I-Acidosis inguquko ku-acid - isisekelo sokulinganisa ekunyukeni kwe-acidity. Lokhu kungenxa yokuqongelelwa kwama-organic acid egazini.
I-Acidosis kusifo sikashukela ivame ukwenzeka ngokuqongelela kwemizimba ye-ketone - ketoacidosis. Futhi, ngokukhuphuka kokuhlushwa kwe-lactic acid egazini, i-lactic acidosis ingenzeka.
Zombili lezi zinhlobo ziba nenkambo ebunjiwe yesifo sikashukela futhi zidinga ukulaliswa esibhedlela ngokushesha, ngoba ukwanda kwezimpawu ze-acidosis kuholela ekomeni.
Izimbangela ze-ketoacidosis kushukela
Ngokushoda kwe-insulin emangqamuzaneni, izimpawu zokubulawa yindlala zivela ngenxa yokuntuleka kweglucose. Ngamandla, umzimba uqala ukusebenzisa izitolo zamafutha. Amafutha, lapho ephukile, akha imizimba ye-ketone - i-acetone, i-acetoacetic ne-beta-hydroxybutyric acid.
Ama-Ketones avela egazini ayakhishwa kumchamo, kodwa uma amaningi akhiwa, khona-ke izinso azikwazi ukubhekana nomthwalo futhi i-acidity yegazi ikhuphuka. Isifo sikashukela sikashukela singenza impilo yesifo siphathwe ngendlela engafanele:
- Yeqa umjovo we-insulin.
- Ukuyekiswa okungagunyaziwe kokwelashwa.
- Umthamo omncane we-insulin lapho kungekho ukulawula i-glucose egazini.
- Ukwemukelwa kwenombolo enkulu yemikhiqizo emnandi noma kafulawa, ukweqa ukudla.
- I-insulin ephelelwe yisikhathi noma isitoreji esingafanele somuthi.
- Ipeni noma isipompo esingalungile.
- Umuthi wokufika kwesikhathi wokulashwa kwe-insulin yohlobo lwe-2 yesifo sikashukela uma kukhonjisiwe
Kwezifo ezithathelanayo ezihlasela kakhulu, ukuhlinzwa, ikakhulukazi ama-pancreas, ukulimala, ukushiswa okukhulu, futhi ngesikhathi sokukhulelwa, ukulungiswa kwamthamo kuyadingeka, uma lokhu kungenziwa, khona-ke ingozi yokulimala kwe-ketoacidotic ikhuphuka.
I-ketoacidosis ingenzeka ngokusetshenziswa kwama-glucocorticosteroids, ama-diuretics, ama-hormone ocansi, ama-antipsychotic, ama-immunosuppressants. Imiphumela yokushisa ephazamisayo ngesimo se-frostbite noma ukushisa okushisayo, ukopha, ukushaya kwenhliziyo nemivimbo kungadala ukwanda kweglucose yegazi ne-insulin eyengeziwe ukunxephezela.
Ngenkambo ende yesifo sikashukela sohlobo 2, kwehla ukugcotshwa kwe-insulin, okudinga ukushintshwa ekwelashweni kwe-insulin.
I-ketoacidosis ingaba ukubonakaliswa kokuqala kwesifo sikashukela sohlobo 1.
Izimpawu nokwelashwa kwe-ketoacidosis
I-Acidosis ehambisana nokwanda kwemizimba ye-ketone ikhula ngokuqhubekayo ngezinsuku eziningana, kwesinye isikhathi lesi sikhawu singancishiswa saba amahora ayi-12-18.
Ekuqaleni, kuvela izimpawu ezihambisana nokukhuphuka kweglucose yegazi: ukoma okhuphukayo, ukuvama kokuchama kaningi, isikhumba esomile, ubuthakathaka obukhulu, ikhanda kanye nesiyezi, ukuncipha kokudla kanye nokuqina, kanye nomoya ophelile we-acetone. Lezi yizimpawu ze-ketoacidosis emnene.
