ʻO ka maʻi diabetic hyperglycemic hyperosmolar

ʻO ka diabetic hyperglycemic hyperosmolar syndrome (HHS) kahi pilikia o ka maʻi diabetes type 2. Pili ia i ke kiʻekiʻe o ke kō a me ke kō (glucose) me ka ʻole o ketones.

He kūlana ʻo HHS o:

• ʻO ke kiʻekiʻe o ke kō (glucose) kiʻekiʻe
• Ka nele loa o ka wai (make wai)
• Hoemi i ka makaʻala a i ʻole ka noʻonoʻo (i nā manawa he nui)

Kūkulu ʻia paha nā ketones i ke kino (ketoacidosis). Akā ʻokoʻa ia a ʻoluʻolu pinepine ke hoʻohālikelike ʻia me ka ketoacidosis diabetic.

ʻIke pinepine ʻia ʻo HHS i ka poʻe me ka maʻi diabetes type 2 ʻaʻohe o ko lākou maʻi diabetes. Hiki paha ia i loko o ka poʻe i hōʻike ʻole ʻia me ka maʻi kō. Lawe ʻia ke ʻano e:

• Maʻi kīnā
• Nā maʻi ʻē aʻe, e like me ka hōʻeha puʻuwai a i ʻole ka hahau
• ʻO nā lāʻau e hōʻemi i ka hopena o ka insulin i loko o ke kino
• ʻO nā lāʻau a i ʻole nā ​​kūlana e hoʻonui ai i ka nalowale o ka wai
• Ke holo nei i waho, a i ʻole lawe ʻole i nā lāʻau diabetes

ʻO ka maʻamau, hoʻāʻo nā puʻupaʻa e hana i kahi pae glucose kiʻekiʻe i ke koko ma ka ʻae ʻana i ka glucose keu e waiho i ke kino i ka mimi. Akā lilo kēia i mea e lilo ka wai i ke kino. Inā ʻaʻole ʻoe e inu i ka wai lawa, a inu paha ʻoe i nā wai i piha ke kō a mālama i ka ʻai ʻana i nā meaʻai me nā wīwī, lilo ʻoe i maloʻo loa. Ke hiki mai kēia, ʻaʻole hiki i nā puʻupaʻa ke hoʻopau hou i ka glucose keu. ʻO ka hopena, hiki i ke kiʻekiʻe o ka glucose i kou koko ke lilo i kiʻekiʻe loa, i kekahi manawa ʻoi aku ma mua o 10 mau manawa i ka nui maʻamau.

ʻO ka lilo o ka wai e hoʻonui i ke koko ma mua o ka maʻamau. Kapa ʻia kēia ʻo hyperosmolarity. He kūlana ia i loaʻa i ke koko ke kiʻekiʻe o ka paʻakai (sodium), glucose, a me nā mea ʻē aʻe. Kuhi kēia i ka wai mai nā kino ʻē aʻe o ke kino, me ka lolo.

ʻO nā kumu pilikia me:

• ʻO kahi hanana koʻikoʻi e like me ka maʻi, ka puʻuwai, ka hahau, a i ʻole ke ʻoki hou
• Hewa puʻuwai
• Make wai hōʻino
• Loaʻa palena ʻole i ka wai (ʻoi aku i nā poʻe me ka dementia a i ʻole nā ​​mea moe)
• Makahiki
• Hana maikaʻi ʻole ka hakuʻala
• Ka maikaʻi ʻole o ka mālama ʻana i ka maʻi kō, ʻaʻole ka ukali ʻana i ka hoʻolālā lapaʻau e like me ke kuhikuhi
• Ke kū a holo paha i waho o ka insulin a i ʻole nā ​​lāʻau ʻē aʻe e hoʻohaʻahaʻa i ke kiʻekiʻe o ka glucose

Pākuʻi ʻia paha nā ʻōuli i kekahi o kēia mau mea:

• Hoʻonui i ka make wai a me ka urination (i ka hoʻomaka o ka maʻi maʻi)
• Manaʻo nāwaliwali
• Nusea
• Kaumaha emi
• Waha maloʻo, alelo maloʻo
• Fiva
• Ka hopu ʻana i nā maʻi
• Huikau
• Koma

Eʻoi aku paha ka maikaʻi o nā ʻōuli ma nā lā a i ʻole nā ​​pule.

