Metabolic acidosis: zimayambitsa, Zizindikiro, chithandizo

Metabolic acidosis (kuyambira lat. Acidus - acidic) ndikuphwanya mulingo wa asidi-mzimba m'thupi momwe ma asidi amadziunjikira chifukwa cha kupangika kwawo kapangidwe, kumwa, kuchepa kwa thupi, komanso chifukwa cha kutayika kwa bicarbonates kudzera mu impso kapena m'mimba. Mpaka nthawi yina, njira zowumiriza zimapangidwira, koma kenako kuchuluka kwa asidi kumatha mphamvu zawo, ndipo acidemia imachitika - zomwe nthawi zina zimatchedwa acid acidization. Muyezo wotsika wamagulu a magazi a pH ndi 7.35 (mtengo womwe umakhala pakati pa 7.35-7.45 umawoneka ngati wabwinobwino), acidemia imanenedwa kuti pomwe magazi a pH amakhala ochepa, ndiye kuti osakwana 7.35. Izi zimabweretsa kuphwanya kwa kusintha kwamphamvu kwa thupi komwe kumachitika mthupi, zomwe zimapangitsa kuti pakhale kusokonezeka kwapafupifupi ntchito zonse za thupi, kuphatikizapo kupuma koopsa, koopsa m'moyo komanso mtima.

Amayambitsa Metabolic Acidosis

Acidosis si matenda odziyimira pawokha, koma chizindikiro chomwe chimatha kukhala ndi matenda ambiri komanso matenda amisempha, kuphatikizapo:

• zinthu zoika moyo pachiwopsezo (matenda am'kati ndi matenda obwera pambuyo pake, mantha, ziwalo zingapo, sepsis),
• matenda am'mapapo (mphumu yayikulu, chibayo cham'mimba, kugona ziphuphu),
• matenda a neuromuscular (Guillain-Barré syndrome, amyotrophic lateral sclerosis, myasthenia gravis),
• matenda opatsirana (botulism),
• kulephera kwa aimpso
• shuga wowonjezera,
• kusala
• kusowa kwamadzi (kusowa kwamadzi),
• mimba yovuta
• kutsegula m'mimba kwa nthawi yayitali
• fistulas m'matumbo
• matumbo dysbiosis (kuchuluka kwa D-lactate ndi m'mimba microflora),
• kuledzera
• mankhwala osokoneza bongo
• poyizoni ndi methyl mowa (methanol), antifreeze, ethylene glycol, komanso salicylates ndi mankhwala ena.

Metabolic acidosis imatha kuchitika chifukwa chokhala ndi nkhawa yayitali chifukwa chogwiritsa ntchito mphamvu, kulimbitsa thupi.

Zambiri

Metabolic acidosis (MA) kapena acidemia ndi mkhalidwe womwe umalumikizidwa ndi kusintha kwa ntchito zamapuloteni ofunikira motsutsana ndi maziko osuntha gawo la acid-base kupita ku mbali ya acid. Amayamba kudwala kwambiri matenda amtundu winawake, poyizoni wina, amadzidzimu amtundu uliwonse. Mild acidemia siyomwe imayendera limodzi ndi zizindikiro za matenda. Pochotsa chomwe chimayambitsa kulephera, mkhalidwe wabwinobwino wamkati umakhala wabwinobwino popanda kuchitapo kanthu kuchipatala. Sekulu acidosis imafunikira chithandizo ku ICU chifukwa choopsa kwambiri pa ngozi ya kupuma komanso mtima. Odwala amafunikira kuwunika pafupipafupi kwa zida zofunika kwambiri, tsiku lililonse ndipo nthawi zina masana pamagazi kukayesedwa.

Zomwe zimapangitsa acididemia kuchuluka kapena kuchepa kwa asidi wamafuta, komanso kuchulukitsidwa kwa zotupa zamagazi amchere. Metabolic acidosis imapezeka muzochitika zonse za kugwedezeka, kufa matenda, ndi matenda a postresuscitative. Kuphatikiza apo, matenda a pathology amatha kukhala ndi njira zambiri zothandizira matenda othandizira komanso opaleshoni. Kutengera ndi kuphwanya komwe kumayambira, acidization imatha kuchitika chifukwa cha lactate kapena matupi a ketone. Mitundu yotsatirayi yamikhalidwe iyi imasiyanitsidwa:

• Lactic acidosis. Amachitika ndikuwonjezereka kwa anaerobic glycolysis m'misempha. Mitundu yambiri ya lactic acidosis imapezeka mwa odwala omwe ali ndi vuto lalikulu la minofu hypoxia, kupuma, komanso kuchepa kwa magazi a systolic pansi pa 70 mm Hg. Art. Kuwona sepsis, hypovolemia, kapangidwe kazinthu zambiri za D-lactate matumbo microflora. Zoyipa zomwe zimayambitsa masinthidwe ku KShchS zimadziwika kuti ndizogwira ntchito zolimbitsa thupi, kuphatikizapo kuwonjezera kulimbitsa thupi. Acidification sifunikira kukonzanso ndipo imangoyenda yokha ikangotha ​​kupumula kwa minofu.
• Ketoacidosis. Ndi chizindikiro cha matenda amtundu wina. Amapezeka m'matenda a shuga, kuperewera komanso kupweteka kwambiri kwaimpso, mowa poyizoni, mowa, methyl glycol, salicylates, komanso kuphwanya ntchito ya chiwindi. Kuphatikiza apo, kuchuluka kwa matupi a ketone kumawonjezeka pamapeto pa kudwala, ndikukula kwa ziwalo zingapo.
• Kutaya chifukwa. Amapezeka mu matenda angapo am'mimba thirakiti: kutsegula m'mimba kwa nthawi yayitali, fistulas m'matumbo, matumbo a mkodzo. Chotsirizachi ndi chifukwa cha opareshoni, pomwe ma impretion a m'matumbo amachitika ndi chikhodzodzo kulephera. Mkodzo umakhala ndi pH ya 5-7, ndiye kuti, ndi acidic sing'anga. Pamene ilowa m'matumbo, imasokoneza malo amchere wamatumbo.

Metabolic Acidosis Imachepetsa HCO₃ ndi kuchuluka kwa Cl -. Potaziyamu ayoni m'maselo amasinthidwa mwachangu ndi sodium ndi hydrogen, kuwonjezereka kwa K + m'madzi a m'magazi kumachitika. Pakakhala kulephera kwa aimpso, potaziyamu yambiri amachotsedwa mu mkodzo. Nthawi yomweyo, mulingo wake m'magazi umakhalabe pafupi ndi wabwinobwino, ndipo hypokalemia ya intracellular imapangidwa. Pakulephera kwa impso, plasma imakhala ndi kuchuluka kwa K + ions. Masinthidwe ang'onoang'ono amakalipiridwa ndi kachitidwe ka buffer: bicarbonate, phosphate, hemoglobin, mapuloteni. Amasinthanso maproteni, ochirikiza homeostasis, komabe, machitidwe a machitidwe awa sikokwanira kuti acidosis yayikulu. Kutsika kwa pH kumachitika, komwe kumakhudza kuphatikizika kwa mankhwala a amphoteric. Ntchito yamahomoni, ma neurotransmitters amasintha, ntchito zama receptor zida zimasokonekera.

Gulu

Pali magawo angapo a alkalemia. Chimodzi mwazinthu zodziwika bwino za magawidwewo ndi kusiyana kwa anionic - kusiyana m'ndende za K +, Na + ndi CL -, HCO₃ -. Nthawi zambiri, ndi 8-12 mmol / lita. Ngati chizindikirochi chikasungidwa, amalankhula za alkalosis yokhala ndi dzenje labwinobwino; chowonjezera chikuwonetsa kuchepa kwa kuchuluka kwa Mg +, Ca + c kapena kuchepa kwa phosphates, albin, ndi acid organic. Zochita zachipatala zimagwiritsa ntchito magawo a mibadwo yolingana ndi malipiro a MA:

1. Zolipidwa. Ndi asymptomatic, kusunga homeostasis kumachitika chifukwa chogwira ntchito mwamphamvu machitidwe. The pH imasungidwa pa 7.4, kuchepera kwa maziko ndi zero, kukakamiza pang'ono kwa CO2 kumasungidwa ku 40 mm Hg. Art. Imadziwika nthawi yayitali yogwira minofu yambiri, komanso koyambirira kwamatenda amkati. Kuwongolera kuchipatala sikofunikira.
2. Zolipidwath. Mlozera wa haidrojeni umasungidwa mkati mwa malire oyenera kapena amachepera pang'ono (7.35-7.29). Pali kuchepa kocheperako kwa besi (mpaka -9). pCO2 imachepa chifukwa cha comperatory hyperventilation, koma sikutha phindu la 28 mm Hg. Art. Pali chithunzi chosawoneka bwino cha matenda. Kugwiritsa ntchito madzi osokoneza bongo sikofunikira.
3. Idalipira. pH imatsika m'munsi mwa 7.29; BE kuperewera kumatha -9 mmol / lita. Osalipidwa ndi pulmonary hyperventilation. Kukakamira pang'ono kumatsikira mpaka 27 mm Hg. Art. kapena wotsika. Pali Symbomatology mwatsatanetsatane, kuwonongeka kotsika kwa thanzi la wodwalayo. Kusamalidwa mwadzidzidzi ndi ma buffer ndikofunikira.

Zizindikiro za metabolic acidosis

Mitundu yolipidwa kapena yolipidwa imakhala ya asymptomatic. Ndi kuchepa kwa bicarbonate kopitilira -10, cholembera cha hydrogen pansipa 7.2, Hyperventilation yolumikizira imachitika. Imadziwoneka yokha mu kupuma kwakuya, pang'ono pang'ono. Momwe matendawa amayamba kutha, wodwalayo amakula. Matenda acidosis ana kumabweretsa kukula ndi kukula. Zizindikiro zina zamatenda zimatengera zamatsenga. Kutsegula m'mimba, kuyabwa kwa khungu, polyuria, kusokonezeka kwa mawonekedwe, chizungulire zitha kudziwika. Mbiri yokhala ndi njala kwanthawi yayitali, kudya kwakachulukidwe ka salicylates, ethylene glycol, methanol kapena ethanol, kupezeka kwa matenda a shuga, matenda am'mimba, kulephera kwa impso.

