Chisamaliro chodzidzimutsa cha ketoacidotic chikomokere chifukwa cha matenda ashuga
| Matenda a shuga ketoacidosis | |
|---|---|
 Kapangidwe ka mankhwala a matupi atatu a ketone: acetone, acetoacetic, ndi beta-hydroxybutyric acid. | |
| ICD-10 | E 10.1 10.1, E 11.1 11.1, E 12.1 12.1, E 13.1 13.1, E 14.1 14.1 |
| ICD-9 | 250.1 250.1 |
| Diseasesdb | 29670 |
| eMedicine | med / 102 |
Matenda a shuga ketoacidosis (ketoacidosis) Kodi chosinthika cha metabolic acidosis chokhudzana ndi kuphwanya kagayidwe kazakudya kaamba ka kuchepa kwa insulin: kuchuluka kwa glucose ndi matupi a ketone m'magazi (kwambiri kuchuluka kwa thupi) komwe kumachitika chifukwa cha kusokonekera kwa kagayidwe kazakudya zamafuta acid (lipolysis) ndikusintha kwa amino acid. Ngati kuphwanya kwa kagayidwe kazakudya sikumayima munthawi yake, matenda a shuga a ketoacidotic amakula.
Kupanda matenda ashuga a ketoacidosis (acetonemic syndrome mwa ana, matenda a cyclic acetonemic kusanza, kusanza kwa acetonemic- - zizindikiro zingapo zoyambitsidwa ndi kuwonjezereka kwa matupi a ketone m'madzi am'magazi - njira yamakhalidwe yomwe imachitika kwambiri mwana, yowonetsedwa ndi magawo obwereza akusintha, kusinthana kwa nthawi yonse yokhala ndi thanzi lathunthu. Amayamba ngati zolakwika zazakudya (kupuma pang'ono ndi njala kapena kumwa kwambiri mafuta), komanso motsutsana ndi maziko a matenda amtundu, opatsirana, endocrine komanso kuwonongeka kwa dongosolo lamanjenje. Pulayimale (idiopathic) imasiyanitsidwa - imapezeka mu 4 ... 6% ya ana azaka 1 mpaka 12 ... zaka 13 ndi sekondale (chifukwa cha matenda) acetonemic syndrome.
Nthawi zambiri, mthupi la munthu, chifukwa cha kagayidwe kakakulu, matupi a ketone amapangidwa nthawi zonse ndikugwiritsidwa ntchito ndi minofu (minofu, impso):
Chifukwa cha kufanana kwamphamvu, kukhazikika kwawo m'madzi a m'magazi nthawi zambiri kumakhala koopsa.
Etiology
Anthu odwala matenda ashuga ketoacidosis amakhala woyamba pakati pamavuto amodzi a endocrine matenda, kufa kumafika 6 ... 10%. Mu ana omwe ali ndi matenda a shuga omwe amadalira insulin, ichi ndi chomwe chimapangitsa kuti anthu azifa. Milandu yonse yamikhalidwe imeneyi ikhoza kugawidwa m'magulu awiri:
- matenda ashuga a ketosis - chikhalidwe chodziwika ndi kuchuluka kwa matupi a ketone m'magazi ndi minyewa popanda mawu oopsa komanso kuperewera kwa madzi m'thupi,
- matenda ashuga ketoacidosis - ngati vuto la insulin siliperekedwako nthawi ndi chithandizo chakunja kapena zomwe zimapangitsa kuchuluka kwa lipolysis ndi ketogeneis sikuchotsedwa, njira ya pathological imapitilira ndikupangitsa kuti chitukuko cha ketoacidosis chidziwike.
Chifukwa chake, kusiyanasiyana kwa pathophysiological mwa zinthu izi kumatsitsidwa ku kuopsa kwa zovuta za metabolic.
Sinthani ya Etiology |
Ketoacidotic chikomokere shuga
Vuto lalikulu kwambiri la shuga ndi ketoacidotic chikomokere. Malinga ndi kuyerekezera kosiyanasiyana, 1-6% ya anthu odwala matenda ashuga amakumana ndi vuto ili. Gawo loyamba, ketoacidosis, imadziwika ndi kusintha kwamphamvu m'thupi. Ngati izi sizikuyimitsidwa pakapita nthawi, chikomokere chimayamba: kusunthika kwakukulu kwa kagayidwe kachakudya kumachitika, kutha kwa chikumbumtima, ntchito zamanjenje, kuphatikiza chapakati, zimasokonekera. Wodwala amafunikira chisamaliro chodzidzimutsa ndi kupita naye kuchipatala msanga. Kukula kwa matendawa kumatengera gawo la chikomokere, nthawi yomwe amakhala osazindikira, komanso mphamvu zolimbitsa thupi.
