Sulfoniluree (Glipizide/Glyburide) Ɓooygol : Ko waɗi suukara e nder ƴiiƴam ina ustoo laabi keewɗi caggal suukara¶

Sulfonilureeji - ina heen glipiziid (Glukotrol, Glukotrol XL), gliburiid / glibendesklamiid (DiaBeta, Glinaas, Mikronaas), glimepiriid (Amaril), gliklaziid (Diyamikron), e gliklazid asdemipro-mi (repaglinide [Prandin] e nateglinide [Starlix]) ko leɗɗe jabet fannu 2 ɗe neɗɗo huutortoo e hunuko, ɗe nganndu-ɗaa ko sekretagog insulin. Nandugol e metformin (gollotooɗo e moƴƴinde ɓuuɓri insulin, tee fotde mum meeɗaa ustude suukara e nder ƴiiƴam neɗɗo celluɗo), sulfonilure ina jokkondiri no feewi e Sulfonilure Receptor-1 (SUR1) feccere potaasiyom gonɗo e ATP (K-ATP) laabi e dow ƴiye beta pankreas, doole pankreas ina ɓuuɓna ɓuuɓri mawndi, jokkondirndi e insulin nder ƴiiƴam tawa ina ƴeewa no suukara ñawɗo oo ustiri. Ɗum noon, sulfonylureas ina woni e doggol "Pill gooto ina waawi warde" sukaaɓe : gooto 5 mg mala 10 mg tablet glipizide walla glyburide mo cukalel tokosel muuɗi e aksidaa - walla doseeji ñalnde kala ɗi mooftata e mawɗo mawɗo sabu mboros bonɗo e nder reedu walla jokkondiral e leɗɗe (hono trimetoprim-sulfametoksazol [Bactrim] walla flukonazol) - ina addana nguurndam juutɗam neuroglycopenie, ɓuuɓri, bonnugol ngaandi duumiindi, e komaa duumotooɗo waktuuji 24 haa 72+. Ko ɓuri bonde nii, safrude doseeji sulfonilurea ɓurɗi heewde no insulin ordinateer nii, tawa ko e pusde tan bolusuuji keewɗi Dextrose nder ƴiiƴam (D50W mala D25W) tan ina addana faggudu ŋakkere suukara bonndu : kala ɓeydagol suukara IV ina addana pankreas mo sulfonilurea ɓuuɓnata oo yaltinde ɓurɗo heewde insulin, addana suukara e nder ƴiiƴam ruttaade les haa yettoo toɓɓe warngooji (< 30 mg/dL mala < 1.7 mmol/L) Hojomaaji 30 haa 60 caggal ɗuum so wonaa tawa safrooɓe ɓee ina ndokka ɗoon e ɗoon ñawu nguu, hono Octreotide (Sandostatin), ngam haɗde insulin pankreas yaltude e nokku ɗo ngu ummorii ɗoo.

So tawii cukalel ngel muumtii hay pillol jabet gootol, walla so tawii mawɗo ƴettuɗo glipizide, gliburide, glimepiride, walla gliklazide ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina haɓa, ina ɓuuɓtoo e haala, walla ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo e haala, walla ina ɓuuɓtoo, noddu limoore emergency nokku maa (911 e nder Dental Dowlaaji Amerik911). e nder leydi Angalteer) e laawol men limooje caɗtuɗe regginorde ɗoon e ɗoon, e ƴeewtaade caɗeele jabet, ketoasidosis jabet e ngonka hiperosmolar, e seppude ballal gadanal.

