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Ọrịa mamịrị Ketoacidosis (DKA) na Hyperosmolar Hyperglycemic State (HHS)

Nọmba mberede dị iche na mba. Ibe a na-eji 911, nọmba maka United States na Canada. Ọtụtụ mba ndị ọzọ na-eji 112, 999, ma ọ bụ nọmba ọzọ. Chọta nọmba maka obodo gị.

Ketoacidosis na-arịa ọrịa shuga (DKA) na Hyperosmolar Hyperglycemic State (HHS) bụ ihe mberede hyperglycemic abụọ kachasị dị ize ndụ na nlekọta ọrịa shuga, nke nwere ike ịkpata akpịrị ịkpọ nkụ siri ike, ujo ọbara ọbara, ọzịza ụbụrụ (edema ụbụrụ), coma, na ọnwụ ma ọ bụrụ na agwọghị ya ngwa ngwa na mmiri intravenous ụlọ ọgwụ, nnọchi electrolyte, na insulin. Ọ bụ ezie na DKA na-etolite ngwa ngwa karịa ọtụtụ awa ruo otu ụbọchị mgbe enweghị insulin zuru oke ma ọ bụ nke siri ike na-amanye imeju ọkụ ọkụ n'ime ketones acidic, HHS na-ewuli ọtụtụ ụbọchị ruo izu (ọtụtụ mgbe na ndị toro eto nwere ụdị ọrịa shuga 2), na-ebuga shuga ọbara ruo oke ọkwa ma na-agbapụta ruo 9 ruo 12 lita (2.4 ruo 3.2 galọn) mmiri si n'ahụ. Nkwenye ozugbo nke akara ịdọ aka ná ntị dị ka vomiting, mgbu afọ, iku ume ngwa ngwa, ma ọ bụ mgbagwoju anya, jikọtara ya na ule ketone ọbara nke ụlọ na njem ahụike mberede ngwa ngwa, na-azọpụta ndụ.

Ịgbọ agbọ na-arịa ọrịa shuga ma ọ bụ ketones dị elu bụ ihe mberede ahụike, ọ bụghị ahụhụ afọ

Ọgbụgbọ, ọgbụgbọ, na mgbu afọ bụ ihe ama ama nke Ketoacidosis ọrịa shuga (DKA), ọ bụghị naanị gastroenteritis viral. Echela na onye nwere ọrịa shuga Type 1 ma ọ bụ Ụdị nke Abụọ na-agbọ agbọ nwere nsị nri ma ọ bụ flu afọ. Tụkwasị na nke ahụ, ndị ọrịa na-aṅụ ọgwụ ** SGLT2 inhibitor ** (dị ka empagliflozin, dapagliflozin, canagliflozin, ma ọ bụ ertugliflozin) nwere ike ịmalite Euglycemic DKA na-eyi ndụ egwu ọbụlagodi mgbe mkpịsị aka ha dị n'ọbara na-adị ka ihe kwesịrị ekwesị (n'okpuru $11.1\text{ mmol/L} $/t $ 2 mg). Mgbe ọ bụla onye nwere ọrịa shuga na-agbọ agbọ ugboro ugboro, na-eku ume miri emi na ngwa ngwa, na-arahụ ụra ma ọ bụ nwee mgbagwoju anya, ma ọ bụ gosi ketones ọbara na ma ọ bụ karịa \(1.5\text{ to }3.0\text{ mmol/L}\), kpọọ ndị ọrụ ahụike mberede ma ọ bụ gaa na ụlọ mberede ozugbo.

Mee nke a ugbu a

  1. Kpọọ nọmba mberede nke mpaghara gị ozugbo ma ọ bụrụ na onye ahụ nwere mgbagwoju anya, iro ụra, iku ume miri emi na ngwa ngwa, na-agbọ agbọ ugboro ugboro, ma ọ bụ nwee ketone ọbara \(\ge 3.0\text{ mmol/L}\). Kpọọ 911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom, ma ọ bụ hụ ha niile. nọmba mberede. Gwa onye ozi ahụ na onye ọrịa nọ na-enyo enyo ** Ketoacidosis ọrịa shuga (DKA)** ma ọ bụ Hyperosmolar Hyperglycemic State (HHS) na ọ chọrọ nleba anya mmiri mmiri n'ime intravenous n'ụlọ ọgwụ yana nleba anya electrolyte.
  2. Nwalee ma mkpịsị aka glucose ọbara yana beta-hydroxybutyrate ketones ozugbo (ọ bụrụ na mita dị).** Atụkwasịla obi na ọgụgụ ihe mmetụta na-aga n'ihu n'oge akpịrị ịkpọ nkụ ma ọ bụ ujo, n'ihi na mmiri anụ ahụ dị n'azụ ụkpụrụ ọbara. Detuo ọnụ ọgụgụ glucose ọbara kpọmkwem (ma ọ bụ dee ma ọ bụrụ na mita ahụ gụrụ "HI", nke na-apụtakarị n'elu \(27.8\ederede{ka }33.3\text{mmol/L}\) [\(500\text{ to }}600\text{mg/dL}\)]) na kpọmkwem ọkwa ketone ọbara dị na $\text color (mmol/L).
  3. ** Chebe ụzọ ikuku site n'itinye onye iro ụra, mgbagwoju anya, ma ọ bụ ọgbụgbọ n'akụkụ ha n'ọnọdụ mgbake.** Ya adịla mgbe ị na-enye onye ọ bụla na-ada mbà mmiri, nri, ma ọ bụ ọgwụ ogwu, na-ada ụda okwu, mgbagwoju anya, ma ọ bụ na-agbọ agbọ, n'ihi na ọ na-adị mfe ịmịnye mmiri mmiri n'ime ngụgụ ha (aspiration pneumonia). Ọ bụrụ na onye ahụ* na-amụ anya nke ọma, mụrụ anya ma nwee ike ilo na-agbọpụ**, gbaa ya ume ka ọ ṅụọ mmiri nkịtị ma ọ bụ mmiri electrolyte na-enweghị shuga (ihe dị ka milimita 250 [ihe dị ka mmiri mmiri ounces] kwa nkeji 15 ruo 30 maka okenye) mgbe ọ na-eche nlekọta ahụike.
  4. ** Lelee mgbapụta insulin maka tubing kinks ma ọ bụ cannula ọdịda, na echekwala nnukwu injections insulin subcutaneous.** Ọ bụrụ na onye ọrịa na-eji mgbapụta insulin ma nwee ọkwa glucose ọbara dị elu yana ketones dị elu (\(\ge 1.5\text{mmol/L}\)), chere na saịtị mgbapụta adaala: ** enyela bolus mgbazi site na mgbapụta. Kama, soro atụmatụ omume ụbọchị ọrịa ha nyere iwu site na iji pen ma ọ bụ sirinji insulin subcutaneous ọhụrụ n'ime saịtị akpụkpọ ahụ ọhụrụ ***. Ya adịla mgbe ọ bụla enyela nnukwu injections insulin na-enweghị usoro ma ọ bụ ugboro ugboro iji manye oke shuga dị n'ọbara tupu ndị na-ahụ maka ahụike abịarute, n'ihi na ịhapụ glucose ọbara ma ọ bụ osmolality ọbara ngwa ngwa na-enweghị saline tupu etinye ya na potassium na-akpata ọnwụ ** ụbụrụ edema *** (ụbụrụ ụbụrụ) na ** njide obi hypokalemic **.
  5. *Enyela acetaminophen (paracetamol), aspirin, ma ọ bụ ibuprofen nye nwatakịrị ma ọ bụ onye nọ n'afọ iri na ụma na DKA a na-enyo enyo, ma zere bicarbonate. mee ka isi na ubu onye ọrịa bulie ntakịrị elu n'ogo ogo 30 ma ọ bụrụ na ha na-amụ anya, ma hapụkwa ndị otu ụlọ ọgwụ jikwaa okpomọkụ na acidosis nke ọma.
  6. ** Kpọkọtanụ ihe niile gbasara ọrịa shuga, ndepụta ọgwụ (karịsịa SGLT2 inhibitors na steroids), na ndekọ mita na-adịbeghị anya maka ndị na-ahụ maka ahụike.

