Metabolic acidosis - ụdị, akara na otu esi agwọ

A na-ahụta nguzogide Acid n’ime ahụ ike n’oge niile, ọbara ahụ nwere mmeghachi alkaline na-adịghị ike. Mgbe ọ gbagọrọ acid acidis, metabolic acidosis malitere, alkalis - alkalosis. Enweghi ike ịchekwa n'akụkụ acidic bụ ihe a na-ahụkarị, ndị dọkịta nke ọkachamara niile na-eche ya ihu.

Acidosis n'onwe ya anaghị eme ya; ọ na-etokarị oge niile site na nsogbu ma ọ bụ ọrịa ọ bụla. Enwere ọtụtụ ihe kpatara acidosis: site na ọrịa shuga na ịdoụ ọgwụ ascorbic acid. N'okwu niile, usoro ndị dị na ahụ na-aga n'ihu otu ahụ: mmeghachi omume biochemical na-akwụsịlata, protein na-agbanwe usoro ha. Ọnọdụ a dị oke egwu, ruo na akụkụ ahụ na ọnwụ.

Metabolic acidosis - gịnị ka ọ bụ?

Protein dị na sel niile nke ahụ anyị. A na-ahụ ha na homonụ, na enzymes, yana sistem. Ndi na edozi bu amphoteric, ya bu, ha nwere njigide nke acid na ihe ndi ozo. Ha na-arụ ọrụ ha na oke oke warara pH: 7,37 - 7,43. N'agbanyeghi uzo obula si na ya, ndi ihe n’ile n’enweghi ike dozikwa uzo ha. N'ihi ya, enzymes na-efunahụ ọrụ, a na-emebi ọwa ion, membranes cell na-akwụsị ịrụ ọrụ ha, ndị na-anabata ya na-ada, ma na-emebi ọgba aghara nke mkpịsị akwara.

Ọrịa shuga na oke nrụgide ga-abụ ihe mgbe ochie

• Normalization shuga -95%
• Mwepu nke akwara mbufụt - 70%
• Mwepu nke obi ike -90%
• Bibie ọbara mgbali elu - 92%
• Mmụba na ume n'ụbọchị, na-eme ka ụra na-ehi ụra n'abalị -97%

Site na nsonaazụ ọjọọ ndị dị otú a, ahụ na-echebe onwe ya n'enweghị enyemaka site na enyemaka nke usoro nchekwa nri nke ọtụtụ ọkwa. Ihe bụ isi bụ bicarbonate. Nnu nke carbonic acid na bicarbonates na-adi n’ime obara mgbe niile, nke, n’enwekwu abawanye n’ime ihe acid n’ego n’agha, wepu ya ozugbo. N'ihi mmeghachi omume ahụ, a na-emepụta acid carbonic, nke na-abanye n'ime carbon dioxide na mmiri.

Aka akụrụ na-egbochi mkpụkọ nke bicarbonates ọbara, usoro nke ọzọ na-apụta: a na-apụtakarị ikuku hydrogen na mmamịrị, a na-eweghachi bicarbonate n'ọbara.

Ọ bụrụ na asịm n’ụba hiri nne na-esi n’èzí pụta ma ọ bụ guzobe ahụ, acidosis na-amalite. Ejiri ya na dobe na PH ruo 7.35 na n'okpuru. Ihe kpatara ngbanwe nke ntụpọ acid nwere ike ịba ụba nke carbon dioxide, nsogbu akụrụ na ịkwụsị ọrụ ha iji weghachi bicarbonate, iwepu oke nke ntọala site na eriri afọ. Nwere ike ime ka acidification na agbagọ metabolic Filiks, nke bụrụ nke metabolic acidosis pụtara.

Ebumnuche na ihe mmepe

Iji gwọọ acidosis, ezughị iwebata bicarbonates na-efu efu n'ime n'ọbara. Ọzọkwa, ụfọdụ, iwebata ha nwere ike ịdị njọ. Iji wepu acidosis, odi nkpa ighota n’okpuru ihe ihe ndi mmadu malitere ime.