Waɗde ɗum jooni¶

1. Noddu 911 / 112 / 999 e Poison Control ɗoon e ɗoon e ƴeewtaade glucose ƴiiƴam e junngo maa so tawii aɗa jogii meeteer: So tawii ñawɗo oo ina ɗaanii, ina ɓuuɓtoo, ina ɓuuɓna konnguɗi, ina nannga, walla ina jaabaaki, noddu ambulance Advanced Life Support (ALS) ɗoon e ɗoon. So tawii cukalel tokosel walla cukalel tokosel ina waawi muñde hay so tawii ko pillol sulfoniluree walla meglitinide GOOTOL (glipizide, glyburide/glibenclamide, glimepiride, gliclazide, repaglinide), nawde ɓe to departemaa urgence ɗoon e ɗoon - kala ko sukaaɓe njiyti sulfonylurea ina ɗaɓɓi naatde e safrirde fotde waktuuji 24 sabu ŋakkere suukara bonnde ina waawi heɓtaade ɗoon e ɗoon waktuuji 8 haa 18 caggal nde cukalel ngel ɓuuɓtii pillol ngol (haa teeŋti noon so cukalel ngel ina ɗaanii).
2. So tawii neɗɗo oo ina WAƊI, ina waawi muñde e jam, rokku ɗum suukara jaawɗo PLUS ñaamdu karbohidrat/protein caɗtundu ɗoon e ɗoon: Hokku 15 to 20 grams e glukos jaawɗo golloraade (120 mL [4 oz] e njuumri ɓiɓɓe leɗɗe keewndi walla soda mo alaa ko ñaami, 3 haa 4 taƴe glukos, walla 1 kaas njuumri/suukara ɓuuɓɗo e ndiyam), rewi heen ɗoon e ɗoon ko ñaamdu ɓuuɓndu e poroteyiin (hono ɓuuɓri ɓuuɓri walla sandwich ɓuuɓri). Woto meeɗ waɗde ñaamdu, jugo, walla gel e nder hunuko neɗɗo gonɗo e ŋoŋɗi, ŋoŋɗi, walla ŋoŋɗi.
3. Famde ko waɗi inɗe Glucagon (GlucaGen, Baqsimi, Gvoke) ina heewi waasde walla bonnude mborosaaji e nder tooke Sulfonylurea: So tawii neɗɗo oo ina anndi, tee IV ina woodi tawo, aɗa waawi huutoraade Glucagon kit e nder ɓalndu walla e nder nofru so tawii ina woodi e junngo. Kono tan, jeertina safrooɓe wonde glukagon ina tuugii e restoraaji glikogen heeñere (ko yaawi ustaade e doseeji sulfonylurea) E glukagon ina ustoo to bannge cellal pankreas beta ngam yaltinde insulin ƁURI, ina heewi kadi saabaade ŋakkere suukara e nder hojomaaji 30 haa 5.
4. Jeertin safrooɓe e safrooɓe e nder suudu safrirdu e "Faandu Ɓoornugol Dekstroos IV" e ɗaɓɓude OKTREEOTID: Haaldu e ekipaaji safrooɓe: "Ɗum ko Sulfonilurea (Glipizid / Glyburide / Glimepiride) ɓurtuɗo - bolusuuji D50W puɗɗiiɗi e nder ƴiiƴam tan ina mbaawi ustude insulin rewtinoowo ; Oktreotide ɗoon e ɗoon caggal nde feewnitaaki suukara e nder ƴiiƴam."
5. WOTO haɗtu nguura e cukalel ngel alaa ko woni e mum so wonaa ñawu nguu, ngel fadi e nder ƴeewndo e nder safrirde: So cukalel ngel naatii e ƴeewndo waktuuji 24 caggal nde ngel muuɗii pillol sulfonylurea, accu ngel ñaama no haanirta nii tawa ngel ƴeewtotoo suukara ƴiiƴam ngel e nder leeso kala 1 to 2 hours. Kono, WOTO fuɗɗoro dextrose nder ƴiiƴam ngam haɓaade ñawu nguu (D5W mala D10W) toɓɓere e cukalel ngel alaa maale, ngel suukara ƴiiƴam mum ina woodi, sibu glucose prophylactic IV ina suuɗa so tawii cukalel ngel ina ɓuuɓna pillol ngol tigi rigi haa toɓɓere ndee mumta, cukalel ngel neldee galle mum e nder mboros bonɗo.
6. Ƴeewto butelaaji leɗɗe goɗɗe ñawɗo oo ngam anndude "Multipliers Sulfonylurea Hidden": Ngaddaa kala butel pill to suudu safrirdu. E mawɓe wonduɓe e jabet fannu 2, komaa sulfoniluree baawɗo warde nguurndam ɓuri heewde feeñde wonaa e ƴettude pillitol ɓeydangol, kono ko e fuɗɗoraade ñawu nguu walla ñawu nguu (Trimetoprim-Sulfametoksazol [Bactrim/Septra], Flukonazol [Lefloksasin,/Difloksasin],/ Klaritromisin) walla ƴellitde ñawu nguu (AKI), kaɗoowo laɓɓingol gliburid walla glimepirid gonɗo e nder ɓalndu.

Lekki kuulal : Njuɓɓudi sukaaɓe e mawɓe sulfoniluree / meglitinide ɓurɗo heewde e Oktreotiid¶

flowchart TD
    Start["Sulfonilurea (Glipizid, Gliburid/Glibenklamid, Glimepirid, Gliklazid) walla Meglitinid (Repagliniid, Nategliniid) Tuumaaɗo ina heewi / mooftu"] --> CheckBG{"Ƴeewto STAT Lelnde Koppi & Lab Serum Glucose"}

    CheckBG -->|Hypoglycemic: Blood Glucose < 60-70 mg/dL (< 3.3-3.9 mmol/L) OR Any Neuroglycopenic Symptoms (Confusion, Diaphoresis, Seizures, Coma)| TreatHypo["1. Immediate Glucose Restoration: - Awake/Alert: Oral Glucose (15-20 g) + Complex Carbohydrate Meal - Altered/Unconscious: IV Dextrose Bolus (Adults: D50W 50 mL [25 g]; Children: D25W 2-4 mL/kg OR D10W 5-10 mL/kg [0.5-1 g/kg]) 2. Administer Activated Charcoal (1 g/kg) if < 1-2 Hours Post-Ingestion (Or up to 4-6h for Extended-Release Glipizide XL)"]