Mbelata nsogbu hyperglycemic na osisi mkpebi ketone

Jiri eserese ụlọ ọgwụ a iji nyochaa shuga ọbara dị elu, kọwaa ọbara ma ọ bụ mmamịrị ọgụgụ ketone, wee kpebie n'etiti njikwa ụbọchị ọrịa ụlọ na njem ụlọ ọgwụ mberede ozugbo.

flowchart TD
    Start["Onye nwere ọrịa shuga amaara ma ọ bụ nke a na-achọpụtabeghị nwere: <br/> Glucose ọbara>= 13.9 mmol/L (250 mg/dL) <br/> ma ọ bụ ọrịa ọ bụla / ọgbụgbọ / vomiting (ọbụlagodi ma ọ bụrụ na glucose <13.9 mmol/L na SGLT2i)"] --> RedFlags{"Ọ BỤLA Ọkọlọtọ na-acha uhie uhie mberede?<br/>1. Mmimi, iku ume ngwa ngwa (Kussmaul respirations) ma ọ bụ ume mkpụrụ osisi<br/>2. Ọgbụgbọ na-adịgide adịgide ma ọ bụ enweghị ike idobe mmiri mmiri ruo awa 2 ruo 4<br/>3. Nnukwu mgbu afọ, mgbagwoju anya, oke ike ọgwụgwụ, ma ọ bụ okwu na-adịghị mma<br/>4. Ketones ọbara> = 3.0 mmol/L (ma ọ bụ 'nnukwu' ketones mmamịrị) <br/>5. Mita na-agụ 'HI' (> 33.3 mmol/L / 600 mg/dL) na akpịrị ịkpọ nkụ."}

    RedFlags -->|"EE: Otu ọkọlọtọ uhie ọ bụla dị"| CallEMS["Mberede ụlọ ọgwụ ozugbo (DKA ma ọ bụ HHS):<br/>1. Kpọọ 911/112/999 ozugbo<br/>2. Ọ bụrụ na ụra ma ọ bụ ịgba agbọ: ọnọdụ mgbake & Ọ dịghị ihe site n'ọnụ (NPO) <br/>3. Ọ bụrụ na ọ mụrụ anya nke ọma & ghara ịgba agbọ: Obere sips nke mmiri nkịtị<br/>4. Achịkọtala nnukwu ọgwụ insulin tupu mmiri IV/potassium"]

    RedFlags -->|"Mba: Njikere, na-eku ume nke ọma,<br/>adịghị agbọ agbọ na-adịgide adịgide"| CheckKetones{"Lelee ketones ọbara (Beta-Hydroxybutyrate) <br/> ma ọ bụ eriri ketone mmamịrị"}

    CheckKetones -->|"Ketones ọbara sitere na 1.5 ruo 2.9 mmol/L (Ketones mmamịrị na-agafeghị oke)"| ModKetones["Ketonemia na-agafeghị oke (ịdọ aka na ntị DKA na-abịa): <br/>1. Kpọtụrụ ndị otu ọrịa shuga ma ọ bụ ndị enyemaka ahụike ngwa ngwa ozugbo<br/>2. Ọ bụrụ na ọ dị na mgbapụta insulin: Nye mgbazi ngwa ngwa site na PEN/SYRINGE<br/> ka ọ bụrụ saịtị ọhụrụ wee gbanwee infusion infusion dum <br/>3. Na-aṅụ 250 ml (8 oz) mmiri na-enweghị shuga kwa nkeji 30 ruo 60<br/>4. Lelee glucose ọbara na ketone n'ime awa 2 (Gaa ER ma ọ bụrụ na ọ na-ebili)"]

    CheckKetones -->|"Ketones ọbara sitere na 0.6 ruo 1.4 mmol / L<br/>( Chọpụta obere ketones mmamịrị)"| MildKetones["Obere / Chọpụta Ketonemia: <br/>1. Soro usoro iwu ụbọchị ọrịa edepụtara maka insulin na-eme ngwa ngwa<br/>2. Akwụsịla insulin basal/na-arụ ọrụ ogologo oge (ọbụlagodi na ọ naghị eri nri) <br/>3. Tinye mmiri mmiri (ma ọ bụ mmiri carbohydrate ma ọ bụrụ na glucose <10 mmol/L / 180 mg/dL) <br/>4. Na-enyochagharị glucose ọbara na ketone kwa awa 2 ruo 4 ọ bụla"]

    CheckKetones -->|"Ketones ọbara <0.6 mmol/L (Nkịtị) <br/> na glucose 13.9 ruo 22.2 mmol/L (250-400 mg/dL)"| NoKetones["Hyperglycemia na-enweghị ketosis: <br/> - Were usoro mmezi nke insulin na-eme ngwa ngwa<br/> - Ṅụọ ọtụtụ mmiri ma nyochaa maka akara mmiri HHS."]

Ịghọta pathophysiology: Ihe kpatara DKA na HHS ji eto na otu ha si dị iche

Ọ bụ ezie na ma DKA na HHS na-esite n'omume insulin ezughi oke jikọtara ya na homonụ na-akpata nchekasị (** glucagon, cortisol, epinephrine, na hormone nke uto **), ha na-agbaso ụzọ abụọ dị iche iche nke biochemical nke na-akọwa ihe kpatara mgbaàmà ha, ụkpụrụ ụlọ nyocha, na ihe ize ndụ ụlọ ọgwụ ozugbo dị iche.