Ngokukhula okusebenzayo kwemizimba ye-ketone, isicanucanu kanye nokuhlanza kuyangezwa, iphunga elinamandla le-acetone livela emlonyeni, ukuphefumula kubuye kube nomsindo futhi kujule. Imizimba yeKetone inobuthi ebuchosheni, ngakho-ke iziguli ziba ezibulalayo, zingacasuki, zinqotshwe ikhanda, zidideke, abafundi baphendule ukukhanya bese izinga lokushaya kwenhliziyo liba kaningi.
I-Acids icasula ulwelwesi lwama-mucous lwesisu namathumbu, ngakho-ke kukhona ubuhlungu besisu nokungezwani odongeni lwesisu, okufana nezimpawu zenqubo yokuvuvukala okungapheli noma isilonda sesisu. Ngasikhathi sinye, umsebenzi wamathumbu wamathumbu buthaka.
Umfutho wegazi uqala ukuncipha, ukuphuma komchamo kuncipha. Lesi sithombe sasemtholampilo sihambisana nobunzima be-ketoacidosis yeswekile.
Ngokukhula kwe-ketoacidosis, kuvela izimpawu ze-precoma:
- Ukulimazeka kwenkulumo.
- Ukwehla komzimba: isikhumba esomile nolwelwesi lwe-mucous; uma icindezelwa ezinhlamvini zamehlo, zithambile.
- Ukucindezelwa kokukhishwa kwabafundi, abafundi baba mncane.
- Ukuphefumula okungaphakathi.
- Isibindi sikhulisiwe.
- Izikhova.
- Ukunyakaza kwamehlo okubandakanya.
- Ukuqwashiswa okungafanele ngesimo sokubekezela, ukubona izinto ezithambile noma ukudideka.
Esibonakalweni sokuqala se-ketoacidosis, kukhonjiswa esibhedlela ophuthumayo. Ukuqinisekisa ukutholakala kwale sifo, kwenziwa ucwaningo lokuhlaselwa kweglucose (kungakhuphuka kuye ku-20 - 30 mmol / l), pH, kanye nemizimba ye-ketone esegazini.
Ngaphezu kwalokho, ukuba khona kwama-ketones kumchamo nokuqukethwe kwama-bicarbonate ku-serum nakho kuyahlaziywa, futhi i-sodium ne-potassium esegazini, i-urea ne-creatinine kunqunywa. Ukukhuphela ngaphandle i-lactic acidosis, izinga le-lactic acid egazini liyahlolwa.
I-Ketoacidosis iphathwa nge-insulin, futhi amazinga kashukela egazini ayahlolwa njalo ngehora; ukuphathwa okuqinile kwezixazululo ze-potassium ne-sodium bicarbonate kanye nokubuyiselwa ngamandla kokushoda kukamoya wegazi kuyakhonjiswa.
Izifo ezihlangana nazo ezibangela i-acidosis ziyelashwa.
I-Lactic acidosis kushukela
Ukuqongelelwa kwe-lactic acid egazini, okudlula izinga le-5 mmol / l, kubangela ukwanda kwe-acidity yegazi. Lesi simo sikhula uma ukwakheka kwe-lactate kunyuke, futhi ukucutshungulwa kwesibindi nokuqunjelwa kwezinso kuncishisiwe.
I-Lactic acid ikhiqizwa amaseli abomvu egazi, izicubu zemisipha, ungqimba lobuchopho bezinso, ulwelwesi lwe-mucous lwesisu esincane, kanye nezicubu zesisu. Esibindi, i-lactate iguqulwa ibe ushukela noma isetshenziswe kumjikelezo weKrebs (ukuguqulwa kwe-citric acid).
Izinga le-lactic acid lingakhuphuka ngokusetshenziswa ngokweqile kwama-carbohydrate, ukucindezelwa kwengqondo nomzwelo, ukudakwa ngokweqile, ngokuxineka ngokomzimba noma i-conculsive syndrome.
