U Diyaargarowga Masiibada ee Isticmaalayaasha Bambooyinka Insulin-ka iyo Bukaannada Sifaynta: Beddelka Saliingaha Gacanta iyo Cunto Potassium¶

Marka duufaan, daadad, daad-gureynta dabka, ama burburka xadhkaha korantada ee maalmo badan ay dhacdo, shakhsiyaadka la nool cudurka sonkorowga ku tiirsan insulin-ta ama cudurka kelyaha ee heer-ku-dhammaadka waxay la kulmaan si degdeg ah, dheef-shiid kiimikaad nafta halis gelisa 12 ilaa 72 saacadood gudahood. Haddii bamka insulinku dillaaco, lumiyo awoodda batteriga, ama uu dhammaado faleebo la iska lahaa inta lagu jiro daad-gureynta, gulukoosta dhiiggu waxay u soo kacdaa dhimasho. ketoacidosis sonkorowga 4 ilaa 8 saacadood gudahooda ilaa uu bukaanku isla markiiba u gudbi karo cirbadaynta gacanta isagoo isticmaalaya qorshe qoraal ah oo horay loo xisaabiyay. Isla mar ahaantaana, haddii waddooyinka daadadku ama korontadu go'do ay xidhaan xarumaha bukaan-socodka dhiig-baxa laba ama saddex maalmood, bukaannada kelyaha anuric waxay la kulmaan wadnaha aamusnaanta ee kor u kaca potassium-ka dhiigga ama cabudhinta dheecaanka xad-dhaafka ah ilaa ay isla markiiba xidhaan cunto kelyaha oo degdeg ah oo 3-maalmood ah. Kahor intaanay xaalad degdeg ahi dhicin, ku kaydi boorsada dheef-shiid kiimikaadka oo go'an oo ay weheliyaan kaaga daawooyinka heerkulka xasaasiga ah, xafid sida loo maareeyo sifeynta fistula iyo xaaladaha degdega ah ee hyperkalemia, oo badbaadi degaankaaga nambarada degdega ah (911 gudaha Mareykanka iyo Kanada, 112 guud ahaan Midowga Yurub, 999 gudaha Boqortooyada Ingiriiska) oo saaran kaarka biyuhu.

Hadda samee tan¶

1. **Daabac oo dami kaarkaaga Insulin Pump Basal iyo Bolus Settings Card maanta Ku dheji hal nuqul oo daboolan gudaha shandadaada go-ka-sokorta oo koobi labaad ku hayso boorsadaada.
2. ** Kaydi insuliin-ta basal ee shaqaynaysa muddada dheer, U-100 saliingadaha insuliinka ah, iyo irbadaha qalinka ee ku jira xidhmadaada gurmadka Weydiiso dhakhtarkaaga endocrinologist in laguu qoro warqad kaydin ah ** qalimaan insulin-ta basal ama fijaanooyin muddo-dheer shaqaynaya (sida insulin glargine ama insulin degludec), ugu yaraan ** 30 saliingadaha Insuliinka ee U-100 jeermiska0.3 mL ama 0.5 mL awoodda), iyo 4 milimitir ama 5 milimitir cirbadaha qalinka ah si aad ugu beddesho irbadaha maalinlaha ah ee Badan (MDI) marka uu bamku jabo ama uu lumiyo awoodda.
3. ** Xidho mitirka gulukoosta dhiigga ee caadiga ah, 100 xabbo oo tijaabo ah, xadhig ketone ah, iyo glucagon diyaar u ah in la isticmaalo.** Dareemayaasha gulukoosta ee joogtada ah (CGM) waxay fashilmaan marka gudbiyeyaashu ka dhammaadaan, taleefannadu dhintaan, ama xabaggu ka dillaaco biyaha daad ama dhididka. Had iyo jeer xidho glucometer-ka faraha dhaqameed ee leh baytariyada lacagta qadaadiicda ah ee unugyada, dhiigga ama kaadida ** xariijimaha baaritaanka ketone ***, sanka ama auto-injector glucagon, iyo 300 garaam oo kaniini gulukoos ah oo si degdeg ah u shaqaynaya.
4. ** Bukaanka dhiigbaxa: Geli Hemodialysis daabacan "Sheet Run" iyo Kit Xiniinyaha Dhiigbaxa Xididada ku rid boorso aan biyuhu lahayn Ku xidh xaashidan dhinac 3 koob oo caag ah oo nadiif ah, nadiif ah 10 x 10 centimeter (4 x 4 inch) suufka faashad, iyo xidhid kateetarka xididka.
5. ** Dhis 3-maalmood Potassium-hooseeya, Sodium-hooseeya, Sanduuqa Cunnada Degdegga ah ee dareeraha xaddidan cunista, badarka bariiska la kariyey, iyo ukunta cad-cad ee fadhida shelf ama la luqluqdo tuna-sodium hooseeya) oo lagu daray koob yar oo cabbir ah oo lagu xaddidayo wadarta guud ee dareeraha ilaa ** 500 ilaa 700 millilitir (16 ilaa 24 wiqiyadood oo dareere ah) 24 saacba**.
6. ** Weydii dhakhtarkaaga nefroolka wax ku saabsan kaydka musiibada ee xirmooyinka potassium-ku-xidha afka ah.** Haddii aad hesho hemodialysis dayactirka, weydii dhakhtarkaaga kelyaha haddii aad sidday dawada degdega ah ee 3-maalmood ah ee qalabka casriga ah ee potassium-ga afka ee afka laga qaato (sida sodium zirconium cyclosilicate ama patiromer) oo wata tilmaamo qoran oo ku saabsan goorta la bilaabayo qaadashada bukaan-socodka.