Zambiri zimasokoneza kagayidwe kachakudya. Kuyankha ku kayendetsedwe ka ma Pressor amines kumachepetsedwa kapena kulibe. Pali kuchepa kwa myocardial contractility, kulipirira tachyarrhythmia. Plasma hyperkalemia kukhalapo kwa aimpso kulephera kwamitsempha chifukwa cha fibrillation ya atria. Pali zizindikiro za kuphwanya kwa atrioventricular conduction. Odwala amadandaula za kupweteka pachifuwa, palpitations, kusowa kwa mpweya. Pakufufuza kwakuthupi, khungu limakhala loumbika kapena lamanjenje, lozizira pakukhudza, zimachitika ndendende, zodzaza ndi kupsinjika, kupuma kuli kwakuya, kolemera, kopanda phokoso. Mwina chitukuko cha encephalopathy.

Mavuto

Mkulu metabolic acidosis pa siteji yotsitsa imayambitsa chopinga cha kupuma. Hyperventilation imaloŵedwa m'malo ndi kupuma kosafupika. Ubongo hypoxia umayamba, zomwe zimapangitsa kuti musakhale ndi chikumbumtima komanso chikomokere. Ntchito ya impso, chiwindi chimaphwanyidwa, kulephera kwazinthu zingapo kumachitika. Kuphwanya kwa neuromuscular conduction kumapita patsogolo, zomwe zimayambitsa chisokonezo muzochitika zamagulu onse amthupi. Poyamba, atiria arrhythmias imafalikira kuma ventricles. Kukhathamiritsa kwa chomaliza kumawonedwa, kufa kwa matenda kumapezeka.

Zizindikiro

Kuzindikira kwa AM mu ICU odwala kumachitika ndi mankhwala ochititsa dzanzi. Pamaso pa matenda amtundu wa somatic, kufunsira kwa akatswiri opapatiza kumafunikira: endocrinologist, dokotala wa opaleshoni, nephrologist, hepatologist. Matenda a metabolic acid amatha kuwonedwa ndi katswiri wazachipatala pamaziko a kunja. Kuzindikira kumakhazikitsidwa pamaziko a maphunziro awa:

• Zakuthupi. Sizilola kudziwa molondola zomwe zasinthidwa, popeza zizindikiro zakuphwanya ndizosakhudzika ndipo zimatha kuchitika m'njira zina zambiri. Komabe, chithunzi chofananira cha chipatalachi chimapereka zifukwa zosankhira kusanthula kwa asidi-acid acid ndi ma electrolyte a plasma.
• Laborator. Ndiwo maziko a kusaka matenda. Acidemia yapezeka ndi kuchepa kwakachepera kapena kwakukulu pH, kuchepa kwa ma bicarbonates, kuchepa kwa kupanikizika pang'ono kwa kaboni dayokisi. Kuti mupeze mtundu wa acidosis, kusiyana kwa anionic ndikuyerekeza. Kuti mumveke bwino za njira ya kutayikiridwa kwa maziko, zingakhale zofunika kuphunzira dzenje la anion osati plasma, komanso mkodzo.
• Z Hardware. Zimachitika kuti mudziwe zomwe zimayambitsa matenda, komanso kuzindikira kusintha komwe kukubwera. Pa ECG, kukulitsa kwa T wave, kukulira kwa QRS zovuta, kutha kwa fundani wa P, mafunde akulu kapena ang'ono-ozungulira, malo osasinthika amadziwika. Ngati kusuntha kumachitika pagulu lalikulu, zizindikiro za kukula kwa chiwindi, ndulu, komanso kuchuluka kwa madzi m'mimba mwa m'mimba zitha kuzindikirika.

Chithandizo cha Metabolic Acidosis

Chithandizo cha MA popanda kuchotsera zomwe zimayambitsa ndizosatheka, kutengera kupezeka ndi chithandizo cha matenda oyambitsidwa. Pankhani ya matenda ashuga ketoacidosis, kusintha kwa shuga m'magazi ndikofunikira; vuto lactic acidosis, mpumulo wa ischemia ndi hypoxia ndikofunikira. Wodandaula, wodwalayo akuwonetseredwa njira zoyenera zotsitsimutsira. Chithandizo cha muzu wa acidemia ikuchitika limodzi ndi kukula kwa acid-maziko a mkati chilengedwe. Kuti muchite izi, gwiritsani ntchito njira izi:

1. Mankhwala. M'mitundu yowola yamatenda, kukonza kumachitika ndi kulowetsedwa kwa sodium bicarbonate. Nthawi zina, njira zothetsera buffer sizigwiritsidwa ntchito. Kuyika kwa lactasol, womwe umapangidwa m'chiwindi ndikupanga HCO3, ndizotheka. Mlingo wa electrolyte umabwezeretsedwa ndi kulowetsedwa kwa disol, acesol, ndi trisol. Ndi hypoproteinemia, kusintha kwa protein kumasonyezedwa. Matenda a oxidative njira mu minofu amachitika poika multivitamin maofesi, pantothenic ndi pangamic acid.
2. Z Hardware. Ndizofunikira pamapulogalamu ovuta pokonzekera ntchito zofunika. Kulephera kwa kupindulira ndi chizindikiro chosamutsa wodwala ku makina amkati mwa mpweya, kuchepa kwa ntchito yaimpso kumafuna hemodialysis. Ndi kuchepa kwa kuthamanga kwa magazi, hardware (kudzera pa jekiseni) kulowetsedwa kwa vasopressors imachitidwa. Ngati michere yamitsempha yamagazi imagwiritsidwa ntchito, chithandizo cha ma electropulse, kutikita minofu kwamtima kosadziwika.

Zotsogola ndi kupewa

Njira yamatendawa imatengera njira yayikulu komanso njira yothetsera kuthetseratu. Pambuyo pochotsa zomwe zimayambitsa acididemia, kuphwanya acid-base syndrome kumakhala koyenera ngakhale pa nthawi yobwezera. Kubwezeretsanso kwa mankhwala osokoneza bongo a bicarbonates ndikusunga ukazitape wa acidization sikulola kukwaniritsa kukhazikika kwa index ya hydrogen ndi BE (chosonyeza kuchuluka kwa HCO₃) Katetezedwe kamakhala munthawi yake chithandizo chomwe chingayambitse acidosis, kukhazikitsa shuga m'magazi, ndikukumana ndi hemodialysis panthawi yolephera aimpso. Pansi pa zikhalidwe za ICU, metabolic acidosis imadziwika ndikuwongolera koyambira koyambirira ndi zowerengetsera zamasiku onse za acid-base.

Zizindikiro

Zizindikiro za metabolic acidosis zimatengera mwachindunji matenda omwe amayambitsa matenda.

Mawonetsero akulu ndi:

• kupumira msanga
• kusanza kokhazikika ndi kusanza, komwe sikumasintha mkhalidwe wa munthu,

Tiyenera kudziwa kuti nthawi zina mawonetseredwe akunja akhoza kukhala kuti palibe.

Ngati zotsatirazi zikuchitika, muyenera kupita ndi wodwala kuchipatala msanga kapena kuyimbira gulu la ambulansi kunyumba:

• kupuma mwamphamvu komanso pafupipafupi
• kufooka kwakanthawi - mpaka pomwe wogwidwa sangathe kutuluka.
• kukomoka
• chisokonezo.

Muzochitika zotere, njira zonse zodziwira ndi kuwachiritsa zimachitika pang'onopang'ono.

Zizindikiro ndi metabolic acidosis

Zizindikiro ndi zizindikiro makamaka zimachitika chifukwa cha metabolic acidosis. Wofatsa acidemia palokha ndi asymptomatic. Ndi acememia wambiri, nseru, kusanza, ndi malaise ambiri.

Kuopsa pachimake acidemia ndi chinthu chomwe chimalimbikitsa kusokonezeka kwa mtima ndi kutsika kwa magazi komanso kuyamba kugwedezeka, minyewa yamitsempha yam'mimba, komanso chikomokere.

Zizindikiro nthawi zambiri zimakhala zopanda pake, chifukwa chake, kudziwika koyenera kwa matendawa ndikofunikira kwa odwala omwe amapita kwamatumbo ambiri kwamkodzo. Zizindikiro zimayamba pakapita nthawi ndipo zimaphatikizaponso kudya anorexia, kuchepa thupi, polydipsia, kufoka, komanso kutopa. Ululu mu sternum, kuwonjezeka komanso kuthamanga kwa mtima, kupweteka kwa mutu, kusintha kwa malingaliro, monga nkhawa yayikulu (chifukwa cha hypoxia), kusintha kwa kulakalaka, kufooka kwa minofu, komanso kupweteka kwa mafupa kumatha kudziwikanso.

Lactic acidosis

Lactic acidosis imayamba ndi kuchuluka kwa lactate, kuchepa kwa kagayidwe kake, kapena zonse ziwiri.

Lactate ndichabwinobwino wopangidwa ndi shuga ndi amino acid metabolism.Mtundu wovuta kwambiri wa lactic acidosis, mtundu A, umayamba ndi kuchuluka kwa lactate, komwe ndikofunikira pakapangidwe ka ATP mu ischemic tishu (kuperewera 02). Nthawi zambiri, kukhathamiritsa kwa lactate kumapangidwa mosakwanira kukhathamiritsa kwa minofu chifukwa cha hypovolemic, mtima kapena septic mantha ndipo amawonjezeredwa kwambiri chifukwa chakuchepa kwa kagayidwe kamatenda a lactate m'magazi a chiwindi osagwiritsidwa ntchito bwino. Lactic acidosis imawonedwanso mu hypoxia yoyamba chifukwa cha pulmonary pathology komanso hemoglobinopathies osiyanasiyana.

Type B lactic acidosis imayamba munthawi ya kuphatikiza minofu ndipo siyowopsa. Zomwe zimapangitsa kuchuluka kwa kupanga lactate kumatha kukhala okonza minofu ya m'deralo pa ntchito yawo yowonjezereka (mwachitsanzo, pakulimbitsa thupi, kukokana, kunjenjemera chifukwa cha kuzizira), zotupa zoyipa komanso kudya zina zamankhwala kapena poizoni. Zinthu izi zimaphatikizanso recript transcriptase inhibitors ndi biguanides - phenformin ndi metformin. Ngakhale phenformin silipezekanso m'maiko ambiri, imagwiritsidwabe ntchito ku China.

