I-lactic acidosis ibizwa nangokuthi yi-lactic acidosis. Lesi simo, esidonsela amandla i-hyperlactacidemic coma, siyinkinga edingekayo yesifo sikashukela.
I-lactic acidosis ivela njenge-lactic acid eqongelela emzimbeni womuntu. Kuthintwe ngu:
- Imisipha yesikhumba
- Isikhumba
- Ingqondo.
Ngemuva kokuqongelelwa kwenani elithile le-acid, i-lactic acidosis iguqulwa ibe yi-metabolic acidosis.
Kubaluleke kakhulu kubo bonke abantu abanesifo sikashukela ukwazi izimpawu eziphambili ze-lactic acidosis.
Izimbangela ze-Lactic Acidosis
I-Lactic acidosis ivela ngenxa:
- Izifo ezithathelanayo nezifo,
- Ukopha okukhulu,
- Uphuzo oludakayo,
- Ukuqanjwa kwe-myocardial acute,
- Ukulimala kakhulu emzimbeni,
- Ukwehluleka kwangempela
- Isifo sesibindi esingamahlalakhona.
Isici esikhulu esibangela i-lactic acidosis ukuthatha i-biguanides, ngokwesibonelo, iMetformin ivame ukuthathwa. Kulokhu, kubonakale izimpawu ze-lactic acidosis ezigulini ezinesifo sikashukela, zithatha imishanguzo yeqembu elinciphisa ushukela ngaleli zinto ekwakhiweni kwalo.
Uma izinso noma isibindi zithintekile, noma umthamo omncane we-Biguanides ungadala i-lactic acidosis. Lesi simo sidalwa ukuqunjelwa kwezidakamizwa emzimbeni.
I-Lactic acidosis yenzeka nge-skeletal misuli hypoxia. I-Hypoxia ingenzeka, ngokwesibonelo, ngokuzikhandla komzimba okuhlala isikhathi eside. Kuzodinga nokwelashwa.
Uma kungekho khona okusobala kwe-hypoxia, khona-ke imbangela yalesi simo ingaba yi-leukemia nezinye izinqubo eziningana zesisu. Ezinye izizathu zingafaka:
- Ukwehluleka kokuphefumula
- Ukuhlasela kwenhliziyo okukhulu kwamaphaphu,
- Ukuqanjwa kwamaphakathi
- Ukushoda kwe-Thiamine emzimbeni.
Izimpawu ezibalulekile ze-Lactic Acidosis
I-Lactic acidosis, imvamisa, ingena kwifomu elinamandla, cishe amahora ambalwa. Ngokuvamile, izimpawu zingase zingabikho ngokuphelele, kepha kuyadingeka ukwelashwa.
Iziguli ziqaphela ubuhlungu bemisipha nemizwa engathandeki evelayo ngemuva kwe-sternum. I-Lactic acidosis inezimpawu ezilandelayo:
- ukunganaki
- ukuphefumula ngokushesha
- ukuqwasha
- ukozela
Ukuboniswa kokwehluleka kwenhliziyo kuyizimpawu zakudala ze-acidosis enzima. Ukwephulwa okunjalo kuthuntubeza i-contractility, isimilo se-myocardium, ngenkathi i-lactic acidosis ikhula.
Ngemuva kwalokhu, i-lactic acidosis icaphukisa ukuwohloka okuqhubekayo esimweni esivamile, okuthi, ngenxa yokwanda kwe-acidosis, isisu siqale ukulimala, ukugabha kuyabonakala.
Uma isimo sesiguli i-lactic acidosis sanda kakhulu, khona-ke izimpawu zingahluka kakhulu: kusuka ku-areflexia kuya ku-paresis ne-hyperkinesis.
Ngokushesha ngaphambi kokuqala kokhokho, okuhambisana nokuphelelwa ukwazi, isiguli siqala ukuphefumula esinomsindo ngemisindo engasho lutho yokuphefumula. Ukuhogela kwesimilo kwe-acetone akubangeli i-lactic acidosis. Ngokuvamile, lolu hlobo lokuphefumula lwenzeka nge-metabolic acidosis.
Ngokuhamba kwesikhathi, i-lactic acidosis iqala ukuzibonakalisa ngezimpawu zokuwa. Okokuqala, i-oligoanuria ivela, nangemva kwe-anuria. Njengomphumela walokhu, ukuthuthukiswa kwe-DIC kuqala - ukuhlangana kwe-intravascular. Uma lezi zimo zitholakala, udokotela kufanele ngokushesha enze ukwelashwa.
