Yonke imisuka yezinto eziphilayo yomzimba womuntu inezinga elithile le-pH. Isibonelo, ukusabela kwesisu kungama-acidic (pH 1.5-2), negazi lincane i-alkali (isilinganiso pH 7.3-7.4). Ukuzigcina lezi zibalo zisezingeni elifanele kubalulekile empilweni yomuntu ejwayelekile. Konke ukusabela kwezinto eziphilayo okuhlala kwenzeka emzimbeni kuthinta kakhulu ukuphazamiseka kubalo lwe-acid-base.
Izimbangela zokwenzeka
I-ketoacidosis ingadala lezo zinto:
- inani elingafanele le-insulin lokwelapha isifo sikashukela sohlobo 1;
- ukuphambuka kwimodi ejwayelekile yomjovo (ukweqa, ukuchitha isikhathi);
- ukusetshenziswa kwezidakamizwa eziphelelwe yisikhathi eziye zaphelelwa umsebenzi;
- ukufaka esikhundleni sokwelashwa kwe-insulin “nezindlela” eziyingozi nezinye izindlela zokwelapha;
- uhlobo 1 lwesifo sikashukela esingaziwa, umuntu ayengazi ngalo, futhi ngenxa yalokho alwenzanga ukuntuleka kwe-insulin egazini.
I-Ketoacidosis nayo ingakhula nesifo sikashukela sohlobo 2. Lokhu kwenzeka uma kwenzeka isikhathi eside lesi sifo, ngenxa yokuthi ukukhiqizwa kwe-insulin yaso kuphazamiseka, futhi kwesinye isikhathi kuvalwe ngokuphelele. Ngaphezu kwalokho, kunezici ezingaqondile zomzimba lapho buthaka khona futhi ngenxa yalokho kungenzeka ukuthi ukhulise i-ketoacidosis yesifo sikashukela:
- isimo ngemuva kwezifo ezithathelanayo, zokuphefumula nezamagciwane, ukulimala;
- isikhathi se-postoperative (ikakhulukazi esimweni sokuhlinzwa kwe-pancreatic, noma ngabe umuntu akazange abe nesifo sikashukela ngaphambili);
- ukusetshenziswa kwezidakamizwa eziphikiswa kwabanesifo sikashukela, esenza buthaka isenzo se-insulin (lokhu kufaka phakathi i-hormonal ne-diuretics);
- ukukhulelwa nokuncelisa ibele.
I-insulin kufanele igcinwe ngaphansi kwalezo zimo ezinikezwe imiyalo, ngoba kunzima ukubikezela umphumela wayo emzimbeni lapho kuphakanyiswa umuthi ongcolile
Izimpawu
I-ketoacidosis ku-mellitus yesifo sikashukela, yize kuyisimo esiphuthumayo, kepha ihlala ikhula kancane kancane, ngokwanda kwezimpawu. Ngakho-ke, ngemizwa yokungabaza emzimbeni, kungcono ukuphinda ulinganise ushukela nge-glucometer futhi wenze ukuhlolwa kwe-acetone emchameni ekhaya.
Izimpawu zokuqala ze-ketoacidosis zifaka:
- isifiso sokuphuza njalo; umlomo owomile;
- ukuchama njalo;
- ikhanda
- Isiyezi
- ubuqili.
Ukwazi komuntu ngalesi sigaba kusagcinwa. Angacabanga acabangele futhi ahlole isimo, yize izinga le-glucose esegazini selivele liphakanyisiwe, kanti nemizimba ye-ketone iyatholakala emchameni, okuvame ukuthi ungabi lapho.
Ngaphezu kwalokho, impilo yomuntu iya ngokuya ikhula kancane, bese kuba nesimo esihle. Izimpawu zalesi sigaba se-ketoacidosis yesifo sikashukela:
- ukuphefumula okunomsindo;
- iphunga le-acetone elivela kumuntu elizwakala lide kude;
- i-stupor (isimo umuntu angaphenduli ngaso ezintweni ezicasulayo, akakwazi ukukhuluma nokucabanga kahle, kepha ngasikhathi sinye, azikho izinto eziphazamisayo);
- ukukhuphuka kwenhliziyo;
- isikhumba esomile nolwelwesi lwe-mucous;
- ukwehlisa umfutho wegazi;
- ukugabha (imvamisa ngenhlanganisela yegazi elimnyama lama-venous).