1. Ketoacidosis na-arịa ọrịa shuga (DKA): agụụ na-agụ n'etiti ọtụtụ ihe

Na ** Ketoacidosis na-arịa ọrịa shuga (DKA), enwere ụkọ insulin na-ekesa siri ike ma ọ bụ zuru oke. Enweghị insulin, glucose na-anọ n'ime ọbara ma ghara ịbanye n'ime akwara ma ọ bụ sel abụba maka ume. N'ịche na anụ ahụ na-agụ agụụ, gland adrenal na pancreas na-ewepụta oke glucagon, adrenaline na cortisol, nke na-ebute cascades abụọ dị ize ndụ: - ** Lipolysis na-adịghị enyocha ya na ketogenesis (Metabolic Acidosis):** anụ ahụ adipose (abụba) na-agbaji ngwa ngwa n'ime acid fatty free, nke na-aga na imeju. Imeju na-atụgharị acid fatty ndị a ka ọ bụrụ ahụ ketone atọ: ** beta-hydroxybutyrate ** (acid bụ isi na-ekesa na DKA), acetoacetate, na acetone (nke ngụgụ na-ekupụ, na-amịpụta "pear drop" na-atọ ụtọ ma ọ bụ ntu-polish na-ewepụ isi na ume). Ketoacids ndị a siri ike na-emeri sistemu nchekwa bicarbonate ọbara, na-agbada ọbara arterial \(\text{pH}\) n'okpuru \(7.30\) (na n'okpuru \(7.00\) na DKA siri ike). - ** Osmotic Diuresis na Electrolyte Depletion:** Ozugbo glukos ọbara gafere ọnụ ụzọ akụrụ nke ihe ruru \(10.0 ederede {na }11.1\text{ mmol/L}\) (\(180\text{ to } }200\text{mg/dL}\)), glucose na ketones na-asọba n'ime mmamịrị, potassium, magnesium, potassium, pụọ n'ahụ. Okenye na DKA na-atụkarị 5 ruo 7 lita (1.3 ruo 1.8 galọn) mmiri ahụ (\(100\text{mL/kg}\)) n'ime awa 24.

2. Hyperosmolar Hyperglycemic State (HHS): Oke akpịrị ịkpọ nkụ na oke ọbara

Hyperosmolar Hyperglycemic State (HHS) na-emekarị n'ime ndị toro eto nwere ụdị ọrịa shuga nke abụọ ** (n'agbanyeghị na ọ na-apụtawanye na ndị nọ n'afọ iri na ụma na ndị na-eto eto nwere oke ibu na ụdị ọrịa shuga 2). N'adịghị ka DKA, onye nọ na HHS ka na-emepụta ** naanị zuru ezu insulin nke pancreatic iji gbochie mmebi abụba (lipolysis) na nhazi ketone **, mana ** ezughị insulin iji kwụsị imeju ịwụsa glucose n'ime ọbara ma ọ bụ ịkwaga glucose n'ime sel. - N'ihi na onye ọrịa ahụ anaghị aghọ acidotic ozugbo (enweghị ọgbụgbọ ngwa ngwa ma ọ bụ Kussmaul na-eku ume n'ime awa 24 mbụ), ha anaghị enwe mmetụta nke ukwuu n'ụbọchị 1. Kama nke ahụ, glucose ọbara na-arịgo n'elu ** ọtụtụ ụbọchị ruo izu 2 , na-erukarị ** $ 33.3 ederede { ka } } 66.6 ederede { mmol/L $ 1 \(. mg/dL}\)). - Nke a na-adịghị akwụsị akwụsị osmotic diuresis na-agbapụta 9 ruo 12 lita (2.4 ruo 3.2 galọn) mmiri (\(100\text{to}200\text{mL/kg}\),ma ọ bụ ihe ruru pasentị 20 nke mkpokọta mmiri ahụ) site n'ahụ onye ọrịa. Mgbe ọrịa, ọrịa strok, dementia, ma ọ bụ ndị nọọsụ enweghị ike imeghari na-egbochi onye ahụ ịṅụ mmiri zuru oke iji nọgide na-enwe, ọbara osmolality na-arị elu \(320\text{ mOsm/kg}\). A na-amịpụta mmiri ozugbo na mkpụrụ ndụ ụbụrụ, na-akpata ike ọgwụgwụ dị ukwuu, adịghị ike akwara ozi nke na-eṅomi a. ọrịa strok, ọdịdọ, coma, na akwara akwara ma ọ bụ venous ọbara mkpụkọ (pulmonary embolism ma ọ bụ infarction myocardial). N'ihi na ndị ọrịa na-akawanye nká na mmiri na-esiwanye ike karị, **HHS na-ebu ọnụ ọgụgụ ọnwụ nke pasent 10 ruo 20, nke dị ihe dị ka ugboro 5 ruo 10 karịa ọnụ ọgụgụ ọnwụ nke DKA ***.

ntụnyere isi na isi: DKA vs. Euglycemic DKA vs. HHS vs. Hypoglycemia

Jiri tebụl diagnostic a na-ahụ maka ụlọ ọgwụ (gụnyere 2024 Joint ADA / EASD / JBDS / AACE / DTS Consensus Report on Hyperglycemic Crises in Adults na ISPAD Ntuziaka ụmụaka) iji mata ọdịiche dị n'etiti ihe mberede ọrịa shuga:

Njirimara Clinical ma ọ bụ Biochemical Ketoacidosis ọrịa mamịrị oge ochie (DKA) Euglycemic DKA (euDKA) Ọnọdụ Hyperosmolar Hyperglycemic State (HHS) Hypoglycemia siri ike (sugar dị ala)
** Profaịlụ onye ọrịa na-ahụkarị *** Ọtụtụ n'ime Ụdị ọrịa shuga mellitus nke 1 (gụnyere ụmụaka/ndị okenye a chọpụtara ọhụrụ), ma ọ bụ ketosis na-adịkarị mfe ** Ụdị ọrịa shuga 2** n'okpuru oke nrụgide/ọrịa. Ụdị 1 ma ọ bụ ụdị ọrịa shuga 2 na-ewere ** SGLT2 inhibitors ***, ma ọ bụ ** ime ime ***, ibu ọnụ, nri ketogenic, ịwa ahụ bariatric, ma ọ bụ ịṅụ mmanya na-aba n'anya. Ọtụtụ n'ime ** ndị okenye nwere ọrịa shuga 2dị nke abụọ** (na-enwekarị ọrịa, ọrịa strok, nkụchi obi, diuretics, ma ọ bụ enweghị ike ịnweta akpịrị ịkpọ nkụ). Onye ọ bụla na-ewere insulin ma ọ bụ ** sulfonylurea pills** (glipizide, glimepiride, glyburide).
Ọsọ mmalite ** Ngwa ngwa: awa 4 ruo 24 *** (nwere ike ịmalite na ** n'okpuru awa 4 ** ma ọ bụrụ na mgbapụta insulin kwụsịrị ma ọ bụ gbochie). ** Ngwa ngwa ka ọ dị ntakịrị: awa ruo ụbọchị ole na ole *** (nchọpụta na-egbu oge n'ihi na shuga ọbara na-adị ka ihe nkịtị). ** nwayọọ na aghụghọ: ọtụtụ ụbọchị ruo izu 2 ** nke polyuria na-aga n'ihu, polydipsia, na adịghị ike. ** Nkeji ***: Mmalite na mberede nke ịma jijiji, ọsụsọ, mgbagwoju anya, ma ọ bụ njide.
** Ọkwa glucose ọbara *** Ọtụtụ mgbe \(\ge 11.1 ederede mmol/L}\) (\(\ge 200\ederede{mg/dL}\)) (nke na-abụkarị \(14\ederede {ka }30\ederede { mmol/L}\) [\(250\ederede{ gaa }550\ederede{mg/dL}\)]). ** N'okpuru \(11.1 ederede { mmol/L}\) (\(< 200\text{mg/dL}\))**, mgbe ụfọdụ ihe na-emekarị (\(5.5\ederede {ka }9.0\ederede{ mmol/L}\) [\(100\ederede{ga }}160\ederede{mg/dL}\)]). \(\ge 33.3\ederede{mmol/L}\) (\(\ge 600\ederede{mg/dL}\)), na-agụkarị "HI" na mita ụlọ (\(600\ederede{ka }1,200+\ederede{mg/dL}\)). N'okpuru \(3.9\ederede{mmol/L}\) (\(< 70\ederede{mg/dL}\)); neuroglycopenia siri ike n'okpuru \(3.0\ederede{mmol/L}\) (\(54\ederede{mg/dL}\)).
** ketones ọbara ($ beta$ -Hydroxybutyrate)** \(\ge 3.0\ederede{mmol/L}\) (ma ọ bụ ketones mmamịrị \(\ge 2+\) / agafeghị oke-na-ibu). \(\ge 3.0\text{ mmol/L}\) (n'agbanyeghị ọkwa shuga dị n'ọbara nkịtị ma ọ bụ nke dị nwayọọ). \(< 3.0\text{ mmol/L}\) (ketones adịghị ma ọ bụ naanị obere agụụ agụụ; ketones mmamịrị adịghị mma ma ọ bụ chọpụta). ** Nkịtị ($ <0.6\ederede { mmol/L}$)**.
** Aterial / Venous pH & Bicarbonate *** Acidotic: \(\text{pH} <7.30\) na serum bicarbonate \(< 18\text{ mmol/L}\) (\(< 10\text{ mmol/L}\) na DKA siri ike). Acidotic: \(\text{pH} <7.30\) na serum bicarbonate \(< 18 ederede { mmol/L}\). ** Ọ bụghị nke ukwuu acidotic **: \(\text{pH} \ge 7.30\) na serum bicarbonate \(ge 15 ederede {ka} }18\ederede { mmol/L}\). ** pH nkịtị.
Ụkpụrụ iku ume na isi ume ** Kussmaul respirations** (miri, ngwa ngwa, na-arụ ọrụ na-asụ ude iji gbanyụọ \(\text{CO}_2\)) + ** ume acetone dị ụtọ/mkpụrụ osisi**. Kussmaul respirations + ume na-amị mkpụrụ + ọgbụgbọ/ọgbọ. ** iku ume na-emighị emi ma ọ bụ nkịtị *** (belụsọ na oyi baa ma ọ bụ sepsis bụ ihe na-akpalite); enweghị isi acetone mkpụrụ osisi. Nkịtị ma ọ bụ ngwa ngwa na-emighị emi; icha mmirimmiri, ọsụsọ jụrụ oyi.
** Mgbaàmà nke eriri afọ *** ** Nke a ma ama ***: ọgbụgbọ siri ike, ọgbụgbọ na-adịgide adịgide, na mgbu afọ na-agbasa nke ukwuu (na-eṅomi nnukwu appendicitis ma ọ bụ pancreatitis). ** Ihe a ma ama ***: ọgbụgbọ, ọgbụgbọ, enweghị agụụ, mgbaka afọ, na ahụ erughị ala. ** Dị nro ma ọ bụ na-anọghị ***: mgbu afọ bụ ihe a na-ahụkarị ma ọ bụrụ na ọrịa afọ na-akpata kpatara ya. Agụụ na mbụ, na-aga n'ihu ruo mgbagwoju anya ma ọ bụ anabataghị ya.
Ọnọdụ Neurology Mkpu na DKA dị nro; iro ụra, ike ọgwụgwụ, ma ọ bụ nzuzu na DKA na-agafeghị oke ruo oke. Ike gwụrụ, adịghị ike, isi ọwụwa, na ọgbụgbọ; na-aga n'ihu n'ụra ma ọ bụrụ na agwọghị ya. **Mmetụta akwara ozi miri emi ***: mgbagwoju anya, ịhụ anya, hemiparesis (stroke mimic), ọdịdọ, ma ọ bụ coma n'ihi Serum Osmolality \(> 320\text{mOsm/kg}\). Mkpasu iwe mberede, okwu na-adịghị mma, ọdịdọ, ma ọ bụ amaghị ihe ọ bụla; na-atụgharị ngwa ngwa na glucose/glucagon.
** Nkezi Mkpokọta Mbelata Mmiri (okenye)** \(5'ederede{gaa }7\ederede{lita}\) (\(100'ederede{mL/kg}\)). ** $ 3 ederede {na } } 5 ederede {lita} $** (osmotic glucose diuresis, ma ọ bụrụ na vomiting siri ike). \(9'ederede{gaa }12\ederede{lita}\) (\(100'ederede {ka }200\ederede{mL/kg}\)). ** Ọ dịghị** (chọrọ glucose ma ọ bụ glucagon ozugbo; lee mberede ọrịa shuga).

Ịmata akara ịdọ aka ná ntị na SGLT2 inhibitor "Euglycemic DKA" ọnyà

Kedu ka mgbaàmà DKA si aga site na Ketosis Early ruo Acidotic Collapse

  1. ** Nkeji 1: mmalite hyperglycemia na ketonemia (awa 1 ruo 6):**
  2. Akpịrị ịkpọ nkụ na-adịghị agwụ agwụ (** polydipsia**), ọnụ na-akpụ akpụ, na njem na-aga mamiri (** polyyuria**), gụnyere ịkpọlite ọtụtụ ugboro n'otu abalị (ma ọ bụ akwa ụra na mberede n'ime nwatakịrị zụrụ azụ mposi).
  3. Adịghị ike nke anụ ahụ zuru oke, ike ọgwụgwụ, ọhụụ na-adịghị mma, na isi ọwụwa.
  4. Ọbara glucose na-adịkarị karịa \(13.9\text{mmol/L}\) (\(250\text{mg/dL}\)) na ketones ọbara na-ebili n'etiti \(0.6\text{ na}1.5\text{ mmol/L}\).
  5. ** Nkeji 2: Ketoacidosis guzosiri ike (awa 6 ruo 18):**
  6. Ọgbụgbọ, ọgbụgbọ ugboro ugboro, na oke mgbu afọ: Acidemia na ọnya afọ na-akpasu eriri afọ na mgbidi afọ. Ozugbo vomiting malitere, onye ọrịa agaghịzi edebe mmiri ọnụ ọnụ, na-eme ka akpịrị ịkpọ nkụ dị ngwa ngwa banye n'ọgbada ala.
  7. Kussmaul iku ume ("agụụ ikuku"): N'ihi na ọbara dị acidic dị ize ndụ, ebe akụkụ iku ume nke ụbụrụ na-amanye ume iku ume miri emi, ngwa ngwa, na-asụ ude iji fepụ carbon dioxide acidic (\(\text{CO}_2\)). Ndị na-ekiri ekiri na-emehiekarị ude miri emi a maka ọgụ ụjọ ma ọ bụ ụkwara ume ọkụ, n'agbanyeghị na ngụgụ na-ada nke ọma.
  8. Mkpụrụ osisi "pear drop" ma ọ bụ ntu na-ewepụ ume: Ihe na-akpata site na acetone gas na-agbanwe agbanwe na-esi na capillaries pulmonary na-ekpochapụ.
  9. ** Nkeji 3: DKA akwụghị ụgwọ na ujo (awa 12 ruo 24+):**
  10. Anya gbadara agbaze, ire akpụkpọ anụ kpọrọ nkụ, turgor akpụkpọ ahụ na-adịghị mma, adịghị ike ngwa ngwa (\(> 120\text{bpm}\)), ọbara mgbali na-ada ada, mgbagwoju anya, enweghị ike ịmụrụ anya, edema ụbụrụ, na njide obi.