    CheckBG -->|Euglycemic & Asymptomatic: Blood Glucose >= 70 mg/dL (>= 3.9 mmol/L)| ObserveProtocol["1. Kuuɓal kuuɓtodinngal (1 g/kg) so tawii < 1-2 Waktuuji caggal nde ñaami 2. Jaɓde ñaamde no haanirta nii ; WOTO FUƊƊU Prophylactic IV Dextrose walla Octreotide (Masks Onset) 3. ƳEEWTE WAƊDE E ƳEEWTE SUUKU Q1-2H: - Denndaangal ñamri sukaaɓe & mawɓe Ƴellitaare yaajnde / Glyburide: Jaɓde ko famɗi fof waktuuji 24 e nder jamma (ina hawri e ƴettugol ko yaawi O) (Repagliniid/Nategliniid) : Ko famɗi fof waktuuji 8-12"]

    TreatHypo --> StartOctreotide["ƊAƊƊI ƊIƊI : FUƊƊO OKTREEOTID (SANDOSTATIN) CAGGAL ƊAƊƊAARE HIPOPOLISEMIK ADOORE (Ina haɗa laabi kalsiyum gonɗi e ɓuuɓri gonndi e ƴiiƴam Beta ngam haɗde ɓuuɓri gonndi e ƴiiƴam : - Mawɓe : 50 haa 100 mcg ko famɗi fof waktuuji 24) - Sukaaɓe : 1 haa 1,5 mcg/kg (Max 50 mcg) SC walla IV Kala waktuuji 6 (Walla Infuse IV jokkondirɗo e 50-125 ng/kg/min / 25-50 mcg/h e nder ñawɓe ɓe ngalaa ɓuuɓri)"]

    StartOctreotide --> MaintenanceCare["1. Doggol Toppitagol IV Dekstroos (D5W walla D10W) Titre ngam reentaade suukara e nder ƴiiƴam 80-120 mg/dL (4,4-6,7 mmol/L) + Ñaamde nde alaa ko haɗi e hunuko So neɗɗo ummiima 2. Ƴeewtaade suukara e nder ƴiiƴam kala 30-60 hojom Toɓɓere Kreatinin, Potaasiyom, & Insulin/C-Peptiid (Tabitin Hiperinsulinemi nder ɓalndu: Insulin toowɗo + C-Peptiid toowɗo)"]

    ObserveProtocol --> DelayedDrop{"Mbele suukara e nder ƴiiƴam ina ustoo < 60-70 mg/dL e kala nokku e nder ƴeewndo?"}
    DelayedDrop -->|YES| TreatHypo
    DelayedDrop -->|NO: 100% Euglycemic for 24 Full Hours Without IV Dextrose or Octreotide| SafeDischarge["Safe for Discharge (Caggal nde sukaaɓe / Psychiatric walla Renal Leɗɗe njuɓɓinaa)"]

    MaintenanceCare --> WeanProtocol["KUULAL ƳEEWTE 24 HOUR CAGGAL OCTREOTIDDE : Caggal nde Oktreotide & IV Dextrose dartinaa, ƴeewndo ñawɗo oo e nder safrirde e ñaamdu hunduko tan fotde waktuuji 12 haa 24 timmuɗi ɓeydaaɗi ngam tabitinde wonde alaa ko rewi heen (haa teeŋti e FalimepiriilG walla RenalG)"]

Patofisiyoloji: No Sulfonilureas udditirta pankreas "On" e no Oktreotide "Off" "Off".¶

1. Kaskaad gonɗo e ɓuuɓri pankreas (SUR1 -> K-ATP -> VGCC -> Insulin)¶

E nder pankreas celluɗo, ƴiiƴam beta ina yaltina insulin tan so suukara e nder ƴiiƴam ɓeydiima caggal nde neɗɗo ñaami :

1. Sensing Glucose Fisiologique Normal: So suukara e nder ƴiiƴam ina ummoo dow 80 to 90 mg/dL, suukara ina naata e nder ƴiiƴam pankreas (beta) rewrude e... GLUT2 jolngooji e ina mbaylee e glikolisis e mitokondriyaaji e nder ATP. Ɓeydagol nder geese ATP-to-ADP ina uddita Laabi potaasiyom gonɗi e ATP (K-ATP kanaal) dow ɓuuɓri cellal.
2. Depolarisaasiyoŋ e ɓuuɓri kalsiyum: Sabu iyon potaasiyom gonɗo e mbaydi moƴƴiri (K+) nattii waawde yaltude e nder ɓalndu, ɓuuɓri ɓalndu beta depolarizes (ina wonta charge positif). Ndeeɗoo depolarisaasiyoŋ kuuraa ina uddita Laabi Kalsiyum gonɗi e Voltage-Gated L-type (VGCC), ina addana kalsiyum ekstraselulaar (Ca2+) ngam ɓuuɓde e nder ƴiiƴam betaa, e ustude eksositosis (fusiyoŋ e yaltinde) ɓuuɓri gonndi e insulin gonndi e ɓuuɓri (e sara C-peptide ekimolar) e nder ƴiiƴam portal.
3. No Sulfonilureeji njiyrata Switch: Kala... K-ATP kanaal ko oktamer mahaaɗo e poreeji nay Kir6.2 ɓuuɓri taariindi e Sulfoniluree Reseptor-1 (SUR1) ko ɓuuɓri. Sulfonilureeji (glipisiid, glibuliid, glimepiriid, gliklazid) e meglitiniid (repagliniid, nategliniid) ina njokkondiri no feewi e SUR1 subunit e mekaniik coktirgal ngal K-ATP kanaal udditaa, ina rewi haa laaɓi e sensor glukos ATP no woorunoo e cellal. Hay so suukara e nder ƴiiƴam ñawɗo oo ina ustoo to... 15 mg/dL e ATP nder geese ina ustoo haa yettoo toɓɓe heege, ko... K-ATP kanaal ina heddii ina udditoo, kalsiyum ina jokki e ruttaade, cellal beta ina jokki e yaltinde insulin keewɗo baawɗo warde, tawa kadi ina haɗa glukoneogenesis e glikogenolisis hepatik.