Kwezifo ezinzima zenhliziyo nemithambo yegazi, kuvela i-lactic acidosis enkudlwana. Kungaba nge-pathologies enjalo:
- Isifo sokuphefumula sokuphefumula.
- Ukuhlinzwa kwenhliziyo.
- Ukwehluleka kokujikeleza kwe-angina pectoris, i-myocarditis, i-cardiomyopathy.
- Ukulahleka kwegazi nokuphelelwa ngumzimba ngokuthuthukiswa kokuqina kwemithambo yegazi
- Nge-sepsis.
- Izifo ze-Oncological.
I-Acidosis enokugcwala kwe-lactate ingadala ubuthi nge-methanol, i-calcium chloride, i-coma yanoma imuphi umsuka. Izidakamizwa ezisehlisa ushukela eqenjini le-Biguanide (Metformin 850 noma Fenformin) zivimba ukwakheka kwe-glucose esibindini kusuka ku-lactate, ngakho-ke i-lactic acidosis ingaba yinkinga ekwelapheni isifo sikashukela.
I-Lactic acid ekugxilweni okukhulu inobuthi ohlelweni lwezinzwa oluphakathi. Ngakho-ke, ngokuthuthukiswa kwe-acidosis, ukudangala kokuzwa, ukwehluleka ukuphefumula kanye nomsebenzi wohlelo lwethambo lokuqina kwenhliziyo kukhula. Izimpawu ze-diabetesic lactic acidosis ngokuvamile azihlukile kokuhluka kwe-ketoacidotic. Okuwukuphela kokuphawuleka ukuhla ngokushesha komfutho wegazi nokukhula kwesimo sokushaqeka.
Ngokuthola kwe-lactic acidosis, aqondiswa izinkomba zegazi pH - ukwehla okungaphezulu kuka-7.3 mmol / L, ukuntuleka kwe-bicarbonate egazini, ukwanda kwezinga le-lactic acid.
Ukwelashwa kwe-acidosis ezimweni zokunyuswa kokuqina kwe-lactate kwenziwa ngokuphathwa okukhulu kwe-saline ne-sodium bicarbonate, imijovo ye-lipoic acid ne-carnitine.
Lapho kunquma i-insulin, aqondiswa yinkomba kashukela wegazi.
Uma ingaphezulu kwe-13.9 mmol / l, khona-ke ngisho nalapho kungekho ketoacidosis, iziguli zikhonjiswa i-insulin ngemithamo emincane.
Isifo Sokuvimbela Sikashukela
Ngokuvimbela izinkinga zesifo sikashukela, kumele kuhlonishwe imithetho elandelayo:
- Ukudla okunqunyelwe kokudla okubangela ukukhuphuka okubukhali koshukela wegazi - ukudla okunoshukela kanye nemikhiqizo kafulawa omhlophe, ukuhambisana nombuso wokuphuza.
- Ukudla ngehora, kucatshangelwa imijovo ye-insulin.
- Ukwelashwa kwe-insulin okulawulwa ushukela wegazi.
- Ukushintsha umthamo wezidakamizwa ezilwa nesifo sikashukela ngokubonakala kwezifo ezihlangene, ukulimala, ukungenelela kokuhlinzwa nokukhulelwa.
- Shintsha ngesikhathi i-insulin ngohlobo 2 sikashukela.
- Ukuhlolwa njalo kwe-endocrinologist nokuhlolwa kwegazi kwe-biochemical kwe-glycated hemoglobin, cholesterol ne-lipid metabolism, i-renal kanye ne-hepatic tata.
- Funa ukwelashwa okuphuthumayo kwizimpawu zokuqala noma i-acidosis esolwayo.
Ividiyo ekulesi sihloko izoqhubeka nesihloko sezinkinga zesifo sikashukela.