Ngesikhathi sokuhlolwa kwesiguli, udokotela angabona izimpawu “zesisu esibuhlungu”: izinhlungu, ukungezwani kwemisipha esiswini kanye nezimpawu zokubonisa inqubo yokuvuvukala ye-peritoneum. Ngakho-ke, i-ketoacidosis kwesinye isikhathi ingadideka ne-pathologies yokuhlinzwa yohlelo lokugaya ukudla. Uma kungekho ukwelashwa okwanele, isigaba se-sopor singaba nomphumela oyingozi kakhulu we-ketoacidosis - coma.
Ezinye izinkomba ze-ketoacidosis nazo zitholakala kwezinye izifo, ngakho-ke kudingeka ukuthi zihlukaniswe ngokuhamba kwesikhathi notshwala nobuthi bezidakamizwa, izinqubo ezithathelwanayo kanye ne-syncope "elambile"
Coma
Ushukela wegazi ku-coma ungafinyelela ku-20-30 mmol / L. Kulokhu, i-acetone ihlala itholwa emchameni. I-Coma ene-ketoacidosis ibonakaliswa yizimpawu ezilandelayo:
- ukulahleka kwengqondo;
- ukuvimbela kwezimpawu eziningi ezibalulekile;
- ukwehla okukhulu kwengcindezi;
- ishayela elibuthakathaka;
- ukuphefumula okujulile nokunomsindo;
- ukuntuleka kokuphendula kokuncipha komfundi ukukhanya;
- iphunga elibukhali le-acetone kulo lonke igumbi lapho kukhona khona isiguli;
- ukwehla okukhulu kokuchama (noma ukungabikho kwayo ngokuphelele);
- ukuphefumula okunomsindo nokuphefumula okujulile.
Ukwanda koshukela wegazi nokuba khona kwama-ketones kumchamo kuwuphawu lokuthi isifo sikashukela siphelile, futhi umuntu udinga usizo lodokotela
Usizo lokuqala
Uma isifo sikashukela sinezimpawu zonke ze-ketoacidosis, kufanele ngokushesha ushayele i-ambulensi futhi ungeniswe esibhedlela nodokotela. Ngokushesha lapho lokhu sekwenziwe, kulapho kuvela khona ithuba lokwelashwa okusheshayo noluphumelelayo olunezinkinga ezimbalwa. Ngaphambi kokuba udokotela afike, isiguli singanikwa usizo olunjalo:
- hlinzeka ngokuhlala ezimweni ezolile;
- ukubheka ukuthi ngabe uyazi yini (uma onesifo sikashukela engaphenduli imibuzo, ungazama “ukumshukumisa” ngokuhlikihla izindlebe bese uxhawula amahlombe akhe kancane);
- Ungamshiyi umuntu enganakekelwa;
- hlinzeka isiguli ukufinyelela komoya omusha, susa izingubo kuye ezicindezela isifuba.
I-Ketoacidosis ayikhonjelwa ekwelashweni okuzimele ekhaya. Okuyingozi kakhulu kuleli cala ukusetshenziswa kwalamakhambi esintu. Abasebenzi bezokwelapha kuphela abanganikeza usizo olufanele, ngakho-ke ngaphambi kokufika kweqembu lama-ambulensi, into ebaluleke kakhulu hhayi ukulimaza umuntu. Esikhundleni sokusebenzisa izindlela ezingalungile zokwelapha, kungcono ukulungiselela imibhalo yesiguli bese uqoqa iphakethe lezinto esibhedlela ukuze ungachithi isikhathi esibalulekile kulokhu.
Ukulindela udokotela, akudingekile ukuphoqa isiguli ukuthi siphuze kakhulu, ngoba inani le-fluid lilawulwa ngisho esibhedlela. Lapho ihanjiswa ngaphakathi ngosuku lokuqala, akumele yedlule i-10% yesisindo somzimba womuntu
Izimiso zokwelashwa okungatheni
I-ketoacidosis etholakele kunoma yisiphi isigaba ayikwazi ukwelashwa ekhaya. Lesi yisimo esibuhlungu somzimba lapho umuntu adinga khona usizo lwezokwelashwa futhi nokuhlolwa njalo kwezokwelapha uma kunezimpawu ezandayo. Esibhedlela, izidakamizwa ezilandelayo zivame ukubekelwa isiguli:
- i-insulin yokunciphisa ushukela wegazi;
- i-saline yemvelo yokuqeda ukomisa;
- izidakamizwa ze-alkaline zokuqeda ukushintshwa kwe-pH ohlangothini lwe-acid futhi kubuyiselwe ibhalansi;
- imithi yokuxhasa isibindi;
- izixazululo ze-electrolyte ukunxephezela ukulahleka kwamaminerali nokugcina ukusebenza kwenhliziyo.