2. Hol ko waɗi Oktreotide ko ñawndorde fisik timmunde (Blockade de calcium à la main)¶

Sabu sulfonilure ina cokka... SUR1 / K-ATP kanaal to dow kaska, rokka suukara ɓurɗo heewde (D50W) ina ɓeyda tan ATP nder geese e ina ɓeyda ɓuuɓri kalsiyum e eksositosis insulin so tawii ɓuuɓri sulfoniluree fuɗɗiima diwde walla ɓuuɓde.

• No Oktreotiid gollortoo: Oktireotiid ko analog oktapeptiid sintetik juutɗo golle, nannduɗo e hormon somatostatin. So Oktreotide ina waɗa e les ɓalndu walla e nder ƴiiƴam, ina jokkondiri e Somatostatin mo sifaa-2 e mo sifaa-5 (SSTR2 e SSTR5) Jaɓɓotooɗe G-protein e dow ɓalndu betaa-sel pankreas.
• Taƴre dowri toŋngoode: Softinde... SSTR2 / SSTR5 ina haɗa jolɗe kalsiyum ɗe voltage-gated (VGCC) e haɗde adenilat siklaas ( ).cAMP) e eksositosis ɓuuɓri insulin distal. Sabu laabi kalsiyum gated voltage ina njooɗii dow e... SUR1 / K-ATP kanaal, Octreotide ina udda naatgol kalsiyum, ina haɗa haa laaɓa ɓuuɓri insulin hay so tawii sulfoniluree ina jokki e jokkondirde e... SUR1 jaɓɓotooɗo.
• Antidote gonɗo e mbaydi ɗiɗmiri (Diazoxide): Ko adii nde Oktreotide wontata mbaydi toppitagol, safrooɓe ina kuutoroo Diazoxide (Proglycem), ko benzotiyadiyazin mo alaa diƴƴe, udditirɗo no feewi K-ATP laabi. Hannde, Octreotide ɓuri yiɗeede e Diazoxide sabu Diazoxide ina addana takikardiya refleks tiiɗɗo, hipotension systémique, reentaade ndiyam, e ɓuuɓri, tawi Oktreotide ina selli e hemodinamik, ina weeɓi rokkireede les ɓalndu (50 to 100 mcg SC Q6H), e ɓurde waawde ittude mborosaaji gonɗi e ŋakkere suukara e nder ɓalndu.

Tablo ƴeewndo mawngo : Leɗɗe jabet e nder hunuko e nder doseeji ɓurɗi heewde (hol heen ko addata ŋakkere suukara e nder ɓalndu?)¶

Sabu ñawɓe jabet fannu 2 ina keewi ƴettude leɗɗe keewɗe, anndude hol leɗɗe tigi-rigi ɗe ɓe keɓi, ina hollita so tawii ñawɗo oo ina waawi heɓde ŋakkere suukara e nder ɓalndu :

Porotokol doseeji opitaal e EMS : Dekstroos, Oktreotiid, e Dekontaminaasiyoŋ¶

1. Feewnitde dekstroos nder ƴiiƴam tuugiiɗo e teddeendi (Rewrude e nekrosis ekstravasaasiyoŋ e ɓuuɓri ɓuuɓri)¶

So ñawɗo oo hollitii ŋakkere suukara e nder ɓalndu sabu sulfoniluree (blood glucose < 60 mg/dL [3.3 mmol/L] walla kala maale neuroglycopenic), artirde suukara ngaandi no woorunoo ɗoon e ɗoon e huutoraade ɓuuɓri ɓurndi famɗude e nder ƴiiƴam ngam ustude ɓuuɓri ƴiiƴam e ustude ɓuuɓri pankreas ɓurtundi :