Geedka go'aanka: Insulin-ka bamka bamka oo xumaada ama xiritaanka rugta sifeynta marka ay musiibo jirto¶

Isticmaal jaantuska kala-soocida inta lagu jiro mugdiga, daad-gureynta, ama duufaanka daran si aad uga hortagto ketoacidosis sonkorowga, hypoglycemia daran, wadnaha hyperkalemic, iyo bararka sambabada.

flowchart TD
    Start["Dhacdooyinka Musiibada: Korontada oo go'a, ka bixitaan, ama xiritaanka rugta caafimaadka"] --> PatientType{"Ku-tiirsanaanta caafimaadkee ayaa khuseysa?"}

    PatientType -->|"Insulin Pump / Isticmaalaha CGM"| PumpCheck{"Bamka Insuliinka ma saxan yahay, dallacay, oo lagu shubay qalab dheeri ah?"}
    PumpCheck -->|"Haa, si caadi ah u shaqeeya"| PumpConserve["1. Ku xidh bamka dib u dallaci kara bangiga korontada ee la qaadi karo 50% kharash; 2. Ka ilaali fiilooyinka insulinta ee kiish uumi-kiciyey ee biyaha (15C ilaa 30C); 3. Qiimaynta CGM hubinta shaashadda; Ku hay mitirka faraha iyo gulukoosta jirka"]
    PumpCheck -->|"Maya: Bamka oo dillaacay, qoyan, batari dhintay, ama ka baxay faleebo"| PumpFail["U BEDELA BOQORTOOLKA ISKU DIRKA BUUGGA (MDI) isla markiiba:; 1. Ka saar bamka cannula maqaarka si looga hortago jahawareerka; 2. Ka soo jiid qoran kaarka Beddelka Pump-to-Siringe ka-bac; 3. Ma leedahay Insulin-Basal (Glargine/ Degludec) oo shaqaynaysa muddo-dheer?"]

    PumpFail -->|"Haa, qaado Basal Insulin"| GiveBasal["Ku duri qiyaasta 24-saac ee dheer ee Basal-ka-qaadista ee qalinka ama saliingaha U-100; + Ku duri Insuliin-ku-shaqaynta degdegga ah cuntada ka hor iyo hagaajinta gulukooska sare"]
    PumpFail -->|"Ma jiro Insulin Basal ah oo la heli karo"| RapidBridge["BRIDGE SAMEYNTA DEGDEGGA AH:; Ku duri xisaabinta 3-ilaa-4-saac Basal oo u dhiganta iyadoo la isticmaalayo insulin-ta degdega ah; iyada oo loo sii marayo saliingaha U-100 3 ilaa 4 saacadoodba maalin iyo habeen + tijaabi ketones"]

    PatientType -->|"Dhiig-baxa Dhiig-baxa ama Bukaanka Sifaynta Peritoneal"| DialCheck{"Xaruntaada sifeynta bukaan-socodka ma furantahay mise waa la heli karaa?"}
    DialCheck -->|"Rugta Caafimaadku Waa Xirantay ama Waddooyinku Daadmay"| DialDiet["KULLI 3-maalmood oo ah habraaca badbaadada kelyaha ee degdegga ah:; 1. Bilow 3-maalmood adag oo Potassium-yar (<1,500 mg/maalintii) Cunto isla markiiba; 2. Xaddid wadarta qaadashada dareeraha ilaa 500 ilaa 700 mL (16 ilaa 24 oz) 24kii saacadoodba; 3. Wac khadka degdega ah ee masiibada rugta caafimaadka/KCER si aad u hesho qayb kayd ah oo furan; 4. Qaado xidhidhka potassium ee degdega ah ee loo qoray haddii uu takhtarka nephrologist ku sheego"]
    DialDiet --> RedFlags{"Wax lug ah oo daciif ah, bushimaha oo gariiraya, garaaca wadnaha oo gaabis ah, ama neefta oo hawo qabta?"}
    RedFlags -->|"Haa"| CallEMS["Wac 911 / 112 / 999 isla markiiba:; Ku dhawaaq 'Bukaanka Sifaynta Sifaynta ee laga shakisan yahay Hyperkalemia ama bararka sambabada'; Si toosan u fadhiiso 90 darajo oo luguhu hoos u laalaadanayaan"]
    RedFlags -->|"Maya"| MonitorWeight["Miisaanka maalin kasta (ku xaddid korodhka 0.5-1.0 kg/maalintii) oo u bax qaybta isbitaalka oo furan"]

Qaybta 1: Bamka Insuliinka iyo u diyaargarowga musiibada CGM¶

In ka badan kala badh dadka qaba nooca 1-aad ee xanuunka macaanka iyo qaar badan oo qaba insuliin-ku-tiirsan Nooca 2-aad ee sonkorowga waxay ku tiirsan yihiin ** faleebo insulin subcutaneous ah oo joogto ah (CSII)** iyada oo loo sii marayo bambooyin tuubbo leh oo isku xidhan ama bambooyin dhejis ah oo tuubo-la'aan ah, oo lagu lammaaniyo ** Monitor Glucose Monitor (CGM) Iyadoo aaladahani ay bixiyaan kontorool maalinle ah oo gaar ah, waxay soo bandhigayaan afar dhibcood oo jilicsan oo guuldarreysiga ah inta lagu jiro musiibo:

1. ** Ku-tiirsanaanta Korontada iyo Battery-ga:** Bambooyin-tuubo casri ah oo casri ah iyo kontaroolayaasha bamka-boobka waxay ku shaqeeyaan baytariyada lithium-ion ee gudaha lagu shuban karo (ama baytariyada lithium AA-ga gaarka ah) oo ku dhinta 2 ilaa 5 maalmood gudahooda iyada oo aan lahayn koronto.
2. ** Hardware faleebo iska leh:** Kama soo saari kartid insulin kaartridge bamka hore loo buuxiyey mana ku duri kartid jidhkaaga ilaa aad haysato silingaha insulin ee caadiga ah ee U-100 (ama qalimaan qalimaan insulin). Haddii faleebo balaastiig ah oo kuugu dambeysay ay ku xirto xirmada suunka marka la raranayo gaariga daadgureynta, bamkaagu wuxuu noqonayaa caag aan faa'iido lahayn.
3. ** Maqnaanshaha Kaydka Basal ee Subcutaneous:** Sababtoo ah bambooyinka waxay ku shubaan analogs insulin-ta degdega u shaqeysa (insulin lispro, insulin aspart, ama insulin glulisin) ee ugu sarreeya 60 ilaa 90 daqiiqo oo gasha 3 ilaa 5 saacadood gudahood, joojinta bixinta bamka waxay jidhka ka tagtaa insulinta eber 2 ilaa 3 saacadood gudahood.
4. ** Qufulka Daruuraha iyo Taleefanka Casriga ah:** Isticmaalayaal badan ayaa ku kaydsada qiyamkooda asalka ah, saamiga karbohaydraytyada, iyo arrimaha xasaasiga ah oo keliya gudaha menu-ka bamka ama marinka daruuraha. Marka shaadhka bamka uu dillaaco ama uu batteriga talefanku dhinto, bukaan-socodka iyo takhtarka hoyga degdegga ah midkoodna ma garanayo baahida insulin ee bukaanka ee maalinlaha ah.

Tillaabo-tallaabo: Diyaarinta Kaarka Beddelka Bamka-To-Singe-qoran¶

Isticmaale kasta oo bamka insulinta isticmaala waa inuu la fadhiistaa dhakhtarkooda endocrinologist ama Khabiirka Waxbarashada Sonkorowga (CDCES) sannadkiiba hal mar si uu u buuxiyo jireed, biyuhu aanu lahayn Kaarka Beddelka Fashilka Bamka Degdegga ah. Weligaa ha qiyaasin qiyaasaha insulinta inta lagu jiro xiisadda. Kaarkaagu waa inuu si cad u diiwaan geliyaa lixdan lambar:

Sida looga gudbi karo bamka insulinta ee fashilmay una guuri lahaa irbado gacanta ah (Laba Xaaladood)¶

Marka bamkaagu uu xumaado, uu dhex maro biyaha daadka, ama uu ka dhamaado faleebada faleebada, jidh ahaan ** ka saar oo ka saar faleebo bamkii hore ama balastar isla markiiba** si aad u hubiso in insuliin lama filaan ahi ay soo daadanayso, ka dibna raac sawirka ku habboon sahaydaada:

Dhacdada A: Waxaad haysataa Insulin-Basal oo muddo-dheer shaqaynaysa (Glargine, Detemir, ama Degludec) IYO Insulin-ku-shaqayn degdeg ah¶

Kani waa habka ugu badbaadsan, heerka dahabiga ah ee kaydinta musiibada oo ay ku taliyaan Ururka Sonkorowga Maraykanka (ADA), Diabetes UK, iyo Isbahaysiga Jawaabta Musiibada Macaanka (DDRC): 1. Insulin-ka Basal-ka-Dheer-dheer ee laguu qoray ku maamul qalin ama sirinjiye U-100: Ka eeg kaarka beddelka qoraalka ah ee takhtarkaaga qaddarka asalka ah ee hal mar (ama laba-maalintii) horay loo xisaabiyay. Sababtoo ah insulinta basaska ee mudada dheer shaqaynaysa waxay qaadataa 2 ilaa 4 saacadood si ay si buuxda u gaadho duritaanka ugu horraysa ka dib, qorshahaaga kala-guurka ee qoran waxa laga yaabaa inuu ku tilmaamo inaad siiso qiyaas yar oo 1 ilaa 2-saac ah oo isku-kordhin ah isla markaaba aad ka jarto bamka haddii sonkorta dhiigaagu hore u sarraysay. 2. Yaree insulinta asalka ah 10% ilaa 20% haddii aad samaynayso shaqo musiibo oo culus ama cunto qaybin: Qaadashada jawaannada ciidda, u lugaynta masaafo dheer si aad u daadgurayso, ama cunto cunto yar oo degdeg ah waxay si wayn u kordhisaa dareenka insulinta. Horay ugala hadasho "dhimista asaasiga ah ee dhaqdhaqaaqa musiibada" (badanaa 80% basal caadiga ah) kaadhkaaga qoran ka hor. 3. ** Sii Insulin dhaqsaha leh cuntada ka hor iyo sixitaannada gulukooska sareeyo:** Ku isticmaal qaaciidooyinkaaga qoran ICR iyo ISF qalin si degdeg ah u shaqeynaya ama sirinji U-100 ah oo laga soo saaray fijaanadda degdegga ah ee bamkaaga. Sug ugu yaraan ** 3 ilaa 4 saacadood inta u dhaxaysa qiyaasaha sixitaanka** si aad uga fogaato "insulin-ku-soo-ururinta" (duridda qiyaas sixid labaad ka hor inta tallaalkii hore ee dhaq-dhaqaaqa degdega ah uusan dhammaanin shaqada, taasoo sababeysa daahitaanka hypoglycemia).

