Hypoglycemia: classified, tlhahiso ea kliniki le khoutu ea ICD-10

Boemo ba Hypoglycemic le hypoglycemic coma

Boemo ba hypoglycemic ho lefu la tsoekere ke ho fokotseha ha tsoekere ea mali kapele, ho tsamaeang le ho lahleheloa ke kelello ka potlako ka lebaka la ho kenngoa ha tekanyetso ea insulin kapa meriana e itseng khahlanong le semelo sa ho ja lijo tse sa lekaneng tsa lik'habohaedreite ka lijo. Kotsi ea hypoglycemia ea mofuta oa 2 lefu la tsoekere e tlaase haholo ho feta ho lefu la tsoekere la mofuta oa 1.

Etiology le pathogeneis

Lisosa tsa maemo a hypoglycemic:

• lithethefatsi tse ngata tsa insulin, lithethefatsi tse ling tse theolelang tsoekere,

• Ho tlōlela sejo se latelang,

• ho ikoetlisa ka matla.

Ho ruruha ho sa foleng, ho hloleha ha sebete, ho hloka tlhokomelo e sa feleng ea adrenal cortex, ho sithabela maikutlong, ethanol, salicylates, li-block tsa β-adrenergic, amphetamine, haloperidol, phenothiazines li ka holisa nts'etsopele ea maemo a hypoglycemic. Hypoglycemia ea masea a sa tsoa tsoaloa e bakoa ke ts'ebetso ea hyperinsulinism ho bana ba tsoaletsoeng ke bo-'mè ba nang le hyperglycemia, mme e bonahala haholo ka tšohanyetso, boima bo tlase, ba fumanang phepo e nepahetseng.

Hypoglycemia e bonolo e hlaha hangata ho bakuli ba nang le lefu la tsoekere la 1 mme ke eona theko eo mokuli a e lefang bakeng sa taolo e ntle ea metabolic le kalafo e matla ea lefu la tsoekere.

Glucose ke mohloli o ka sehloohong oa matla bakeng sa lisele tsa boko. Kaha kelello ha e khone ho kopanya glucose kapa ho e boloka ka mokhoa oa glycogen nako e fetang metsotso e fokolang, ts'ebetso ea eona ea bohlokoa e itšetlehile ka phepelo e sa feleng ea tsoekere e tsoang maling a potoloha. Ntle le tšebeliso ea lithethefatsi tse ngata le phallo ea ho ja litla-morao ho bakuli ba nang le lefu la tsoekere, matla a ho loants'oa nts'etsopele ea hypoglycemia a mpefalitsoe ke ho eketsa secretion ea glucagon, glucose hormone, somatotropic hormone, adrenocorticotropic hormone kapa adrenaline (seo ho thoeng ke anti-regulation ea hloleha ho hlaha). Ho fokotseha ha khatello ea tsoekere ka tlase ho 1.7-2.7 mmol / L ho lebisa ho neuroglycopenia, tlala ea matla ea lisele tsa methapo ea kutlo, e hlalosang lipontšo tsa eona tsa bongaka ka mokhoa oa lits'oants'o tsa boits'oaro maemong a hypoglycemic ea boemo bofe kapa bofe bo tebileng. Ka lebaka la khaello ea matla le mathata a tebileng a metabolic, hypoglycemic coma le "cerebral" edema li nts'etsapele liseleng tsa boko. Ntle le moo, hangata hypoglycemia e matla e baka tšenyo bokong bo ntseng bo hola, haholoholo ho bana ba banyenyane (ba ka tlase ho lilemo tse 5). Tlhokomelo e lokela ho nkuoa ho qoba hypoglycemia e maemong ohle.

Liponahatso tsa kliniki

Hypoglycemia hangata e tsamaellana le boemo ba tsoekere ea mali e ka tlase ho 2,5-3.3 mmol / L mme e ka ba matšoao le asymptomatic. Matšoao a hypoglycemia a ka aroloa ho:

• neurogenic - e nang le matšoao a adrenergic (ho ruruha, pallor, chill, ho thothomela, ho nyekeloa, lets'ollo, ho eketseha ha GARDEN, tachycardia, ho tšoha, ho tšoenyeha le ho tšoenyeha) le tlhaho ea cholinergic (tlala, paresthesia - tsebetso ea molomo, ntlha ea leleme),

• neuroglycopenic: bofokoli, ho opeloa ke hlooho, ho fetoha ha boitšoaro, ho tepella, pono e sa tsitsang le puo, ho tsekela, ho akheha, ho satalla, ho tsitsipana, ho lahleheloa ke kelello.

Matšoao a hypoglycemia e ka ba:

• bonolo (I degree): tlala, pallor, bofokoli, mofufutso o batang, ho thothomela, ho phomola ha koloi le ho se tsikinyehe, matšoenyeho, litoro tsa bosiu, ka linako tse ling ho otsela,

• ho satalla ho lekaneng (II degree): ho opeloa ke hlooho, bohloko ba ka mpeng, liphetoho tsa boits'oaro (ho feto-fetoha ha maikutlo kapa ho ba mabifi), ho bola, ho ruruha, ho fufuleloa, puo le ho fokola hoa pono. Ho masea le masea a sa tsoa tsoaloa, hypoglycemia e bontšoa ke ho tšoenyeha, ho lla ho sa thijoeng, boitšoaro bo mabifi,

• boima (bohato ba III): lethargy, ho ferekana kelellong, ho lahleheloa ke kelello, ho fufuleloa haholo, tachycardia, hypotension ea methapo, ho ruruha ha mucous membrane, makhopho, ho ruruha ha mesifa ea masticatory, matšoao a Babinsky.

Hypoglycemia e matla, ea nako e telele e sa rarolloang e tsoela pele ho fihlela mokokotlo o tebileng: makhopho le mofufutso o khaotsa, areflexia, hypotension e tsoelang pele ea bophelo bo botle, le edema ea methapo. Ho fihlella standardoglycemia esita le hyperglycemia sethaleng sena sa boemo ba hypoglycemic ha ho lebise katlehong. Haeba komello e nka nako e fetang hora, bokuli ba ho kula ha bo monate.

Ho bakuli ba bang ba nang le lefu la tsoekere, seo ho thoeng ke atypical hypoglycemia syndrome se ka hlaha, ka lebaka leo komello e ka bang teng ntle le matšoao a ts'ebetso ea ts'ebetso ea kutloelo-bohloko (lefu lena le etselitsoeng ho latela nako e telele ea lefu lena, neuronomic neuropathy, nalane ea khafetsa ea hypoglycemia Sistimi e khahlanong le taolo). Sena ke 'nete haholo bakeng sa hypoglycemia ea bosiu, e leng eona feela lets'oao la tsoekere e tlase hoseng ka mpeng e se nang letho. Lebaka khafetsa ke ho nka tekanyetso e phahameng ea insulin ea nako e telele bakeng sa ho qoba hyperglycemia ea hoseng.

Hypoglycemia e sa khethoang: Lefu la kelello

Ho fumanoa ha hypoglycemia hangata ha ho thata haeba mokuli a le teng, ho na le matšoao le nalane ea hae. Leha ho le joalo hore moetlo oa tsoekere ea mali ha o thehiloe ka mokhoa o hlakileng mme o ipapisitse le lilemo le bong, hypoglycemia hangata e utloisisoa e le ho fokotseha ha boemo ba glucose ba plasma - Tlhahlobo e fapaneng

E etselitsoe mefuta e meng ea lefu la tsoekere, lefu la sethoathoa

Pehelo ea lefutso

E na le khoutu ea hypoglycemia ho latela ICD 10 - 16.0. Empa Psychology ena e na le lihlopha tse 'maloa:

• hypoglycemia e sa hlalosoang - E2,
• hypoglycemic coma ha ho na le lefu la tsoekere - E15,
• 4 - litlolo tsa tlholeho ea gastrin,
• 8 - Litlolo tse ling tseo mokuli a atlehileng ho li hlakisa nakong ea thuto.
• mefuta e meng - E1.

