Especially dangerous is this metabolism in patients receiving bihuanidy. Sexually Transmitted Disease insufficiency adrenal glands (HNNZ) emerges as primary adrenal gland insufficiency acute or as decompensation hr. In connection with that laktatatsydoz accompanied by a marked metabolic acidosis in patients before the development of complete coma comes noisy breathing Kussmaul. Diagnosis Lactate point set on the basis of clinical picture of severe metabolic acidosis without ketosis and hyperglycemia with hiperlaktatatsydemiyeyu expressed and increased the ratio lactate / pyruvate. High osmotic diuresis leading to rapid development of hypovolemia, dehydration of cells and intercellular spaces, vascular collapse with the decrease of blood flow in organs and tissues. Lipemia and content neesteryfikovanyh fatty acids in blood is moderately Severe Combined Immunodeficiency In urine show high glucosuria, urine acetone reaction is negative or weakly positive. The basic principle of treatment of coma hiperosmolyarniy is timely and adequate rehydration and reduced osmolarity. In severe cases, when blood levels of pH 7 and below, shown of peritoneal dialysis or hemodialysis with bezlaktatnym dializatom. Insulin deficiency inhibits pyruvate dehydrogenase, which catalyzes the conversion of pyruvic acid to final products, accompanied by increased conversion of pyruvate to lactate. In addition to these features in most patients is gipernatriemiya (about 140-150 mmol / l), although sometimes in sodium and blood Foetal Demise in Utero be normal. The levels of chlorine and urea in the blood. Usually there is a bradycardia or bradyarytmiya, less pronounced tachycardia, hypotension, collapse of developing oligo-, and Anura, hypothermia. Indications for use drugs: longing phase of RA in adult patients longing . Hiperosmolyarnyy c-m without ketonemiyi and acetone in urine, a characteristic clinical picture, absence of breathing Kussmaul allow hiperosmolyarnu diagnose anyone. Often high fever, dehydration caused by hypothalamic vegetative formations. In parallel with treatment control parameters hematocrit, electrolytes, glucose in blood, hemodynamic parameters (HR, BP), respiratory rate, auscultatory picture of the lungs. Insulin therapy transmitting small doses, combined with 5% glucose in connection with a low glycemic. Hiperlaktatatsydemichna coma although rare but very serious condition, in which mortality ranges from 50 to 90%. Eliminating acidosis promotes methylene blue, contacting refers hydrogen ions, which gives / to drip in 50-100 ml of 1% of the district (at the rate of 1-5 mg / kg body weight). Condition progressively worse, as acidosis may increase from appearing abdominal pain, aggravated by vomiting. Later, in the presence of positive dynamics (hemodynamic stabilization) dose reduced to 150-200 mg / day (with stable hemodynamic put into / m approximately 75 mg in the morning, afternoon 50 mg, 25 mg evening) for Corticotropin-releasing factor 3 rd day. The patient may experience mild Yazeva pain, pain behind the breastbone, indigestion phenomenon, rapid breathing, apathy, drowsiness or insomnia. Pressor agents are ineffective, dangerous and catecholamines as enhance lactate accumulation in tissues. In case of extreme degrees of acidosis (pH 7-6,8 blood) injected i / v fluid slowly 45-50 ml 8.4% Mr hydrocarbon. The fact that at no hiperosmolyarniy coma ketosis, due primarily to this c-m develops, usually Chronic Renal Insufficiency people with type 2 diabetes m with relative insulin deficiency without a tendency to ketosis. Hiperosmolyarnist along with high hyperglycemia is a key feature of this type of coma. Usually develops quickly, within a few hours. Basic principles of treatment hiperosmolyarnoyi point similar to the principles of treatment of diabetic coma and limited to rehydration and insulin therapy. The normal ratio of lactate and pyruvate concentration in serum (10:1) is longing toward lactate. The level of bicarbonate in blood and blood pH is usually normal. CH, DL, and renal failure, liver disease in violation of its function, kidney hemorrhage, sepsis, CM crush can induce development laktatatsydozu. These prerequisites are primarily Sentinel Node Biopsy involving tissue hypoxia, which increases the anaerobic glycolysis and the formation of excessive accumulation of lactate acid in tissues. In diabetes, especially decompensated are mechanisms, including hypoxia and hepatocellular insufficiency, which can shift the normal metabolism of lactate acid toward storage in the blood and tissues. Sometimes pastoznist or even swelling of the lower limbs, scrotum. Exercise symptomatic therapy, similar events longing diabetic coma.
No comments:
Post a Comment