• Mawɓe: Njuɓɓudi 25 to 50 mL e 50% Dekstroos (D50W, ina waɗi 12.5 to 25 grams e glucose) rewrude e laabi IV periferik walla hakkundeeji kisal (walla 100 to 250 mL e 10% Dekstroos [ 1 ].D10W] ina ɓuuɓnee e yaawre e nder hojomaaji 5 haa 10, ko ɗum addanta flebitis seeɗa e ɓuuɓri glycémique ɓurndi yooɗde e... D50W).
• Ɓiɓɓe e sukaaɓe tokosɓe: Woto meeɗ pusde D50W e nder ƴiiƴam cukalel tokosel (hiperosmolarite mum ɓurtuɗo [ 1 ].2,525 mOsm/L] ina addana ƴiiƴam ɓuuɓɗam e nekrosis ƴiiƴam timmuɗam so tawii ina ekstravasate). E nder heen, rewa e "Kuulal 50" (Dose in mL/kg x % Dextrose = 50, ko rokkata ** .0.5 grams/kg e suukara**):
• 10% Dekstroos (D10W, ɓuri yiɗeede ko e sukaaɓe tokosɓe e sukaaɓe tokosɓe): Njuɓɓudi 5 mL/kg (0.5 g/kg) Bolus IV (haa... 10 mL/kg [1 g/kg] ngam ɓuuɓri hipoglisemik tiiɗndi).
• 25% Dekstroos (D25W, sukaaɓe mawɓe): Njuɓɓudi 2 mL/kg (0.5 g/kg) haa 4 mL/kg (1 g/kg) Bolus IV.
• Njuɓɓudi Thiamine e nder mawɓe ɓe ngalaa nguura walla alkol: E nder mawɓe wonduɓe e rafi kuutoragol alkol walla ŋakkere nguura tiiɗnde, njuɓɓinee 100 mg e Tiamin (Vitamin B1) gonɗo e nder ƴiiƴam e sara (mo meeɗaa leeltude) bolol dekstroos gadano ngam haɗde ensefalopati Wernicke ɓuuɓɗo.

2. Rejim Oktreotiid (Sandostatin) laaɓtuɗo e Titgol Infuse Jokkondiral¶

Ɗoon e ɗoon caggal nde feewnitaa eɓɓoore hipoglisemik adannde ndee (walla ɗoon e ɗoon nde ngar-ɗaa so tawii EMS ko adii opitaal ina rokka ɗum en dextrose IV walla suukara e nder hunuko ngam ƴeewde so tawii suukara ina famɗi e nder ƴiiƴam), fuɗɗoo Octreotide :

1. Doseeji gonɗi e nder ɓalndu (SC) walla e nder ƴiiƴam (IV) (Protokol gonɗo e doggol adanngol):
2. Mawɓe: 50 mcg to 100 mcg les ɓalndu (SC) walla seeɗa seeɗa e nder ƴiiƴam (IV) kala waktuuji 6 ko famɗi fof waktuuji 24. (Tip clinique: Injection subcutanée ina rokka batte depot ɓuuɓɗe, duumotooɗe e nder waktuuji 6 haa 8, ina reena ɓuuɓri juutndi walla bradycardie sahaa e sahaa fof ina yiyee e pusgol IV jaawngol).
3. Nyawɓe sukaaɓe: 1 to 1.5 mcg/kg (haa ko ɓuri heewde e... 50 mcg dose kala) e nder ɓalndu (SC) walla IV kala waktuuji 6 ko famɗi fof waktuuji 24.
4. Infusion oktreotiid jokkondirɗo e nder ƴiiƴam (Ngam doseeji ɓurɗi heewde e anniyaaji walla Hipogliseemi refraktoor):
5. So tawii ñawɗo oo muusii sappooji taƴe Glucotrol XL walla Glyburide ɗe njuumri juutndi, ina jokki e heɓde ɓuuɓri suukara e nder ƴiiƴam hakkunde taƴre Q6H doseeji, ndokka ** fuɗɗoode50 to 100 mcg Bolus IV** (1 to 1.5 mcg/kg e sukaaɓe) rewi heen ɗoon e ɗoon ko jokkondiral IV Octreotide at 25 mcg/hour to 50 mcg/hour e nder mawɓe (walla 50 to 125 ng/kg/minute [3 to 7.5 mcg/kg/hour] e nder sukaaɓe).
6. Dekontaminaasiyoŋ ɓalndu ngam yaltinde ko yaawi e yaajde (Glucotrol XL) Tablettes:
7. Kuuɓal kuuɓtodinngal Dose Gooto (1 g/kg, ko ɓuri heewde 50 g): Waɗde e hunuko so tawii ñawɗo oo ina hollita e nder waktuuji 1 haa 2 caggal nde o ñaami, tawa ina ŋoŋɗi haa timmi, ina reena laawol mum.
8. Glipizide (Glucotrol XL) "GITS" Kosam Pompe Osmotik: Glucotrol XL ina huutoroo ɓuuɓri sellulose-asetaat (Sistem safaara ɓalndu, GITS) mo ɓuuɓnataa ko seeɗa seeɗa, mo ɓuuɓnata ɗum seeɗa seeɗa transits ɓalndu nduu fof. E nder doseeji mawɗi anniyaaji ɓurɗi heewde e Glucotrol XL, ndokkee Kuuɓal kuuɓtodinngal haa waktuuji 4 haa 6 caggal nde njuumri ndii ñaami e ƴeewtaade Irrigaasiyoŋ ɓalndu fof (WBI) e ɓuuɓri elektorolit poliyetilen glikol (PEG-ES at 1.5 to 2 L/hr e nder mawɓe walla 25 mL/kg/hr e nder sukaaɓe) ngam ɓuuɓnude kosam pompe osmotik ɗe ɓuuɓnaaka e nder ɓalndu.