Mefuta e meng ea hypoglycemia ho ea ka ICD ke hyperinsulinism le encephalopathy, e bang teng ka mor'a ho akheha ka lebaka la tsoekere e sa lekaneng ea mali.

Leha e le taba ea hore ho ea ka sehlopha sa ICD, hypoglycemia e na le likhoutu tse thathamisitsoeng hantle, ha u khetha meriana bakeng sa liphallelo le kalafo, lingaka le tsona li lokela ho tataisoa ke lipalo tsa lisosa tsa kantle (class XX).

Pehelo ea boima

Ho na le methapo e meraro ea ho teba ha hypoglycemia:

• bonolo. Ha ho etsahala, letsoalo la mokuli ha le fokotsehe, 'me o khona ho lokisa boemo ba hae ka boeena: letsetsa ambulense kapa, haeba sena e se ketsahalo ea pele, noang litlhare tse hlokahalang.
• boima. Ha ho etsahala, motho oa hlokomela, empa a ke ke a emisa ka boikemelo lipontšo tsa lefu la ho kula ka lebaka la khatello ea hae e matla le / kapa bokuli ba mmele.
• hypoglycemic coma. E tšoauoa ka ho lahleheloa ke kelello le ho se khutlele ha eona nako e telele. Tšenyo e kholo e ka hlahisoa ntle le thuso ho motho ea boemong bona - esita le lefu.

Mabaka a ntlafatso

Hypoglycemia e ka hlaha ka lebaka la lintlha tse ngata, bobeli kantle (kantle) le endo native (kahare). Hangata ho hlaha:

• ka lebaka la khaello ea phepo e fosahetseng (haholo-holo, ka ts'ebeliso e tloaelehileng ea lik'habohaedreite tse ngata),
• ho basali nakong ea ho ilela khoeli,
• ka tšebeliso e sa lekaneng ea mokelikeli,
• ha ho ikoetlisa ka ho lekaneng,
• Khahlano le semelo sa mafu a tšoaetsanoang a tšoaetsanoang,
• ka lebaka la ponahalo ea neoplasms,
• e le karabelo kalafong ea lefu la tsoekere,
• ka lebaka la mafu a tsamaiso ea pelo,
• ka lebaka la bofokoli ba 'mele (ho sa tsoa hlaha),
• ka lebaka la ts'ebeliso e mpe ea lino tse tahang le mefuta e meng ea lithethefatsi tsa narcotic,
• ka hepatic, renal, pelo le mefuta e meng ea ho hloleha,
• ka tsamaiso ea methapo ea tharollo ea 'mele.

Mabaka a thathamisitsoeng ke mabaka a kotsi. Ke eng e ka sebeletsang e le sesosa sa kholo ea kholo ea maqhubu a mmele, se khetholloang ke litšobotsi tsa 'mele: sepheo sa lefutso, ho sithabela maikutlong jj. Hape, boemo bona e ka ba lebaka la phetoho e matla ea khatello ea khase ea plasma ho tloha holimo ho ea ho tloaelehileng. Glycemia e joalo ha e kotsi ebile e ka lebisa ho holofala kapa lefu la mokuli.

Liphuputso tse 'maloa li bonts'a hore khafetsa boemo bo amanang le lefu la kelello bo hlahang ho batho bo nang le bokhoba ba tahi. Sena se bakoa ke taba ea hore ka lebaka la tahi e tloaelehileng ea ethyl, mmele o qala ho sebelisa NAD ka tsela e sa tloaelehang kapele. Hape, ts'ebetso ea gluconeogenesis e qala ho theoha butle-butle ka har'a sebete.

Alcoholic hypoglycemia e ka hlaha eseng feela khahlano le tšebeliso e mpe ea lino tse tahang hangata, empa hape le ts'ebeliso e le 'ngoe ea litekanyetso tse kholo.

Lingaka li boetse li tšoaea linyeoe tseo tsoekere e fokolang ea mali e sa tloaelehang e fumanoang ho batho ba neng ba kile ba sebelisa litekanyetso tse fokolang tsa joala. Kotsi e phahameng ka ho fetisisa ea ho theha lefu lena ka mor'a ts'ebeliso ea ethanol e teng ho bana.

Hypoglycemia e khetholloa ke letoto la matšoao. Ha tsoekere e theoha 'meleng, mokuli o atisa ho hlasimoloha kelellong, ka lebaka leo a ka bang mabifi le / kapa a tšoenyeha, a tšoenyehile a bile a tšohile.

Ho feta moo, a ka 'na a lahleheloa ke bokhoni ba ho tsamaea sepakapakeng mme a utloa bohloko ba hlooho. Ho ferekana ho hoholo ha 'mele le hona ke tšobotsi ea boemo bona.

Hangata mokuli o qala ho fufuleloa haholo, letlalo la hae lea fetoha, 'me maoto le matsoho a hae a qala ho thothomela. Tumellanong le sena, o na le maikutlo a matla a tlala, eo, leha ho le joalo e ka tsamaeang le ho nyekelwa ke pelo. Setšoantšo sa kliniki se tlatsitsoe ke bofokoli bo akaretsang.

Lintho tse bonts'itsoeng khafetsa ka boemo bona ke: ho senyeha ha pono, ho akheha ho fihlela motho a akheha, moo motho a ka oelang ho komeng, ho hlaseloa ke sethoathoa, ho kula ho sa bonahaleng.

Hypoglycemic coma

Khoutu ea ICD bakeng sa coma ea hypoglycemic ke E15. Sena ke boemo bo hlobaetsang, boo ka ho fokotseha ho hoholo ha tsoekere ea mali ho hlahang ka potlako haholo.

Ponahatso ea eona ea pele ke ho lahleheloa ke kelello. Empa, ho fapana le ho akheha ho tloaelehileng, mokuli ha a tsoe ho eona kamora metsotsoana e seng mekae, empa a lula ho eona bonyane ho fihlela tlhokomelo e nepahetseng ea bongaka e fanoa.

Hangata nako pakeng tsa matšoao a pele a hypoglycemia le syncope ka boeona e khuts'oane haholo. Ha ho na mokuli kapa ba haufi le eena ba bonang li-harbouan tsa komisi, 'me ho bonahala eka ho bonahetse ka tšohanyetso. Hypoglycemic coma ke tekanyo e fetelletseng ea boemo bona ba methapo.

Leha taba ea hore lipontšo tsa kliniki li ka pele ho komello hangata li sa hlokomeloe, li teng ebile li hlahisoa ka mokhoa o latelang: ho fufuleloa ka matla, vasospasm, phetoho ea sekhahla sa pelo, maikutlo a tsitsipano, jj.

Ka nts'etsopele ea eona, pele ho na le ts'oaetso ho neocortex, ebe ho latela cerebellum, ka mor'a moo bothata bo amang likarolo tse tlase, 'me, qetellong, e fihla medulla oblongata.

Hangata, komisi e etsahala ka lebaka la ho kenngoa litekanyetso tse fosahetseng tsa insulin 'meleng (haeba mokuli a e-na le lefu la tsoekere). Haeba motho a sa tšoaroe ke lefu lena, a ka boela a hlaha ka lebaka la ho ja lijo kapa lithethefatsi tsa sulfa.