Ukuze ungalimazi ubuchopho, izinga likashukela egazini alikwazi ukwehliswa kakhulu. Kusezingeni eliphezulu ukunciphisa lezi zinani ngomfutho ongafika ku-5.5 mmol / ihora (lokhu kungatholakala ngokuphathwa kwe-insulin ngamandla kumayunithi ama-4 ukuya kwayi-2 / ihora)
Ukwelashwa kwe-ketoacidosis ngaphandle kwe-insulin akunakwenzeka, ngoba ukuphela kwomuthi osusa imbangela ye-ketoacidosis. Yonke eminye imishanguzo nayo iyadingeka esigulini, kepha isenzo sabo sihlose ekwelapheni nasekuvikeleni ubunzima obudalwa yilesi simo.
Zonke izidakamizwa ezifakiwe zilotshwe emlandweni wezokwelapha wesiguli. Kunemininingwane eqoshiwe yezimpawu kanye nanoma yiluphi ushintsho esimweni sesiguli. Kumuntu ophethwe yisifo sikashukela esibhedlela, lo umqulu obaluleke kakhulu wezokwelapha oqukethe yonke imininingwane nge-ketoacidosis. Isiguli sithola imininingwane eyisisekelo emlandweni wezokwelapha lapho sikhululwa ukwethulwa ku-endocrinologist emtholampilo lapho uhlala khona.
Izici ze-ketoacidosis ezinganeni
I-ketoacidosis yesifo sikashukela ezinganeni ibonakaliswa yizimpawu ezifanayo nakomuntu osemdala. Lokhu kungenye yezinkinga ezifihlayo nezibucayi kakhulu zesifo sohlobo 1, okungaholela kwimiphumela emibi kumzimba okhulayo. Ngakho-ke, ebuntwaneni, ukubonakala kwe-acetone kumchamo nokugxuma kushukela kuyinkomba eqondile yokunakwa kwezokwelapha ngokushesha.
Izici zokubonakaliswa kwe-ketoacidosis esigabeni sokuqala ezinganeni:
- i-pallor ejwayelekile yesikhumba, kepha kube mnyama ebusweni;
- ukuhlanza njalo
- Ubuhlungu besisu
- ubuthakathaka
- iphunga le-acetone kusuka ekuhlanzeni, ezindlini zomchamo nomchamo.
Uma ingane iba nobulwelwe futhi yomile ngaso sonke isikhathi, kungakuhle ukukala izinga le-glucose egazini lakhe ngokushesha futhi ihlole ukuba khona kwe-acetone emchameni
Kwesinye isikhathi i-acetone kumchamo ivela ngisho nasezinganeni eziphilile ezingaguli nesifo sikashukela. Lokhu kungenxa yokuthi ama-pancreas abo awakakhuli ngokuphelele, futhi kwesinye isikhathi angadala ukungasebenzi kahle okunjalo. Lesi simo sibizwa nge- "acetonemic syndrome." Kungaphansi nangendlela yokwelashwa esibhedlela. Udokotela kuphela ongahlukanisa i-pathology eyodwa kusuka kwenye, futhi kulokhu, ngaphezu kokuhlolwa, ukuhlolwa okuningiliziwe kwengane kuyadingeka.
Ukuvimbela
Ukuvikela i-ketoacidosis, isiguli esinoma yiluphi uhlobo lwesifo sikashukela kufanele siqaphe inhlala-kahle yabo futhi siphathe impilo yabo sina. Kuyelulekwa ukulandela imigomo enjalo:
- jovela ngesikhathi inani elinqunyelwe le-insulin;
- ungalokothi uguqule umthamo onconyelwe umuthi ngokwakho ngaphandle kadokotela;
- gcina ukudla okunengqondo nokudla okunqunyiwe;
- qapha njalo ushukela wegazi;
- ngezikhathi ezithile hlola impilo ye-glucometer kanye namapensela we-insulin;
- funa ukwelashwa uma kunezimpawu ezingabazisayo.
Izinkinga ezinzima ze-ketoacidosis zingaba yi-edema yamakhemikhali, inyumoniya, ukwehluleka kwentliziyo kanye nezinye izimo ezibuhlungu zomzimba. Ukuze uvikele lokhu, kudinga ukukhonjwa nokwelashwa ngesikhathi. Ukuqapha njalo kwesiguli esibhedlela kanye nokufingqwa kwakhe okuningiliziwe ngokuphuma emzimbeni maqondana nezenzo ezengeziwe kuyingxenye ebalulekile yokuvimbela ukuphindaphinda kwe-ketoacidosis.