Njira yachilendo ya lactic acidosis ndi D-lactic acidosis, yomwe imayamba chifukwa cha kuyamwa kwa D wa lactic acid (chipatso cha kuphatikiza kwa mabakiteriya) mu colon mwa odwala eunoileal anastomosis kapena pambuyo poyambira matumbo. Izi zimasungidwa m'magazi chifukwa anthu lactate dehydrogenase amangowononga lactate.

Kuzindikira ndi kuchiza mtundu wa lactic acidosis A ndi B ndi ofanana ndi zina zamitundu ina ya metabolic acid. Ndi D-lactic acidosis, kusiyana kwa anion ndizochepa kuposa momwe amayembekezera pakuchepetsa komweko ku HCO₃ -, mawonekedwe a osmolar gap mu mkodzo ndiwotheka (kusiyana pakati paosankhidwa ndi mkodzo wowerengeka). Kuchiza kumatsikira ku kulowetsedwa kwa mankhwala, kuchepetsa zakudya, komanso (nthawi zina) kupereka mankhwala othandizira (mwachitsanzo metronidazole).

Zoyambitsa zazikulu za metabolic acidosis

Mkulu wa anion wapamwamba

• Ketoacidosis (matenda ashuga, uchidakwa wambiri, kuperewera kwa chakudya, kugona ndi njala).
• Lactic acidosis.
• Kulephera kwina.
• Ma sumu a Acid
• Methanol (mawonekedwe).
• Ethylene glycol (oxalate).
• Paraacetaldehyde (acetate, chloroacetate).
• Salicylates.
• Zoopsa zomwe zimayambitsa lactic acidosis: CO, cyanides, iron, isoniazid.
• Toluene (poyamba anali wamkulu anionic kusiyana, pambuyo pake excretion wa metabolites amakhala ndi kusiyana).
• Rhabdomyolysis (chosowa).

Nthawi zambiri anion kusiyana

• Kutayika kwa m'mimba kwa NSO - (kutsegula m'mimba, ileostomy, colonostomy, fistula yamatumbo, kugwiritsa ntchito ma resion a ion-exchange).
• Ureterosigmoidostomy, ureteroileal drainage.
• Kutayika kwa impso za HF3
• Tubulo-interstitial matenda a impso.
• Renal tubular acidosis, mitundu 1,2,4.
• Hyperparathyroidism
• Kulandila kwa acetazolamide, CaCI, MgSO4.

• Hypoaldosteronism.
• Hyperkalemia
• Parenteral makonzedwe a arginine, lysine, NH CI.
• Kuyambitsa mwachangu kwa NaCI.
• Toluene (mawonedwe mochedwa)

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Hyperchloremic metabolic acidosis

Zimayambitsa hyperchloremic metabolic acidosis

• Exo native katundu ndi hydrochloric acid, ammonium chloride, arginine chloride. Zimachitika pamene michere ya acidic (hydrochloric acid, ammonium chloride, methionine) ilowa m'thupi.
• Kutayika kwa Bicarbonate kapena kuchepa magazi. Nthawi zambiri zimawonedwa m'matumbo am'mimba thirakiti (matenda otseguka m'mimba, fancula ya pancreatic, ureterosigmoidostomy), pomwe ma bicarbonates am'malo amasinthidwa ndi ma chloride (milliequivalent pa milliequivalent), chifukwa impso zimasunga sodium chloride, kuyesa kusunga kuchuluka kwa madzimadzi am'mimba. Ndi mitundu iyi ya acidosis, phula la anionic (AP) nthawi zonse limafanana ndi zoyenera.
• Kuchepa kwa secretion kwa asidi ndi impso. Nthawi yomweyo, kuphwanya kwa kubwezeretsa kwa bicarbonate ndi impso kumaonekanso. Kusintha kumeneku kumachitika chifukwa cha kubisala kwapadera kwa H + m'matumbo a impso kapena chifukwa chokwanira cha aldosterone. Renal proximal tubular acidosis (PKA) (mtundu 2), a impal distal tubular acidosis (DKA) (mtundu 1), tubular acidosis ya mtundu 4 yokhala ndi secretion yosakwanira ya aldosterone kapena kukana kwake imasiyanitsidwa kutengera mtundu wa zosokoneza.

Proximal aimpical tubular metabolic acid (mtundu 2)

Monga chifukwa chachikulu cha proximal tubular acidosis, kuphwanya kwa mphamvu ya ma proximal tubules kukulitsa kubwezeretsanso kwa bicarbonates kumaganiziridwa, zomwe zimatsogolera kulowa kwawo kolowera ku distal nephron. Nthawi zambiri, bicarbonate yonse yosefera (26 meq / l) imasungidwanso mu tubules yovomerezeka, yokhala ndi proximal tubular acidosis, yomwe imatsogolera kutulutsidwa kwa bicarbonate kwambiri mumkodzo wa mkodzo wa alkaline. Kulephera kwa impso kubwezeretsanso kwathunthu kumayambitsa kukhazikitsidwa kwatsopano (m'munsi) plasma bicarbonate, komwe kumatsimikizira kuchepa kwa magazi pH. Mlingo wokhazikitsidwa kumenewu wama bicarbonate m'magazi tsopano umasinthidwanso ndi impso, zomwe zimawonetsedwa ndi kusintha kwa mkodzo kuchokera ku alkaline kupita ku acidic. Ngati bicarbonate imaperekedwa kwa wodwalayo pansi pazinthu izi kuti magazi ake akhale ofanana, mkodzo umasinthanso zamchere. Izi zimagwiritsidwa ntchito pofufuza proximal tubular acidosis.

Kuphatikiza pa vuto la bicarbonate reabsorption, odwala omwe ali ndi proximal tubular acidosis nthawi zambiri amawonetsa kusintha kwina mu proximal tubule function (kupatsanso mphamvu kwa phosphates, uric acid, amino acid, glucose). Kuzunzika kwa K + m'magazi nthawi zambiri kumakhala koyenera kapena kosachepera.

Matenda akuluakulu omwe proximal tubular acidosis imayamba:

• Fanconi's syndrome, yoyambira kapena mkati mwa matenda am'banja (cystinosis, matenda a Westphal-Wilson-Konovalov, tyrosinemia, etc.),
• hyperparathyroidism,
• matenda a impso (nephrotic syndrome, angapo myeloma, amyloidosis, Gougerot-Sjogren's syndrome, paroxysmal nocturnal hemoglobinuria, aimpso veins thrombosis, medullary cystic impso, ndi kupatsirana kwa impso),
• kutenga okodzetsa - acetazolamide, etc.

Distal renal tubular metabolic acidosis (mtundu 1)

Mu distal renal tubular acidosis, mosiyana ndi proximal tubular acidosis, kuthekera kubwezeretsa bicarbonate sikokwanira, komabe, pali kuchepa kwa secretion ya H + m'matumbo a distal, chifukwa chomwe mkodzo wa pH suchepa pansi pa 5.3, pomwe pH yochepa kwambiri 4.5-5.0.

Chifukwa cha kusowa kwa ma distal tubules, odwala omwe ali ndi distal renal tubular acidosis sangathe kumasula kwathunthu H, zomwe zimapangitsa kuti pakhale kufunika kosiyanitsa ma ayoni a hydrogen omwe amapangidwa pa metabolism chifukwa cha plasma bicarbonate. Zotsatira zake, mulingo wa bicarbonate m'mwazi nthawi zambiri umachepa pang'ono. Nthawi zambiri, odwala omwe ali ndi distal renal tubular acidosis, acidosis imakula, ndipo matendawa amatchedwa infal infal real tubular acidosis. Milandu iyi, kumasulidwa kwa H + kwathunthu kumachitika chifukwa cha impso, yomwe imadziwonetsa yokha pakupanga kwa ammonia, komwe kumachotsa ma ioni a hydrogen ambiri.

Odwala ndi distal aimpso tubular acidosis, monga ulamuliro, hypokalemia kumachitika, concomitant mavuto kukulitsa (kukula retardation, amakonda nephrolithiasis, nephrocalcinosis).

Matenda akuluakulu omwe amayamba kudwala aimpso acidosis:

• Matenda a matenda ogwirizana a matenda oopsa a hepatitis, matenda oyamba ndi chiwindi, chithokomiro, khungu la alveolitis, matenda a Gougerot-Sjogren),
• nephrocalcinosis ndi idiopathic hypercalciuria, hyperthyroidism, vitamini D kuledzera, matenda a Westphal-Wilson-Konovalov, matenda a Fabry, matenda a impso (pyelonephritis, nephropathy, kupatsirana nephropathy, kugwiritsa ntchito mankhwala (amphotericin B, analgesics), mankhwala.

Pazifukwa zosiyanitsa mitundu ya proximal retile tubular acidosis ndi distal reular tubular acidosis, zitsanzo zomwe zimakhala ndi bicarbonate ndi ammonium chloride zimagwiritsidwa ntchito.

Wodwala yemwe ali ndi vuto la rex tubular acidosis yoyambitsa bicarbonate, mkodzo pH umachulukira, koma mwa wodwala yemwe ali ndi distal real tubular acidosis, izi sizichitika.

Kuyesedwa ndi katundu wa ammonium chloride (onani "Njira Zowonera") kumachitika ngati acidosis imakhala yochepa. Ammonium chloride imaperekedwa kwa wodwala pa mlingo wa 0,1 g / kg kulemera kwa thupi. Pakupita maola 4-6, kuchuluka kwa bicarbonate m'mwazi kumachepa ndi 4-5 meq / l. Odwala omwe ali ndi distal renal tubular acidosis, mkodzo pH umakhalabe pamwamba pa 5.5, ngakhale kuchepa kwa plasma bicarbonate, ndi proximal retile tubular acidosis, monga mwa anthu athanzi, mkodzo pH umachepera m'munsimu 5.5 (nthawi zambiri pansi pa 5.0) .