Ọnyà Euglycemic DKA (euDKA): Gịnị kpatara shuga ọbara nkịtị ka nwere ike zoo DKA na-egbu egbu

N'ime afọ iri gara aga, ** Sodium-glucose Cotransporter-2 (SGLT2) inhibitors **, gụnyere ** empagliflozin (Jardiance), dapagliflozin (Farxiga / Forxiga), canagliflozin (Invokana), ertugliflozin (Steglatro), na sotagliflozin (Steglatro), na sotagliflozin (SGLT2) inhibitors maka ọrịa obi na-adịghị ala ala (Inpefa) aghọọla ọrịa akụrụ na-adịghị ala ala. Ọgwụ ndị a na-arụ ọrụ site na ịmanye akụrụ ka ọ tụfuo gram 60 ruo 100 nke glucose n'ime mmamịrị kwa ụbọchị.

N'ihi na akụrụ na-ekpochapụ shuga dị n'ọbara mgbe niile n'ime mmamịrị, ọ bụrụ na onye ọrịa na-ewere SGLT2 inhibitor na-ebute ọrịa, kwụsị iri nri n'oge nje afọ, na-awa ahụ, malite nri obere carbohydrate/ketogenic nri, ma ọ bụ na-ebelata dose insulin ha, ** imeju ha na-awụpụ ketone acid acid mgbe mkpịsị aka ha glucose na-anọ n'ụzọ aghụghọ ($ 60. }11.0\text{ mmol/L}$ ma ọ bụ \(110\ederede{ka }199\ederede{mg/dL}\))**.

Iwu Kwụsị DKA maka SGLT2 Inhibitors

Ntuziaka ọrịa shuga mba ụwa (ADA, EASD, UK JBDS na Health Canada / FDA) nyere iwu iwu "Kwụsị DKA" maka onye ọ bụla na-ewere SGLT2 inhibitor (empagliflozin, dapagliflozin, canagliflozin, ertugliflozin): - ** S *** n'elu na-ewere mbadamba ihe mgbochi SGLT2 ozugbo ọ bụrụ na ị na-arịa ọrịa siri ike, ahụ ọkụ, ọgbụgbọ, vomiting, ma ọ bụ enweghị ike iri nri na ịṅụ ihe ọṅụṅụ na-emekarị, ma kwụsị ya ** 3 ruo 4 ụbọchị tupu ịwa ahụ ma ọ bụ colonoscopy ọ bụla. - Test ** ketones ọbara* (ọ bụghị naanị shuga dị n'ọbara) mgbe ọ bụla ị na-enwe ọgbụgbọ, ike ọgwụgwụ, mkpụmkpụ ume, ma ọ bụ nwee afọ mgbu, ** ọbụlagodi ma ọ bụrụ na mita glucose ọbara gị na-agụ nke ọma ($ 5.5 ederede {mmol/L} $ / $ 100\text{ ruo } 180 ederede \() mg/d. - ** O ** ral fluids na carbohydrates: Ọ bụrụ na ketones ọbara na-ebuli (\)> 0.6\text{ ka }1.5\text{ mmol/L}$) na glucose ọbara bụ ihe nkịtị, onye ọrịa chọrọ n'ezie ** ma carbohydrates (15 ruo 30 grams shuga / ihe ọṅụṅụ) yana insulin na-eme ngwa ngwa n'ụlọ ọgwụ iji gbanyụọ ọkụ imeju. - ** P *** ezigara ngalaba mberede ozugbo wee gwa dọkịta ahụ n'ụzọ doro anya: * "Ana m ewere SGLT2 inhibitor ma chọọ nyocha ọbara beta-hydroxybutyrate ketone na venous blood gas check iji wepụ Euglycemic DKA."

Nnwale ọbara ketone vs. mmamịrị ketone strips: Gịnị kpatara mita ọbara ji dị elu na mberede

Mgbe ị na-elele DKA n'ụlọ, ** capillary blood ketone mita ** (nke na-atụ ** beta-hydroxybutyrate [\(\ beta\)-OHB]** na-eji mkpịsị mkpịsị aka, dị ka mita glucose) ziri ezi ma rụọ ọrụ karịa itinye na-agụ ** urine ketone strips ** (nke na-atụ naanị ** acetoacetate): site na mmeghachi omume nitropus.

  1. ** Mpempe mmamịrị na-efunahụ DKA n'oge:** N'oge DKA siri ike, imeju na-emepụta ihe ruru ugboro iri beta-hydroxybutyrate karịa acetoacetate**. N'ihi na mpempe mmamịrị enweghị ike ịchọpụta beta-hydroxybutyrate ma ọlị, eriri mmamịrị nwere ike igosi naanị "trace" ma ọ bụ "obere" ketones mgbe beta-hydroxybutyrate ọbara adịlarị na \(3.5 ederede{mmol/L}\) na-eyi ndụ egwu.
  2. ** Mmiri mmiri na-ekpo ọkụ na-egbochi mmamịrị:** Onye na-arịa oke mmiri na-ekpo ọkụ na DKA ma ọ bụ HHS na-enwekarị ike ịmepụta ihe nlele mmamịrị ruo awa ole na ole, ebe mgbada ọbara mkpịsị aka na-ewe sekọnd 10.
  3. ** Mpempe mmamịrị na-emepụta mkpu ụgha n'oge mgbake: *** Ka DKA na-ekpebi ọgwụgwọ, beta-hydroxybutyrate na-atụgharị azụ n'ime acetoacetate ma na-agbanye n'ime mmamịrị, na-eme ka eriri mmamịrị ghọọ odo odo ("nnukwu") awa mgbe a kpochapụrụ acidosis ọbara n'ezie.

Otu esi akọwa ọnụọgụ ketone ọbara beta-hydroxybutyrate (\(\beta\)-OHB).

Ọgụgụ ketone ọbara (\(\text{mmol/L}\)) Ihe mgbawa mmamịrị ruru Pụtara ụlọ ọgwụ na ihe omume ozugbo achọrọ
** N'okpuru \(0.6\ederede{ mmol/L}\)** Ihe ọjọọ ** Oke nkịtị.** Enweghị ketosis dị. Jikwaa ọkwa glucose ọbara dị elu site na iji usoro mgbazi ziri ezi na mmiri.
\(0.6\ederede{gaa }1.4\ederede{mmol/L}\) Chọpụta obere (\(+\)) Ketonemia dị nro (ịdọ aka ná ntị mbụ) Ahụ amalitela ire abụba n'ihi ụkọ insulin ma ọ bụ ibu ọnụ. Tinye iwu ụbọchị ọrịa: were insulin na-arụ ọrụ ngwa ngwa, ṅụọ 250 ruo 500 ml (8 ruo 16 oz) nke mmiri kwa elekere, yana ** nyochaghachi glucose na ketones ọbara n'ime awa 2 **.
\(1.5\ederede{gaa }2.9\ederede{ mmol/L}\) Obere (\(++\)) ** Nnukwu ihe ize ndụ nke ịmalite DKA.** Kpọtụrụ ụlọọgwụ maka ọrịa shuga ma ọ bụ ekwentị enyemaka ahụike ngwa ngwa ugbu a. Ọ bụrụ na ị na-eji mgbapụta insulin, nye mmezi dose site na ** insulin pen/syringe subcutaneous** ma dochie ntinye infusion dum. Na-aṅụ ihe ọṅụṅụ kwa nkeji 30 ma nwalee ọzọ n'ime awa 1 ruo 2; gaa na ụlọ mberede ma ọ bụrụ na vomiting emee ma ọ bụ ọkwa adịghị ada.
\(3.0\ederede { mmol/L}\) ma ọ bụ karịa Nnukwu (\(+\) ruo \(++++\)) ** Mberede ahụike: Ketoacidosis nke ọrịa mamịrị puru omume (DKA)** Kpọọ 911/112/999 ma ọ bụ hazie njem ụlọ ọgwụ mberede ozugbo maka saline, potassium na ọgwụgwọ insulin.