3. 6 Mawɗe Leɗɗe-Leɗɗe e Reedu Caɗtuɗe Sulfonylurea Coma e Mawɓe¶

Ko ɓuri 70 e nder teemedere e naatgol e opitaal ngam ŋakkere suukara sulfonylurea tiiɗnde e nder mawɓe ɓurɓe duuɓi 65 ina tawee e ñawɓe ƴettuɓe doseeji mum en keewɗi, tawa ina kawra e gooto e geɗe jeegom (6) gonɗe e ɓuuɓri :

1. Enzim CYP2C9 ina haɗa (Bactrim, Fluconazole, Metronidazole, Amiodarone): Sitokrom hepatiik P450 CYP2C9 ko enzim gadano mbayliigu glipizid, gliburid, glimepirid, e tolbutamid. Fuɗɗoraade balɗe 5 trimetoprim-sulfametoksazol (Bactrim / Septra) ngam ñawu nguu walla flukonazol (Diflucan) ngam ñawu nguu ina ɓeyda ɓuuɓri sulfoniluree e nder ƴiiƴam fotde 200% haa 4008% e nder waktuuji 4.
2. Antibiyotikaaji fluorokinolon (Ciprofloxacin, Levofloxacin, Moxifloxacin): Ko yaawi haɗde ƴiiƴam beta pankreas K-ATP laabi e bannge sulfonylureas AND ina kaɗa enzim CYP, ina addana neɗɗo ŋakkere suukara e komaa ŋakkere suukara (ina jogii jeertinaango FDA Boxed).
3. Gemfibrosil + Repagliniid (CYP2C8 + OATP1B1 Bloke): Ƴettude lekki fibraat kolesterol gemfibrozil (Lopid) e meglitiniid repagliniid (Prandin) ina ɓeyda ƴiiƴam repagliniid folde 8,1 (810%) e juutde feccere nguurndam mum gila e waktu 1 haa ko ɓuri waktuuji 12 ; so tawii itrakonazol ina woodi kadi, tolnooji ɗii ina ɓeydoo 19-fol.
4. Beta-Blokeruuji ɗi cuɓaaka (Propranolol, Nadolol, Carvedilol): Mask adrenerjik yurmeende maale jeertinaango arano ngam ustude suukara e nder ƴiiƴam (haɗde diƴƴe, ɓuuɓri, e ŋakkere, tawa ina acca ɓuuɓri kolinerjik [diaphoresis] ina woodi) e sahaa gooto haɗde suukara hepatik gonɗo e ɓalndu nduu, ina haɗa glycogeno gonɗo e ñawɗo oo komaa neuroglikopenik tawa jeertinaani.
5. Salisilat (Aspirin) Doseeji ɓurɗi heewde walla AINE Doseeji toowɗi : ina ustoo sulfonilureeji e nokkuuji jokkondirɗe e albumin plasma, ina ustoo no feewi ɓuuɓri insulin tawa ina haɗa glukoneogenesis.
6. Njaɓɓugol ƴiiƴam (AKI) walla ñawu ƴiiƴam ɓuuɓngu (CKD): So glipizide ina wayloo e nder heeñere wonta geɗe ɗe ngonaa golle, gliburiid (glibenklamiid) e glimepiriid ina waylee wonta geɗe hidroksilaaɗe kuutorteeɗe (4-trans-hydroxyglyburide e M1) ɗe fawii tan ko e ƴiye ngam yaltinde. So tawii mawɗo mo glyburide heɓi ŋakkere ndiyam seeɗa sabu gastroenteritis viral walla fuɗɗotoo ko ustude ACE/AINE, ɗeen mbayliigaaji kuutortooɗi ina moofta fotde balɗe 3 haa 5, ina addana ɗum ŋakkere suukara e nder ɓalndu.