Epidemiology

Boemo bo matla ba ho feto-fetoha ha maikutlo ho fapaneng hangata bo hlaha ho bakuli ba nang le mofuta oa 1 le lefu la tsoekere la 2, le ho batho ba se nang lefu la tsoekere. Ho ata ha hypoglycemia ha ho tsejoe, empa ho fokotseha ha hypoglycemic coma ho bakela bakuli ba nang le lefu la tsoekere la 3-4%.

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Lisosa tsa hypoglycemia le hypoglycemic coma

Hypoglycemia e thehiloe ho insulin e feteletseng e nang le khaello ea lik'habohaedreite kapa ts'ebeliso ea tsona e potlakileng.

Lintho tse ka sehloohong tse bakang nts'etsopele ea hypoglycemia ho lefu la tsoekere:

• Haholo ka tšebeliso ea insulin kapa ea morero ka boomo
• ho tlōla lijo tse latelang kapa ho se lekane,
• ho ikoetlisa ho eketsehileng (ha u ntse u nka lethathamo la khafetsa la PSSS),
• tšebeliso ea lino tse tahang (thibelo ea tsoekere) ka joala),
• phetoho ho pharmacokinetics ea insulin kapa PSSS ha e tsamaisoa ka mokhoa o sa lokelang (mohlala, ho potlakisa ho kenngoa ha insulin ka ente ea methapo ho e-na le ho ts'oaroa), ho se sebetse hantle ha (cumulation of PSSS maling), litšebelisano tsa lithethefatsi (ka mohlala, beta-blockers, salicylates, MAO inhibitors le tse ling tse ka bakang phello ea PSSS)
• autonomic neuropathy (ho sitoa ho ba le hypoglycemia).

Lisosa tse sa tloaelehang tsa hypoglycemia (eseng ho lefu la tsoekere feela) li kenyeletsa:

• insulinoma (tumello e hlahisang insulin ho tsoa lisele tsa pancreatic beta),
• li-tumor tse seng tsa beta-cell (hangata li-mesenchymal tumors, tse ka hlahisang lintlha tse kang insulin), likotsi ho li-enzyme tsa metabolism tsa carbohydrate (ka glycogenoses, galactosemia, ho se mamellehe ha gluctose),
• ho hloleha ha sebete (ka lebaka la ho senyeha ha gluconeogeneis ka tšenyo e kholo ea sebete),
• ho haella ha adrenal (ka lebaka la kutloelo-bohloko e eketsehileng ho insulin le tokollo e sa lekanyetsoang ea lihormone tse loantšanang le karabelo ea hypoglycemia).

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Glucose ke mohloli o ka sehloohong oa matla bakeng sa lisele tsa cortex, lisele tsa mesifa le lisele tse khubelu tsa mali. Bongata bo bong bo sebelisa FFA maemong a ho itima lijo.

Ka tloaelo, glycogenolysis le gluconeogenesis li boloka tsoekere e maling maling le ka ho itima lijo nako e telele. Tabeng ena, litaba tsa "insulin" lia fokotsoa 'me li bolokoa li le tlase. Boemong ba glycemic ba 3,8 mmol / L, keketseho ea secretion ea lihormone joalo ka glucagon, adrenaline, kholo ea kholo ea kh'holeseite le cortisol e tsebahala (ho feta moo, boemo ba lihormone tsa kholo le cortisol bo eketseha feela ka hypoglycemia ea nako e telele. Ka mor'a matšoao a autonomic, ho hlaha li-neuroglycopenic (ka lebaka la ho se lekane ha glucose bokong).

Ka keketseho ea nako ea lefu la tsoekere, ka mor'a lilemo tse 1-3 ho na le phokotseho ea secretion ea glucagon ha e arabela hypoglycemia. Lilemong tse latelang, secretion ea glucagon e ntse e fokotseha ho fihlela ho tlohela ka botlalo. Hamorao, secretion e sebetsang ea adrenaline e fokotseha esita le ho bakuli ba se nang neuropathy ea autonomic. Ho theoha ha secretion ha glucagon le adrenaline hypoglycemia ho eketsa kotsi ea hypoglycemia e matla.

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Matšoao a ho mpefatsa kelello le hypoglycemic coma

Matšoao a hypoglycemia a fapane. Ha boemo ba tsoekere ea mali bo fokotseha ka potlako, ho khanya liponahatso tsa bongaka. Monyako oa glycemic oo ho bonahatsoang lipilisi tsa kliniki ke motho ka mong.Ho bakuli ba nang le kalafo ea nako e telele ea lefu la tsoekere, matšoao a hypoglycemia a ka etsahala le ka boemo ba tsoekere ea mali ba 6-8 mmol / L.

Matšoao a pele a hypoglycemia ke matšoao a limela. Tsena li kenyeletsa matšoao:

• ts'ebetso ea ts'ebetso ea methapo ea kutlo ea parasympathetic:
  • tlala
  • ho nyekeloa, ho hlatsa,
  • bofokoli
• ts'ebetso ea ts'ebetso ea methapo e nang le kutloelo-bohloko:
  • ho tšoenyeha, ho ba mabifi,
  • mofufutso
  • tachycardia
  • thothomela
  • mydriasis
  • hypertonicity ea mesifa.

Hamorao, ho hlaha matšoao a ho senyeha ha methapo ea methapo ea kutlo, kapa matšoao a neuroglycopenic. Tsena li kenyeletsa:

• ho teneha, ho fokotseha bokhoni ba ho tsepamisa maikutlo, ho ferekanya kelello,
• hlooho e opang, leseli,
• khokahano e senyehileng ea metsamao,
• li-automatism tsa khale (li-grimaces, reflex Reflex),
• ho tsitsipana, matšoao a amanang le methapo ea kutlo (hemiplegia, aphasia, pono habeli),
• amnesia
• ho otsela, ho akheha kelellong, ho mang,
• mafu a amanang le ho hema le ho potoloha ho potoloha.

Likarolo tsa setšoantšo sa kliniki ea lino tse tahang ke bokhoba ba nakoana le monyetla oa ho khutla hape ha hypoglycemia (ka lebaka la khatello ea "gluconeogeneis" sebeteng), hammoho le matšoao a amanang le "neuroglycemia" holim'a matšoao a limela.

Nocturnal hypoglycemia e ka ba asymptomatic. Matšoao a bona a sa tobang ke ho fufuleloa, lits'oareho, ho robala ka ho tšoenyeha, ho tšoaroa ke hlooho hoseng, 'me ka linako tse ling posthypoglycemic hyperglycemia hoseng haholo (Somoji phenomenon). Hyperglycemia e joalo ea posthypoglycemic e hlaha ho arabeloa ha hypoglycemia ho bakuli ba nang le tsamaiso ea methapo e sa sebetseng. Leha ho le joalo, hangata hyperglycemia ea hoseng e bakoa ke pilisi e sa lekaneng ea mantsiboea ea insulin ea nako e telele.

Lipontšo tsa kliniki tsa hypoglycemia ha li hole haholo le maemo a tsoekere ea mali kamehla. Kahoo, bakuli ba nang le lefu la tsoekere mellitus e rarahaneng ke autonomic neuropathy ba ka se utloe ho fokotseha ha maemo a glucose a mali a 6,7 ​​mmol / L.

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Hypoglycemia e sa boleloang: kalafo

- Ho fana ka tlhokomelo ea bongaka maemong a tšohanyetso sethaleng sa pele ho bophelo ba pele:

Phekolo e itšetleha ka ho teba ha hypoglycemia.

