ʻO ka mālama pilikia no ka ketoacidosis maʻi maʻi i nā keiki a me nā ʻōpio

E.N.Sibileva
Ka Luna o ka Keʻena ʻĀina ʻO Pediatrics, FPK o ke Kulanui Kauka ʻĀkau o Haukapila, Kaukaʻi ʻĀina, Luna ʻĀina ʻOihana Endocrinologist, Keʻena ʻOihana olakino, ʻAlama o ka Hoʻonaʻo Arkhangelsk

ʻO ka ketoacidosis Diabetic ka mea iʻoi loa ka nani a hoʻomohala hou i ka hoʻopiʻi o ka maʻi maʻi. Hōʻike kēia ʻano i ka hui pū ʻana o ka hema o ka insulin i ʻole a me ka hema, ʻo kahi hope ma muli o ka hoʻonui ʻia ʻana o ke kino o ka nui a me nā mea āpau pūlima insulin.

Hōʻike ʻia ʻo Ketoacidosis e:
▪ kiʻekiʻe ma ka hyperglycemia me ka osmotic diuresis me acetonuria,
▪ ka make ʻana o ka wai o ka koko ma muli o ka protein catabolism,
▪ ka haʻalele ʻana o nā bicarbonates, ka hoʻopili ʻana i nā loli i ke kūlana acid-base i ke ala o ka hopena metabolic acid.

ʻO ka ulu ʻana o nā maʻi metabola koʻikoʻi me ka hemahema o ka insulin uncoordinated e alakaʻi i ka hypovolemia, kahi hōʻailona hōʻemi o nā kalepona potassium i loko o nā ʻili, a me ka hōʻuluʻulu ʻana o ka waika β-hydroxybutyric i loko o ka pūnaehana o ka pūnaehana. A ke hopena, e hōʻike ʻia nā hōʻailona haumania e ka maʻi hemodynamic kino, ka maʻi maʻamau o ka renal prerenal, he manaʻo hoʻonaninani a me ka maʻi hemostasis.

I nā hihia liʻiliʻi, i nā keiki he:
1. Hyperosmolar coma:
▪ kiʻekiʻe loa hyperglycemia
▪ hoʻomau ʻia ka sodium i ke kino
▪ haʻi ʻia ka huhū
▪ ketosis ʻaʻano
2. Lactatecedemic coma - kahi maikaʻi loa o ka piko ma nā keiki, maʻamau ma kona hoʻomohala ʻana he maʻi hypoxia kino kūleʻa me ka hōʻiliʻili o ka lactate i loko o ke koko.

Hana ʻia ka maʻi ketoacidosis maʻi

1. Ka hoʻoponopono ʻana i nā hemahema o ka insulin
2. Hoʻolā
3. ʻO ka weheʻana o ka hypokalemia
4. Hoʻomau i ka acidosis

Ma mua o ka lawe ʻana i ka lapaʻau, uhi ʻia ka mea maʻi me nā ʻaina wela, kahi hāleʻa nasogastric, kahi wahi mālama i ka ʻāpana i loko o ka ʻōpū.

Ke hoʻoponopono ʻana i ka mahu o ka insulin

Hoʻohana ʻia ka hana pōkole hana pōkole. ʻOi aku ka maikaʻi o ka lawelawe ʻana i ka insulin ma o ka lineamate i loko o kahi hoʻonā albumin 10%; inā ʻaʻohe lineomat, ua hoʻonoho ʻia ka insulin i kēlā me kēia hola. ʻO ka ʻōlelo mua o ka insulin o ka 0.2 U / kg, a ma hope o hoʻokahi hola 0.1 U / kg / hola. Me ka hoʻohaʻahaʻa ʻana i ke kōpaʻa koko i 14-16 mmol / l, ua emi ka nui o ka insulin i ka 0,05 U / kg / hola. Me ka hoʻohaʻahaʻa ʻana i ke kōpaʻa koko i 11 mmol / L, e hoʻololi mākou i ka hoʻokele subcutaneous o ka insulin i kēlā me 6 hola.