Dhacdada B: Bamkaagu wuu jabay oo kaliya waxaad haysataa dhalooyinkaaga/kartoodhkaaga Insulin-da Degdega ah (Insulin-Basal-basalka ah oo aan muddo-dheer shaqaynayn)¶

Haddii lagugu soo daadgureeyay kaliya bamkaaga iyo fiilkeeda insulin-ta degdega ah u shaqaynaysa (lispro, aspart, ama glulisin) oo aanad lahayn insuliin basal oo wakhti dheer shaqaynaysa: 1. ** Waxaad si toos ah insulinta dhaqsaha leh uga soo saari kartaa dhalo dhalada ah, kaydka bamka caaga ah, ama xitaa septum-ka caagga ah ee caarada qalinka insulinta ee la tuuri karo adoo isticmaalaya saliingaha insulin U-100 caadiga ah.** 2. Weligaa haku durin qiyaas basal ah oo buuxa 24-saac iyadoo la isticmaalayo insuliin dhaqsaha badan: Duritaan 20+ unug oo insulin dhaqsaha u shaqeysa waxay hal mar keeni doontaa hypoglycemia oo dilaa ah 90 daqiiqo gudahood. 3. Raac jadwalka 3-ilaa-4-saac ee degdegga ah ee Micro-Basal: Sababtoo ah insulinta dhaqsaha badan u shaqeysa waxay socotaa kaliya 3 ilaa 4 saacadood maqaarka hoostiisa, waa inaad dhigataa alaarmiga oo aad durtaa ** 3-saac ama 4-saac oo jajab ah qiyaasta basalkaaga 3 ilaa 4 saacadoodba, 24 saacadood maalintii, oo ay ku jiraan laba jeer oo aad toosinayso habeenkii farmashiye ama hoy degdeg ah oo leh insuliin waqti dheer shaqaynaysa. - Tusaale kaarkaga qoran: Haddii bamkaagu si caadi ah wax u shubo 0.8 units/hour Habeenkii, qiyaasta buundada 4-saac ee dhaq-dhaqaaqa degdega ah waa \(0.8 \times 4 = 3.2\text{ units}\) 3 units saliingaha U-100) ayaa lagu duraa 4tii saacadoodba mar.

14-ka maalmood ee Sonkorowga & Liiska hubinta Bacaha Musiibada ee CGM¶

Ku xidh alaabtan bac dahaaran, bac-qabasho iyo biyo-celin ah oo lagu kaydiyay agagaarka albaabkaaga hore:

• Kaarka Beddelka Bamka-to-MDI-qoraal ee La-saaray iyo sahayda 14-maalmood ee dhammaan daawooyinka afka.
• Insulin-dhaqso u shaqaynaysa + Kaabta Insulin-Basal ee shaqaynaysa muddo-dheer lagu kaydiyo qaboojiyaha si fudud loo qabsan karo, oo lagu daray ** boorsada qaboojinta uumi-dhaqdhaqaaqa biyaha** taasoo ilaalinaysa insuliin inta u dhaxaysa \(15 darajo qoraal{C iyo }30 darajo C\) ($59 darajo qoraal{F ilaa }86 darajo koronto la'aan ilaa 2 maalmood)* Eeg ilaalinta insuliinka iyo dawooyinka ammaan inta ay korontadu go'an tahay.
• 30 ilaa 50 saliingaha Insuliinka U-100 oo nadiif ah (0.3 mL ama 0.5 mL cabbirka) IYO ** 30 cirbadaha qalinka caalamiga ah ee 4 mm **.
• ** 5 ilaa 7 xirmooyinka faleebada matoorka ee firaaqada ah, kaydka kaydka, ama seeraha xabagta ***, oo ay weheliso tirtirayaasha maqaarka iyo cajaladda caafimaadka.
• ** 2 ilaa 3 dareemaha CGM ee firaaqada ah iyo fiilada gudbiyaha ***, oo lagu daray **20,000 mAh bangiga korantada USB *** oo leh fiilada ku dallaca ee ay u baahan yihiin bamka iyo qaatahaaga (oo lagu daray baytariyada lithium AA spare haddii ay khuseyso).
• ** Mitirka Gulukoos Dhiiga ee Far-dhaqameedka, Aalaadda Daloolinaysa, baytariyada qadaadiicda firaaqada ah (CR2032), iyo 100 xariijimo tijaabo ah** oo ku jira fijaankooda daboolan.
• ** Xariijimaha Baaritaanka Beta-Ketone ee Dhiiga ama Xariinka Ketone-ka ee Kaadida** si loo hubiyo Ketoacidosis-ka Sonkorowga hore mar kasta oo gulukoosku dhaafo \(13.9\qoraalka{mmol/L}\) (\(250\text{mg/dL}\)) ama marka uu jiro jirro.
• Laba Xirmooyinka Samatabbixinta Glucagon-ka aan dhicin (sanka lagu buufiyo ama dareeraha auto-injector) oo lagu daray 300+ garaam oo karbohaydrayt fudud u dhaq-dhaqaaqa (kiniinnada gulukooska, baakadaha gel gulukoosta, ama baakadaha malabka).
• ** Konteenarka Sharps Safarka ee La Qaadan Karo** (ama saabuunta dharka lagu dhaqo ee gidaarka qaro weyni ku suntan tahay "BIOHAZARD SHARPS").