• Hypoglycemia e bonolo (I degree).

Mokuli a ka emisa ketsahalo eo ka boyena a nka 10-20 g ea lik'habohaedreite ka mokhoa oa matlapa a dextrose (tsoekere), lero, seno se monate. Bana ba banyenyane haholo ba ke ke ba ithusa, ka hona, bana ba ka tlase ho lilemo tse 5-6 ha ba na hypoglycemia, e ka nkoang e le matšoafo.

• Tekanyo e itekanetseng ea hypoglycemia (II degree)

e emisoa ke ho hlahisoa ha 10-20 g ea dextrose (tsoekere) kahare, empa ka thuso ea batho ba sa lumelloang, ka mor'a moo tee e monate e nang le bohobe bo tšoeu e lokela ho fanoa.

• Hypoglycemia e matla (sehlopha sa III).

- Ho kenngoa 20, 40, 60 ml ea tharollo ea dextrose ea 20-40% (tsoekere, lethal dose e le 'ngoe ea 200 mg / kg, 1 ml ea tharollo ea glucose ea 20% = 200 mg) ka mokhoa o pharalletseng ho fihlela mokuli a tlohela komello. Methapo ea tsoekere ea mali e lokela ho fihla ho 10-15 mmol / L. Ho se tsebe letho metsotso e 30 ka mor'a ho thatafala ha glycemia ho bonts'a lefu la mokokotlo, le hlokang kalafo e nepahetseng.

Bohlokoa! Tsamaiso ea tsoekere e potlakileng e ka lebisa ho hypokalemia. Tsamaiso e fetelletseng ea tharollo ea 40% ea dextrose (tsoekere) e ka lebisa kholong ea lefu la tsoekere. Ka hypoglycemia ea nako e telele, ho senyeha ha boko ho ka hlaha - ho khothalletsoa ho kenya tharollo ea 10% ea dextrose (glucose).

- Haeba o sa tsebe letho, o ts'oaroa ke phepelo, tharollo ea 5% dextrose (tsoekere) e tsamaisoa ka matla ka tekanyo ea 10,5 ml / kg / h (10 mg / kg / min, 1 ml ea tharollo ea 5% dextrose = 50 mg) tseleng sepetlele. Kamora ho hlaphoheloa kelellong, ts'ebetso ea methapo ea tharollo ea 5% ea dextrose (tsoekere) ka tekanyo ea 5 ml / kg / h e lokela ho tsoelapele nakong eohle e lebelletsoeng ea ts'ebetso ea insulin kapa sethethefatsi sa hypoglycemic se ileng sa etsa hore komisi ena e thibele ho khutlela morao.

- Hammoho le kenyelletso ea dextrose (tsoekere), maemong a mang, tsoekere e ea tsamaisoa (bakeng sa bana ba ka tlase ho lilemo tse 10 ka tekanyo ea 0.5 ml, bakeng sa bana ba ka holimo ho lilemo tse 10 - 1 ml intramuscularly), e thusang ho fetola glycogen ea sebete ho tsoekere. Ho hlaphoheloa hoa letsoalo ho etsahala nakong ea metsotso e 5-10. Glucagon e ka baka ho hlatsa, ka hona takatso e matla e lokela ho thibeloa.

- Prednisone ka tekanyo ea 2 mg / kg kahare.

- Ho kena sepetlele ka potlako ho mokuli ea nang le hypoglycemia e matla ho ICU sepetlele se nang le lefapha la endocrinology. Ka kelello e khutliselitsoeng - ho kena sepetlele lefapheng la endocrinology.

- Tlhahiso ea tlhokomelo ea bongaka ea boemo ba tšohanyetso sethaleng sa pele ho nako:

• Bolus intravenous tsamaiso ea 1 ml / kg ea tharollo ea 20% ea dextrose (tsoekere, 1 ml ea tharollo ea 20% = 200 mg / ml) bakeng sa metsotso e 3.

• Ho kenella ha fluores ho etsoa ka tharollo ea 1 le ea 2 (bona kalafo ea hyperglycemic coma) ntle le ho kenyelletsa insulin tlasa taolo ea maemo a tsoekere ea mali.

• Tekanyo ea infravenous infusion ea dextrose (tsoekere) ke 10 mg / kg / min (ka tharollo ea 5% - 0,2 ml / kg / min).

• Haeba ho hlokahala, li-hormone tsa contrainsulin (glucagon, adrenaline kapa prednisone) lia tsamaisoa.

• Ho khutlisetsa metabolism ea intracellular, ascorbic acid, thiamine (vithamini B1), pyridoxine (vithamine B6) li sebelisoa.

• Thibelo ea hypoglycemia e phetoang, e ka lebisang ho senyeha hoa kelello.

Tse ling

Hypoglycemia ho masea le ho bana ba baholo

Hypoglycemia ho bana ba lihlopha tsena tsa lilemo ha e ngata haholo ho feta ho masea a sa tsoa hlaha.

1. Lisosa tse kholo ka ho fetisisa tsa hyperglycemia ho masea ke mefuta e fokolang ea hyperinsulinemia, bofokoli ba tlhaho ea lihormone tse loantšanang, kapa mathata a amanang le metabolic. Hypoglycemia e bakoang ke mathata ana hangata e etsahala ha a le likhoeli li 3 ho isa ho tse 6, ha boroko ba bosiu bo ba telele (mekhahlelo lipakeng tsa phepelo e teletsana, 'me ho itima lijo ha ngoana bosiu ho fihlela lihora tse 8).

2. Ho bana ba baholo ho feta selemo, hypoglycemia hangata e bakoa ke ho sitoa ho boloka standardoglycemia nakong ea ho itima lijo kapa bofokoli bo fumanoeng ba lihormone tse loantšanang.

3. Nako e telele ea ho anyesa e qeta, hypoglycemia ea morao e etsahala.

Hypoglycemia e matla e bontšoa ke ho tsitsipana, ho akheha kapa ho akheha. Ka hypoglycemia e bonolo kapa e leka-lekaneng, matšoao a methapo a ke ke a bitsisoa (ho se khonehe, ho tepella, ho otsela, ts'ebelisano e mpe ea mekhatlo). Bakeng sa tlhahlobo ea mafu, ho bohlokoa ho hlahloba khafetsa matšoao a hypoglycemia le kamano ea bona le nako ea lipakeng pakeng tsa ho fepa.

Melao-motheo ea tlhahlobo ea mafu. Boikemisetso ba tsoekere, li-insulin le li-hormone tsa "contra" tse maling tse nkiloeng nakong ea ho qala ha matšoao li ka tiisa tlhahlobo le ho fumana sesosa sa hypoglycemia. Ha tsietsano e ba teng leseeng, ho hlokahala hore ho qheleloe ka thoko hypoglycemia. Haeba ho ne ho ke ke ha khoneha ho nka mali ka nako ea ho ts'oaroa, tlhahlobo e etsoa ka tlala le tsamaiso ea glucagon tlasa tataiso ea kamehla ea ngaka. Ho kenella ho kenella ka hare ho lihora tse 10-20, haeba ho tsitsipana ho hlaha, ba felisoa ka ente ea iv kapa intramuscular ea glucagon. Pele ho tsamaiso ea glucagon le metsotso e 30 ka mor'a ts'ebetso, mali a nkoa ho khetholla li-metabolites le li-hormone (bona tafole. 33.3).