Ihe nwere ike ime metabolic acidosis:

1. Enweghị insulin ma ọ bụ nguzogide insulin siri ike. N'ihi nke a, anụ ahụ anaghị enweta nri nri, ọ na-amanye ya iji abụba ndị na-agbasa iji mepụta acid.
2. Mkpesa kpụ ọkụ n'ọnụ nke lactic acid na ọrịa ọrịa imeju, ụkọ insulin na ọrịa shuga, enweghị oxygen na anụ ahụ n'ihi ọrịa nke arịa ọbara, akpa ume, obi.
3. Alcohol consumptionụbiga ihe ọ alcoholụ vụ na-aba n'anya ókè, sochiri ọgbụgba oge na oge ibu ọnụ.
4. Ibu ọnụ ogologo oge ma ọ bụ oke abụba nri.
5. Ooụbiga ahụ n'ahụ mgbe eji ya eme ihe: ethylene glycol - mmanya, ihe mejupụtara antifreeze; salicylic acid karịrị 1.75 g kwa kilogram nke ịdị arọ; methanol.
6. Na-egbu egbu na vapors nke toluene, nke dị na agba, varnishes, gluu, sol.
7. Mbelata nke akụrụngwa renal glomerular n'ihi nephropathy, pyelonephritis, nephrosclerosis, ọgwụgwọ ụfọdụ ọgwụ: ọgwụ mgbochi mkpali; amphotericin - ọgwụ antifungal; tetracycline bụ ọgwụ nje; nkwadebe lithium - psychotropics; acetazolamide (diacarb); spironolactone (Veroshpiron) - diuretics.
8. Ọnwụ hydrocarbons sitere na nri diges n’ihi afọ ọsịsa, fistulas nke mpụga.
9. Doụ ọgwụ metformin nke ukwuu, bụ́ ọgwụ a gwara ka ọ bụrụ ụdị ọrịa shuga na-enweghị insulin. Metmata Metformin n’arụ ndị ọria n’arụ ọrụ ma ọ bụ ọrụ akụrụ.
10. Mmepụta cortex adrenal ezughi oke nke aldosterone ma ọ bụ deoxycorticosterone.
11. Nwepu ahihia na imebi ihe aka ya site na akịrị.
12. Iwebata acid na nri nri parenteral ma ọ bụ ammonium chloride iji belata ọzịza.
13. Ọkpụkpụ akwara necrosis n'ihi mgbatị agbatị ogologo oge, ọkụ, myopathy, ọnya trophic na mgbanwe gangrenous na ọrịa mellitus.

Diseasedị ọrịa

Dabere n'ihe kpatara mkpokọ acid na ọbara, acidosis kewara:

Aciddị acidosis jikọtara ọnụ na-ebukwa, karịsịa na ndị ọrịa nwere nsogbu metabolic na-adịghị ala ala. Dịka ọmụmaatụ, ihe ize ndụ nke acidosis n'ihi nnukwu shuga na ọrịa shuga na-abawanye site na ị consumptionụ mmanya na nephropathy na-arịa ọrịa shuga.

Dabere na nkwụghachi ụgwọ, acidosis kewara n'ụdị atọ:

• acidosis kwụrụ ụgwọ: Mgbaàmà oria di obere, acidity di nso n’obe di ala nke onodu kwesiri ekwesi. Achọghị ọgwụgwọ pụrụ iche, ọ dị mkpa iji chọpụta ma wepụ ihe kpatara mmebi ahụ;
• acidosis gbara gharịị: ọnọdụ ala, onyunyo choro;
• n'ụdị metabolic acidosis - pH nke ọbara na-agbadata na ndụ egwu ma ọ bụ na-aga n’ibelata. Achọrọ ụlọ ọgwụ ngwa ngwa, mmezi nke acidity na ngwọta pụrụ iche, n'ọnọdụ ụfọdụ ịmaliteghachi usoro. Enweghị ọgwụgwọ, acidosis decompensated nwere ike ibute coma ma bute ọnwụ nke onye ọrịa.

Ntuziaka maka ịchọpụta ogo metabolic acidosis:

Ọrịa na akara

Site na echiche nke pathophysiology, acidosis bụ usoro a na-ahụkarị yana mgbaàmà izugbe. Acos acidisis gbara ụgwọ ka enwere ike amata na mgbanwe site na nchịkọta nke ọbara na mmamịrị. Ọrịa dị na onye ọrịa ugbu a dabere kpam kpam na ọrịa ahụ mere ka acidity gbanwee.

Ka ọnọdụ ahụ na-akawanye njọ, mgbaàmà mbụ a na-ahụkarị maka ụdị acidosis niile - na-abawanye, iku ume ugboro ugboro. A kọwara ya site na mmụba nke ọdịnaya carbon dioxide n'ime ọbara n'oge arụ ọrụ nke sistem ahụ na-arụ ọrụ. Mgbe akwara oxygen nke anụ ahụ malitere, mkpụmkpụ ume na-apụta, iku ume na-efe efe - ọ na-eme mkpọtụ, kwụsịtụ n’agbata iku ume na-ebelata, wee kwụsị kpamkpam.