Malinga ndi ziwerengero, 80-90% ya odwala omwe alowetsedwa kuchipatala ali ndi vuto la ketoacidotic coma akhoza kupulumutsidwa.
Ketoacidotic chikomokere - ndi chiyani?
Mtundu wamtunduwu umanena za matenda a shuga a hyperglycemic. Awa ndi matenda omwe amayamba chifukwa cha hyperglycemia - shuga wambiri. Mtundu wamtunduwu umavuta msanga m'mitundu yonse ya kagayidwe, kusintha kosungunuka kwamadzi ndi ma elekitirodiya m'thupi, ndikuphwanya magazi oyambira a asidi. Kusiyana kwakukulu pakati pa ketoacidotic ndi mitundu ina ya chikomicho kupezeka kwa matupi a ketone m'mwazi ndi mkodzo.
Zowopsa zambiri chifukwa cha kuchepa kwa insulin:
- Mtheradi, ngati mahomoni ake omwe sanapangidwe, ndipo chithandizo chamankhwala sichinachitike,
- wachibale pamene insulin ilipo, koma chifukwa cha kukana insulini sikuzindikirika ndi ma cell.
Nthawi zambiri chikomokere chikukula mofulumiram'masiku ochepa. Nthawi zambiri, ndi iye yemwe ali woyamba chizindikiro cha matenda a shuga 1. Ndi mtundu wodziyimira pawokha wa insulin, zovuta zimatha kudziunjikira pang'onopang'ono, kwa miyezi yambiri. Izi zimachitika ngati wodwala samalabadira chithandizo ndipo akasiya kuyeza glycemia pafupipafupi.
Pathogenesis ndi zomwe zimayambitsa
Mphamvu ya coma's limagwirira ntchito zimakhazikika pamikhalidwe yodabwitsa kwambiri - ziwalo zathupi zimafa ndi njala, pomwe pali kuchuluka kwamphamvu m'magazi, gwero lalikulu lamphamvu.
Chifukwa cha kuchuluka kwa shuga, osmolarity wamagazi amawonjezeka, omwe ndi chiwerengero chonse cha zigawo zonse zosungunuka mkati mwake. Mkulu wake ukadutsa 400mm / kg, impso zimayamba kuchotsa glucose wambiri, kumasefa ndi kuwuchotsa m'thupi. Kuchuluka kwa mkodzo kumawonjezeka kwambiri, kuchuluka kwa madzi amkati ndi ma extracellular kumachepetsedwa chifukwa chodutsa m'matumbo. Kuthetsa madzi kumayamba. Thupi lathu limakhudzana nayo mosiyanasiyana: imaletsa kuphipha kwa mkodzo kuti madzi asungunuke. Kuchuluka kwa magazi kumachepa, mamasukidwe ake amakula, ndikuyamba yogwira magazi.
Komabe, maselo anjala akuwonjezera vutoli. Kuti athe kulipira mphamvu, chiwindi chimaponyera glycogen m'magazi okoma kale. Pambuyo pakuchepa kwa malo ake, mafuta makutidwe ndi okosijeni amayamba. Zimachitika ndikupanga ma ketones: acetoacetate, acetone ndi beta-hydroxybutyrate. Mwachilengedwe, ma ketoni amagwiritsidwa ntchito mu minofu ndikuchotsa mkodzo, koma ngati alipo ochuluka kwambiri, insulini sikokwanira, ndipo kukodza kumaleka chifukwa cha madzi am'mimba, amayamba kudziunjikira m'thupi.
Mavuto owonjezereka a matupi a ketone (ketoacidosis):
- Ma ketones amakhala ndi poizoni, motero wodwalayo amayamba kusanza, kupweteka kwam'mimba, zizindikilo zakukhudzana ndi gawo lamanjenje lamkati: choyamba, chisangalalo, kenako kukhumudwa.
- Ndi acids ofooka, motero, kudzikundikira kwa ma ketones m'mwazi kumapangitsa kuti ma hydrogen ayoni ambiri azikhala ndi kuchepa kwa sodium bicarbonate. Zotsatira zake, pH yamwazi imatsika kuchoka pa 7.4 mpaka 7-7.2. Acidosis imayamba, yodzala ndi zopinga za mtima, zamanjenje komanso zam'mimba.
