Hyperosmolar coma: mea, lalau mai, symptoms,ʻike, lapaʻau

Hyperosmolar coma ua loa olelo diagnosed i loko o nā mea maʻi mua o ka 50 makahiki i hana eha iaʻi mai mimikō no mehana i ka lōpū loa, ua hikiwawe compensated no ka kūikawāʻai a me ka lapaʻauʻia. E hoʻomōhala ana i ke alo o ke kāʻei kua degridratatsii meaola kūpono diuretics, vascular maʻi o ka lolo a me ka hakuʻala. Make nei mai hyperosmolar coma kīnā 30% pae.

kumu

Hyperosmolar coma, ke kumu o ka a i pili i ka pae o ka monakō koko, mea he complication o mimikō a me ka mea i ka hopena o kaʻoi ala i loko o ke koko kōpaʻa (oi ma mua o 55,5 mmol / L) hui me ka hyperosmotic a me ka nele o ka acetone i loko o ke koko.

Nā kumu no kēia kŰia mea:

• oi dehydration kūpono ma ka ikaika ka luaʻi, diarrhea,'ā a ma hooloihi ae i lapaʻau ma ka hoʻohana 'ana o diuretic lāʻau;
• lawa pahaʻaʻohe insulina, nā endogenous a me exogenous (i ke kumu no keia kŰia i ia i ka nele o ka insulina a me ka hewa lapaʻau regimen);
• hoomahuahua ae la lakou koi no ka insulina, i hiki ke hana me ka hopena o ka 'aʻe' loa o kaʻai, i ka hoike o ke kiaʻana i kāna hoʻomākaukau o monakō koko, i ka ulu ana o ka infectious maʻi (oi pneumonia a me infectious lesions o ka urinary'āpana), i kēiaʻoki kino, poino, ka lapaʻauʻia, i loaʻa ai ka waiwai o ka hakaka o ka insulina ( i ka pau hormones a me glyukokorstikoidov hoomakaukau).

pathogenesis

Eia naʻe, uaʻaʻole maopopo maopopo keʻano papa hana o ka? Acaeoey o ka maʻi moku'āina. Ua Ua manaoio aku i ka ulu ana o keia complication e loli ai blockade monakō koko kala ma nā puʻupaʻa, a me ka mahuahua haawi ana o ka waiwai i loko o ke kino a me kona? Iecaianoaaiiuo ma ke akepaʻa. A pau keia auoiaea ua uhi pū ma ka insulina, e like me ka paleʻana i ka ka hanaʻana o ka monakō koko ma kaʻike ākea nā'aʻaʻa. Keia ua pau hui me ka dehydration.

Eia hou, ka mea, ua manaoio aku i ke alo o ke kanaka endogenous (i hanaʻia i loko o ke kino) insulina inhibits keʻano o ka hanaʻana e like me lipolysis (hālāwai hope o ka momona,) a me ka ketogenesis (i ke kahua o ka germ aeee). Naʻe, i kēia insulina mea e lawa ke uhi i ka nui o ka monakō koko i ua hua mai ma ke akepaʻa. He nolaila, e pono ai aaieieno? O exogenous insulina.

Inā kokololio lilo o ka loli ma ka nui dala emi ka bcc (koko ka leo), a hiki aku i ka hanaʻia naʻe o ke koko a me ka hoomahuahua i ka osmolarity. Kēia hana ia mea ku pono i ka hua i loko o ka lehulehu o ka monakō koko, potasiuma a me ka paʻakai Ion.

symptoms

Hyperosmolar coma e hoʻomōhala ana i, na symptoms o ka iʻikeʻia ma mua no kekahi mau lā a me ka pule. Ma keia hihia, ke hoʻomanawanui ulu na hoailona i mea ano o decompensated mimikō (koko kō pae hiki ole e like ai '):

• polyuria (hoʻonuiʻia mimi ho okumu);
• mahuahua makewai;
• mahuahua dryness o kaʻili, mucous membranes;
• koke kaumaha poho;
• a eia i ka nawaliwali;
• He He pono no o ka dehydration deteriorating ola: hoemi i ka leo o kaʻili,'ōnohi a poʻopoʻo ka, ke koko, a me ka wela.

neurological symptoms

Eia hou kekahi, symptoms i e malama ia ma ka'emi'ōnaehana:

• hallucinations;
• hemiparesis (i mea hoʻonāwaliwali maoli o ka naau mai ka neʻe 'ana);
• olelo kāna hana, ka mea, ua kau i slurred;
• koʻikoʻi ke kāʻili 'ana;
• areflexia (reflexes wa e kaawale aku o kekahi a oi) ole giperlefksiya (hoonui reflexes);
• Muscle ke kanana nei;
• hoʻopōʻino ike paka i.

Symptoms hou i kekahi mau lā ma mua ia e hoʻomaka i ka hoʻomōhala hyperosmolar coma i loko o nā keiki a me nā mākua.

hiki complications

I Ina o untimely kōkua i hoʻomōhala complications. Common mau:

• kāʻili 'ana, a hiki e ukali ma ka twitching lihilihi, maka (mau symptoms paha eʻike makaʻole i' ē aʻe);
• hohonu aa koko thrombosis;
• pancreatitis (li nui o ka pancreas);
• ʻaʻa puʻuwai insufficiency.

Loli no hoi ana i loko o ka gastrointestinal'āpana, i ikea ka luaʻi, bloating, abdominalʻeha, intestinal motility kāna hana (i kekahi manawa, he mea intestinal iaʻi), akā, ka mea, i eʻaneʻane unnoticeable.