Kedu ihe kpatara na ị gaghị atụba oke ọgwụ insulin n'ụlọ tupu ịbata ụlọ ọgwụ

Mgbe onye ọrịa ma ọ bụ onye òtù ezinụlọ hụrụ mita glucose ọbara na-agụ \(28.0\text{ mmol/L}\) ($ 500\text{mg/dL}$) ma ọ bụ "HI", mmuo na-abụkarị ịgbanye nnukwu insulin na-arụ ọrụ ngwa ngwa (ma ọ bụ na-agbagharị injection kwa nkeji 30 ọ bụla) tupu ịga ụlọ ọgwụ. ** Inye onye ọrịa nwere nnukwu mmiri ọgwụ insulin na DKA ma ọ bụ HHS na mpụga ụlọ ọgwụ dị ize ndụ** n'ihi ihe atọ gbasara ahụike:

1. Oke akpịrị ịkpọ nkụ na-egbochi nnabata insulin nke subcutaneous, wee tụfuo ya ozugbo

Mgbe onye ọrịa nọ na DKA ma ọ bụ HHS na-agbaze site na lita 5 ruo 10, arịa ọbara na akpụkpọ ahụ na abụba dị n'okpuru akpụkpọ ahụ na-egbochi iji chekwaa ọbara na-eruba na obi na ụbụrụ. Otutu dose nke insulin na-eme ngwa ngwa nke a gbabara n'okpuru akpụkpọ ahụ na-anọdụ ala n'obere ebe nchekwa subcutaneous na-adịghị mma. Ozugbo ndị na-ahụ maka ahụike na-amalite saline nke eriri afọ na mgbasa nke anụ ahụ na-alọghachi, ebe nchekwa ahụ a gbakọtara na-abanye n'ọbara n'otu oge, na-ebute oke ujo hypoglycemic.

2. Ịkwọba potassium n'ime sel tupu ịlele ụlọ nyocha ọbara na-ebute njide obi

N'oge DKA na HHS, osmotic diuresis na-ebute oke potassium (\(\text{K}^+\)) n'ime mmamịrị. Ọ bụ ezie na potassium zuru ezu na-ebelata, potassium serum na mbụ na-adị ka ihe nkịtị n'ihi na acidosis na-ewepụ potassium na sel. ** Insulin na-amanye potassium si n'ọbara banye n'ime sel.** Ọ bụrụ na a na-enye insulin nke ukwuu tupu ụlọ ọgwụ enyocha ọbara ọbara potassium (na tupu etinye potassium chloride n'ime intravenous mgbe \(\text{K}^+ < 5.0\text{ to } }5.2\text{ mmol/L}\), ma ọ bụ mgbe a na-ejide insulin ma ọ bụrụ $\text{K.ol/Plucet{K}}/Plushm}). n'ime nkeji ole na ole, na-ebute ** hypokalemic ventricular arrhythmias na njide obi.

3. Ịdaba shuga ọbara ngwa ngwa na HHS ma ọ bụ DKA ụmụaka na-ebute Cerebral Edema na Vascular Collapse.

  • Na HHS: Ọbara dị elu bụ ike osmotic bụ isi na-ejide mmiri n'ime akwara ndị gbajiri agbaji, na mkpụrụ ndụ ụbụrụ emegharịwo kwa ụbọchị ruo oke osmolality (\(> 320\text{mOsm/kg}\)). Ntuziaka ụlọ ọgwụ (UK JBDS na ADA/EASD 2024 nkwenye) na-ekwu na ** elekere mbụ nke ọgwụgwọ HHS bụ $ 0.9 \% $ nkwụghachi mmiri saline nkịtị naanị**, nke na-ebelata shuga ọbara n'enweghị ihe ọ bụla site na \(2.8 ederede{mmol/L/hr}\) \(50\text{mmol/L/hr}\) $50\text{7t}mg Inye insulin buru ibu na-ebu ụzọ eme ka mmiri si na akwara pụta (na-ebute ndakpọ ọbara) na n'ime mkpụrụ ndụ ụbụrụ, na-ebute ** ụbụrụ ụbụrụ ma ọ bụ osmotic demyelination **.
  • N'ime ụmụaka DKA: Ụmụaka na ndị nọ n'afọ iri na ụma na-enwekwa ike n'ụzọ pụrụ iche maka **DKA edema cerebral edema na-ejikọta ya, nke na-ebu ọnụ ọgụgụ ọnwụ nke pasent 20 ruo 25. Iwedata glucose ọbara ngwa ngwa site na iji insulin boluses (ma ọ bụ inye sodium bicarbonate intravenous) na-abawanye ohere nke ọzịza ụbụrụ na-egbu egbu.

Ịmata edema ụbụrụ (ụbụrụ ụbụrụ) na ụmụaka na ndị okenye

Lelee nwatakịrị ọ bụla, onye nọ n'afọ iri na ụma, ma ọ bụ onye na-eto eto nwere DKA anya maka ihe ịrịba ama nke ịrị elu nrụgide intracranial (cerebral edema), nke nwere ike ịmalite tupu ọ bịarute ụlọ ọgwụ ma ọ bụ awa 4 ruo 12 mgbe ọgwụgwọ amalitechara:

Akara ọkọlọtọ ọbara ọbara nke edema ụbụrụ (ihe mberede neurocritical ozugbo)

  • ** Ọhụrụ ma ọ bụ na-akawanye njọ isi ọwụwa** (karịsịa mgbe emeziwanye nke mbụ).
  • Mgbanwe na mberede na omume: Iwe iwe na-adịghị ahụkebe, mkpasu iwe, ezumike, ma ọ bụ iro ụra mberede na enweghị ike iteta.
  • Ọnụ ọgụgụ obi na-ebelata (bradycardia) jikọtara ya na ọbara mgbali elu (Cushing's triad): N'ime onye ọrịa DKA akpọnwụwo nkụ, ọnụọgụ obi na-adịkarị ngwa ngwa (\(110\text{ ka }150\text{bpm}\)). Ọ bụrụ na ọnụ ọgụgụ obi nwatakịrị na-agbada na mberede gaa \(60\text{to }70\text{bpm}\) mgbe ụra na-arahụ ha, chere na ụbụrụ na-agba ya ozugbo.
  • ** Ọgbụgba a na-alọghachi, ụmụ akwụkwọ na-ahaghị nhata, anya gafere, mkpụgharị ahụ na-adịghị mma, ma ọ bụ enweghị mgbagha.**
  • Eme ngwa ngwa: Bulie isi ihe ndina ahụ ruo ogo 30, mee ka olu etiti dị n'etiti, ma mee ka ndị dọkịta mara ozugbo ka ha nwee ike ịnye saline intravenous ** hypertonic \(3 \%\) saline ($ 3\text{to }5\text{ mL/kg}\()** ma ọ bụ **mannitol (\)0.5\text{ to }$/g} g)

Ọnọdụ mberede pụrụ iche: ọdịda mgbapụta insulin na iwu "Pen First".