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Tubular metabolic acidosis yokhala ndi vuto losakwanira la aldosterone (mtundu 4)

Hypoaldosteronism, komanso kuphwanya kwamphamvu kwa aldosterone, imawerengedwa kuti ndiyomwe imayambitsa kukula kwa proximal renal tubular acidosis, yomwe imakhala ikuchitika nthawi zonse ndi hyperkalemia. Izi ndichifukwa chakuti aldosterone nthawi zambiri imawonjezera kubisika kwa onse K- ndi H-ions. Chifukwa chake, ndi kusakwanira kwa timadzi timeneti, ngakhale titakhala kuti tili ndi GFR, Hyperkalemia ndi kuphwanya kwamikodzo kwamkodzo kumapezeka. Kuyesedwa kwa odwala kumawonetsa hyperkalemia yomwe siyikugwirizana ndi kuchuluka kwa kulephera kwa impso, komanso kuwonjezeka kwa mkodzo p ndi kusokonezeka komwe kumachitika chifukwa cha kuchuluka kwa ammonium chloride (monga momwe ndi distal renal tubular acidosis).

Kuzindikira kumatsimikiziridwa ndikuzindikira kwa serum aldosterone ndi renin. Kuphatikiza apo, kuchuluka kwa magazi a aldosterone sikukwera poyankha kutsika kwa sodium kapena kuchepa kwa magazi mozungulira magazi.

Chizindikiro choperekedwa chimadziwika ngati kusankha hypoaldosteronism kapena, pozindikira kuchepa kwa kupanga kwa impso, monga hyporeninemic hypoaldosteronism ndi hyperkalemia.

Zoyambitsa matendawa:

• kuwonongeka kwa impso, makamaka mu gawo la matenda a impso,
• matenda ashuga
• mankhwala - NSAIDs (indomethacin, ibuprofen, acetylsalicylic acid), sodium heparin,
• Kusintha kwazimpso ndi impso.

Ketoacidosis

Nthawi zambiri amakumana pomwe osakwanira makupidwe amtundu wamafuta acids kwa CO₂ ndi madzi, zomwe zimatsogolera pakupanga kwa beta-hydroxybutyric ndi acetoacetic acid. Nthawi zambiri, ketoacidosis imayamba motsutsana ndi maziko a matenda a shuga. Ndikusowa kwa insulin komanso kupangika kwa glucagon, lipolysis imachulukitsa, yomwe imatsogolera kulowa kwa mafuta a asidi am'magazi. Nthawi yomweyo, mapangidwe a matupi a ketone m'chiwindi amawonjezeka (kuchuluka kwa ma ketoni a plasma amapitilira 2 mmol / l). Kudzikundikira kwa ma keto acid m'mwazi kumatsogolera kuti m'malo mwa bicarbonate ndikutukuka kwa metabolic acidosis ndi kusiyana kwa anionic. Makina ofanana amawululidwa ndi nthawi yayitali yanjala. Panthawi imeneyi, ma ketoni amatenga shuga ndi gwero lalikulu lamphamvu mthupi.

Lactic acidosis

Amayamba ndi kuchuluka kwa magazi a lactic acid (lactate) ndi pyruvic acid (pyruvate). Ma acid onsewa amapangika nthawi zonse pamankhwala a glucose metabolism (Krebs mzunguko) ndipo amagwiritsidwa ntchito ndi chiwindi. M'mikhalidwe yomwe imakulitsa glycolysis, mapangidwe a lactate ndi pyruvate amawonjezeka kwambiri. Nthawi zambiri, lactic acidosis imayamba kudabwitsidwa pamene, chifukwa cha kuchepa kwa mpweya m'matupi amtundu wa anaerobic, lactate imapangidwa kuchokera ku pyruvate. Kuzindikira kwa lactate acidosis kumapangidwa mukazindikira kuchuluka kwa lactate m'madzi a m'magazi komanso kupezeka kwa metabolic acidosis yomwe ili ndi kusiyana kwakukulu kwa anionic.

Acidosis ngati poyizoni ndi kuledzera

Mothandizidwa ndi mankhwala osokoneza bongo (acetylsalicylic acid, analgesics) ndi zinthu monga ethylene glycol (gawo la antifreeze), methanol, toluene amathanso kutsogolera kukula kwa metabolic acidosis. Gwero la H + mu izi ndi salicylic ndi oxalic acid (ngati ethylene glycol poyizoni), formaldehyde ndi formic acid (ngati methanol waledzera). Kudzikundikira kwa ma asidi m'thupi kumabweretsa chitukuko cha acidosis komanso kuwonjezeka kwa kusiyana kwa anionic.

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Kulephera mwamphamvu kwaimpso ndipo makamaka kukomoka kwake nthawi zambiri kumayendetsedwa ndi kukula kwa metabolic acidosis. Limagwirira ntchito yopanga matenda ammagazi a asidi mu kulephera kwaimpso ndizovuta komanso zosiyanasiyana. Pamene kukula kwa aimpso kulephera kumawonjezeka

zinthu zoyambirira zomwe zidapangitsa kuti metabolic acidosis itha kutaya pang'ono, ndizinthu zatsopano zomwe zimatsogolera zimaphatikizidwa.

Chifukwa chake, ndi kuperewera kwambiri kwaimpso kwakanthawi, gawo lalikulu pakupanga zovuta zama asidi-kusewera limaseweredwa ndi kuchepa kwa kuchuluka kwa ma asidi chifukwa cha kuchepa kwa chiwerengero cha ma nephrons omwe amagwira ntchito. Kuchotsa kupangika kwapafupipafupi kwa H + komwe kumapangidwira impholeyma ya impso, ammonia sikokwanira, chifukwa zina zomwe asidi sanasamalidwe ndi bicarbonate (amasintha mawonekedwe a impso distal tubular acidosis).

Komabe, pakadali pano kulephera kwa impso, kuphwanya kuthekera kwa impso kuti kubwezeretsanso madzi a bicarbonate kumatha kuchitika, komwe kumayambitsa chitukuko cha kusokonekera kwa asidi-msingi wofanana ndi aimpso distal tubular acidosis.

Ndi kukula kwa aimpso kulephera (GFR pafupifupi 25 ml / min), chinthu chachikulu pakukula kwa acidosis ndikuchedwa kuchepa kwa organic acid anions (sulfates, phosphates), komwe kumapangitsa kukula kwa acidosis ndi AP yayikulu mu odwala.

Hyperkalemia yomwe imayamba ndi ESRD imathandizanso kukulitsa acidosis, yomwe imachulukitsa kuphwanya asidi excretion chifukwa choletsa mapangidwe a ammonium kuchokera ku glutamine.

Ngati odwala omwe akudwala aimpso amayamba kukhala ndi hypoaldosteronism, chomaliza chimathandizira mawonetseredwe onse a acidosis chifukwa kuchepa kwambiri kwa secretion ya H + ndi hyperkalemia.

Chifukwa chake, pakakhala matenda aimpso kulephera konse kosiyanasiyana kwa metabolic acidosis, titha kudziwa: hyperchloremic acidosis yokhala ndi Normokalemia, hyperchloremic acidosis ndi hyperkalemia, acidosis yomwe ikukula kwambiri.

Zovuta za Acidosis

Acidosis imaganiziridwa lero chinthu chofala kwambiri chamakono. Koma kaamba ka kayendedwe kabwino ka thupi lathu, ndikofunikira kuti lizitha kukhalabe ndi chilengedwe komanso acidity munthawi zonse. Popeza acidity yachilendo ndi phindu la pH ndi zizindikiro za 7.35-7.45, acidosis imakhala yachilengedwe momwe acidity imatsika pH 7.35.

Zomwe zimapangidwira acidization wa thupi ndizinthu zina, monga malo oipitsidwa, moyo momwe mumakhala mayendedwe ochepa kwambiri ndipo, inde, zakudya zosayenera. Zonsezi zimayambitsa moyo wopanda pake pamutu wamutu komanso kutopa.

Tsoka ilo, munthu wamakono amadya lero zinthu zotere zomwe zimatsogolera pakupanga kwa acidosis mwa iye. Kuphatikiza apo, ndikulakwitsa kuganiza kuti zakudya za acidic zimayambitsa acidization kapena acidosis m'thupi.Mwambiri, ma acid ndi chotsatira cha kagayidwe kachakudya mthupi nthawi yakusweka ndi kukonza kwa zakudya zomwe zimakhala ndi mafuta, ma hydrocarbons, phosphates, amino acid okhala ndi sulufule. Chifukwa cha kugawanika kwa zinthu zonsezi, ma acid omwe amapangidwa kuchokera ku organic amapangidwa, omwe sangasinthidwe ndi zipatso zamasamba atsopano ndi zipatso zomwe zimalowa m'thupi, komanso chifukwa cha zinthu zamchere zomwe zimapangidwa chifukwa cha kagayidwe.

Kuti mukhale ndi acid komanso alkaline bwino, machitidwe othandizira magazi amafunikira, komanso mapapu ndi impso. Mothandizidwa ndi mapapu, ma acid osasunthika amachotsedwa m'thupi, ndipo osagwirizana ndi impso. Kuphatikiza apo, zakudya zomwe munthu ali nazo, momwe amakhala m'maganizo komanso nthawi yakatsiku zimatha kusokoneza chamoyo. Monga lamulo, theka lachiwiri lausiku limadziwika ndi zochuluka za zotupa za metabolic mu mkodzo, zomwe zimatha kutsimikiziridwa mu kuchuluka kwa peresenti mothandizidwa ndi mayeso a litmus. Ndipo 99% ya ma asidi omwe amapezeka mumkodzo ali omangidwa. Mitundu ya pH yovomerezeka yamkodzo imafanana ndi mfundo kuchokera pa 6.2 mpaka 6.9. Ndipo ngati izi zimatsitsidwa kuchokera ku 4.5 kupita ku 6.0, ndiye kuti izi zikuwonetsa kuti kuchuluka kwazinthu zambiri kumalowa m'thupi zomwe zimayambitsa kupangidwa kwa ma acid m'thupi.

Kuphatikiza apo, zovuta zam'mapapu, impso, kapena kusokonezeka kwakukulu kwa metabolic kungayambitse acidosis. Koma mitundu yambiri yamatenda oyamba imatha kubweretsa latent acidosis, yomwe imakhala ndi zotsatira zoyipa kwakanthawi. Palinso matenda angapo omwe amayambitsa matenda a rheumatic chikhalidwe, zilonda zam'mimba, caries, matupi awo amakhudzidwa, minyewa yotupa yachilengedwe komanso neurosis.