Qaybta 2: Diyaargarowga masiibada dhiig-baxa dhiigbaxa iyo sifaynta peritoneal¶

Bukaanka qaba Marxaladda 5aad Cudurka kelyaha ee daba-dheeraada (Cudurka kelyaha ee marxaladda-dhamaadka ah, ama ESRD) kuwaas oo ku tiirsan saddex jeer-toddobaadkii ** dhiig-baxa dhexe ee dhiigga , * dhiig-baxa dhiig-baxa guriga, ama maalin kasta ** sifaynta xubinta taranka (PD)* waxay ka mid yihiin dadka caafimaad ahaan ugu nugul masiibo kasta oo dabiici ah. Kal-fadhi 4-saac ah oo dhiig-baxa dhiig-baxa ah wuxuu u baahan yahay qiyaastii *120 ilaa 160 litir (32 ilaa 42 gallon) oo ah biyo la daweeyay ultra-pure reverse-osmosis iyo awood koronto oo saddex-waji ah oo joogto ah. Marka duufaannada, dhulgariirrada, qaboobaha qaboojiyaan, ama daadadku ay garaacaan cadaadiska biyaha ee dawladda hoose ama saldhigyada korontada, xarumaha bukaan-socodka sifeynta ee gobolka oo dhan waxay isku mar xidhi karaan 48 ilaa 96 saacadood.

Xeerka 1: Qaado "Qaliinka Hore" Kulanka Sifeynta Kahor Musiibada¶

Mar kasta oo duufaan, dabaylo wata, ama daadad waaweyn la saadaaliyo 48 ilaa 72 saacadood ka hor, bixiyeyaasha sifaynta bukaan-socodyadu waxay hawl galiyaan "Jadwallada qalliinka sifaynta hore" (oo soconaya 24-saacadood oo dheeraad ah si loo sifeeyo bukaan kasta ka hor dabayshu waxay dejin dhulka). - Weligaa ha ka boodin kalfadhiga sifaynta dabaylaha ka hor si aad ugu xidho ama uga baxdo iyadoon la ogaysiin: In la sifeeyo isla ka hor duufaantu waxay ku siinaysaa kayd dheef-shiid kiimikaad 48-72-saac nadiif ah oo leh potassium yar iyo eber dareere xad-dhaaf ah. - Haddii aad u guurto magaalo kale, qaado xaashida socodsiinta dhiigbaxa Daabacan: Xarun kasta oo "marti" ah oo sifeyn ah ama waaxda gargaarka degdega ah ee isbitaalka ee aaggaaga daadgureynta waxay u baahan tahay saxdaada ** Miisaanka Qalalan ee Bartilmaameedka }3\text{K}$) si uu si degdeg ah kuu garaaco adoon keenin wadna xanuun ama hypotension.

Xeerka 2: Quful 3-maalmood ee Gurmadka Kelyaha-Potassium-yar, Dheecaan-yar ee kelyaha marka ay musiibo dhacdo¶

Haddi dhulgariir lama filaan ah, daadad ama mad madow ay kaa hor istaagaan inaad gaarto sifeynta, waxa afkaaga geliyo 72 saacadood ee soo socda ayaa go'aaminaya inaad badbaaday. Sifeynta kelyaha la'aanteed, laba shay ayaa si degdeg ah u dila bukaannada la seegay sifaynta: 1. Potassium-ka cuntada (K+): Waxay soo saartaa potassium dhiigga ka sarreeya \(6.0\qoraalka{ to }7.0\text{ mmol/L}\), taasoo keenta curyaan lugaha kor u kacaya iyo wadnaha oo istaaga si lama filaan ah (fibrillation ventricular ama asystole). 2. ** Dheecaan iyo Sodium (Na+):** Halkii millilitir oo dareere ah oo aad cabto waxay si toos ah ugu jiraan xididdada dhiiggaaga, taasoo kor u qaadeysa cadaadiska dhiigga oo gaarsiiya heerar qallafsan oo sambabadaada daadiya dareere (** bararka sambabada degdega ah**).

Raac jawaabta rasmiga ah ee Jawaabta Degdegga ah ee Bulshada kelyaha (KCER), ** National Kidney Foundation (NKF)**, iyo CDC 3-maalmood Cunnada kelyaha ee Degdegga ah si adag ilaa aad dib ugu soo noqoto mashiinka sifaynta:

Shuruuc gaar ah oo loogu talagalay Bukaanka Sifeynta Sokorowga (Maareynta Labada Xaaladood Si Wadajir ah)¶