ʻO ka pono o ka insulin i ka wā i hoʻopuka ʻia ai mai kahi coma he 1-2 mau pūʻulu / kg / lā.
Hoʻolohe ʻAʻoleʻoi aku ka kiʻekiʻe o ka emi ʻana o ke koko i ka 5 mmol / hola! Inā ʻaʻole, hiki i ka hoʻolālāʻana o ka serema cerema.

Hoʻolaulau

Hoʻopili ʻia ka waiʻai e like me ka makahiki:
▪ i nā keiki o nā makahiki 3 mua o ke ola - 150-200 ml / kg kaumaha / lā, e pili ana i ka pae o ka dehydration,
▪ ma nā keiki kahiko - 3-4 l / m2 / lā
Ma nā minuke 30 mua o ka hoʻomaka o ka 1/10 mau lā o ka helu. I nā hola 6, ʻo 1/3 o ka nui o ka maʻi i kēlā me kēia lā, i nā hola 6 e hiki mai nei - ¼ ka lā o kēlā me kēia lā, a laila pōkole.
He mea kūpono ia e hoʻoiho i kahi wai me kahi infusomat, inā ʻaʻole ma laila, e nānā pono i ka helu o nā hāʻule i kēlā me kēia minuke. Hoʻohana ʻia kahi 0.9% sodium chloride e like me ka hoʻomaka ʻana. Pono e lawelawe ʻia ʻo saline ma mua o 2 mau hola. A laila pono e hoʻololi i kahi kūleʻa glucose 10% e hui pū me ka hoʻonā a Ringer i kahi māhele o 1: 1. Hoʻopaʻa ʻia nā wai āpau i hoʻokomo ʻia i loko o kahi mahana o 37 ° C. Inā hemo loa ke keiki, hoʻohana mākou i kahi ʻōnaehana albumin 10% ma mua o ka hoʻomaka ʻana i ka hoʻokele ʻana o nā crystalloids ma ka nui o ka paona 5 ml / kg, akā ʻaʻole iʻoi aku ma mua o 100 ml. colloids iʻoi aku ka maikaʻi i ke kahe wai.

Ke hoʻoponopono paʻakai

Pono e hoʻomanaʻo ʻia ʻo ka lawa ʻole o ka hoʻoponopono ʻana o ka pāhana e hōʻemi ana i ka hopena o ka mālama ʻana! I ka hoʻomaka ʻana o ka urine e hoʻokaʻawale ma o ka catheter (ʻo iaʻo 3-4 mau hola mai ka hoʻomaka ʻana o ka lāʻau), pono ia e hoʻomau me ka hoʻoponopono ʻana o ka pāhare pālolo. Hoʻomaopopo ka paʻakai pākōlehu 7.5% ma ka hopena o 2-3 ml / kg / lā. Hoʻohui ʻia ia i ka wai i hoʻopaʻa ʻia ma ka palena o 2-2,5 ml o ka pāhare pāloli ma 100 ml o ka wai.

Hoʻoponopono Acidosis

I mea e hoʻoponopono pono ai i ka acidosis, hoʻohana ʻia kahi ʻano hōʻuluʻulu hou o 4% pākaʻaila o 4 ml / kg. Inā hiki ke hoʻoholo ʻia ka BE, a laila, ʻo ka nui o ka hopena o ka bicarbonate he 0.3-BE x ka nui o ke keiki i ka kg.
Hoʻopau ʻia ka hana Acidosis ma nā hola 3-4 o ka lapaʻau, ʻaʻole ma mua, no ka mea Hoʻololi maikaʻi ka maʻi insulin me ka rehydration pololei i ka ketoacidosis.
ʻO ke kumu no ka hoʻopuka hou ʻana i ka soda:
▪ hoʻomau i ka adynamia
▪ hōʻea o ka ʻili
▪ nui hanu nui