Ɗaɓɓaande laboratuwaar ñaawoore: Seerndude ɓurtugol sulfoniluree e ɓuuɓri insulin (Insulin vs. C-Peptide)¶

So mawɗo walla cukalel ina wondi e ŋakkere suukara e nder ɓalndu, nde alaa ko firti (blood glucose < 40 mg/dL) e alaa daartol laaɓtungol e ñaamde pillol, ƴettude tuuba ƴiiƴam gooto ɓeydaaɗo e dow boɗeejo/haako-ñebbe e nder sahaa gonaaɗo oo (ko adii walla ko adii nde Dekstrose IV rokketee) ngam Insulin serum, C-Peptide, Beta-Hidroksibutirat, e Sulfonilylurea diagnosis

• Hiperinsulinemi pankreas nder ɓalndu (Sulfoniluree / Meglitinide ɓurɗo heewde WALLA Insulinoma): Sabu ƴiiƴam ñawɗo oo e hoore mum ina feewna proinsuline, ko ɗum feccata 1:1 e 1 molekul Sede Pesurum + 1 molekul CBO- C-Peptide ina maantiniri TOOWDE (Insulin > 3 mcIU/mL e C-Peptide > 0.6 ng/mL e nder ŋakkere suukara), e plasma/urine Ekran Sulfoniluree ina moƴƴi.
• Insulin farmasi eksogen (Dose insulin ɓurɗo heewde / bonɗo / aksidaa) : Insulin njulaagu njulaagu (Humulin, Novolog, Lantus, Humalog) ina laaɓtina tawa alaa ko woni e mum so wonaa C-peptide, tee insulin gonaaɗo oo ina suppita ɓalndu ñawɗo oo e hoore mum. Ko ɗum waɗi, Insulin e nder ƴiiƴam ina TOOWƊI no feewi tawi C-Peptide e nder ƴiiƴam ina SUUƊI / ƳEEWTAA (< 0.2 ng/mL).

Limooje emergency diiwaan e porotokolle agence¶

Naamne keewɗe naamneede¶

Hol ko waɗi rokkude Dextrose e nder ƴiiƴam (D50W) suukara fiyaaɗo e hoore mum ina addana suukara ƴiiƴam ñawɗo oo ɓeydaade tiiɗde caggal hojomaaji 30 ?¶

E nder doseeji sulfoniluree, lekki kii ina jokkondiri no feewi e ƴiye beta pankreas, ina jogoo laabi potaasiyom mum en udditaaɗi haa pankreas ina prime ngam yaltinde insulin jokkondire. So doktoor walla safroowo ina ɓuuɓna ɓuuɓri 50% Dextrose (D50W) e nder ƴiiƴam tawa rokkaani Octreotide, ɓuuɓri suukara e nder ƴiiƴam ina ɓuuɓtoo e nder ƴiiƴam pankreas, ina addana ɗum ɓuuɓri mawndi, ɓuuɓndi, ɓuuɓri insulin kesiri. E nder hojomaaji 30 haa 60, oon ɓuuɓol mawngol gonngol e insulin ina momta denndaangal suukara gonɗo e nder ƴiiƴam ñawɗo oo, ina riiwta suukara e nder ƴiiƴam ñawɗo oo, haa arti noon e tolnooji baawɗi warde nguurndam.

Hol no Oktreotiid haɗirta suukara e nder ƴiiƴam e nder Glipizide walla Glyburide ɓurɗo heewde ?¶

Oktreotiid ko mbaydi sintetik e hormon tagoore biyeteeɗo somatostatin. So tawii sulfonilureeji hono glipizide e glyburide ina ndokka laabi potaasiyom e nder ƴiiƴam pankreas beta uddude e fuɗɗoode laawol kuuraa, ƴiiƴam beta haa jooni waawaa yaltinde insulin so wonaa tawa iyon kalsiyum ina naata e nder laabi kalsiyum gonɗi e joofnirde laawol ngol. Oktreotiid ina jokkondiri e jaɓɓotooɗe somatostatin e nder ƴiiƴam beta, ina uddita ɗoon e ɗoon ɗeen laabi kalsiyum gonɗi les - ina ustoo ɓuuɓri insulin pankreas e nder hojomaaji seeɗa hay so tawii pillol sulfoniluree ina woni e ɓanndu.

Hol ko waɗi doktoor waawaa fuɗɗoraade ɓuuɓri suukara e nder ƴiiƴam ngam haɗde (D5W mala D10W) ɗoon e ɗoon e dow cukalel tokosel ngel ina waawi muñde pillol Glipizide kono ina jogii suukara e nder ƴiiƴam mum no haanirta nii ?¶

So cukalel tokosel addaama to suudu safrirdu caggal nde yiyti butelaaji udditiiɗi, safrooɓe ɓee ina keewi anndude no feewi so tawii ko goonga cukalel ngel ɓuuɓtii pillol walla ko ngel yani tan e leydi. So tawii doktoor hookii cukalel ngel alaa ko woni e mum so wonaa ɓuuɓri IV dextrose preventive walla rokki Octreotide ɗoon e ɗoon tawa suukara ina woodi, ɓuuɓri ndii maa artificiel mask toɓɓere suukara e nder ƴiiƴam fotde waktuuji keewɗi, addana ekipaaji ɗii wiyde e fenaande hay pill gootol ɓuuɓnaaka e yaltinde cukalel ngel pillal requine tan daquiry of home hopitaal. E nder ɗuum, sukaaɓe ɓe ngalaa maale ñawu nguu ina njaltinee fotde waktuuji 24 e ñaamde no woorunoo tawa alaa glukos IV tawa ina ƴeewtoo suukara ƴiiƴam e nder waktuuji 1 haa 2 kala, ina fuɗɗoo IV Dextrose e Octreotide e sahaa nde toɓɓere goonga les 60 haa 70 mg/dL waɗata.