Chifukwa chake, kuchepa kwa insulin m'matenda a shuga kumayambitsa hyperosmolarity, kusintha kwa acid-base usawa, kuchepa mphamvu kwa thupi, komanso kupha thupi. Kuphatikizika kwa zovuta izi kumabweretsa kukula kwa chikomokere.
Zomwe zimayambitsa kukomoka:
- kusowa koyamba kwa matenda a shuga 1,
- kudziletsa kwakang'ono kwa shuga mu mtundu uliwonse wa matenda ashuga,
- Njira yolakwika ya insulini: zolakwika pakuwerengera, kupunduka, jakisoni, kulembera kapena kulembera, kuchotseredwa insulin, kusungidwa bwino.
- kuchuluka kwa chakudya chamafuta kwambiri omwe ali ndi GI yayikulu - phunzirani magome apadera.
- Kuperewera kwa insulini chifukwa cha kuchuluka kwa mahomoni a antagonist, omwe amatha kutheka kwambiri, kuvulala kwambiri, kupsinjika, matenda a endocrine,
- chithandizo cha nthawi yayitali ndi steroids kapena antipsychotic.
Zizindikiro za ketoacidotic chikomokere
Ketoacidosis imayamba ndi kuwonongeka kwa matenda a shuga - kutuluka kwa shuga m'magazi. Zizindikiro zoyambirira zimaphatikizidwa ndi hyperglycemia: ludzu ndi kuchuluka kwamkodzo.
Kuchepetsa mphuno ndi ulesi kumawonetsa kuchuluka kwa ketone. Ketoacidosis imatha kuzindikira pakadali pano pogwiritsa ntchito zingwe zoyeserera. Pamene mulingo wa acetone ukukwera, ululu wam'mimba umayamba, nthawi zambiri ndi chizindikiro cha Shchetkin-Blumberg: kumverera kumawonjezeka pamene dokotala akukanikiza pamimba ndikuchotsa dzanja lake mwadzidzidzi. Ngati palibe chidziwitso chokhudza wodwala m'magazi, ndipo kuchuluka kwa ma ketones ndi glucose sikunayesedwe, kupweteka kotereku kungakhale kolakwika kwa appendicitis, peritonitis, ndi njira zina zotupa mu peritoneum.
Chizindikiro china cha ketoacidosis ndicho kukhumudwitsa kwa kupuma ndipo, chifukwa chake, mawonekedwe a kupuma kwa Kussmaul. Choyamba, wodwalayo amalowetsa mpweya pafupipafupi komanso mopitilira muyeso, kenako kupuma kumakhala kosowa komanso kaphokoso, ndi fungo la acetone. Asanayambike kukonzekera kwa insulin, chinali chizindikiro ichi chomwe chimawonetsa kuti ketoacidotic chikomachi chimayamba pafupi kufa.
Zizindikiro zakutha kwamadzi ndikhungu louma komanso ma mucous membrane, kusowa kwa malovu ndi misozi. Togor ya khungu imacheperanso, ngati mungayitsinitse ndikutupa, ichira pang'onopang'ono kuposa masiku onse. Chifukwa cha kutayika kwa madzi ndi ma kilogalamu angapo, thupi la odwala matenda ashuga limachepa.
Chifukwa cha kuchepa kwa magazi, kutsika kwa orthostatic kumatha kuchitika: wodwalayo amaponya kupanikizika kwambiri pakusintha kwamphamvu kwa thupi, motero amayamba kuzimiririka m'maso, chizungulire. Thupi likasinthira malo atsopano, kupanikizika kumakula.
Zizindikiro za Laborator zomwe zimayamba:
| Chizindikiro | Mtengo | |
| Hyperglycemia, mmol / L | > 18, nthawi zambiri pafupifupi 30 | |
| Kuchepa kwa magazi pH | 6,8-7,3 | |
| Kuchepetsa magazi a bicarbonate, meq / l | 300, 3 | |
Zizindikiro za Coma - kutentha kugwa, kupweteka kwa minofu, kuponderezana kwa chidwi, kunyalanyaza, kugona. Wodwala matenda ashuga amataya chikumbumtima, poyamba imatha kuchira kwakanthawi, koma chikomacho chikamakulirakulira, amasiya kuyankha kwa omwe akwiya nawo.
