye notshwala.
Izidakamizwa kufanele zithathwe ngokuya ngohlelo olunqunywe udokotela ohambelayo. Ukweqa imijovo nakho akwamukeleki. Impilo yeshelufu yezidakamizwa kubalulekile ukuthi uyihlole njalo. Ukuphuza imithi ephelelwe yisikhathi kungenza isimo sakho sibe sibi kakhulu. Ngaphezu kwalokho, kubalulekile ukugcina imithetho yokugcina. Ngaphandle kwalokho, umuthi ungahamba kabi, ungasebenzi.
Zonke izincomo zikadokotela kumele zilandelwe. Kubalulekile ukugwema izimo ezicindezelayo, uphathe noma iyiphi i-pathologies ngesikhathi esifanele, futhi uvikele ukuthuthukiswa kwezifo ezenza inkambo yesifo sikashukela ibe khona.