Ndị ọrịa na-eji infusion insulin subcutaneous na-aga n'ihu (CSII) ** mgbapụta insulin na-ebu ihe ọghọm pụrụ iche na mmalite ngwa ngwa DKA: - N'adịghị ka ndị na-agba ọgwụ na-ewere insulin basal na-arụ ọrụ ogologo oge (glargine, degludec, ma ọ bụ detemir) nke na-arụ ọrụ n'okpuru akpụkpọ ahụ maka awa 24 ruo 42, ** mgbapụta insulin nwere naanị insulin na-eme ngwa ngwa ** (lispro, aspart, ma ọ bụ glulisin). - Ọ bụrụ na Teflon cannula n'okpuru akpụkpọ ahụ na-akụ, na-agbapụ, ma ọ bụ ngọngọ, ** na-ekesa insulin na-adaba na efu n'ime awa 2 ruo 3 ** na ** DKA zuru oke nwere ike ịmalite n'ime awa 4 ruo 6 **.

Ndepụta nchọpụta nsogbu nke insulin nzọụkwụ site na-agbapụta ketone

  • ** Nzọụkwụ 1:** Ọ bụrụ na glucose ọbara bụ \(\ge 13.9\text{mmol/L}\) (\(250\text{mg/dL}\)) na ketones ọbara bụ \(\ge 1.5\text{mmol/L}\), ** were ya na saịtị infusion mgbapụta adaala ***, ọbụlagodi na enweghị mkpu mkpuchi.
  • Nzọụkwụ 2: Ebupụla bolus mgbazi site na pọmpụ. Jiri nkwado ndabere* ** pen ma ọ bụ sirinji insulin enwere ike ịtụfu** iji tinye usoro mgbazi ngwa ngwa enyere n'ime mpaghara ọhụrụ.
  • Nzọụkwụ 3: Wepu cannula/pod ochie, lelee akpụkpọ ahụ ka ọ na-acha ọbara ọbara ma ọ bụ na-esi ísì insulin, na fanye ntinye infusion ọhụrụ, ebe nchekwa, na insulin ọhụrụ na saịtị ọhụrụ.
  • ** Nzọụkwụ 4: ** Ṅụọ 250 ruo 500 milliliters (8 ruo 16 ounces fluid) mmiri wee lelee glucose ọbara na ketones n'ime nkeji 90 ruo 120 **. Ọ bụrụ na ketone na-ebili ma ọ bụ vomiting amalite, kpọọ 911/112/999 ma ọ bụ gaa na ụlọ mberede.

Iwu ọla edo nke nlekọta ụbọchị ọrịa iji gbochie DKA na HHS

Ihe karịrị ọkara nke nnabata ụlọ ọgwụ maka DKA na HHS na-ebute site na ọrịa nkịtị (ọrịa urinary tract, oyi baa, flu, COVID-19, ma ọ bụ gastroenteritis) ebe mmejọ ọgwụ na-eme. Soro iwu ise ndị a gbasara ụbọchị ọrịa zuru ụwa ọnụ nke American Diabetes Association (ADA), Diabetes UK na ISPAD kwadoro:

  1. Iwu nke 1: Akwụsịla ịṅụ insulin basal (na-arụ ọrụ ogologo oge), ọbụlagodi na ị na-agbọ agbọ na iri nri efu.
  2. N'oge ahụ ọkụ ma ọ bụ ọrịa, homonụ nchekasị na-eme ka imeju gị na-awụsa glucose na ketones n'ọbara gị mgbe niile, ọbụlagodi na afọ efu. Ịkwụsị insulin na-eme ogologo oge kwa ụbọchị (Lantus, Toujeo, Tresiba, Levemir) n'ihi na ị naghị eri nri bụ isi ihe na-akpata DKA.
  3. Iwu nke abụọ: Lelee glucose ọbara na ketone n'ọbara kwa awa 2 ruo 4 gburugburu elekere (gụnyere otu abalị).
  4. Atụkwasịla naanị na ihe nleba anya glucose na-aga n'ihu (CGM) n'oge akpịrị ịkpọ nkụ, na-elele ketones mgbe shuga ọbara karịrị \(13.9\text{mmol/L}\) (\(250\text{mg/dL}\)) ma ọ bụ mgbe ọgbụgbọ.
  5. ** Usoro nke atọ: Na-aṅụ 100 ruo 250 milliliters (3.5 ruo 8 fluid ounces) nke mmiri kwa nkeji 30 ruo 60, na-adaba ụdị mmiri na shuga ọbara gị.
  6. ** Glucose ọbara karịrị \(10.0 ederede  ruo } 11.1 ederede mmol/L}\) ($ 180 ederede { ka } 200\ederede {mg/dL}$):** Ọṅụnụ ** mmiri mmiri na-enweghị shuga** (mmiri nkịtị, ihe ngwọta electrolyte na-enweghị shuga, ma ọ bụ efere nnu doro anya).
  7. ** Ọbara glucose n'okpuru \(10.0 ederede mmol/L}\) ($ 180 ederede mg/dL}$) na ọgbụgbọ ma ọ bụ ketones dị elu:** Sip ** mmiri nwere carbohydrate** (ihe ọṅụṅụ mkpụrụ osisi gbazere, ngwọta rehydration nke ọnụ mgbe niile, ma ọ bụ ice pops) tinyere insulin ụbọchị ọrịa nyere iwu ka imeju na-agbanwe.
  8. ** Usoro nke anọ: Soro Chart Insulin mgbakwunye ụbọchị ọrịa nke endocrinologist dere (nke na-abụkarị 10% ruo 20% nke ngụkọta kwa ụbọchị).**
  9. Ọtụtụ ụlọọgwụ na-enye eserese dabere na ** mkpokọta dose kwa ụbọchị (TDD)** nke insulin. Mgbe a na-ebuli glucose ọbara site na ketones dị nwayọọ ma na-agafeghị oke ($ 0.6 ederede {na } } 2.9 "ederede { mmol/L}$), ndị ọrịa na-ejikarị ** 10 ruo 20 pasent nke TDD ha dị ka insulin na-eme ngwa ngwa kwa awa 2 ruo 4, na-eduzi atụmatụ nlekọta ederede ha.
  10. Iwu nke 5: Kwụsị ọgwụ "SADMANS" n'oge akpịrị ịkpọ nkụ ma ọ bụ vomiting.
  11. Otu ndị na-arịa ọrịa shuga na-eji okwu mkpọ okwu "SADMANS" maka ọgwụ kwa ụbọchị nke a ga-akwụsịtụ nwa oge n'oge oke vomiting, afọ ọsịsa, ma ọ bụ akpịrị ịkpọ nkụ iji gbochie Euglycemic DKA, nnukwu mmerụ ahụ akụrụ na lactic acidosis:
    • S *** ulfonylureas (glipizide, gliclazide, glimepiride: na-ebute hypoglycemia ma ọ bụrụ na anaghị eri nri)
    • Ndị na-egbochi A *** CE (lisinopril, ramipril, enalapril: na-emebi filtration akụrụ mgbe mmiri gwụchara)
    • ** D *** iuretics / ọgwụ mmiri (furosemide, hydrochlorothiazide: akpịrị ịkpọ nkụ na-akawanye njọ na HHS)
    • M *** etformin (na-ebute lactic acidosis ma ọ bụrụ na akụrụ akpọnwụ akpọnwụ enweghị ike ikpochapụ ya)
    • ** A *** ngiotensin Receptor Blockers / ARBs (losartan, valsartan, candesartan)
    • ** N *** ọgwụ mgbochi mkpali na steroidal / NSAIDs (ibuprofen, naproxen: mmebi akụrụ akpọnwụ akpọnwụ)
    • S *** GLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin: na-akpalite Euglycemic DKA)