Nō hoʻi, ma laila nō vestibular kāna hana.

lapaʻau '

Inā e manao i kaʻike, o hyperosmolar coma,ʻike, ua nānā 'ana i keʻena hoʻokolohua ho'āʻo ma. Ma 'ana, i ka hoʻokolokolo' hōʻike kiʻekiʻe koko monakō koko pae a me ka osmolarity. Eia hou, hiki ke kiekie pae o ka paʻakai, kiʻekiʻe maʻiʻo o ka huina lāʻau lapaʻau kumuʻiʻo a me koena naikokene. e mahuahua urea pae hiki no hoi. Ma ka hoʻokolokolo 'ana o ka mimi ketone kino (acetone, acetoaceticʻakika a me ka betaoksimaslyanaya) ia i kona manao.

Eia hou, aole mea i ala o ka acetone ma ka lewa exhaled ma ke ahonui a me ka ketoacidosis (mai ka pioloke o ka carbohydrate pūnao) i hai giperoglikemiey a me ke koko osmolarity. Ke hoomanawanui i keia neurological symptoms, e like me'āno'ē Babinski (Jog mailaila aku reflex), mahuahua Muscle leo,ʻeluaʻaoʻao nystagmus (involuntary oscillatory ana o na maka).

kū mai i waena o ka mea 'ē aʻe ana:

• Ultrasound a X-Ray ka ninaninau ana i na pancreas;
• electrocardiography;
• hoomaopopo ana i ka nui o ka monakō koko i loko o ke koko.

O kekahi ano nui ia hoʻi ka palena pauʻike. O ke kumu ho i ka mea i gipersmolyarnaya coma i ia i ka hopena i wale mimikō akā, no hoi , a hepaticʻaʻa puʻuwai insufficiency kumuhana e loaa ana thiazide diuretics.

lapaʻau

Inā diagnosed hyperosmolar coma, pilikia mālama mea e hoʻopau degidrotatsii, hypovolemia, a hoʻihoʻi hou wai koko osmolarity.

E hakakā hydration meaola i hoʻohana hypotonic pāʻoihana o ka paʻakai koloriside. Manaʻo kōkua mai ka 6 a hiki i 10 nā lika no ka lā. Inā he mea pono nui o ka pāʻoihana, piʻi pū. I loko o nā hola ma hope o ka hoouka kaua ana o ka pathological hoi kekahi koi 'ia e hoʻolauna 2 nā lika o ka paʻakai koloriside pāʻoihana i.v., ukali ma ka hoike ana o droplets hele i ka uku o ka 1 L / h. Ke ana ia mai ai i normalization osmolarity a me ke koko, i loko o ka venous ipu. A hoailona o ka dehydration mea, e hoʻopau i ke ano o ka hoʻomanawanui ka ike paka i.

Inā diagnosed hyperosmolar coma, lapaʻau pono i ka ho'ēmiʻana giperoglikemii. No keia mea, intramuscularly a intravenously lawelawe insulina. Ua Ua koi 'ia e lawe mai ke kanana' mana o ke koko kō lehulehu. Ka mahele lāʻau mua o 50 iniha, kapuaʻi, a ua maheleia i ka hapalua, a hoʻolauna i loko o ke kino i loko o naʻano likeʻole. Ma ka hihia o ka hypotension hooponopono iaoia wale intravenously. Eia insulina i lawelawe i loko o ka mea nui o drip intravenous a me intramuscular. Mau ana i lawe mai a hiki i ka nui o ka monakō koko 14 mmol / ho'āo ai.

Noaia o ka hooponopono ana o insulina i e kekahi mau:

• 20 Iu intramuscularly hookahi wale;
• 5-8 U kela 60 minuke.

I ka hanana i ke kō kaʻilikai i hāʻule i 13,88 mmol / l, hypotonic pāʻoihana o ka paʻakai koloriside pono e puku i ka monakō koko pāʻoihana.

Ma lapaʻau hyperosmolar coma pono a eia i ka mālamaʻana o ke koko potasiuma, mai ana no ka pathological hoi pono ka lawelawe ana potasiuma koloriside.

I mea e pale aku nani o ka lolo, e like me ka hopena o ka hypoxia i loko o nā mea maʻi intravenously injected pāʻoihana o glutamicʻakika i loko o ka nui o ka 50 ml. I loaa heparin koi, no ka mea, i ke kamepiula a thrombosis, piʻi pū dramatically. Kēia pono o ka mana o ke koko clotting.

E like me ka rula, hyperosmolar coma e hoʻomōhala ana i loko o nā mea maʻi me ka mehana a lōpū kahua o ka mimikō, no laila, ua hiki maluhia e olelo aku i ke kino perceives ka insulina luawai. No laila, ka mea, ua? Aeiiaiaoaony e inject nā māhele liʻiliʻi o ka lāʻau.

Profilatika complications

Ma ka Kāohiʻana o nā pono ai, a me ka mea'ōnaehana mānowai koko nenoaia,ʻo ia, i ka Kāohiʻana o ka mea'ōnaehana mānowai koko maʻi. Me keia mea he "Kordiamin", "Strofantin", "Korglikon". Ma lalo o hoemiia puʻe i mea ma ka ikaika pae, ka mea, ua paipaiʻia hooponopono Dox pāʻoihana, a me intravenous wai koko gemodeza, kanaka albumin a pau i ke koko.

Ia ma luna o ka Lookout ...

Inā 'oe i kaʻike, o ka mimikō pono mau kekahi, nana i ka endocrinologist, a, e hooko i kona koi, i ka nui, e kū i ke koko kōpaʻa. Ua makemakeʻaloʻana i ka complications o ka maʻi.