1. Hyperinsulinemia. Ena ke sesosa se atileng haholo sa hypoglycemia likhoeling tse 6 tsa pele tsa bophelo.

1) Hangata, hyperinsulinemia e bakoa ke ho ipatela ho eketsehileng ha insulin ho bakoang ke beta-cell hyperplasia, insulinoma kapa nonidi idioblastosis. Ho itima lijo nako e telele ho halefisa bana ba nang le mafu ana.

2) Ho se mamellane ha Leucine. Ho boloka insulin ka mokhoa o feteletseng ho ka bakoa ke li-amino acid tse fumanehang ka lebese, haholo leucine. Ho bana ba nang le mamello ea leucine, hypoglycemia e etsahala kamora ho fepa ka lebese kapa lijo tse nang le leucine e ngata. Secretion ea "insulin" ho arabela leucine hangata e ntlafatsoa ho bana ba nang le beta-cell hyperplasia, insulinoma, kapa nonidi idioblastosis.

3) Tsamaiso ea insulin, tsamaiso ea methapo ea molomo e amanang le hypoglycemic le lithethefatsi tse ling li ka baka hyperinsulinemia ho ngoana ea se nang lefu la tsoekere (lefu la 33, leq. VIII).

c. Phekolo. Ho fapana le masea a sa tsoa hlaha, masea le bana ba seng ba holile ha ba hloke ho kenngoa ha tsoekere ka nako e telele le ho behoa ha somatropin kapa cortisol. Haeba hypoglycemia e bakoa ke beta-cell hyperplasia, insulinoma kapa nezidioblastosis, kalafo ea nako e telele e nang le diazoxide (5-15 mg / kg / letsatsi ka molomo ka tekanyetso e 3 e arohaneng) e etsoa. Ka tloaelo, diazoxide eu lumella ho boloka Normoglycemia ka likhoeli tse 'maloa esita le lilemo. Octreotide le eona e sebetsa. Ka ho khutla ha hypoglycemia nakong ea kalafo le diazoxide, hammoho le phello ea litla-morao tsa diazoxide (hirsutism, edema, hypertension hyper, hyperuricemia), karolo ea pancreatectomy e bontšoa. Ka ho hloka mamello ea leucine, ho fanoa ka lijo tse loketseng.

2. Khaello ea STH kapa cortisol ha se hangata e le sesosa sa hypoglycemia ho bana ba baholo ho feta khoeli. Hypoglycemia ka lebaka la khaello ea lihormone tsena e etsahala feela kamora ho qeta nako e telele ho itima lijo. Ts'oaetso e ipapisitse le liphetho tsa tlhahlobo ea mali e ileng ea nkuoa nakong ea tlhaselo ea hypoglycemia, keketseho ea khatello ea tsoekere kamora ho tsamaisoa ha glucagon kapa ka har'a meeli e tloaelehileng. Nakong ea ho itima lijo, khatello ea tsoekere e ea fokotseha, 'me ho kenella ha mafura a mangata le' mele ea ketone e ea eketseha, joalo ka hypoglycemia ea ho itima lijo. Matšoao a Clinical a hypopituitarism kapa tšenyo ea tšoelesa ea pituitary ho bana ba holileng: kholo e makatsang, e makatsang, matšoao a ho bopa molumo oa intracranial (mohlala, ICP e eketsehileng). Matšoao a ho hloka khaello ea mantlha ea adrenal: hyperpigmentation, tlhoko e eketsehileng ea letsoai, hyponatremia le hyperkalemia.

3. Ho potlakisa hypoglycemia. Ena ke mofuta o atileng haholo oa hypoglycemia ho bana ba likhoeli tse 6 ho isa ho tse 6.

a. Etiology. Sesosa sa ho itima lijo ka potlako ke hypoglycemia ke ho se khone ho boloka li-standardoglycemia nakong ea ho itima lijo. Pathogenesis ea hypoglycemia ea ho itima lijo ha e so ka e hlakisoa (ntle le hypoglycemia kamora ho itima lijo nako e telele ho bakuli ba nang le khaello ea lihormone tse loantšanang - STH le cortisol). Ho potlakisa hypoglycemia hangata ho hlaha ka khaello ea phepo e nepahetseng ho bakuli ba nang le tšoaetso e matla kapa mathata a ka mpeng, haholo-holo ka mor'a ho robala nako e telele. Ka linako tse ling maemong a joalo, hypoglycemia e bonahatsoa ke ho tsitsipana kapa ho se tsebe.

b. Tlhahlobo ea mahlale. Maling a nkiloeng nakong ea tlhaselo ea hypoglycemia, meroallo ea "glucose" le "" "" "insulin" li tlase haholo, 'me masapo a ketone a phahame. Ketonuria e ka etsahala. Keketseho ea khatello ea tsoekere ka mor'a ho tsamaisoa ha glucagon e ka tlase ho tloaelehileng. Ho itima lijo nako e telele bakeng sa lihora tse 14-24 ho halefisa hypoglycemia. Ho kenyelletsa khaello ea lihormone tsa li-contra-hormone, fumana se kahare ho STH le cortisol.

c. Phekolo. Haeba khaello ea STH kapa cortisol e fumanoa, phekolo ea phetisetso ea li-hormone ea etsoa. Haeba ho na le khaello ea lihormone tsa li-contra-hormonal, lijo tse nang le protheine le lik'habohaedreite li fanoe, phepo eo e lokela ho ba e ferekaneng (makhetlo a 6-8 ka letsatsi). Ka bokuli bo boholo bo kopaneng, ho khothalletsoa lino tse nang le tsoekere e ngata. Ho bokellana ha 'mele ea ketone ka har'a moroto ho ikemiselitse kamehla. Haeba ketonuria e hlaha mokokotlong oa kalafo ea phepo, tsoekere e kenngoa ka tekanyo ea 6-8 mg / kg / min ho thibela hypoglycemia e matla. Phekolo ea lijo li sebetsa hantle ho bakuli ba bangata, ha a le lilemo li 7-8, litlhaselo tsa hypoglycemia li khaotsa.

Idiopathic reactive hypoglycemia ke mofuta oa hypoglycemia e bakoang ke takatso ea lijo (bona le khaolo ea 34, leq. VIII). Mofuta ona oa hypoglycemia hangata o belaelloa ho bana le lilemong tsa bocha, empa ho tsebahala ha ho atise ho netefatsoa. Tlhahlobo ea "idiopathic reactive hypoglycemia" e thehiloe motheong oa sephetho sa tlhahlobo ea mamello ea glucose: lihora tse 3-5 kamora ho nka tsoekere ka tekanyo ea 1.75 g / kg (boholo ba 75 g) mahloriso a glucose ea mali.

Tlhokomelo ea bongaka ea tšohanyetso Sesebelisoa sa motlakase: Boetapele ba naha / ed. S.F. Bagnenko, M.Sh. Khubutia, A.G. Miroshnichenko, I.P. Minnullina. - M: GEOTAR-Media, 2015. - (Lihlooho "National Guides"). - http://www.rosmedlib.ru/book/ISBN9785970433492.html

Ho bala ho eketsehileng (ho khothalelitsoe)

1. Aynsley-Green A, et al. Nesidioblastosis ea manyeme: Tlhaloso ea ramatiki le taolo ea methapo e matla ea neonatal hyperinsulinemic hypoglycemia. Arch Dis Ngwana 56: 496, 1981.

2. Burchell A, et al. Hepatic microsomal glucose-6-phosphatase system le lefu la tšohanyetso la masea ka tšohanyetso. Lancet 2: 291, 1989.