Kuzindikira zovuta
Kuti azindikire ketoacidosis komanso chikomokere chikuyandikira, wodwala matenda ashuga ayenera kuyeza shuga wamagazi pazovuta zilizonse:
- ndi nseru
- Ndi ululu wam'mimba uliwonse wamavuto komanso kutulutsa kwanyumba,
- ndi fungo la acetone kuchokera pakhungu, akapuma,
- ngati ludzu ndi kufooka zimawonedwa nthawi imodzi,
- kupuma pang'ono,
- ndi matenda owopsa komanso kuchulukitsa kwa matenda osachiritsika.
Ngati hyperglycemia yapezeka pamwambapa 13, odwala omwe ali ndi insulin ayenera kupanga jakisoni wa mankhwalawa, omwe ali ndi matenda amtundu wa 2, osapatula chakudya ndikuwathandiza othandizira a hypoglycemic. M'magawo onse awiriwa, muyenera kuwona shuga wamagazi ola limodzi, ndipo ndi kukula kwina, pitani kuchipatala msanga.
Kuzindikira mkati mwa chipatala nthawi zambiri kumakhala kovuta ngati dokotala amadziwa kuti wodwala ali ndi matenda ashuga. Kupanga "ketoacidotic chikomokere", ndikokwanira kupanga mapangidwe amwazi ndi urinalysis. Njira zazikuluzikulu ndi hyperglycemia, shuga ndi ma ketoni mkodzo.
Ngati chikomacho chimayambitsidwa ndi kuyambika kwa matenda ashuga, kuyezetsa ketoacidosis kumayikidwa ngati wodwalayo ali ndi vuto lotha kuchepa mphamvu, kupuma movutikira, kunenepa kwambiri.
Ketoacidotic chikomaso chagawika magawo malinga ndi zizindikiro izi:
| Zizindikiro | Coma siteji | ||||
| ketoacidosis | choyambirira | chikomokere | |||
| Mkhalidwe wa mucous nembanemba | Zouma | Youma, bulauni | Zouma, zokhala ndi mafinya, zilonda pamilomo | ||
| Kuzindikira | Palibe kusintha | Kugona kapena ulesi | Sopor | ||
| Mimbulu | Kukwera kwakukulu kowonekera | Zochepa kapena ayi | |||
| Kubweza | Nthawi zambiri, nseru imakhalapo. | Pafupipafupi, mbewu zofiirira | |||
| Mpweya | Palibe kusintha | Zowawa, zazikulu, zopweteka zimatha kukhalapo | |||
| Kuwerengera magazi, mmol / l | shuga | 13-20 | 21-40 | ||
| ma ketoni | 1,7-5,2 | 5,3-17 | |||
| ma bicarbonates | 22-16 | 15-10 | ≤ 9 | ||
| pH | ≥ 7,3 | 7,2-7,1 | Kwa ma ruble 147 okha!
Kubwezeretsa madzi bwino, wodwalayo amalemedwa ndipo ma dontho amaikidwa ndi sodium chloride: 10 ml pa kilogalamu ya kulemera, kuthamanga kwamadzi - 20 ml, ndi hypovolemic shock - 30 ml. Ngati izi zimachitika pambuyo pake. Mukatuluka mkodzo, mlingo umachepetsedwa. Wodwala matenda a shuga amatha kutumikiridwa ndi magazi tsiku lililonse. zosaposa 8 l zamadzimadzi. Mankhwala a insulinHigh shuga insulin mankhwala (> 30) amayamba nthawi yomweyo ngati chithandizo cha madzi m'thupi. Ngati vuto la madzi ndilofunika, ndipo shuga osapitilira 25, insulin imayamba kutumizidwa mochedwa pofuna kupewa hypoglycemia chifukwa cha kuphatikizika kwa magazi munthawi yomweyo komanso kusamutsa shuga m'maselo.