Qiyaastii 40% ilaa 50% bukaannada sifaynta sifaynta ayaa sidoo kale qaba cudurka macaanka. Inta lagu jiro musiibo, **labada caadooyinka caadiga ah waxay isku dhacaan si khatar ah : 1. ** Marna ha isticmaalin Juice Orange, Muuska, Shukulaatada, ama Caanaha si aad u daweyso sonkorta dhiiga oo hooseysa (hypoglycemia) haddii aad sifeyso: Hal \(240\text{mL}\) Taa beddelkeeda, dawee hypoglycemia (<3.9 mmol/L ama <70 mg/dL) gaar ahaan kaniiniyada gulukooska saafiga ah, tuubooyinka gel glucosea, nacnaca sonkorta adag, malab, ama sonkorta miiska oo lagu milmay 1 qaado oo biyo ah *, oo ay ku jiraan ** eber potassium iyo dareere aan muan. 2. Ka fogow Kobciyeyaasha Kaloriyada Ada-Nacnaca/Sokorowga ee ku taxan cuntada caadiga ah ee aan sonkorowga lahayn kelyaha ilaa aad si firfircoon u daaweyso sonkorta dhiiga oo hooseysa ama aad karbohaydraytyada ku daboosho insulin. Taa baddalkeeda, isticmaal **saliid saytuun, saliid canola, subag aan milix lahayn, ama jiis aan milix lahayn ** buskudka sodium-yar iyo bariiska cad si aad u hesho kalooriyo uruursan adigoon ku tusin gulukoosta dhiigga ama potassium dhiigga.

Qaybta 3: Ilaalinta gelitaanka xididdada xididada iyo habaynta sifaynta xuubka xuubka xuubka xuubka xuubka xuubka xuubka caloosha¶

1. Qalabka Gargaarka AV Fistula / Qalab iyo Kateetarka Dhexe¶

Sida tafatiran ee our Sifeynta fistula oo dhiigbaxa iyo sifaynta sifaynta oo seegtay hagaha gargaarka degdegga ah, Bukaan kasta oo dhiig-baxa dhiig-baxa ah waa inuu ku hayaa xidhmada ka-hortagga gelitaanka ee ku-xidhan shandaddooda: - Qalabka Xakamaynta Dhiigbaxa: Xidhmada 3 caag nadiif ah oo koofiyadaha dhalada laga leexiyay , nadiif ah 10 x 10 cm (4 x 4 in) afar geesoodka faashad, iyo faashad hemostatic ah. Haddii qolofta cirbadda fistula ay dillaacdo inta lagu jiro daad-gureynta, ** weligaa ha ku duubin shukumaan qubeyska cududda cududda; Riix ** hal far ama fur dhalada caag ah oo nadiif ah *** si toos ah ugu dheji daloolka bar-tilmaameedka 15 ilaa 20 daqiiqo oo joogto ah adigoo cududda kor uga qaadaya wadnaha oo wac adeegyada gurmadka. - Muuqaalka-sare "MAYA BP/MAYA IV/GACANTA GARABKA DIALYSIS ACCESS ARM" Xarig-gacmeedka Digniinka Caafimaadka: Inta lagu jiro kala soocida hoyga fowdada ama samatabbixinta, xidho faashad digniin caafimaad oo guduudan oo dhalaalaya cududdaada fistulaha si ay dhakhaatiirta caafimaadku waligood u qaadin katiinka cadaadiska dhiigga ama gelin khadka IV marinka noloshaada qaliinka. - Kateetarka Venous-ka dhexe (Permcath) Isku-xidhka iyo Labbisyada Biyaha Aanay Celin: Haddii aad ka siddo kateetarka laabta ama qoorta, ku xidh ** daan-daan-fudud-fudud oo balaastiig ah, dhaymo hufan oo aan biyuhu lahayn (Tegaderm), iyo koofiyadaha nadiifka ah. Weligaa ha u oggolaan biyaha daadku ama biyaha qasabadda ee aan karkarin inay taabtaan goobta kateetarka laga baxo; Haddii tuubada tuubada kateetarka ay dillaacdo ama furku ka dhaco, ** tuubada isla markiiba ka jaleec inta u dhaxaysa nasashada iyo laabtaada una jiifso ** dhinacaaga bidix adigoo madaxaagu hooseeya* si aad uga hortagto caabuq hawo ah oo dilaa ah.

2. Sifeynta xubinta taranka ee guriga (PD) Inta ay korontadu go'an tahay¶

Bukaanka isticmaalaya mashiinka baaskiilka otomaatiga ah (** APD / CCPD**) guriga habeen dhaxe waxay ka badbaadi karaan koronto-la'aan maalmo badan haddii ay horay u sii diyaariyaan: - ** Ku hayso 7 ilaa 14 maalmood agabka Twin-Bag CAPD-ga (Y-sets iyo bacaha bullaacadaha) kaydinta:** Marka ay korontadu go'do oo uu istaago baaskiilkaaga habeenkii, isla markiiba u beddel ** isweydaarsiga cuf-isjiidadka gacanta Ka soo laalaad bacda xalka oo ka sarraysa dhererka garabka oo dhig bacda dheecaanka si siman dhulka si ay cufisjiidku u dareeraan oo ay calooshaada uga buuxiso koronto la'aan. - ** Sida si badbaado leh loogu diiriyo bacaha xalinta PD iyada oo aan lahayn koronto ama microwave:** Waligaa ha ku shubin dareeraha PD qaboow, iyo waligaa bacda PD haku kululayn microwave ama haku dhex galin dekedaha caaga ah biyo wasakh ah (taas oo sababa peritonitis dilaa ah). Taa baddalkeeda, ku duub bacda dibadda ee engegan ee qallalan ** tuwaal qallalan oo nadiif ah oo ay la socdaan kimikalka gacmo-kuleyliyaha ama dhalooyinka biyaha kulul** (ka ilaalinaya dhammaan qoyaanka dekedaha), ama ku qabo bacda jirkaaga buste hoostiisa ilaa ay ka gaarto heerkulka jirka ($ 37 darajo C / 98.6 darajo F$). - Ka-hortagga Gacan-Biyo-la'aanta: Haddii biyaha qasabadda ay hoos yimaadaan ogeysiis biyo- karkari ah ama la xiro, gacmahaaga ku xoq 60 ilbiriqsi ** 60% ilaa 80 % xoqin alkohol ah, xidh maaskaro wajiga qalliin, oo dami taageerayaasha ka hor inta aadan isku xirin qalabkaaga wareejinta PD.