3. Khaello ea Carnitine. Lancet 335: 631, 1990. Mohlophisi.

4. Haymond MW. Hypoglycemia ho masea le ho bana. Endocrinol Metab Clin North Am 18: 211, 1989.

5. Lefu la polokelo ea Hug G. Glycogen. Ho VC Kelley (ed), Tloaelo ea lingaka. New York: Harper & Row, 1985.

6. Shapira Y, Gutman A. bofokoli ba mesifa ea carnitine ho bakuli ba sebelisang asiti ea valproic. J Pediatr 118: 646, 1991.

7. Sperling MA. Hypoglycemia ka leseeng le lecha le sa tsoa hlaha. Ho F Lifshitz (ed), Pediatric Endocrinology: Tataiso ea Kliniki. New York: Dekker, 1990. Pp. 803.

8. Sperling MA. Hypoglycemia Ho R Behrman (ed), Nelson Textbook of Pediatrics (14th ed). Philadelphia: Saunders, 1992. Pp. 409.

9. Ho shoa ha lesea ka tšohanyetso le mathata a futsitsoeng a oxidation. Lancet 2: 1073, 1986. Sehlophisi.

10. Treem WR, et al. Hypoglycemia, hypotonia, le cardiomyopathy: Setšoantšo sa tleliniki se hlahisang bofokoli ba bolelele ba li-acyl-Co-A dehydrogenase. Lipesaleme 87: 328, 1991.

11. Volpe JJ. Hypoglycemia le likotsi tsa boko. Ho JJ Volpe (ed), Neurology ea ngoana ea sa tsoa hlaha. Philadelphia: Saunders, 1987. Pp. 364.

12. Wolfsdorf JI, et al. Pheko ea kokoana-hloko ea mofuta oa glycogenosis I ho masea: Ho bapisoa ha poone e sa phehoang nako le nako ea phepelo ea tsoekere e sa tsoaneng. J Pediatr 117: 384, 1990.

Ke mafu afe a tsamaeang le hyperglycemia syndrome?

Hyperglycemia syndrome ke letšoao le ikhethang la matšoao a itseng, a tsamaeang le "glucose" e sa bonahaleng ea likarolo tse itseng tsa mmele. Pathological syndrome e etelloa pele ke mafu a mangata:

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• mofuta oa 1 le mofuta oa 2 lefu la tsoekere
• hyperthyroidism
• Lefu la Cushing
• pancreatitis e hlobaetsang
• li-pancreatic tumors tsa mefuta e fapaneng,
• cystic fibrosis.

Boemo ba hyperglycemia boa tsoteha. E ka bakoa ke linyeoe tse le 'ngoe tsa ho eketseha ha tsoekere ea mali le boemo bo tsoekere bo sa foleng ba bongata ba tsoekere.

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Ntle le lisosa tse fumanoeng tsa hyperglycemia, ho na le linyeoe tsa genesis e sa hlalosoang ea pathology.

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Mefuta ea Hyperglycemia

Ka mofuta oa ponahatso, boemo ba tsoekere e phahameng ea mali bo arotsoe ka mefuta e 'maloa:

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• sa foleng
• ea nakoana
• e sa hlalosoang.

Mofuta o mong le o mong oa hyperglycemia o na le lisosa le nts'etsopele ea eona.

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Hyperglycemia e sa foleng

Ena ke letšoao la phetoho ea lipontšo tsa phetoho ea metabolic, e kopaneng le li-neuropathies tse itseng. Pele ho tsohle ke tšobotsi ea lefu la tsoekere.

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Foromo e sa foleng e khetholloa ke 'nete ea hore boemo ba tsoekere e phahameng ke bo sa feleng,' me ho ba sieo ha mehato ea ho felisa ts'ebetso ea methapo ho ka lebisa ho hyperglycemic coma.

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Tlhahlobo ea hyperglycemia e nkuoa ka mpeng e se nang letho, matšoao a eona a khethollang tekanyo ea 'nete ea tsoekere maling.

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Ha e hlalosoe

Ho latela sehlopha sa machaba, hyperglycemia e sa hlalosoang e totobatsoa tlasa khoutu ea 73.9. E ka iponahatsa ka mokhoa o ts'oanang le hyperglycemia efe kapa efe ka likhato tse tharo tsa boima:

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• khanya - ho fihlela ho glucose e fihlang ho 8 mmol / l maling a nkiloeng ka mpeng e se nang letho,
• mahareng - ho fihla ho 11 mmol / l,
• e boima - ho feta 16 mmol / l.

Ho fapana le mefuta e meng ea lefu lena, lefu lena ha le na mabaka a hlakileng a ho ba teng, 'me le hloka tlhokomelo e haufi le tlhokomelo ea tšohanyetso maemong a kotsi.

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Bakeng sa tlhahlobo e felletseng, ho fanoa ka mekhoa e meng ea ho etsa lipatlisiso:

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• Ultrasound ea mpa
• MRI ea kelello
• biochemistry ea mali
• urinalysis.

Ho latela data e fumaneng, ngaka e tseba sesosa sa 'nete ebile e fana ka kalafo e reretsoeng ho felisa lefu lena le tlase. Ha a fola, litlhaselo tsa hyperglycemia li iphetha ka botsona.

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Hypoglycemia

Ha ho na kotsi le ho feta boemo ba hypoglycemia (ka Selatine - hypoglykaemia), e khetholloang ka ho fokotseha ha mahloriso a tsoekere ea mali. Hypoglycemia e bontšoa tlasa khoutu ea E15 le E16 ho ea ka ICD 10.

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Bohlokoa! Boemo ba nako e telele ba tsoekere e khutsitseng ea mali bo ka baka lekhopho le bolaeang le matla ho motho.

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Ka hona, ha palo ea tsoekere e le ka tlase ho 3.5 mmol / l, mehato e potlakileng e lokela ho nkuoa.

Hypoglycemia syndrome

Hypoglycemia syndrome ke letšoao le ikhethang la matšoao a boletsoeng a bokuli bo amanang le methapo e itseng ea methapo. E iponahatsa ka matšoao a latelang:

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• bofokoli
• pallor ea letlalo,
• ho nyekeloa
• mofufutso
• morethetho oa pelo,
• Ho thothomela ha maoto le matsoho.

Maemong a tebileng, lefu la hypoglycemia le iponahatsa e le ho ferekana le ho akheha. Motho ea joalo o hloka thuso ea hang-hang: etsa ente ea tsoekere le ho lekola boemo ba leleme e le hore e se ferekane.

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Mefuta ea hypoglycemia

Ho na le mefuta e meraro ea hypoglycemia ka botebo:

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• degree ea pele
• degree ea bobeli
• hypoglycemic coma.

E 'ngoe le e' ngoe ea mefuta e na le lipontšo le matšoao a eona. Haeba motho a se a bile le mofuta o bobebe kapa o leka-lekaneng oa hypoglycemia, ka nako eo o lokela ho lula a e-na le ntho e monate e le hore a be le nako ea ho emisa tlhaselo e ncha kapele.

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Bohato ba pele

Mokhahlelo oa pele o tšoauoa ka matšoao a latelang:

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• mofufutso
• pallor
• eketseha ha molumo oa mesifa,
• phetoho ea sekhahla sa pelo, hangata ea eona.

Motho ka nako ena a ka utloa tlhaselo e matla ea tlala, ho teneha. Ho bonahala eka u na le letsoele le ka hlahisa litlamorao.

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Coma

E khethoa ke boemo ba tsoekere ea mali bo ka tlase ho 1.6 mmol / L. Matšoao a latelang a ka hlaha:

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• khokahano e robehile
• tahlehelo ea pono
• boemo ba letsoalo
• hemorrhage ea mokokotlo maemong a matla.

