Lefu la tsoekere hyperglycemic hyperosmolar syndrome

Lefu la tsoekere hyperglycemic hyperosmolar syndrome (HHS) ke bothata ba lefu la tsoekere la mofuta oa 2. E kenyelletsa boemo bo phahameng haholo ba tsoekere e maling ntle le botonone.

HHS ke boemo ba:

• Tekanyo e phahameng haholo ea tsoekere ea mali (tsoekere)
• Ho haella ha metsi haholo (ho felloa ke metsi 'meleng)
• Ho fokotsa ho falimeha kapa ho tseba (maemong a mangata)

Ho aha ketone 'meleng (ketoacidosis) le hona ho ka hlaha. Empa ke ntho e sa tloaelehang 'me hangata e bonolo ha e bapisoa le lefu la tsoekere ketoacidosis.

HHS e bonahala hangata ho batho ba nang le lefu la tsoekere la mofuta oa 2 ba sa laoleheng lefu la tsoekere. E kanna ea hlaha le ho ba so fumanoeng ba na le lefu la tsoekere. Boemo bo ka tlisoa ke:

• Tšoaetso
• Maloetse a mang, a kang lefu la pelo kapa stroke
• Meriana e fokotsang phello ea insulin 'meleng
• Meriana kapa maemo a eketsang tahlehelo ea metsi
• Ho felloa ke matla, kapa ho se noe meriana ea lefu la tsoekere

Ka tloaelo, liphio li leka ho bopa tsoekere e phahameng maling ka ho lumella tsoekere e eketsehileng hore e tsoe 'meleng ka har'a moroto. Empa hona ho etsa hore 'mele o lahleheloe ke metsi. Haeba u sa noe metsi a lekaneng, kapa u noa maro a nang le tsoekere 'me u lula u ja lijo tse nang le lik'habohaedreite, u felloa ke metsi. Ha sena se etsahala, liphio ha li sa khona ho tlosa tsoekere e eketsehileng. Ka lebaka leo, boemo ba tsoekere maling a hao bo ka ba holimo haholo, ka linako tse ling makhetlo a fetang a 10 makhetlo a tloaelehileng.

Ho lahleheloa ke metsi ho boetse ho etsa hore mali a tsepame ho feta kamoo ho tloaelehileng. Sena se bitsoa hyperosmolarity. Ke boemo boo ho bona mali a nang le letsoai le lengata (sodium), tsoekere le lintho tse ling. Sena se hula metsi ho tsoa likarolong tse ling tsa 'mele, ho kenyelletsa le bokong.

Mabaka a kotsi a kenyelletsa:

• Ketsahalo e sithabetsang joalo ka ts'oaetso, lefu la pelo, stroke kapa ho buuoa haufinyane
• Ho hloleha ha pelo
• Lenyora le senyehileng
• Phihlelo e fokolang ea metsi (haholo-holo ho batho ba nang le 'dementia' kapa ba sa keneng malaong)
• Botsofali
• Ts'ebetso e mpe ea liphio
• Tsamaiso e mpe ea lefu la tsoekere, eseng ho latela moralo oa kalafo joalo ka ha ho laetsoe
• Ho emisa kapa ho felloa ke insulin kapa meriana e meng e theolelang tsoekere

Matšoao a ka kenyelletsa efe kapa efe ea tse latelang:

• Ho nyoroa le ho ntša metsi (qalong ea lefu lena)
• Ho ikutloa o fokola
• Ho nyekeloa
• Ho fokotsa boima ba 'mele
• Molomo o omileng, leleme le ommeng
• Feberu
• Ho oa
• Pherekano
• Coma

Matšoao a ka mpefala ho feta matsatsi kapa libeke.

Matšoao a mang a ka hlahang ka lefu lena:

• Ho lahleheloa ke maikutlo kapa ts'ebetso ea mesifa
• Mathata ka motsamao
• Ho senyeha ha puo

Mofani oa tlhokomelo ea bophelo o tla u hlahloba 'me a botse ka matšoao a hau le nalane ea bongaka. Teko e kanna ea bontša hore u na le:

• Ho omella haholo
• Feberu e phahameng ho feta 100.4 ° F (38 ° C)
• Ho eketseha ha lebelo la pelo
• Khatello ea mali e tlase ea systolic

Teko e ka etsoang e kenyelletsa:

• Mali osmolarity (mahloriso)
• BUN le maemo a creatinine
• Tekanyo ea sodium ea mali (e hloka ho fetoloa bakeng sa boemo ba tsoekere ea mali)
• Teko ea Ketone
• Tsoekere ea mali

Tlhatlhobo ea lisosa tse ka bang teng e ka kenyelletsa:

• Litso tsa mali
• X-ray sefubeng
• Electrocardiogram (ECG)
• Ho hlahloba urinal
• CT ea hlooho

Qalong ea kalafo, sepheo ke ho lokisa tahlehelo ea metsi. Sena se tla ntlafatsa khatello ea mali, tlhahiso ea moroto le tsamaiso ea mali. Tsoekere ea mali le eona e tla fokotseha.

Maro le potasiamo li tla fanoa ka mothapo (ka methapo). Sena se tlameha ho etsoa ka hloko. Tekanyo e phahameng ea tsoekere e phekoloa ka insulin e fanoang ka mothapo.

Batho ba hlahisang HHS hangata ba se ba ntse ba kula. Haeba a sa phekoloe hang-hang, a ka oa, a akheha kapa a shoa.

Ha e sa alafatsoe, HHS e ka lebisa ho tse ling tsa tse latelang:

• Ho tshoha
• Ho thehoa ha mali
• Ho ruruha ha boko (cerebral edema)
• Ho eketsa boemo ba asiti ea mali (lactic acidosis)

Boemo bona ke ba tšohanyetso ea bongaka. E-ea kamoreng ea maemo a tšohanyetso kapa u letsetse nomoro ea ts'ohanyetso ea lehae (joalo ka 911) haeba u ba le matšoao a HHS.

Ho laola mofuta oa 2 oa lefu la tsoekere le ho lemoha matšoao a ho felloa ke metsi 'meleng le tšoaetso ho ka thusa ho thibela HHS.

HHS; Ho haelloa ke lefu la hyperglycemic hyperosmolar; Nonketotic hyperglycemic hyperosmolar coma (NKHHC); Coma e se nang maiketsetso (HONK); Hyperglycemic hyperosmolar e seng ketotic; Lefu la tsoekere - hyperosmolar

• Mofuta oa 2 oa lefu la tsoekere - o ka botsa ngaka ea hau eng

• Ho lokolloa ha lijo le insulin

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Lebovitz HE. Hyperglycemia ea bobeli ho ea ho maemo a meriana le kalafo. Ka: Jameson JL, De Groot LJ, oa Kretser DM, et al, eds. Endocrinology: Batho ba baholo le bana. La 7th. Philadelphia, PA: Elsevier Saunders; 2016: khaolo ea 42.

Sinha A. Maemo a tšohanyetso a lefu la tsoekere. Ka: Bersten AD, Handy JM, li-eds. Buka ea Oh’s Intensive Care. La 8th. Philadelphia, PA: Elsevier; 2019: khaolo ea 59.