Insulin imagwiritsidwa ntchito yochepa chabe. Pakuyambitsa kwake, infusomat imagwiritsidwa ntchito - chipangizo chomwe chimapereka molondola, mosalekeza mankhwalawa mumtsempha. Ntchito patsiku loyamba la mankhwalawa ndikuchepetsa shuga mpaka 13 mmol / l, koma osathamanga kuposa 5 mmol / l pa ola limodzi. Mlingo umasankhidwa payekha kutengera mulingo wa shuga wodwala komanso kupezeka kwa insulin, nthawi zambiri pafupifupi magawo 6 pa ola limodzi. Ngati wodwalayo sakudziwanso kwa nthawi yayitali, insulin imayamwa ndi glucose kuti apange kuchepa kwa mphamvu. Pamene wodwala matenda ashuga ayamba kudya payekha, kulowetsedwa kwa timadzi timene timayendetsa timadzi timene timasinthidwa ndikuyamba kubaya. Ngati vutoli la ketoacidotic likupezeka ndi shuga osadalira insulin, pambuyo poti wodwalayo sangasinthe kupita ku insulin, adzangosiyidwa ndi chithandizo cham'mbuyomu - zakudya zapadera komanso mankhwala ochepetsa shuga. Kupewa kwa QCWodwala matenda ashuga okha ndi amene amatha kupewa kukomoka. Mkhalidwe waukulu ndi kubwezeretsedwa kwakanthawi kwamatendawa. Kuyandikira kwambiri kwa shuga pamlingo, kumachepetsa zovuta zake. Ngati shuga nthawi zambiri amaposa 10, kapena 15 mmol / l, kupatuka kulikonse pazomwe zikuchitika nthawi zambiri kumatha kubweretsa kukomoka: matenda, vuto lakudya, chisangalalo chachikulu. Osayesa kulimbana ndi kupuma komwe kumayambira nokha ngati mukumva kugona kapena kutopa kwambiri. Kuzindikira kwamtunduwu kumatha kutha pakapita mphindi. Ngati muli ndi shuga kwambiri komanso simukumva bwino, itanani ambulansi, itanani anansi anu, tsegulani khomo lakutsogolo kuti madotolo alowe mwachangu mnyumba mukakhala kuti simungathe kutuluka. Dziwani bwino za mitundu mitundu ya matenda ashuga, ndipo abale anu aziwerenga za iwo. Sindikizani malamulo a chithandizo choyamba, ayikeni pamalo otchuka. Mu pasipoti yanu, chikwama cha foni kapena chitseko cha foni, ikani zambiri zamtundu wanu wa matenda ashuga, chithandizo chamankhwala ndi matenda ena. Adziwitseni anzanu ndi anzanu kuti muli ndi matenda ashuga, ndiuzeni zomwe muyenera kuyitanira ambulansi. Kukula kwa coma makamaka kumadalira zochita zoyenera za ena komanso madokotala azadzidzidzi. ZingathekeVuto lalikulu kwambiri la ketoacidotic coma ndi matenda otupa. Imayamba maola 6-48. Ngati wodwalayo sakudziwa chilichonse panthawiyi, kutupa ndikovuta kwambiri kuzindikira. Ikhoza kukayikiridwa ndi kusapezeka kwa zabwino zabwino, zotsimikizika ndi ultrasound kapena CT yaubongo. Edema imayamba nthawi zambiri pamene chithandizo cha ketoacidotic coma yozama chikuchitika ndikuphwanya: shuga amachepetsa msanga kuposa kuperewera kwa madzi, ndipo ma ketoni amachotsedwa. Ngati kwambiri ketoacidosis ndi glucose wochepera 8 mmol / l akupitilira, chiopsezo cha edema ya m'magazi ndi chachikulu kwambiri. Zotsatira za edema ndizowonjezereka kawiri pachiwopsezo cha kufa kwa chikomokere, mavuto akulu amitsempha, mpaka komanso kuperewera kwa thupi. Kufa ziwalo, kutaya mawu, matenda amisala. Mavuto a kukomoka amatanthauzanso kupindika kwakukulu, mtima komanso kulephera kwaimpso, pulmonary edema, asphyxiation mukakomoka. Onetsetsani kuti mwaphunzira! Kodi mukuganiza kuti kuyamwa kwa mapiritsi ndi insulini kwa nthawi yonse yokhayo ndi njira yokhayo yothanirana ndi shuga? Sichowona! Mutha kutsimikizira izi nokha ndikuyamba kuzigwiritsa ntchito. werengani zambiri >> Kusamalira mwadzidzidzi
Ngati ndi kotheka, ayenera kumvetsetsa zomwe amafuna kwa iwo. Algorithm ya kuyambika kwa ketoacidotic coma ndi motere:
Ambulansi ikafika, madokotala azichita zinthu zotsatirazi:
Pambuyo pa izi, wodwalayo amapezeka m'chipatala nthawi yomweyo ndikupititsidwa kuchipatala. Nthawi zambiri, odwala oterewa amatumizidwa kumalo osungirako odwala kwambiri. Njira zonse zothandizira achire zimachitika kumeneko. ZochiziraChithandizo cha odwala omwe ali ndi vuto la ketoacidotic chikomokere kapena mawonekedwe ake akhungu amafunika kuchipatala msanga. Anthu oterowo amatumizidwa kumalo osungirako odwala kwambiri, komwe amayang'aniridwa ndi asing'anga. Pambuyo pake, matenda osiyanasiyana amachitika. Kuti musiyanitse kholo ndi chikomokere, ma insulin 10-20 amaperekedwa kwa wodwala. Njira zina zochizira zimapangidwira pokhapokha kupezeka kwa matenda oyenera. Chithandizo cha matenda ashuga chikufuna kumalizidwanso mwachangu kwa insulin. Izi zikuthandizira kuchepetsa shuga m'magazi, zomwe zimapangitsa kuti zinthu zikhale bwino. Zitachitika izi, wodwalayo amapatsidwa njira yothetsera sodium yomwe imathandiza kuti madzi athetse madzi m'thupi.