Site na metabolic acidosis, enwere mwepụta nke adrenaline na ndị bu ya ụzọ, yabụ, ọrụ nke obi na - eme ngwa ngwa, n'ihi nke nsị ahụ na - eme ngwa ngwa, ọpụpụ ọbara na - abawanye n'otu oge, mgbali ahụ na - ebili. Nke nta nke nta, protein nke akpụkpọ ahụ sel na-efunahụ ụfọdụ ọrụ ha, ion hydrogen na-abanye n’ime sel, yana potassium na-ahapụkwa ha. Calcium na-ahapụ ọkpụkpụ; hypercalcemia na-apụta n'ọbara. N'ihi ịba ụba electrolytes nke ọbara, ihe mgbaàmà ahụ na-agbanwe na nke ọzọ: mgbali nrụgide, arrhythmia na-eme. Ihe ịrịba ama dị otú a na-egosi na acidosis abanyela n'ọnọdụ dị egwu.

N’etiti akara ndị na-eme ugboro ugboro, ọgbụgbọ na ọgbụgbọ pụkwara ịmata. A na - eme ha site na mmanya ketones, ihe ndị a na - ewe site na mpụga ma ọ bụ mmụba nke ụda akwara, nke na - eduga n'ịba ụba glands na cramping.

A na-ahụkwa ọrịa site n'akụkụ nke sistemụ akwara etiti: a na-emikpu onye ọrịa ahụ na ọnọdụ gbajiri agbaji, na-ehi ụra. Iwe na iwe nwere ike ịgbanwe ya. Na mmụba nke acidosis, onye ọrịa na-efunahụ mmụọ.

Ihe e ji amata ụdị ụfọdụ nke metabolic acidosis:

• maka ketoacidosis, isi nke acetone si anụ na ọnụ onye ọrịa bụ ihe mgbu, afọ na-egbu mgbu, esemokwu nke mgbidi afọ. Na-arịa ọrịa shuga, ketoacidosis na-amalite naanị shuga dị elu, nke akpịrị ịkpọ nkụ, polyuria na akpụkpọ mucous na-agakọ;
• ihe ịrịba ama mbụ nke acidosis kpatara site na ị medicationsụ ọgwụ gụnyere mbelata arụmọrụ ha;
• mgbe metabolic acidosis na-eso oké mmanya, onye ọrịa ahụ nwere ike ịnwe ume iku ume - enweghị isi, enweghị isi;
• ọ bụrụ na acidosis kpatara ọrịa akụrụ, ọkachasị akwara gbasara akụrụ, a na-ahụkarị ihe ịrịba ama nke ihu abụọ: akwara fibrillation, akwara afọ. Ume onye ọrịa nwere ike ịnwe isi amonia;
• ubara lactic acid guzobere n’oge lactic acidosis na-egosipụta ihe mgbu n’olu, na-akawanye njọ site na ha. Ọ bụrụ na ihe kpatara lactic acidosis bụ nsogbu akpa ume, akpụkpọ ahụ onye ọrịa ahụ na-ebu ụzọ achawa agbaji, jiri nwayọ gbanwee uhie ma nwee ọsụsọ.

Nchoputa nke acidosis

Ọrịa nke acidosis a rụrụ n'ime nkebi abụọ. Nke mbụ na-ekpebi ma enwere ntụgharị na acidity ọbara na ụdị ya. Nke abụọ na-ekpughe ihe kpatara metabolic acidosis.

A ga-ekpebi steeti acid-base, ma ọ bụ pH nke ọbara, ihe oxygen na carbon dioxide dị n’ime ya nwere ike ikpebi n’ime ụlọ nyocha site na iji nyocha gas. A na - enweta ọbara site na akwara radial, mgbe ụfọdụ site na capillaries na mkpịsị aka. Nnyocha ahụ na-ewe ihe karịrị minit 15.

Iji chọpụta ụdị nke acidosis n'ọtụtụ oge, ọmụmụ banyere ogo glucose na lactate n'ime ọbara, anụ ketone na mmamịrị zuru ezu:

N'oge usoro ọgwụgwọ, ọ dị mkpa iji kpochapụ mmebi ahụ kpatara acidosis. Iji chọpụta ya, enwere ike ịme ọtụtụ ọmụmụ, dabere na ọrịa ndị a chọpụtara na mbụ na onye ọrịa na foto ụlọ ọgwụ.