Izimpawu ze-lactic acidosis ukubukeka kwe-intravascular thrombosis ene-hemorrhagic necrosis, izinzwane nezandla.
Naka ukuthi amafomu we-lactic acidosis asheshayo kangakanani, ukwakheka kwenzeka emahoreni ambalwa nje.
Izimpawu zesimo zifaka:
- ulimi olomile
- amagobolondo omile
- isikhumba esomile.
Ukwelashwa nezindlela zokuxilonga ze-lactic acidosis
Ukuxilongwa kwe-lactic acidosis nazo zonke lezi zimpawu ezingenhla kunzima kakhulu ukukuthola. Izimpawu zithathwa njengengxenye yokusiza.
Imininingwane yaselabhorethri inokwethenjwa okwanelisayo okusekelwe ekunqumeni kwe-lactic acid egazini. Ngaphezu kwalokho, izinkomba ezilandelayo zinqunywe:
- ukwehla kwe-bicarbonates yegazi,
- degree ye-hyperglycemia elinganiselayo,
- ukuntuleka kwe-acetonuria.
Lapho ucubungula izimpawu ze-lactic acidosis kanye nesimo uqobo, kubalulekile, okokuqala, ukuthola izinkomba zokuqedwa ngokushesha kwe-hypoxia.
Ngezimpawu zesimo kanye ne-lactic acidosis uqobo, ukunakekelwa okuphuthumayo kubandakanya ukuphathwa kwe-intravenous kwesisombululo se-sodium bicarbonate (4% noma 2,5%) kuze kufinyelele kumalitha ama-2 ngosuku.
I-Metformin ithathwa njengesifo sikashukela, yehlisa i-hyperglycemia, kepha ayithuthukisi i-hypoglycemia. Ngokungafani nokususelwa kwe-sulfonylurea, okubandakanya izidakamizwa ze-sulfa, iMetformin ayikukhiqizi ukukhiqizwa kwe-insulin.
Uma kwenzeka kweqisa ngokweqile ngeMetformin kushukela, i-lactic acidosis ingaqhamuka nokusongela komphumela obulalayo. Isizathu ukugcotshwa komuthi ngenxa yokulimala kwe-renal function.
Uma kuvela izimpawu ze-lactic acidosis, kungcono ukuthi uyeke ukusebenzisa iMetformin. Isiguli kudingeka siphuthunyiswe esibhedlela. I-Metformin iqeda kahle i-hemodialysis ezimeni zezokwelapha. Ngaphezu kwalokho, ukwelashwa okubonakalayo kwenziwa.
I-Hypoglycemia ingakhula uma iMetformin ithathwa nge-sulfonylureas.
Kubalulekile ukuqapha amanani we-pH kanye namazinga e-potassium egazi.
Ngaphezu kwalokho, nge-lactic acidosis nezimpawu, ukwelashwa kwe-insulin kwesimo esisebenzayo sokwenza izakhi zofuzo noma ukwelashwa okukodwa okune-insulin esetshenziswa njengendlela yokwelapha.
Ekwelashweni kwezimpawu kanye ne-lactic acidosis, ama-carboxylases nawo angalawulwa ngokufakelwa indlela ye-Drip ngokwethulwa kwama-200 mg ngosuku.
Ukwelashwa kuqukethe ukuphathwa okuphathelene ne-plasma yegazi kanye nenani elincane le-heparin, okunomthelela kulungiswa kwe-heestasis.
Ukuvimbela I-Coma
Ukuze uvikele i-lactacidemic coma ngenxa ye-lactic acidosis, kuyadingeka ukuvimbela i-hypoxia futhi kulawule ukulawulwa kwesifo sikashukela.
I-Lactic acidosis, izimpawu zayo ingavela lapho kusetshenziswa i-biguanides, kudinga ukuzimisela kwemithamo yazo ngokuhoxa okusheshayo uma kwenzeka izifo ezithathanayo, ngokwesibonelo, inyumoniya.
I-Lactic acidosis inezimpawu ngokubonakala kwezinqubo zokuphindaphindeka, ngakho-ke, abanesifo sikashukela ngokusetshenziswa kwama-biguanides kufanele bakubheke lokhu lapho benza ukwelashwa.
Uma kukhona izinsolo ezibonisa ukusikisela kwe-lactic acidosis, kufanele uthinte isazi se-endocrinologist ngokushesha.