Zizindikiro za Acidosis

Pafupifupi zizindikiro zonse za acidosis munjira yofatsa kapena yapakatikati zimayenderana ndi matenda oyambitsawo. Koma chisonyezo chazindikiritso cha matenda amtunduwu zimadalira kuchuluka kwa kupezeka kwa asidi m'magazi.

Monga lamulo, zizindikiro zazikulu za acidosis zimabisidwa pansi pa zizindikiro za matenda akulu ndipo ndizovuta kuzisiyanitsa. Mwachitsanzo, mtundu wofatsa wa acidosis umakhala ngati asymptomatic kapena nthawi zina kutopa, nseru ndi kusanza zimadziwika. Koma ndi metabolic acidosis yayikulu, hyperpnea imadziwonetsa yokha, yomwe poyamba imadziwika ndi kuya kwamkati kupuma, kenako ndi pafupipafupi (Kussmaul syndrome). Nthawi zina, pali zizindikiro za kuchuluka kwa ECG, kuchepa kwa alkali kudzera m'mimba. Kuphatikiza apo, acidosis yayikulu imayambitsa kukhwimitsa kwa magazi chifukwa chodwala mtima komanso kutsika kwa mtima paziphuphu, ku catecholamines, komanso kuyambitsa kudabwitsika.

Zizindikiro za acidosis motsutsana ndi mawonekedwe amomwe amapumira komanso kuperewera kwa ma asidi m'magazi (acidemia) amawonetsedwa mofooka kuposa metabolic ndi kupuma acidosis. Mwanjira iyi, mtima wodutsitsa umasokonezeka pomwe pH ya magazi ndiyosakwana 7.2. Chiwopsezo cha arrhythmias chimachulukitsidwa kwambiri ndi mtima zomwe zidalipo za pathologies kapena zovuta zina za kagayidwe ka electrolyte. Chifukwa cha acididemia, kuyankha kwamitsempha yamagazi ndi mtima ku ma catecholamine kumachepa, ndipo izi zimayambitsa kutsika kwa magazi pamaso pa hypovolemia kapena mantha.

Ndi acidosis, kupuma kumapangidwira, kukana insulini kumayamba, mapuloteni amawonjezereka, ndipo kapangidwe ka ATP koletsedwa. Ndi mawonekedwe owopsa a mkhalidwe wamtunduwu, ma metabolic mu ubongo amasokonezeka, omwe amachititsa kugona kosalekeza komanso chikomokere.

Njira yovuta kwambiri ya metabolic acidosis imawonetsedwa ndi matenda am'mimba kapena magazi osakwanira kwa zimakhala. Nthawi zambiri, izi zimadziwika ndi lactic acidosis, yomwe ndi yosavuta kuyipeza mwa kupimidwa thupi. Kuchepa kwa magazi kwa magazi kumaphatikizapo kuchepa kwa madzi m'thupi, kuchepa magazi, mantha, kapena matenda amtima. Chizindikiro chakhazikika cha metabolic acidosis mwa mwana, kuphatikiza ndi osakwanira aimpso, ikhoza kukhala kukula kwake pang'onopang'ono. Kukhazikika kwa pang'onopang'ono kwa polyuria kumawonetsa kukhalapo kwa matenda ashuga a ketoacidosis komanso matenda ashuga omwe kale sanawadziwe. Kubadwa kwa metabolic njira kagayidwe kachakudya kumawonetsedwa ndi kupweteka kapena choletsa china chake.

Hepatomegaly ndi metabolic acidosis imayang'aniridwa motsutsana ndi maziko a kulephera kwa chiwindi, kukhala ndi vuto la mtima, sepsis.

Zizindikiro zasayansi yokhala ndi ma electrolyte, glucose, urea nayitrogeni m'mwazi, ndi mkodzo.

Ndi njala kapena kuperewera kwa zakudya m'thupi, ketosis ndi gastroenteritis imayamba. Kuphatikiza apo, ndi kulephera kwa aimpso, nthawi yayitali komanso yachilendo imaphatikizidwa.

Acidosis ndi alkalosis

Njira zambiri zamatenda zomwe zimachitika mthupi zimatha kusokoneza ma acid komanso maziko ake mkati mwake, zimapangitsa acidosis (acidization) ndi alkalosis (alkalization).

Ndi acidosis yolipiridwa ndi alkalosis, kusintha kwamphamvu kwambiri kwa carbonic acid ndi sodium bicarbonate kumachitika, koma kuchuluka kwake kumakhalabe kwabwinobwino 1:20.

Acidosis ndi alkalosis ya zinthu zowonongeka ndi mikhalidwe yomwe masinthidwe amachitika osati mu kuchuluka kwa zidulo ndi ma alkali, komanso kusintha kosungirako kumeneku kumayambira ma acid kapena kumunsi.

Zizindikiro za kupuma, mosiyana ndi vuto losapuma, ndizovuta m'magazi a kaboni dayokisi komanso masamba oyambira.

Njira yopanda kupuma ya acidosis imakhazikika mthupi chifukwa chodzikundikira zinthu zingapo za metabolic zomwe sizinapitirire oxidation. Izi zikuphatikiza lactic acid, acetoacetic ndi hydroxybutyric. Kuchuluka kwa matupi a ketone kumachitika glycogen itakhala yochepa m'chiwindi chifukwa cha kuwonongeka kwamafuta kwambiri, motsutsana ndi mbiri yakufa kwa mpweya, ndipo kusintha kwa tricarboxylic acid kumasokonekera. Kuphatikiza apo, zochitika zosiyanasiyana za m'magazi zimangowonjezera kuchuluka kwa matupi a ketone kangapo, ngakhale kuchuluka kwake kumatsitsidwa ndi impso mu mawonekedwe a mchere wa sodium ndi potaziyamu. Ndipo izi zimachitika chifukwa cha kutayika kwa ma alkalis ambiri ndi kukhazikika kwa acidosis yowonongeka.

Fomu yochepa ya acidosis imachitika chifukwa chochita zolimbitsa thupi kwambiri chifukwa cha kupangika kwa lactic acid. Izi zitha kuwonetsedwa m'matenda a mtima ndi mapapu motsutsana ndi njala ya oxygen. Koma ndi mkhutu wa impso kuwonongeka kwa ma organic amines, sulfates, phosphates, metabolic acidosis kapena excretory akhoza kupanga. Monga lamulo, ambiri aimpso a pathologies amayenda limodzi ndi ma syndromes ofanana.

Ndi matenda otsekula m'mimba, gawo lalikulu la alkali limatayika, ndikutsatira kwa metabolic acidosis, kapena madzi am'mimba a alkaline amatulutsidwa kudzera mu enterostomy. Zotsatira za acidosis iyi, njira zowonjezera-kuphatikizira zimaphatikizidwa zomwe zimayesetsa kusunga acid ndi alkaline homeostasis.

Kulipira kusintha kwa pH ya magazi omwe amapezeka m'thupi, kulowa mwachangu mu ntchito zamapangidwe omwe amathandizira kuchepa kwa asidi ochulukirapo ndi zakumwa kunja kwa maselo ndi khalidwe. Nthawi yomweyo, amalumikizana ndi ma alkali a ma buffer omwe amapanga maselo ndi zakumwa zoposa iwo. Zotsatira zake, alkalosis imachepa, ndipo acidosis imachuluka.

Hyperkalemia imadziwika kuti ndi chizindikiro chofunikira cha acidosis. Kuchuluka kwa ma hydrogen ion kumagawidwa pang'ono m'mafupa, pomwe amasinthanitsidwa ndi zigawo za gawo la mafupa. Pambuyo pake, sodium ndi calcium zimalowa m'magazi kuchokera m'mafupa, motero, motsutsana ndi maziko a metabolic acidosis wa nthawi yayitali, akufewetsa, i.e. decalcification, mafupa. Izi zimawonjezera ndende ya calcium, sodium ndi potaziyamu m'madzi a m'magazi.

Kuphatikiza apo, metabolic acidosis imadziwika ndi kulowa kwa capillaries ndi mitsempha yambiri ya asidi komanso kuchepa kwa mpweya wa kaboni. Komabe, pulogalamu yamphamvu ya kabati yamphamvu imathandizira kuchepetsa mapangidwe a carbonic acid kuchokera ku asidi. Ndiosakhazikika ndipo madzi ndi kaboni dayokisi amapangidwa mwachangu kuchokera pamenepo. Chifukwa chake, dongosolo la m'magazi limayamba kugwira ntchito. Zotsatira zake, kupuma kumakhala kosangalatsa, hyperventilation imayamba m'mapapu, ndipo mpweya wambiri umatuluka m'magazi mpaka kubalanso pakati pa carbonic acid ndi sodium bicarbonate kubwezeretsedwa. Nthawi yomweyo, hyperchloremia ndi hypernatremia zimapitilira.

Pothetsa kupuma kwamkati, kupezeka kwa kaboni dayokisa m'thupi kumadziwika ndipo acidosis ndi mawonekedwe osalipiridwa.

Impso pakufunsira acidosis zimagwira ntchito yofunikira, popeza bicarbonate yaying'ono imapangidwa ndikusefa mkati mwake, ndipo iwo omwe adutsa kusefera amaponderezedwanso. Koma nthawi yomweyo, acidity mu mkodzo imachulukanso chifukwa cha zinthu zofunika za asidi okomeramo. Ambiri mwaiwo ndi ma organic acids aulere.

Acidosis ndi alkalosis zimatha kuyambitsa matenda osiyanasiyana amthupi. Izi zikuwonetsedwa ndi kupuma kwapafupipafupi, kutsika kwakuya kwamitsempha yamagalasi, kuphwanya mphamvu ya kama wamankhwala mokhudzana ndi kuthamanga kwa magazi, ndi kuchepa kwa mtima ndi kutulutsa kwa mtima. Zotsatira zake, kufalikira kwa magazi mu impso kumachepa, ndipo njira zochitira kusefa ndi kubwezeretsedwazo zimasokonekera. Monga lamulo, zinthu za m'magazi zimayambitsa kusintha mu ntchito yamadzi ndi electrolyte equilibrium.