Pambuyo pa izi, katswiri amayang'ana kuchuluka kwa shuga m'magazi aliwonse, pambuyo pake amapanga nthawi yoyenera. Ndi kusintha kwa mkhalidwe, mlingo wa insulin umachepa pang'onopang'ono. Kuthetsa kuwonekera kwa kuchepa thupi kwakuthupi, ndi chikomokere matenda a shuga, madzi ambiri amalowetsedwa m'mitsempha. Poyamba, yankho la sodium chloride limagwiritsidwa ntchito pazifukwa izi. Tiyenera kukumbukira kuti kutengera nthawi yomwe mankhwalawa amathandizira, kuchuluka kwa mankhwalawa kumasiyanasiyana. Chidziwitso cha wodwalayo chikayamba kuchita bwino, chithandizo cha kulowetsedwa chimayima. Zolakwa zamankhwala
Kuyang'anira wodwalaWodwala akakhala kuti ali ndi vuto la ketoacidotic, amayang'aniridwa nthawi zonse. Dokotalayo ayenera kudziwa momwe thupi lake limagwirira ntchito kuti akonze mankhwalawo moyenera. Kuwongolera kumachitika motere:
Kuwongolera kwakukulu kwa wodwalayo kumafotokozedwa ndikuti wodwalayo amatha kukhala ndi zovuta nthawi iliyonse. Zotsatira zoyipa kwambiri za ketoacidotic chikomokere cha mankhwala ake zitha kutchedwa:
Mavuto omwe angakhalepoKetoacidotic chikomaso ndi vuto lalikulu la matenda ashuga. Ngati wodwala sanalandire bwino kapena mosazindikira, wodwala akhoza kukumana ndi zovuta zazikulu. Choopsa chachikulu ndi matenda a edema. Zodabwitsa zoterezi mu milandu yambiri zimatha ndiimfa. Ndikothekanso kuzindikira mawonekedwe a puffuff mu ubongo ndi kusasinthika kwabwino kwa wodwala, ngakhale njira zonse zochiritsira zikuchitika. Poterepa, adotolo awona kusintha kwakukulu mu kagayidwe kake ka zakudya ndi mafuta.
Kuti atsimikizire izi, katswiri amatumiza wodwala kuti atumizidwe ndi mtundu wina waumoyo waumoyo. EEC ndi REC amachitidwanso kuti awunike momwe zimachitika mu ubongo. Ndi thandizo lawo, mutha kudziwa zovuta zomwe zikuchitika komanso kupereka mankhwala oyenera.
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Matenda a shuga ndi matenda oopsa omwe achibale onse apafupi ndi anthu odwala ayenera kudziwa.
Dokotala atatsimikizira kekeacidotic chikomokere, amapatsa jakisoni wa insulin kwa wodwala. Amabayidwa jet kapena intramuscularly pamlingo wa magawo 10-20 pa ola limodzi.
Chithandizo cha ketoacidotic chikomichi chimafunikira kuyenerera kokwanira kuchokera kwa dokotala. Mkhalidwe wotere wokhala ndi chithandizo chosankhidwa mosayenera ungayambitse osati zowawa zokha, komanso ngakhale kufa. Kafukufuku wasonyeza kuti zolakwika zotsatirazi zimakumana nawo kwambiri nthawi zambiri:
Cerebral edema imatha kuzindikiridwa ndi kuchepetsedwa komwe ophunzira amapanga kuyatsa kapena ngakhale posakhalapo, edema ya optic nerve kapena ophthalmoplegia.