I ka mālamaʻana i ka waikikika ma ke ʻano maʻi, kōkana ʻia nā pupu liʻiliʻi heparin 100 huahelu / kg / lā ma 4 injections. Inā hele mai ke keiki me kahi mahana, ua ʻōkuhi koke ʻia kahi antibiotic ākea ākea.
Inā hele mai ke keiki me nā hōʻailona mua o ka ketoacidosis (DKA I), i.e. ʻoiai ke ʻano o ka metabolic acidosis, hōʻike ʻia e nā hoʻopiʻi dyspeptic (nausea, luaʻi), ʻeha, ka hanu hohonu, akā, mālama ʻia ka manaʻo, pono ia:

1. E holoi i ka ʻōpū me ka hopena o ka 2% soda.
2. E kau i kahi hoʻomaʻemaʻe a laila hoʻomau ka lāʻau lapaʻau me ka hopena mahana o ka 2% soda ma kahi kikoʻī o 150-200 ml.
3. E mālama i ka hoʻoulu ʻia o ka infusion therapy, ka mea e loaʻa ai i ka hopena o ka albumin, ka hopena physiological, inā ʻaʻole iʻoi aku ka pae o ka glucose ma mua o 14-16 mmol / l, a laila ua hoʻonā ʻia nā mea hoʻonā o 10% a me Ringer i ka pae o ka 1: 1 ka hoʻohana ʻia. ʻO ka maʻi infusion i kēia hihia ka mea maʻamau ke koho ʻia no nā hola 2-3 e pili ana i nā koi o kēlā me kēia lā, no ka mea ma hope aʻe, hiki iā ʻoe ke hoʻololi i ka rehydration waha.
4. Hoʻololi ʻia ka maʻi insulin i ka palena o 0.1 U / kg / h, i ka pae ʻana o ka glucose i ka 14-16 mmol / L, ua loaʻa ka maʻa i ka 0,05 U / kg / h a ma kahi pae glucose o 11 mmol / L e huli mākou i ka lawelawe ʻākala.

ʻO nā papa hana o ke alakaʻi ʻana i kahi keiki ma hope o ka hoʻopaʻa ʻana i ka ketoacidosis

1. No 3 mau lā - meaʻai No. 5 me ka momona ʻole, a laila 9 papa.
2. ʻO ka inu wai momona, me ka hoʻohanaʻole i ka alkaline solution (wai wai, he hopena o 2% soda), nā wai ʻona e ʻoni ana ka ʻulaʻula ʻulaʻula, no ka mea loaʻa iā lākou kahi nui o ka pāma.
3. Ma o ka waha, he 4% ʻōlelo pākeke pākahi, 1 makana.-1 papa. Kani 4 mau manawa i kahi lā no 7-10 lā, no ka mea ʻoi aku ka lōʻihi o ka hoʻoponopono ʻana o ka hypokalisthia.

4. Ua ʻōlelo ʻia ʻo Insulin ma ka 5 injections ma ke ʻano aʻe o ke ʻano i ka hora 6 a.m. ʻO ka maʻa mua loa he 1-2 mau ʻāpana, ʻo nā hopena hope loa he 2-6 mau ʻāpana, i ka hapa mua o ka lā - 2/3 o ka laʻana o kēlā me kēia lā. Hoʻohālikelike ʻia ka nui o kēlā me kēia lā me ka pau ʻana no ka ketoacidosis, ka maʻamau maʻamau 1 U / kg paona kino. Hoʻopau ʻia kēlā ʻano insulin i mau lā no 2-3, a laila neʻe ke keiki i ka therapy bolus kumu.

Hoʻomaopopo Inā he keiki kahi e hoʻomohala nei i ka ketoacidosis i ke kiʻekiʻe, ua hoʻonoho ʻia nā antibiotics ākea ākea. I ka pilina me nā maʻi hemostasis i hoʻomohala ʻia e ka hypovolemia i hoʻomohala a me ka metabolic acidosis, ua hōʻike ʻia ka heparin i loko o kēlā me kēia lā o 100 U / kg o ke kaumaha o ke kino no ka pale ʻana i ka hoʻolaha ʻana i ka vag coagulation syndrome. Hoʻokahele ʻia ka lāʻau ma luna o ka 4 injections, mālama ʻia ka lāʻau lapaʻau ma lalo o ka mana o kahi coagulogram.