Chifukwa cha njira zazitali za acidosis ndi alkalosis, mafupawo amakhala ofewa, ndipo decalcification amapangidwa. Nthawi yomweyo, kuchuluka kwa potaziyamu kumachepera minofu yam'minyewa ya myocardium, ndipo zomwe cation zomwe zili mu plasma zimachulukana. Njira zonsezi zimakhala zomwe zimapangitsa kuti pakhale mtima wa mtima. Zotsatira zake, myocardium imayamba kumva zolakwika ndi adrenaline, zomwe zimapangitsa kuti khungu lipangidwe. Komanso, mitundu yosiyanasiyana ya arrhythmias imapangidwa, zizindikiro za ECG zimasintha, ndikuchepetsa mphamvu ya contractile ya minofu ya mtima imadziwika. Koma kuphwanya koyenera kwa ma electrolyte kumabweretsa zolepheretsa chisangalalo cha mitsempha ndi minofu. Kuphatikiza apo, kuchuluka kwachulukidwe ka osmotic kunja kwa maselo kumabweretsa minofu ya edema ndi kuchepa kwa madzi m'thupi.

Ndi mpweya acidosis, kaboni dioksidijeni imadziunjikira m'magazi chifukwa cha kuwonongeka kwa mpweya, pulmonary edema, chibayo, hypoventilation, craniocerebral trauma, intracranial hypertension, hemorrhage, ndi mpweya wambiri m'chilengedwe momwe munthuyo alimo.

Lactic Acidosis

Awa ndi mkhalidwe wamavuto womwe kuchuluka kwakukulu kwa lactic acid kumadziunjikira m'magazi. Lactic acidosis imadziwika ndi mitundu iwiri yayikulu: mtundu (A) ndi mtundu (B). Ndi mtundu woyamba, anoxia yodziwikiratu yam'mimba imachitika, ndipo ndi mtundu (B) mawonekedwe awa samawonedwa.

A mawonekedwe a D-lactic acidosis amadziwika mwa iwo omwe ali ndi anatomical kapena ntchito kufupikitsa matumbo ang'ono. Potengera kapangidwe ka michere ndi mabakiteriya, lactic acid imapangidwa, yomwe imapangitsa kuwonjezeka kwa acidosis yokhudzana ndi kusiyana kwa anyezi, komanso chikomokere kapena stupor. Nthawi yomweyo, lactate imakhalabe yachilendo.

Lactic acidosis mtundu (A) ndiwofala kwambiri kuposa ena, chifukwa cha mitundu yosiyanasiyana ya mantha. Maziko a pathogenesis a lactic acidosis ndi kupangika kwa minofu, kutsekemera kwotsatira, komanso kudzikundikira kwa hydrogen ndi lactate ion. Kuchuluka kwa kuyeretsa kwa chiwindi kuchokera ku lactate kumachepetsa chifukwa chakuti kuphatikizika kwa celiac artery ndi hepatic artery kumachepa, ndipo ischemia wa hepatocellular chiyambi imayambanso. Pa pH yotsika kapena mtengo wa 7.0, impso ndi chiwindi zimatha kutulutsa lactate. Kuchiza wodwala yemwe ali ndi lactic acidosis kumakhala ndi kukonza zomwe zimayambitsa kukhumudwa, popeza pali ubale wapakati pakati pa lactate yayikulu yamagazi ndi kufa.

Kuphatikiza apo, hypoxia yacute komanso yowopsa imatha kupangitsa kupangika kwa lactic acidosis yamtunduwu, yomwe imachitika ndi asphyxiation, pulmonary edema, mkhalidwe wa mphumu, kutulutsa kwambiri kwa matenda am'mapapo komanso kusungidwa ndi carboxyhemoglobin, methemoglobin, hem hemoglobin.

Lactic acidosis mtundu (B) umayamba mwadzidzidzi, pakapita maola angapo. Zinthu zomwe zingayambitse kukula kwa matendawa sizikumveka bwino. Amaganiza kuti mapangidwe a lactic acidosis amtunduwu amasonkhezeredwa ndi machitidwe a subclinical dera kuphwanya minofu mafuta. Nthawi zambiri, mawonekedwe oopsa amtunduwu amachititsa kuti magazi aziyenda bwino, zomwe zimapangitsa kuti zikhale zovuta kudziwa komanso zosiyana ndi mtundu wa A (A). Kuphatikiza apo, mtundu (B) lactic acidosis amadziwika ndi ma subtypes atatu.

Poyambirira, mtundu uwu wa acidosis umachitika chifukwa cha matenda ashuga, impso ndi chiwindi, matenda, mthupi, komanso neoplasia. Kusokonezeka kwa chiwindi kuphatikiza ndi lactic acidosis kumayambitsa necrosis yayikulu ndi cirrhosis. Nthawi zambiri, kulephera kwaimpso mu mawonekedwe osakanikirana ndi matenda kumayendera limodzi ndi acidosis, ngakhale palibe ubale wapakati pakati pawo. Kuphatikiza apo, bacteremia, leukemia, matenda a Hodgkin, matenda otchedwa lymphoma, myeloma, khunyu angayambitse kupezeka kwa lactic acidosis.

Subtype yachiwiri imadziwika ndi kupezeka kwa poizoni, mankhwala ophera tizilombo komanso mankhwala chifukwa chodziwonetsa. Potere, mulingo wa lactate m'magazi umachuluka kwambiri.

Mtundu wachitatu wa lactic acidosis ndi wosowa kwambiri ndipo umayambitsidwa ndi glycogenosis wa mtundu woyamba ndi kuchepa kwa hepatic fructose bisphosphatase.

Chithandizo cha Acidosis

Ndi acidosis, palibe chithunzi chotchulidwa makamaka. Kufunika kwakukonzanso kwake kukugona pakapangidwe ka mafupa, chifukwa cha kuchepetsedwa kosalekeza kwa ma hydrogen ions komanso kukula kwa hyperkalemia.

Ndi acidosis yolimbitsa, kudya zakudya zamapuloteni ndizochepa, zomwe zimathandiza kuchepetsa acidosis. Chithandizo cha mankhwala osokoneza bongo chimaphatikizapo kugwiritsa ntchito sodium bicarbonate mkati, ndi mitundu yayikulu yamayendedwe - kayendetsedwe ka magazi. Pankhaniyi ngati pakufunika kuchepetsa kuchuluka kwa sodium komanso kumbuyo kwa hypocalcemia, calcium carbonate ndi mankhwala.

Koma, kwenikweni, acidosis imakhala ndi chithandizo chovuta, kuphatikiza kuthetseratu zinthu za m'maganizo, kuchepa magazi, hypoproteinemia, kukonza njira zopumira, zovuta zamagetsi, hypovolemia, oxidation njira mu minofu, etc. Pambuyo pake, njira zamchere zimagwiritsidwa ntchito poika.

Cocarboxylase, sodium bicarbonate, glutamic acid, nicotinic acid ndi riboflavin mononucleotide amalembera mankhwalawa metabolic acidosis a subcompensated source. Munjira zopweteka kwambiri zam'mimba, mumagwiritsidwa ntchito mchere womwe umapangidwanso mchere, womwe umaphatikizapo sodium bicarbonate. Komanso, kukonza izi, Dimephosphon amagwiritsidwa ntchito, omwe amagwiritsidwa ntchito pamaso pa bronchi ndi mapapu, ricches ndi matenda osokoneza bongo. Komabe, mankhwalawa amatha kuyambitsa matenda a dyspeptic.

Mankhwalawa kwambiri metabolic acidosis osachiritsika chiyambi, kulowetsedwa alkalizing ntchito mu mawonekedwe a yankho la sodium bicarbonate, mtima ndi Astrup. Ndipo pakudya zochepa za sodium, Trisamine ndi mankhwala, omwe amawerengedwa kuti ndi abwino okodzetsa, omwe amachepetsa index ya pCO2. Monga lamulo, imagwiritsidwa ntchito pa pH yamagazi ya 7.0. Koma pochiza makanda ndi makanda obadwa masiku asanakwane, ndikofunikira kuti musagwiritse ntchito, chifukwa zimayambitsa kupuma, kuchuluka kwa alkali mu maselo ndikuwakwiyitsa hypoglycemia ndi hypokalemia.

Zochizira lactic acidosis, mankhwala Dichloroacetate, omwe amachititsa kuti michere yambiri, komanso Carnitine ndi Lipoic acid, agwiritsidwe ntchito kwambiri.

Ndi kuyambitsa kwa mankhwala omwe ali ndi anti-acidotic katundu, kuwunika kuyanjana pakati pa asidi ndi alkali ndikofunikira ndipo ionogram imatsimikiziridwa nthawi yomweyo.
Komanso, mankhwalawa acidosis, wodwalayo ayenera kutsatira zakudya zoyenera komanso zoyenera. Kuphatikiza apo, ndikofunikira kusiya kumwa mowa ndi khofi, komwe kumatha m'malo mwa timadziti tachilengedwe, ma compotes, zipatso ndi mabulosi decoctions. Pasitala, mikate yoyera, mafuta azinyama kuyereketsa zipatso, zipatso, masamba abwino, mafuta azomera. Nthawi zina, pofuna kupewa kukula kwa acidosis, amatenga mpunga, womwe umachotsa poizoni, zinyalala ndi zinthu zina zoyipa mthupi.

Kodi chiwopsezo cha acidosis ndi chiyani?