Ihe ndị bụ isi bụ nyocha ọhụụ na nyocha ọbara dị iche iche nke biochemical, nyocha nke urinal.

Ihe omume ndi nwere ike ime:

1. Protein, sel akụrụ, cylinders na mmamịrị, na uto nke proteininine ọbara na-egosi nsogbu akụrụ.
2. Shuga dị na mmamịrị ahụ na-egosi ọkwa dị n’ọbara, ọtụtụ mgbe, n’ihi ọrịa shuga ma ọ bụ nnukwu ọrịa nke pancreatitis.
3. Uto nke ọbara leukocytes na-egosi na acidosis mere n'ihi mbufụt na malfunction nke otu akụkụ ahụ dị n'ime. Neutrophils nwere ọrịa nje, lymphocytes nwere ọrịa nje.
4. A na-achọpụta mmụba nke mkpokọta bilirubin ma ọ bụ mbelata nke ihe nchebe ọbara na mmebi imeju, cirrhosis.

Dabere na nsonaazụ nyocha ndị ahụ, enwere ike ịkọ ọgwụ ultrasound, gbakọrọ ma ọ bụ onyonyo ndọta. Ọ bụ dọkịta kpebiri ogo ihe nyocha nyocha, na-eburu n'uche ihe kpatara ebubo metabolic acidosis.

Zọ ọgwụgwọ

Ihe izizi ime mgbe akara ngosi ndị a dị n’elu bụ ịkpọ ụgbọ ihe mberede, ebe ọ bụ na ịgwọ metabolic acidosis n’ụlọ anaghị arụ ọrụ ma na-egbu egbu. Ọtụtụ mgbe ọgwụgwọ a tụrụ aro ya na soda anaghị abaghị uru ọ bụla. Carbonate sodium mgbe ọ banye n’ime afọ ga-ewepụ ihe ọ juiceụricụ gastric kpamkpam, ọ bụghị gram nwere ike ịbanye n’ọbara, yabụ, pH ya ga-agbanwe agbanwe.

N'ụlọ ọgwụ maka ọgwụgwọ acidosis, ha na-anwale iwepụ ihe kpatara ya. Na ọrịa shuga, a na-ebelata shuga ọbara site na nchịkwa nke insulin. Maka ketoacidosis na-adịghị arịa ọrịa shuga, a pụrụ ịchọ ihe oriri na-edozi ahụ ma ọ bụ ụmụ irighiri mmiri. A na-ewepụ mmiri mkpochapụ site na nchịkwa volumetric nke nnu. Ọ bụrụ na enweghị ọbara na - apụta mgbe potassium na - alaghachi na sel, a na - ewebata potassium chloride. Site na ọdịda akụrụ na iji ihe ndị na-egbu egbu mejupụta ọbara, a na-eji hemodialysis mee ọbara ahụ.

A na-eji nchịkwa intraven nke edozi alkaline dị ka ebe ikpeazụ, ebe ọ bụ na ha nwere ike igbochi iku ume, belata nrụgide, na-eme ka insulin kwụsịlata, na ịdoụbiga mmanya ókè nwere ike ibute alkalosis. Ọtụtụ mgbe, a na-eji sodium bicarbonate na trometamol eme ihe.

A na-eji sodium bicarbonate mee ihe maka metabolic acidosis siri ike, mgbe pH dara na 7.1, onye ọrịa ahụ nwere ọbara mgbali ala. Enwere ike iji ya maka ọnwụ nke carbonates site na mgbaze nri na oke ịdoụ ọgwụ ọjọọ. A na-agbakọ ego achọrọ site na usoro ahụ. A na-ejizi nwayọ nwayọ nwayọ nwayọ mee ihe, wee na-achịkwa usoro ọbara dị mgbe niile.

Trometamol nwere ike kee ion hydrogen ọzọ, ọ bụghị naanị n'ọbara, kamakwa n'ime sel. A na-eji ọgwụ a eme ihe ebe acidosis dị ogologo nwere ike ịdị ize ndụ nye onye ọrịa. Ihe ga-enyere gi aka iwebata trometamol bu akuru aru oru.

Ọ bụrụ na ejiri ọgwụgwọ ahụ rụọ ọrụ n'oge ma gbochie nsogbu, a na-ewepụ acidosis n'ụbọchị mbụ, mgbe otu izu gasịrị, a ga-ahapụ onye ọrịa ahụ.