Were nkuzi

Inweta nkuzi enyemaka izizi nke sitere na Red Cross, St John Ambulance, ma ọ bụ onye na-ahụ maka ọzụzụ mberede mpaghara, jikọtara ya na mmemme mmụta nchịkwa onwe onye ọrịa shuga, na-enyere gị na ezinụlọ gị aka ịzaghachi nwayọ na n'ụzọ ziri ezi maka ọgba aghara shuga dị ala na nke dị elu.

Ajụjụ a na-ajụkarị

Kedu otu m ga-esi amata ọdịiche dị n'etiti shuga dị ala (hypoglycemia) na ọbara shuga dị elu (DKA ma ọ bụ HHS) ma ọ bụrụ na enweghị m mita aka?

Hypoglycemia na-abịa n'ime nkeji nkeji ma na-ebute ịma jijiji, ọsụsọ na-ajụ oyi, akpụkpọ ahụ na-acha aja aja, na mgbagwoju anya mberede. N'ụzọ dị iche, DKA na HHS na-etolite ihe karịrị awa ole na ole ma na-ebute akpịrị ịkpọ nkụ, mmamịrị ugboro ugboro, akpụkpọ ahụ kpọrọ nkụ, agbọ agbọ, na iku ume ngwa ngwa na ume mkpụrụ; Ọ bụrụ na ịnweghị ike ịnwale shuga ọbara, buru ụzọ gwọọ hypoglycemia a na-enyo enyo n'ihi na shuga dị ala na-emebi ụbụrụ n'ime nkeji nkeji, ebe gram 15 nke shuga agaghị eme ka DKA ma ọ bụ HHS ka njọ.

Onye a na-achọpụtabeghị na ọ nwere ọrịa shuga nwere ike ịmalite na mberede DKA?

Ee, ihe dị ka pasent 20 ruo 40 nke ụmụaka, ndị nọ n'afọ iri na ụma, na ndị na-eto eto ndị a chọpụtara na ha nwere ọrịa shuga 1dị 1 na-achọpụta ọnọdụ ha mgbe agbagara n'ọnụ ụlọ mberede na ọrịa shuga Ketoacidosis. Na-enyo enyo mgbe niile na mmalite mmalite nke ọrịa shuga 1 na DKA ma ọ bụrụ na nwatakịrị ma ọ bụ okenye enweela izu 1 ruo 3 nke ọnwụ na-enweghị atụ, akpịrị ịkpọ nkụ mgbe niile, na mmamịrị mgbe niile (ma ọ bụ akwa akwa ọhụrụ) na-esote vomiting, mgbu afọ, na iku ume ngwa ngwa.

Kedu ihe kpatara o ji dị ize ndụ maka onye nwere mgbapụta insulin iji mgbapụta ahụ dozie shuga ọbara dị elu na ketones?

N'ihi na mgbapụta insulin na-eji naanị insulin na-eme ngwa ngwa yana insulin basal na-arụ ọrụ ogologo oge, ọbara shuga dị elu jikọtara ya na ketones dị elu (1.5 mmol / L ma ọ bụ karịa) na-apụtakarị na cannula n'okpuru akpụkpọ ahụ na-agbaji ma ọ bụ gbochie ya. Ịkwanye bolus mgbazi site na cannula egbochiri adịghị enye insulin mgbe ọ na-egbu oge; jiri mkpịsị mkpịsị insulin nke aka ma ọ bụ sirinji gbanye dose mmezi ahụ n'ime ebe ahụ dị ọhụrụ wee gbanwee ntọala infusion dum.

Kedu ihe ọ pụtara mgbe mita glucose ọbara n'ụlọ gosipụtara "HI" kama nọmba?

N'ọtụtụ mita glucose ọbara nke ndị na-azụ ahịa, "HI" pụtara shuga ọbara nke capillary gafere oke ikike ọgụgụ nke ngwaọrụ, nke na-adịkarị karịa 27.8 ruo 33.3 mmol/L (500 ruo 600 mg/dL). Ọgụgụ "HI" na-adọ aka ná ntị maka ọrịa shuga Ketoacidosis (DKA) ma ọ bụ Hyperosmolar Hyperglycemic State (HHS); lelee ketone ọbara ozugbo, ma ọ bụrụ na onye ahụ nwere mgbagwoju anya, iro ụra, agbọ agbọ, ma ọ bụ nwee ketone karịa 1.5 ruo 3.0 mmol/L, kpọọ ndị ọrụ ahụike mberede ozugbo.

enyochara isi mmalite

  • ** American Diabetes Association (ADA, United States), European Association for the Study of Diabetes (EASD), Joint British Diabetes Societies for Inpatient Care (JBDS, United Kingdom), American Association of Clinical Endocrinology (AACE), na Diabetes Technology Society (DTS):** Hyperglycemic Crises in Adults: A Consensus Caretes. * Diabetologia *, 2024).
  • ** International Society for Pediatric Pediatric and Adolescent Diabetes (ISPAD): ** * ISPAD Clinical Practice Consensus Guidelines: Diabetic Ketoacidosis na Hyperglycemic Hyperosmolar State na Ụmụaka na Ndị Ntorobịa * (Glaser et al., * Ọrịa shuga ụmụaka *).
  • ** National Institute for Health and Care Excellence (NICE, United Kingdom): *** Ụdị ọrịa shuga 1 na ndị okenye: Nchọpụta na njikwa * (NG17) na * Ọrịa shuga (Ụdị 1 na Ụdị 2) na Ụmụaka na Ndị Na-eto Eto: Nchọpụta na Nlekọta * (NG18, gụnyere ụbụrụ ụbụrụ edema na usoro nchịkwa mmiri).
  • ** Njikọ Njikọ Ọrịa Ọrịa shuga Britain maka Nlekọta Ndị Inpatient (JBDS-IP, United Kingdom):** Nchịkwa nke Ketoacidosis ọrịa shuga n'ime ndị okenye na Nchịkwa nke Hyperosmolar Hyperglycaemic State (HHS) n'ime ndị okenye.
  • ** Nchịkwa nri na ọgwụ ọjọọ nke United States (FDA), Agencylọ Ọrụ Ọgwụ na Europe (EMA), na Ọrịa shuga Canada:** * Nchekwa Nchekwa na Nduzi Clinical na SGLT2 Inhibitor-Associated Euglycemic Diabetic Ketoacidosis na Ngwọta Ọgwụ Ụbọchị Ọrịa ("SADMANS" & "Kwụsị DKA" Protocols)*.

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