Ichi ndi vuto lalikulu lomwe limatha kuchitika chifukwa cha matenda opatsirana, kumbuyo kwa matenda ashuga, chiwindi, impso ndi zina. Acid acidization imayambitsa zovuta zingapo pakugwira ntchito kwa ziwalo ndi minofu, momwe zina zowopsa ndizo:

• Kugonjetsedwa kwa maselo mthupi lonse. Chiwongola dzanja chachikulu cha asidi chimasokoneza chipolopolo chakunja cha maselo, zomwe zimayambitsa kusokonezeka kwa ntchito zawo. Popeza poizoni amafalikira ku ziwalo zonse ndi matupi athu, kusintha kwa m'magazi kumatha kukhala kosiyanasiyana,
• Matenda opatsirana Mpweya wa okosijeni m'thupi ndi alkali mu gawo lake la mankhwala. Chifukwa chake, odwala amadziwika ndi kupuma pafupipafupi - Umu ndi momwe thupi limayesera kuchepetsa acidity. Tsoka ilo, njirayi imayambitsa kuchepa kwamitsempha yodwala komanso kuwonjezeka kwa magazi. Zotsatira zake, mkhalidwe wa munthu umangokulira ndikukulitsa chiwopsezo cha zotupa mu ziwalo zosiyanasiyana,
• Kuthamanga kwa magazi. Limagwirira zadzidzidzi zimagwirizanitsidwa ndi kukhalapo kwa vuto la kupuma,
• Zowonongeka m'mimba. Mwa odwala ambiri, pachimake metabolic acidosis imayambitsa kupweteka kwam'mimba, kusokonezeka kwa chimbudzi ndi zina zomwe zimakhala ndi dyspeptic. Ndi kuphwanya kumeneku, zinthu zankhanza monga acetone ndi hydroxybutyric acid nthawi zambiri zimapangidwa, zomwe zimakhazikitsa mucous membrane wam'mimba, esophagus ndi matumbo. Nthawi zina, odwala amataya magazi kuchokera ku ziwalozi.
• Kuponderezedwa kwa chikumbumtima. Zoopsa zomwe zimapangidwa ndi thupi zimakhudza mitsempha ndi medulla. Ndi njira yofatsa, wodwalayo amatha kukwiya, kufooka, kugona, komanso kuvulala kwambiri.
• Kusokoneza mtima. Kuwonongeka kwa maselo ndi minyewa ya m'mitsempha, kusalinganika kwa zinthu zomwe zimachitika komanso zinthu zina zingapo zimakhudza myocardium. Mu magawo oyamba, izi zimatha kuwonetsedwa ndi kugunda kawirikawiri komanso kolimba mtima, kusokonezeka kwa maonekedwe. Ndi matenda oopsa a pathology, mapikidwe a mtima amachepa ndikuchepa. Gawo lomaliza ndikumangidwa kwamtima.

Zophwanya zonsezi sizingangokulitsa thanzi, komanso zimatha kukhala pachiwopsezo cha moyo. Ichi ndichifukwa chake zizindikiro zoyambirira za matendawa ziyenera kupezeka ndi kuthandizidwa mwachangu.

Mitundu ya Metabolic Acidosis

Kuzindikira mtundu wina wa matenda ndizofunikira kwambiri - izi sizimalola kuti mudziwe zomwe zimayambitsa kukula kwake, komanso kudziwa njira zabwino zachipatala. Pakadali pano, madokotala amagwiritsa ntchito magulu awiri omwe amathandizira kuti adziwe matenda.

Yoyamba ikugwirizana ndi matenda ashuga. Ndikofunikira kudziwa ngati wodwala ali ndi matendawa asanayambe chithandizo, popeza metabolic acidosis mu shuga ali ndi mawonekedwe ake. Chithandizo chake chimaphatikizapo kukonza shuga (shuga). Popanda izi, njira zina zamankhwala zilizonse sizingathandize.

Chitsimikizo cha gulu lachiwiri ndi mtundu wa poyizoni wa thupi. Ma acids osiyanasiyana amatha kuchuluka m'magazi a anthu, oopsa kwambiri omwe ndi lactic acid ndi matupi a ketone (acetone, butyric acids). Kutengera zomwe "acidifying" zimatulutsa:

1. Ketoacidosis. M'magazi a wodwala, kupezeka kwa hydroxybutyric acid ndi acetone kumadziwika. Imakonda kumera motsutsana ndi matenda ashuga, komanso imathanso kumatenda ena.
2. Lactic acidosis. Zimaphatikizidwa ndi kuwonjezeka kwa ndende ya lactic acid. Itha kuchitika ndi matenda ambiri, kuphatikiza chifukwa cha kusayenda bwino kwa chiwindi kapena impso, kukulira matenda opatsirana kwambiri, poyizoni, etc.
3. Mtundu wophatikizika. Nthawi zambiri amapezeka mwa anthu omwe ali ndi shuga ambiri komanso pali zinthu zotsutsa. Izi zitha kuphatikizira kupsinjika kwakukulu, kuchuluka kwa thupi, matenda opatsirana, ndi zina zina.

Zomwe zimayambitsa mitundu yosiyanasiyana ndizosiyana. Afunika kudziwika kuti afotokozere mwachangu mtundu wamatendawa ndikuwachitira bwino metabolic acidosis.

Monga tafotokozera pamwambapa, matendawa samangochitika okha. Izi zimachitika nthawi zonse chifukwa cha matenda enanso, omwe amachititsa kuti matenda a metabolic asokonezeke komanso kuchuluka kwa poizoni. Zimayambitsa ndi zomwe zimayambitsa metabolic acidosis zimasiyana siyana. Zambiri zofunikira pankhaniyi zafotokozedwa pansipa.

Mlingo wina wa lactic acid umapangidwa nthawi zonse mthupi lathanzi. Kuwonjezeka kwakukulu kwa kuchuluka kwake kumatha kuchitika ngati kuphwanya mawonekedwe ake (mwachitsanzo, kuwonongeka kwa impso), kusokonezeka kwa metabolic kapena kuperewera kwa oxygen kosakwanira kwa zimakhala.

Vutoli limatha kuchitika chifukwa cha kuwonongeka kwa ma cell anyamula ma oxygen (maselo ofiira am'magazi) kapena chifukwa cha zovuta zina zobadwa nazo.

Madokotala ena amaphatikizanso mawonekedwe a hyperchloremic, omwe amapezeka molumikizana ndi lactic acidosis. Komabe, malinga ndi chidziwitso chochokera m'magazini azasayansi amakono, zovuta za chlorine metabolism sizofunikira kwenikweni. Sichikukhudza machitidwe a mankhwalawa, kotero sanapatsidwe mwanjira ina.

Mkhalidwewu ulibe zizindikilo zilizonse. Kusintha kwa acidity kumayendetsedwa ndi kuchuluka kwa zizindikiro zosiyanasiyana, zomwe zimakhala zovuta kuzolana. Ichi ndichifukwa chake zimakhala zovuta kudziwa matenda kunyumba.

Mawonekedwe wamba omwe amawonekera ndi mtundu uliwonse wa matendawa ndi monga:

• Nthawi zambiri mseru ndi kusanza, pambuyo pake palibe kusintha kwa thanzi,
• Zofooka zakuthwa zomwe zimakakamiza wodwala kuti azigona,
• Maonekedwe a dyspnea pakupuma. Munthu sangathe "kupuma", chifukwa chake kupuma kwake kumachitika pafupipafupi,
• Khungu la pakhungu ndi ma mucous nembanemba (maso, pakamwa ndi m'mphuno),
• Maonekedwe a thukuta lozizira pakhungu,
• Kuchepetsa kutentha kwa mtima ndikuchepetsa kuthamanga kwa magazi,
• Mwinanso kukulitsa khunyu, chizungulire chachikulu ndi kutaya chikumbumtima (mpaka chikomokere).

Monga tanenera, kusintha kwa acidity sikuchitika zokha. Matendawa nthawi zonse amatsogozedwa ndi matenda ena. M'mawu osavuta, tinganene kuti kuwonongeka kwakuthwa chifukwa cha matenda chifukwa cha matenda nthawi zambiri kumakhala chizindikiro choyamba. Pankhaniyi, ndikofunikira kuyitanitsa gulu la ambulansi, lomwe lidzayesetse vutoli ndipo ngati kuli koyenera, gonekerani kuchipatala. Ku chipatala, madokotala akhazikitsa matenda omaliza, ndikupanga maphunziro ofunikira komanso njira zochizira.

Kuyesa Kwa Magazi a Acid Alkaline

Njira yosavuta kwambiri komanso yodalirika yotsimikizira kupezeka kwa metabolic acidosis ndikuwunikira. Izi sizitengera kukonzekera kwapadera kuchokera kwa wodwala. Pakufunika, wodwalayo amatenga magazi kuchokera m'mitsempha, yomwe imatumizidwa ku labotale. Monga lamulo, zotsatira zomalizidwa zitha kupezeka patangopita maola ochepa.

Kuti mumvetsetse zotsatira, muyenera kudziwa tanthauzo la zomwe zikuwonetsa komanso kupatuka kwawo ku matendawa. Izi zikuwonetsedwa pansipa:

Pa pH ya 7.35-7.38 ndi kukhalapo kwa zizindikiritso, kulipidwa kwa metabolic acidosis kumapezeka.

A pH yochepera 7.35 akuwonetsa chitukuko cha decompensated acidosis.

Kusanthula uku ndikokwanira kutsimikizira kukhalapo kwa matenda. Komabe, kuti tifotokozere momwe zimakhalira komanso zomwe zimayambitsa chitukuko, maphunziro owonjezera angapo amafunikira.

Kudziwitsa za mtundu wa matenda

Pachifukwa ichi, madokotala amamuwuza kuti ayesere mkodzo pafupipafupi komanso kuyezetsa magazi osiyanasiyana, zomwe zimaphatikizapo kudziwa kuchuluka kwa shuga ndi lactic acid. Izi ziwiri zimakupatsani mwayi wodziwikitsa mtundu wa kusokonezeka kwa asidi-acid.

Kudziwitsa zomwe zimayambitsa

Kuti adziwe zifukwa, madokotala amatha kuyambitsa maphunziro ambiri, kutengera zomwe akuganiza. Komabe, pali ziyeso zomwe ziyenera kuchitidwa ndi odwala onse omwe ali ndi matendawa. Amakulolani kuti muwunikire zomwe ziwalo zazikulu ndi machitidwe ndi mtengo wotsika kwambiri. "Kuzindikira kocheperako" kumaphatikizapo:

ESR - mpaka 15 mm / ola

Kuwerenga kwa maselo oyera magazi 4-9 * 10 9 / lita. Kuphatikiza:

• Neutrophils 2.5-5.6 * 10 9 / lita (46-72%)
• Lymphocyte 1.2-3.1 * 10 9 / lita (17-36%)
• Monocytes 0.08-0.6 * 10 9 / lita (3-11%).

Ma cell am'magazi (ma cell oyera (maselo oyera)

Mapuloteni - ochepera 0,03 g / l,

Glucose kulibe.