Nā ʻōuli ʻē aʻe i hiki ke loaʻa me kēia maʻi.

• Ka nalowale o ka manaʻo a i ʻole ka hana o nā mākala
• Nā pilikia me ka neʻe
• Ka hoʻohaʻahaʻa ʻōlelo

E nānā ka mea mālama ola iā ʻoe a nīnau e pili ana i kāu mau hōʻailona a me ka mōʻaukala olakino. Hōʻike paha ka hōʻike aia iā ʻoe:

• Ka make nui loa ʻana
• ʻOi aku ka wela ma mua o 100.4 ° F (38 ° C)
• Hoʻonui i ka helu o ka puʻuwai
• Ke kahe haʻahaʻa systolic haʻahaʻa

ʻO nā hōʻoia e hiki ke hana ʻia e:

• ʻO ke osmolarity koko (concentration)
• Nā pae BUN a me nā creatinine
• ʻO ke kiʻekiʻe sodium sodium (pono e hoʻoponopono ʻia no ka pae glucose koko)
• Hōʻike Ketone
• Glucose koko

ʻO ka loiloi no nā kumu kūpono e komo pū paha:

• Nā moʻomeheu koko
• Pākuʻi x-ray
• Electrocardiogram (ECG)
• Urinalysis
• CT o ke poʻo

I ka hoʻomaka ʻana o ka mālama ʻana, ʻo ka pahuhopu ka hoʻoponopono ʻana i ka nalo ʻana o ka wai. E hoʻomaikaʻi kēia i ke koko, ka puka o ka mimi, a me ka holo. E emi pū ke kō kō.

E hāʻawi ʻia nā wai a me ka potassium ma o kahi aa (intravenously). Pono e hana akahele ʻia kēia. Mālama ʻia ka pae glucose kiʻekiʻe me ka insulin i hāʻawi ʻia ma o kahi aa.

ʻO ka poʻe e hoʻomohala iā HHS i ka manawa maʻi. Inā ʻaʻole e mālama koke ʻia, hopu ʻia ke kaohi, koma, a make paha.

Hana ʻole ʻia, alakaʻi paha ʻo HHS i kekahi o kēia mau mea:

• Pāhaʻi
• Hoʻomaʻamaʻa koko
• ʻŌhū o ka lolo (edema cerebral)
• Hoʻonui i ke kiʻekiʻe o ka acid acid (lactic acidosis)

ʻO kēia kūlana he pilikia olakino. E hele i ka lumi pilikia a kāhea paha i ka helu kūloko kūloko (e like me 911) inā hoʻomohala ʻoe i nā ʻōuli o HHS.

ʻO ka kaohi ʻana i ka maʻi maʻamau ʻo 2 a me ka ʻike ʻana i nā hōʻailona mua o ka make wai a me ka maʻi hiki ke pale aku iā HHS.

HHS; Koma hyperglycemic hyperosmolar; Nonketotic hyperglycemic hyperosmolar koma (NKHHC); Koma nonosotic hyperosmolar (HONK); ʻAno non-ketotic hyperglycemic hyperosmolar; Diabetes - hyperosmolar

• ʻAno 2 diabetes - he aha e nīnau aku ai i kāu kauka

• Hoʻokuʻu ka meaʻai a me ka insulin

Crandall JP, Shamoon H. Diabetes mellitus. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 216.

Lebovitz HE. ʻO Hyperglycemia kekona i nā kūlana nondiabetic a me nā hoʻoponopono. I: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Makua a Pediatric. ʻEpekema 7 Piladelapia, PA: Elsevier Saunders; 2016: chap 42.

ʻO Sinha A. Diabetes maʻi kūpilikiʻi. I: Bersten AD, Handy JM, nā huahana. Manuahi Manaʻo Kākoʻo Oh. 8th ed. Piladelapia, PA: Elsevier; 2019: chap 59.