Hangata komisi e hlaha ka potlako le ka boithatelo, thuto e joalo ea kotsi e kotsi haholo ho batho ba nang le lefu la tsoekere.

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Ts'oaretso ea hypoglycemia

Ho na le li-subspecies tse ngata tsa hypoglycemia. Kaofela ha tsona li fapana ka lisosa le mokhoa oa kalafo. Mefuta e latelang ea pathology e khetholloa:

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1. Tai ea joala e hlaha ka lebaka la tšebeliso e telele ea joala ka bongata bo bongata. Ho tlosoa ka matla ka har'a sebete ho baka ho theoha ho matla ha tsoekere ea mali.
2. Mofuta oa neonatal oa hypoglycemia o hlaha ho bana ba tsoaloang ke bo-'mè ba nang le lefu la tsoekere, kapa masea a tlang pele ho nako. Mofuta ona oa bokuli o iponahatsa ka lihora tsa pele tsa bophelo ba ngoana mme o hloka phetoho ea maemo.
3. Mokhoa o sebetsang oa pathology o amahanngoa le khaello ea phepo e nepahetseng, empa ha e lebise ho lefu la tsoekere. Batho ba joalo ba tloaetse ho tlala, ba tsamaea butle.
4. Mofuta o sa foleng oa hypoglycemia ke oa kamehla ebile o hloka kalafo e tloaelehileng. Hangata, foromo ena ke phello ea ho se sebetse hantle ha litšoelesa tse phahameng tsa endocrine - hypothalamus le gland ea pituitary. Ho qholotsa 'muso ke ho itima lijo ka nako e telele.
5. Ho theoha ho matla ha tsoekere ea mali ho ea holimo ho baka hypoglycemia e matla. Mofuta ona oa bokuli hangata o hloka thuso e potlakileng ho mokuli ka mokhoa oa ente ea glucose. Lefu la tsoekere le ka tsosetsa hypoglycemia e mpe haeba ho entsoe lethal dose le leholo la insulin.
6. Foromo ea morao-rao e tsoela pele ntle le matšoao a bonahalang, hangata e iponahatsa bosiu. E le molao, mofuta ona oa hypoglycemia o thehiloe ka mor'a tlhaselo e matla ea lefu lena. Mofuta oa lefu lena o sa feleng o ka ba o sa foleng.
7. Alimentary fomu ea hypoglycemia e etsahala kamora ho buuoa matlalong kapa mpeng. E amana le ho ba sieo ha phello e nkang ea sefuba ka mpeng ka mora ts'ebetso ea ts'ebetso.

Ho joalo, mokhoa o ka sehloohong oa ho phekola lefu la tsoekere la mali a fokolang ke liente tsa tsoekere le phepo e nepahetseng.

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Empa ho bohlokoa hape ho khetholla lefu le tlasa lefu lena le lebisang bothateng bona, 'me u qale ho le phekola ka nako.

Tlhaloso e khutšoane

Hypoglycemia - ho fokotseha ha tsoekere ea mali e ka tlase ho 3.33 mmol / L. Hypoglycemia e ka hlaha ho batho ba phetseng hantle kamora matsatsi a 'maloa a ho itima lijo kapa lihora tse' maloa ka mor'a ho laolla tsoekere, e lebisang ho eketseheng ha litekanyetso tsa insulin le ho fokotseha ha litekanyetso tsa tsoekere ha ho na matšoao a hypoglycemia. Ka karolelano, hypoglycemia e iponahatsa ka ho fokotseha ha maemo a tsoekere ka tlase ho 2.4-3.0 mmol / L. Senotlolo sa ho tsebahatsa lefu ke Whipple triad: • lipontšo tsa neuropsychic nakong ea tlala, • ​​tsoekere ea mali e ka tlase ho 2.78 mmol / l, • phomolo ea tlhaselo ka tsamaiso ea molomo kapa ea methapo ea tharollo ea dextrose. Ponahatso e feteletseng ea hypoglycemia ke hypoglycemic coma.

Lintho Tse Kotsi Phekolo ea "insulin" Boiphihlelo ba nako e telele ba lefu la tsoekere (ho feta lilemo tse 5) • Batho ba baholo • Maloetse a liphio • Maloetse a lefu la sebete: Ho hloleha ha pelo le pelo • Hypothyroidism • Gastroenteritis • Ho bolaoa ke tlala.

Likarolo tsa lefutso. Hypoglycemia ke sesupo se etelletseng pele sa lintho tse ngata tsa lefutso, ka mohlala: • Hypoglycemia ka lebaka la khaello ea glucagon (231530, r) - congenital hypoglycemia e nang le maemo a mangata a insulin le khaello ea glucagon • Hypoglycemia e nang le khaello ea glycogen synthetase (# 240600, r) Ka karolelano: hypoglycemia ea tlhaho, hypoglycemia le hyperketonemia nakong ea ho itima lijo, hyperglycemia le hyperlactatemia nakong ea ho fepa, syndrome e hlasimollang. Laborator: khaello ea "glycogen synthetase" - khaello ea Fructose - 1.6 - phosphatase (229700, r) • Leucine - e hlahisitse hypoglycemia (240800, r) - mefuta e 'maloa ea congenital hypoglycemia • Hypoketotic hypoglycemia (# 255120, carnitine Palmitoyl defase defence I * 600528, 11q, CPT1 defence gene, r).

Etiology le pathogeneis

• Ho potlakisa hypoglycemia •• Insulinoma •• Artificial hypoglycemia e bakoa ke ts'ebeliso ea lithethefatsi tsa "insulin" kapa "molomo" tse sa amaneng haholo le salicylates, b - adrenoblockers kapa quinine) •• Li-tumor tsa extrapancreatic li ka baka hypoglycemia. Ka tloaelo tsena ke makhopho a maholo a fumanehang ka mpeng ea mpa, hangata a hlahang mesenchymal (ka mohlala, fibrosarcoma), leha li-carcinomas tsa sebete le lihlahala tse ling li bonoa. Mochine oa hypoglycemia ha o utloisisoe hantle, ba tlaleha ho kenella ha tsoekere e ngata ke li-tumor tse ling ka popeho ea lintho tse kang insulin. • Hypoglycemia e hlahisoang ke ethanol e bonoa ho batho ba nang le phokotso e kholo mabenkeleng a glycogen ka lebaka la joala, hangata lihora tse 12-24 kamora ho nooa. Ho bolaoa hoa lefu ho feta 10%, ka hona, ho hlahlojoa kapele le ho tsamaisoa ha p - dextrose hoa hlokahala (nakong ea oxidation ea ethanol ho acetaldehyde le acetate, NADP e bokella le ho fumaneha ha NAD e hlokahalang bakeng sa gluconeogenesis e fokotseha). Tlokotsi ea glycogenolysis le gluconeogenesis e hlokahalang bakeng sa ho thehoa ha tsoekere ka har'a sebete nakong ea ho itima lijo ho lebisa ho hypoglycemia • kula mafu a sebete a lebisa ho senyeha ho glycogenolysis le gluconeogenesis e lekaneng bakeng sa hypoglycemia e potlakileng. Maemo a ts'oanang a bonoa ka vaerase e matla ea hepatitis kapa ho senyeha ha chefo e mpe, empa eseng maemong a fokolang a lefu la cirrhosis kapa hepatitis. 1, Lisosa tse ling tsa hypoglycemia e potlakileng: khaello ea cortisol le / kapa GH (ka mohlala, ka ho hloka khaello ea adrenal kapa hypopituitarism). Ho nyekeloa ke pelo le pelo ka linako tse ling ho tsamaisana le hypoglycemia, empa lisosa tsa ho hlaha ha eona ha li utloisisehe hantle.