Mapuloteni onse 65-87 g / l

Total bilirubin 4.9-17.1 μmol / l,

Creatinine 60-110 μmol / L.

Kuwonjezeka kwa kuchuluka kwa bilirubin ndi michere ya chiwindi (ALT, AST) nthawi zambiri kumawonetsa kuwonongeka kwa chiwindi.

Owonjezera creatinine, monga lamulo, ndi chizindikiro cha matenda oopsa a impso kapena kukula kwa matenda a impso (mwachidule - CKD).

Kutsika kwamapuloteni athunthu komanso kuwonjezeka pang'ono kwa zisonyezo zina kungakhale chizindikiro cha matenda osachiritsika a chiwindi, monga matenda a chiwindi kapena matenda oopsa a hepatitis.

Kuchulukitsidwa kwamapuloteni ambiri ndi chizindikiro cha myeloma.

Kuphatikiza pa njira zamtunduwu zowerengera, madokotala atha kulimbikitsa ma ultrasound, kulingalira kwa maginito kapena kuyerekezera kotengera, kusimba kwa ziwalo za munthu payekha komanso njira zina zingapo. Lingaliro pazofunikira zofufuzira zimatsimikiziridwa payekhapayekha, kutengera zomwe zimayambitsa kutsika kwa acidity.

Mfundo zachithandizo

Kuwongolera metabolic acidosis ndi ntchito yovuta ngakhale kwa dokotala wodziwa ntchito. Wodwala aliyense wokayikira matenda amatengedwa kupita kuchipatala, chifukwa amafunika kuwunika pafupipafupi, kulowetsedwa pafupipafupi kwa mayankho, komanso nthawi ndi nthawi maphunziro osiyanasiyana.

Zolinga zonse zamankhwala zimatha kugawidwa m'magulu awiri - kubwezeretsanso kwa acidity yachilendo ndikuchotsa zomwe zimayambitsa matenda.

PH kuchira

Choyamba, madokotala akuyesera kuti adziwe kuti ndi matenda ati omwe adatsogolera kukula kwa matenda. Ngati ndi matenda ashuga, nthawi yomweyo amayamba mankhwala kuti achepetse shuga ndi insulin komanso mankhwala ena. Ndi kukula kwa matenda oopsa, chithandizo chokwanira chimachitika pogwiritsa ntchito antibacterial / antiviral mankhwala. Ngati kuchepa kwa pH kudadzetsa chiwalo chachikulu, dotolo yemwe akupezekapo amayesa kubwezeretsa ntchito yake kapena kuyikanso m'malo mwa mankhwala ndi zida zothandizira (mwachitsanzo, hemodialysis).

Imodzi ndi njira zomwe tatchulazi, kulowetsedwa kwa mankhwala ndikofunikira - kukoka kulowetsedwa kwamitsempha. Kusankhidwa kwa yankho kumachitika malinga ndi mtundu:

Mankhwala abwino kwambiri amachiritsidwe (pakakhala kuti pali ma contraindication) ndi njira ya 2040% ya shuga.

Kuphatikiza apo, ndizotheka kugwiritsa ntchito Reosorbilact ndi Xylate, zomwe zimachotsa bwino ma acetone ndi ma butyric acid m'magazi.

Kulowetsedwa kwa ana kumachitika mogwirizana ndi mfundo zomwezo monga akulu. Chofunikira ndicho kudziwa molondola zomwe zimayambitsa matendawa. Kusiyana kokhako ndi kuchuluka kwa kulowetsedwa kwa magazi - mwana amafunikira madzi ochepa. Madokotala amawerengera kuchuluka kwake kofunika potengera thupi.

Zokhudza chithandizo cha mitundu iliyonse

Popeza maupangidwe osiyana siyana amagwiritsa ntchito mitundu iliyonse, zina mwazithandizo zawo zimasiyana. Mu gawo lino, tikupereka mfundo zofunika kwambiri zomwe ziyenera kutsatiridwa popereka mankhwala:

1. Ndi lactic acidosis, kuwonjezera pa kulowetsedwa, mavitamini a B (thiamine, pyridoxine, cyanocobalamin) ayenera kuyikidwa maola 12 aliwonse. Zinthu izi zimapukusa kagayidwe ndipo zimathandizira acidity. Pothana ndi kusowa kwa mpweya, odwala amapumidwa ndi mpweya wambiri kudzera mumkati wamkati kapena m'mphuno. Mu acidosis yayikulu, pamene kuchuluka kwa lactic acid kukwera nthawi 4-5, madokotala amatha "kuyeretsa" magazi - hemodialysis,
2. Ndi ketoacidosis yopanda matenda a shuga, kuwonjezera pamankhwala ambiri, tikulimbikitsidwa kupereka mankhwala omwe amabwezeretsa dongosolo la m'mimba (Domperidone, Metoclopramide). Izi zimachepetsa kuchepa kwa madzimadzi ndi kusanza ndikuthandizira kugaya chakudya. Thanzi liyenera kuchitika kudzera mkamwa (pogwiritsa ntchito chubu cham'mimba kapena mafupipafupi). Iyenera kukhala ndi kalori yayitali, yamafuta m'matumbo komanso mafuta ochepa. Komanso, odwala amawonetsedwa ndi mavitamini,
3. Mu matenda a shuga a ketoacidosis, njira yayikulu yothandizira ndikukhazikitsa insulin. Kuchepetsa kuchuluka kwa shuga ndi infravenous infusions njira zabwino kwambiri zochizira. Pambuyo pochita izi, nthawi zambiri, pH imabwezeretseka pamakhalidwe abwino ndipo wodwalayo akumva bwino.

Kuchiza mwana kumachitika molingana ndi mfundo zomwezo monga chithandizo cha wodwala wamkulu. Komabe, ziyenera kukumbukiridwa kuti ana ndi ovuta kwambiri kulekerera matenda aliwonse, makamaka omwe amatsagana ndi kusintha kwa acidity. Chifukwa chake, kugonekedwa kwakanthawi kuchipatala komanso chithandizo chamankhwala moyenera ndikofunikira kwambiri kwa iwo.

Mafunso Ofunsidwa Kawirikawiri

Zimatengera zomwe zimayambitsa matendawa. Ngati wodwala ali ndi matenda ashuga, amamuika patebulo popanda chakudya chamafuta ochepa komanso chakudya chama protein ambiri. Ndi mulingo wochepa wa glucose (motsutsana ndi kumbuyo kwa ketoacidosis wopanda matenda a shuga), m'malo mwake, chakudya chamafuta chimayenera kukhala gawo lalikulu la chakudya kuti athe kulipira kuchepa kwa mphamvu.

Zimatengera kuuma kwa matendawo komanso momwe wodwalayo alili. Kutalika kochepa kwa chithandizo, nthawi zambiri, ndi masabata awiri.

Muzochitika zambiri, izi zimachitika ndi ma intrauterine pathologies omwe amachititsa kuti mwana afe ndi mpweya wa okosijeni ndikusokoneza kayendedwe ka michere kudzera mu placenta. Zomwe zimayambitsa zimatha kukhala zisanachitike nthawi zambiri, kukhala ndi pakati, kubereka musanabadwe, zovuta zamtundu wa umbilical, etc. Pankhaniyi, zonse ketoacidosis komanso kuchulukana kwa lactate kumatha kuchitika. Chithandizo cha ana otere chimachitika molingana ndi mfundo zomwe tafotokozazi.

Kutsika kwa magazi pH kokha kumatha kuwononga kwambiri ubongo, mtima, kapena impso. Tiyeneranso kukumbukiranso kuti matenda omwe adayambitsa amatha kupweteketsa ziwalo zina.

Mwa zizindikiritso, ziwiri ziyenera kudziwika: mawonekedwe a kununkhira kwa acetone ndi kukula kwa chikumbumtima. Kuwoneka kwa fungo linalake kuchokera pakhungu la wodwalayo kumangokhala ketoacidosis, pomwe wodwala wophwanya metabolism ya lactic amamva fungo labwinobwino. Pofika nthawi ya chikomokere, munthu amathanso kunena mtundu wina wa matendawa - ndi lactic acidosis, nthawi zambiri, matenda amisala amachitika msanga (patangopita maola ochepa). Mukadwala wodwala wokhala ndi matupi ambiri a ketone m'magazi, kuzindikira kungapitirire kwa maola 12-20.

Mitundu ya Acidosis

Pali metabolic acidosis yokhala ndi anionic yayitali komanso yabwinobwino.

Anionic imeneyi - kusiyana pakati pa kuchuluka kwa ma seramu a Na + (sodium ions) ndi kuchuluka kwa kuchuluka kwa Cl - (chlorine ions) ndi HCO₃ - (bicarbonate kapena bicarbonate ion), motero zimatsimikiza ndi formula Na + - (Cl - + HCO₃ -). Ichi ndi chofunikira chodziwunikira kuti muthandizire kudziwa mtundu wa acidosis, ndi mikhalidwe yomwe idawatsogolera, mwachitsanzo, poyizoni woopsa.

Zinthu za metabolic acidosis mwa ana

Metabolic acidosis ndi njira yodziwika bwino yophunzitsira ana. Pachimake kwambiri metabolic acidosis yonse ili ndi zomwe zimayambitsa komanso kuwonetsa monga akulu, ndipo kuperewera kwamatenda kumabweretsa kukula ndikukula kwakukulu.

Milandu yambiri ya metabolic acidosis yomwe madokotala amakumana nayo ndi yokhudzana ndi lactic acidosis yomwe imayambitsidwa chifukwa chododometsa pamavuto osiyanasiyana a etiology.

Zotsatira ndi zovuta

Vuto la metabolic acidosis likhoza kukhala:

• kusowa kwamadzi
• kutsika kwa magazi pamagazi,
• kuchuluka kwa magazi, kuphatikizidwa ndi chiopsezo cha thrombosis,
• zovuta zamagazi (kuphatikiza zazikulu monga kupunduka kwamatumbo, kugunda kwam'mimba, kugunda kwam'mimba, striposis, stroko),
• ochepa hypo- ndi matenda oopsa,
• ubongo owonongeka,
• chikomokere
• zotsatira zakupha.

Tikukupatsani kuti muwone kanema pamutu wankhani.