Lambarada degdega ah ee gobolka iyo borotokoolka wakaalada¶

Inta lagu jiro masiibo goboleed, shabakadaha sifeynta sifeynta iyo isbaheysiga cudurka sokorowga waxa ay dhaqaajiyaan khadadka kala-soocidda lacag-la'aanta ah si ay ugu jiheeyaan bukaannada barokacay si ay u furaan rugaha caafimaadka, kaydka insulinta degdegga ah, iyo hoyga caafimaadka:

• Mareykanka:
• ** Gurmad Caafimaad:** Wac 911.
• Kajawaabista Degdegga ah ee Bulshada kelyaha (KCER) khadka tooska ah: Wac 1-866-901-3773 si aad u heshid rugaha sifaynta oo furan.
• ** Khadka Caawinta Aasaaska Qaranka ee Kelyaha (NKF):** Wac 1-855-NKF-CARES (1-855-653-2273) (Khadka Degdegga ah ee DaVita: 1-800-400-8331; Khadka Musiibada Fresenius: *1-800-676-1
• Isbahaysiga Ka-jawaabista Musiibada Sonkorowga (DDRC) & ADA: Wac 1-800-DIABETES (1-800-342-2383)*** ama hubi Daryeel Caafimaad diyaar ahRxOpen.org* farmasiyada furan.
• Kanada:
• Adeegyada Degdega ah: Wac 911. La xidhiidh shabakadaada kelyaha ee gobolka (Kidney Foundation of Canada: 1-800-361-7494) iyo Diabetes Canada (1-800-BANTING).
• Uk:
• Adeegyada Degdega ah: Wac 999********************************************************************* si aad u hesho dawooyinka insulinta degdega ah ama isku-duwidda unugga kelyaha. Horay iskaga diwaangeli shirkadahaada adeega Diiwaanka Adeegyada Mudnaanta leh (PSR) si aad u hesho mudnaantii kaydinta tamarta iyo gaarsiinta biyaha.
• Midowga Yurub:
• Adeegyada Degdegga ah: Wac 112. Sido ** Ururka Kelyaha Yurub (ERA)** kaarka musiibada iyo Kaarkaada Caymiska Caafimaadka Yurub (EHIC) oo ay weheliyaan xaashida sifaynta ee daabacan.
• Australia iyo New Zealand:
• Adeegyada Degdegga ah: Wac 000 gudaha Australia ama 111 gudaha New Zealand. La xidhiidh Caafimaadka Kelyaha Australia (1800 454 363) ama Caafimaadka Kelyaha New Zealand (0800 543 639), oo iska diwaangeli sidii ** Macmiil Kaalmo Nololeed ah** adoo isticmaalaya korantada iyo adeegyada biyaha.
• Hindiya iyo Aasiya-Baasifik:
• ** Adeegyada Degdegga ah:** Wac 112 gudaha Hindiya, 119 gudaha Japan, 995 gudaha Singapore, ama 999 gudaha Malaysia iyo Hong Kong. Hayso koobiga jirka ee daawadaada sifeynta, Cagaarshowga B, Cagaarshowga C, iyo natiijooyinka shaybaarka HIV, iyo jadwalka insulinta.

Su'aalaha soo noqnoqda¶

Waa maxay sababta qofka isticmaala bamka insulinta uu u sugi la'yahay 12 ilaa 24 saacadood in uu koronto ama bamka beddelka ahi yimaado?¶

Bamka insuliinka waxa uu geliyaa insuliin dhaqsaha badan, kaas oo ka soo baxa dhiiga 3 ilaa 5 saacadood gudahood. Sababtoo ah ma jiro insuliin basal oo shaqaynaysa oo wakhti dheer ku kaydsan maqaarka hoostiisa, joojinta bixinta bamka waxay keenaysaa yaraanta insulinta 2 ilaa 3 saacadood gudahood. Insuliin la'aanteed, beerku wuxuu dhiiga ku shubaa gulukoos iyo ketones acidic ah, taasoo keenta Ketoacidosis Diabetic (DKA) oo nafta halis gelisa 4 ilaa 8 saacadood gudahood. Isticmaale kasta oo bamka isticmaala waa in uu sitaa insulinta basaska ah ee shaqaynaysa muddada dheer, U-100 silingo, iyo kaadhka beddelka oo qoran si uu isla markiiba u kala wareego marka bamku xumaado.