Hol ko waɗi mawɓe ƴettuɓe doosgal gootal Glyburide walla Glimepiride e kisal duuɓi keewɗi, ɗoon e ɗoon ina njiyloo koye mum en e nder mboros biyeteeɗo « hipoglycémie » caggal nde puɗɗii ƴettude ñawu nguu biyeteeɗo Bactrim (Trimetoprim-Sulfametoxazole) walla Fluconazole ?¶

Sulfonylureas like glipizide, glyburide, and glimepiride are broken down in the liver by the cytochrome P450 enzyme CYP2C9 and excreted by renal tubular transporters. Common antibiotics and antifungals - especially Sulfamethoxazole-Trimethoprim (Bactrim/Septra), Fluconazole (Diflucan), Metronidazole, and Fluoroquinolones (ciprofloxacin, levofloxacin) - potently inhibit the CYP2C9 enzyme and block renal clearance, causing the patient's normal daily diabetes pill to build up in the blood to 3 to 5 times its normal concentration and triggering severe, prolonged hypoglycemic coma.

Hol ko waɗi ñawɗo ina foti jooɗaade e safrirde fotde waktuuji 12 haa 24 goɗɗi CAGGAL nde ɓe ngoppi injections maɓɓe Octreotide e IV sugar drips ?¶

Oktreotiid ina jogii feccere nguurndam waktuuji seeɗa tan, tawi noon sulfonilureeji e nder doseeji ɓurɗi heewde (haa teeŋti e Glipizide XL mo yaltinta ko juuti, walla Klorpropamide mo golle mum juutɗe, walla metaboliteeji Glyburide e Glimepiride kuutortooɗi e ñawɓe ɓe golle mum en ustii) ina mbaawi heddaade e jokkondirde e ho3+6. So ñawɗo oo ina heɓa Octreotide waktuuji 6 kala, suukara e nder ƴiiƴam mum ina nanndi e ko woodi no feewi sabu Octreotide ina jogii pankreas ina uddita. Laawol tan ngam hollirde wonde sulfonilurea oo laɓɓinii ɓanndu nduu haa laaɓi, ko dartinde Oktreotiid e IV dextrose e ƴeewtaade ñawɗo oo e ñaamde tan fotde waktuuji 12 haa 24 timmuɗi ngam hoolkisaade so tawii ŋakkere suukara ina ustoo.

Ardiiɓe jokkondirɓe¶

• Emergency jabet : ballal gadanal ŋakkere suukara e ŋakkere suukara
• Ketoasidosis jabet (DKA) e ngonka hiperosmolar (HHS)
• Status epilepsi, ɓuuɓri juutndi, e leɗɗe hisnude
• Gaññeeje ɓuuɓɗe, rabdomiolisis, e triage urine ɓaleejo
• Tooke ballal gadanal e triage ngam haɓaade tooke

Fuɗɗoode e ardorde laawɗunde¶

• Koolaaɗo kuuɓal Ameriknaajo tookeeji safaara (ACMT) & nokkuuji tooke Amerik: Laabi nanondiral tuugiiɗi e hujjaaji ngam ƴellitde ñaamde sulfonylurea e yaasi safrirde e laabi mooftugol antidote ngam oktreotide.
• Fedde Ameriknaare toppitiinde jabet (ADA) & Fedde Endocrine: Toɓɓere toppitagol jabet: ƴeewndo e njuɓɓudi ñawuuji ŋakkere suukara e nder mawɓe e sukaaɓe e tooke sulfonylurea.
• Koolaaɗo kuuɓal laamɗo (RCEM) & Sarwiis ngenndiijo humpito tookeeji (NPIS, Angalteer): Protokol safaara TOXBASE ngam ɓeydude doseeji sulfonilurea e restoraaji oktreotiid antidote categori A.
• Safaaraaji ekstrakorporeeji e nder tooke (EXTRIP) & Tookoloji kilinik Gollal: Ardorde sukaaɓe "Pill gooto ina waawi warde": Laylaytol doole 24 e hisnude oktreotide e nder ɓuuɓri sulfonilurea.
• Fedde Adunaare Cellal (OMS) : Model Formular e njuɓɓudi ŋakkere suukara tiiɗnde ummoraade e sekretaaji insulin gonɗi e hunuko (Glibenclamide / Gliclazide).

Ngol ɗoo tinndinoore ko ngam humpitaade, lomtinaani ƴeewndo safaara e nder safaara, ƴeewndo Poison Control, walla ƴeewndo safrirde. Sabu tablet sulfonylurea gooto ina waawi saabaade ɓuuɓri gonndi e ɓuuɓri e komaa, min mbasiyii ma no feewi ƴettude ballal gadanal e CPR rewrude e Fedde Adunaare Fedde Croix-Rouge e Sociétés de la Croix-Rouge (IFRC), fedde mon ngenndiire Croix-Rouge, St John a cerified Ambulance.