• Reactive hypoglycemia e etsahala ka mor'a lihora tse 'maloa kamora ho ja lik'habohaedreite Ho ts'oaroa ha lik'habohaedreite ka potlako ho phahamisa secretion ea insulin haholo, ho baka hypoglycemia nakoana kamora ho ja •• Reactive hypoglycemia a lefu la tsoekere. Maemong a mang, ho bakuli ba mathateng a lefu la tsoekere, kamora nakoana, empa ho tsoa ka mokhoa o feteletseng oa insulin. Kamora ho ja, khatello ea "glucose" ea glucose e phahama kamora lihora tse peli, empa e fokotseha ho fihlela boemo ba hypoglycemia (lihora tse 3-5 kamora ho ja) •• Hypoglycemia e sebetsang e fumanoa ho bakuli ba nang le mathata a neuropsychiatric (ka mohlala, ba nang le lefu la mokhathala o sa feleng).

Matšoao (matšoao)

Setšoantšo sa Clinical e hlalositsoeng ke tlala e kopantsoeng le matšoao a methapo le a adrenergic.

• Matšoao a methapo ea kutlo a fokotseha ka ho fokotseha butle-butle ha tsoekere. • Kereseho ea hlooho ea hlooho • Hloho ea hloohoana ea hloohoana • Ho senyeha ha pono (mohlala, diplopia) •• Paresthesias •• Cramps •• Hypoglycemic coma (hangata e hlaha ka tšohanyetso).

• Matšoao a Adrenergic a fokotseha ka ho fokotseha ho hoholo ha maemo a tsoekere? •• Hyperhidrosis •• Ho tšoenyeha •• Ho ferekana ha maemo a feteletseng.

Likarolo tsa lilemo • Bana: hypoglycemia ea nakoana ea nako ea bokhachane, hypoglycemia ea bana ba banyenyane le ba baholo • Batho ba baholo: maemong a mangata, hypoglycemia e amahanngoa le mafu a kopaneng kapa ts'ebeliso ea lithethefatsi tsa hypoglycemic.

Boimana hangata e baka nakoana butle-butle hypoglycemia.

Ts'oaetso

Patlisiso ea laboratori Boikemisetso ba boemo ba glucose ba plasma le tlhahlobo ea mamello ea glucose • Boikemisetso ba C - peptide e senola mohloli oa secretion ea insulin •• Tsoekere e tlase le insulinoma e phahameng, pathognomonic bakeng sa insulinoma, e tsamaisana le boemo bo eketsehang ba C - peptide. Mohloli oa mahloriso a phahameng a insulin • Liteko tsa ts'ebetso ea sebete, boikemisetso ba serum insulin, cortisol.

Matla a lithethefatsi. Sulfonylurea e hlohlelletsa tlhahiso ea li-insulin tsa tlhaho le C - peptide, ka hona, ho kenyelletsa hypoglycemia ea maiketsetso, tlhahlobo ea mali kapa ea urine e etsoa ho litokisetso tsa sulfonylurea.

Lithuto tse khethehileng • Glucose ea plasma kamora ho itima lijo ka lihora tse 72 ka tlase ho 45 mg% (ka tlase ho 2,5 mmol / l) ho basali le ka tlase ho 55 mg% (3.05 mmol / l) ho banna • Ho etsa liteko ka tolbutamide: ha e sebelisoa kahare, boemo ba tsoekere bo ka ho 20- Metsotso e 30 e fokotsehile ka tlase ho 50% • Boikemisetso ba Radioimmune ba maemo a insulin • CT kapa ultrasound ea litho tsa ka mpeng ho kenyelletsa tumor.

Tlhahlobo e fapaneng. Psychogenic hypoglycemia, kapa pseudohypoglycemia. Bakuli ba bangata (hangata basali ba lilemo tse 20 ho isa ho 45) ba fumanoa ba na le hypoglycemia e sebetsang, leha ho le joalo, letšoao le ts'oanang le tloaelo le amahanngoa le ho sebetsa ka matla kapa ho se sebetse hantle ha methapo (khatello ea maikutlo le eona e bapala karolo ea bohlokoa boteng ba matšoao ana). Bakuli ba joalo ho thata ho ba phekola. Keletso ea ngaka-psychotherapist e ea hlokahala.

TLHOKOMELO

Maano • Lijo tse nang le liprotheine tse ngata (ho bakuli ba nang le bothata ba ho lahla) - li tlaase haholo limeleng tsa lik'habohaedreite habonolo. Ho ja khafetsa le ho ja lijo tse bobebe • Ha matšoao a pele a hypoglycemia a etsahala - ho ja lijo tse nang le phepo ea lijo tse bobebe habonolo (likhaba tse 2-3 tsa tsoekere ka khalase ea metsi kapa lero la litholoana, linoelo tse 1-2 tsa lebese, likuku, likharafu) • Haeba mokuli a sa khone ho ja, enta glucagon ka / m kapa s / c (glucagon ha e sebelisoe hangata naheng ea heso) • Maemong a hypoglycemia e bakoang ke lithethefatsi, kenyelletsa tšebeliso ea eona kapa ho lekola tekanyo ea lithethefatsi hantle.

Lithethefatsi tsa khetho

• Tlhokomelo ea bongaka ea maemo a tšohanyetso •• Haeba tsoekere ea molomo e sa khone ho tsamaisoa, 40-60 ml ea 40% tharollo ea methapo ea methapo e kenngoa bakeng sa metsotso e 3-5 e lateloe ke infusion e tsoelang pele ea 5 kapa 10% tharollo ea dextrose. kalafo e qala ka ho kenella ka tharollo ea 10% dextrose tharollo ka tekanyo ea 3-5 mg / kg / min kapa ho feta - lihora tse 48 ka lebaka la menyetla awn khutlela mokhoeng coma.

• Ho a khonahala ho fana ka glucagon ea IM / SC ho mokuli karolong e ka holimo ea lehetla kapa serope (e sa sebelisoeng hangata naheng ea rona). Glucagon hangata e tlosa lipontšo tsa methapo ea hypoglycemia kahare ho 10-25 min; ka ho se sebetse, liente tse phetoang ha li khothaletsoe. Motsoako oa glucagon: bana ba ka tlase ho lilemo tse 5 - 0,25-0.50 mg, bana ba lilemo tse 5 ho isa ho 10 - 0.5-1 mg, bana ba ka holimo ho lilemo tse 10 le batho ba baholo - 1 mg.

Mathata Cerebral edema • Mathata a teng khahlano le methapo ea kutlo.

ICD-10 • E15 Ho hloka taolo ea "secretion" e kahare ea "makhopho" a makhopho a nang le pheko ea mafu a amanang le phepo ea mafu a amanang le phepo e nepahetseng ho "fetole" "lefu la" "" "" "" "" "" "" "" "" "" "Tapo.3" chefo ".

Lintlha Ho totobatsa (tlhahlobo e fetelletseng) ea tlhahlobo ea mamello ea glucose ho ka lebisa ho overdiagnosis ea hypoglycemia. Ho lokela ho hopoloa hore ho feta 1/3 ea batho ba phetseng hantle, matšoao a tšoaetso kapa a asymptomatic hypoglycemia e bonoa nakong ea lihora tse 4 kamora tlhahlobo ena b - Bareki ba adrenergic ba pata matšoao a hypoglycemia.