Ma ka soo saari karaa insulin qalinka insulinta ee la tuuri karo ama bamka bamka aniga oo isticmaalaya sirinji heerka U-100 haddii qalinka ama bamka jabo?¶

Haa, haddii insulinta ku jirta qalinka ama kartoonada ay tahay heerka U-100 uruurinta (100 unug halkii millilitir). Haddii qalinka insulinta uu xumaado ama bamku jabo oo aadan haysan irbado qalin ama faleebo, ku dhaq septum-ka caagga ah caarada qalinka U-100 ama kartoonada khamriga, geli cirbadda saliingaha insulin ee caadiga ah ee U-100 xuubka, oo soo bixi qiyaastaada saxda ah. Waligaa ha u jiidin insulins-kooxeed (U-200, U-300, ama U-500) saliingaha U-100 iyaddoo aan la hayn tilmaamaha beddelka dhakhtarka.

Maxay tahay sababta beddelka milixda ee ku salaysan potassium (sida NoSalt ama Lite Salt) ay u dhintaan bukaannada sifaynta marka ay musiibo jirto?¶

Qaar badan oo ganacsi ah oo beddela xawaash "sodium-hooseeya" waxay ku beddelaan chloride sodium chloride saafi ah. Hal shaaha oo ah hal qaado oo ah chloride potassium beddelka waxa ku jira 2,500 ilaa 2,800 milligaraam oo potassium ah, ku dhawaad ​​labanlaab dhammaan 1,500-miligram ee xadka musiibada maalinlaha ah ee bukaanka hemodialysis anuric. Isticmaalka milixda beddelka ah ee potassium marka sifaynta sifaynta dib loo dhigo waxay kor u qaadi kartaa potassium serum in ka badan 6.5 mmol/L saacado gudahood waxayna sababi kartaa wadne xanuun degdeg ah.

Sidee qofka qaba sonkorowga iyo kelyuhuba ku fashilmeen sifeynta sifeynta si ay u daaweeyaan sonkorta dhiiga oo hooseysa (hypoglycemia)?¶

Weligaa ha isticmaalin cabitaanka liimiga ah, muuska, caanaha, ama shukulaatada si aad u daaweyso hypoglycemia haddii aad ku jirto sifeynta, sababtoo ah cabitaanka liimiga iyo muuska waxaa ka buuxa xaddi khatar ah oo potassium iyo dareere ah. Taa beddelkeeda, raac "Rule of 15" adigoo isticmaalaya 15 garaam oo saafi ah, karbohaydrayt-la'aan ah oo degdeg ah: calalin 3 ilaa 4 kiniin gulukoos saafi ah, tuujin 1 tuubo oo jel gulukoos ah, liq 1 qaado oo malab ah ama sonkor miis ah, ama nuug nacnaca sonkorta adag, ka dibna dib u hubi gulukoosta dhiiggaaga 15 daqiiqo.

Waa maxay dukumeentiyada ay u baahan yihiin rugaha sifeynta sifeynta martida ka hor inta aan la daaweyn bukaan sifeynta la daadgureeyay?¶

Xarumaha sifaynta degdega ah waxay u baahan yihiin xaashida daawaynta Hemodialysis ee daabacan ("Run Sheet") oo faahfaahinaysa miisaankaaga qallalan ee la beegsanayo, qaabka sifeeyaha, dhiiga iyo heerka socodka dhiiga, xajmiyada qubayska potassium iyo kaalshiyamka, qiyaasta heparin, liiska daawooyinka hadda jira, iyo cagaarshowga B, Cagaarshowga C, iyo natiijooyinka shaybaadhka HIV. Ku haysashada koobi dahaadhan boorsadaada go-ga ah waxay ka hortagtaa daahitaanka kala soocida.

Tilmaamaha la xidhiidha¶

• Ilaalinta insuliinka iyo daawooyinka heerkulka-xasaasiga ah inta lagu jiro korontadu go'an tahay
• Dhiigbaxa sifaynta fistula (protocol dhalada-koobeedka) iyo sifaynta sifaynta oo la seegay xaaladaha degdega ah ee hyperkalemia
• Ketoacidosis sonkorowga (DKA) iyo xaalad hyperglycemic hyperosmolar
• U diyaargarowga degdega ah ee dadka naafada ah iyo baahiyaha caafimaad

Ilaha iyo hanuuninta rasmiga ah¶

• Jawaabta Degdegga ah ee Bulshada kelyaha (KCER) & Xarumaha Xakamaynta iyo Kahortagga Cudurrada (CDC, Mareykanka):
• ** National Kely Foundation (NKF, United States) & UK Kidney Association (UKKA):** Qorshaynta Xaaladaha Degdega ah: Cudurka kelyaha ee raaga iyo Xakamaynta Helitaanka Hemodialysis.
• Isbahaysiga Jawaabta Musiibada Sonkorowga (DDRC), Ururka Sonkorowga Maraykanka (ADA), & Bulshada Endocrine: Qorshaha Bukaan-socodka U Diyaargarowga Masiibada Sonkorowga iyo Ka Bedelashada Bamka Insulin-ka una beddelo Duritaanno Maalinle ah oo Badan (MDI).
• Maamulka Cunnada iyo Dawooyinka ee Maraykanka (FDA): Bamka Insulin-ka iyo Gulukooska Joogta ah ee La Socodka Badbaadada Xiliga Musiibooyinka.
• Bulshada Caalamiga ah ee Sifaynta Sifaynta Ilmaha (ISPD): * Tilmaamaha ISPD ee Ka Hortagga Cudurrada Sifaynta Sifaynta Ilmaha iyo Isdhaafsiga Musiibada*.