Rashin maganin hypoglycemia

Halin hypoglycemic da hypoglycemic coma

Halin hypoglycemic a cikin ciwon sukari shine raguwa mai sauri a cikin glucose na jini, tare da rashi mai saurin asarar hankali sakamakon gabatarwar wani abu mai wuce haddi na insulin ko wasu magunguna game da asalin isasshen wadataccen carbohydrates tare da abinci. Lalacewar cututtukan cututtukan ƙwayar cuta a cikin nau'in ciwon sukari na 2 yana da ƙanƙanta da ƙasa fiye da masu ciwon sukari na 1.

Etiology da pathogenesis

Sanadin yanayin hypoglycemic:

• yawan insulin da ya wuce, wasu magunguna masu rage sukari,

• tsallake cin abinci na gaba,

• babban aiki na jiki.

Harshen koda, gazawar hanta, rashin ƙarfi na rashin ƙarfi, rashin kwanciyar hankali, ethanol, salicylates, agents-adrenergic tarewa, amphetamine, haloperidol, phenothiazines suna haifar da ci gaban yanayin hypoglycemic. Hypoglycemia na jarirai ana haifar da shi ta hanyar aikin hyperinsulinism na aiki a cikin yaran da aka haife su ga uwaye masu ɗauke da ƙwayar cuta, kuma ya kasance halayyar haɓaka, mara nauyi, karɓar abinci mai wucin gadi.

Matsakaicin hypoglycemia yana faruwa sau da yawa a cikin marasa lafiya da ke dauke da ciwon sukari na 1 kuma shine farashin da mai haƙuri yake biya don sarrafawa na rayuwa mai kyau da kuma kula da ciwon sukari sosai.

Glucose shine babban tushen samar da makamashi ga kwakwalwar kwakwalwa. Tunda kwakwalwar ba ta da ikon hada glucose ko adana shi ta hanyar glycogen fiye da 'yan mintoci, aikinsa mai mahimmanci ya dogara ne da yawan wadatarwar glucose din da yake gudana a cikin jini. Baya ga yawan shaye-shaye na miyagun ƙwayoyi da cin damuwa tashin hankali a cikin marasa lafiya da ciwon sukari, ikon da zai iya haɓaka ci gaban hypoglycemia yana ƙaruwa ta hanyar ƙara yawan ɓoyewar glucagon, hormone glucose, hormone somatotropic, hormone adrenocorticotropic ko adrenaline (abin da ake kira anti-kayyade lalacewa yana tasowa). Rage yawan haɗarin glucose a ƙasa 1.7-2.7 mmol / L yana haifar da neuroglycopenia, matsananciyar ƙwayar ƙwayar ƙwayar jijiya, wanda ke bayyana alamun bayyanarsa na asibiti a cikin yanayin rikicewar halayyar a cikin jihohin hypoglycemic na kowane tsananin. Sakamakon rashi na kuzari da kuma raunin jijiyoyin jiki, cutar sikila da ƙwaƙwalwar hanji tana haɓakawa a cikin ƙwayoyin kwakwalwa. Bugu da ƙari, yawan hypoglycemia mai tsanani yana haifar da lalacewar kwakwalwa mai tasowa, musamman a cikin ƙananan yara (underan shekaru 5). Dole ne a kula sosai don kauce wa matsanancin rashin ƙarfi a cikin kowane yanayi.

Bayyanar asibiti

Hypoglycemia yawanci yayi daidai da matakin glucose na jini kasa da 2.5-3.3 mmol / L kuma yana iya zama alama da asymptomatic. Za'a iya rarrabewar cututtukan hypoglycemia zuwa:

• neurogenic - tare da alamun adrenergic (sweating, pallor, chills, rawar jiki, tashin zuciya, zawo, haɓaka GARDEN, tachycardia, tashin hankali, damuwa da damuwa) da yanayin cholinergic (yunwar, paresthesia - ƙarancin lebe, tip na harshe),

• neuroglycopenic: rauni, ciwon kai, canjin hali, gajiya, hangen nesa mai rauni da magana, rashi, wuya, kauri, rashi, rashi na tunani.

Sympoomatic hypoglycemia na iya zama:

• m (I digiri): yunwar, pallor, rauni, gumi sanyi, rawar jiki, rashin motsi da tashin hankali, damuwa, bacci, wani lokacin barci,

• matsakaici mai ƙarfi (digiri na II): ciwon kai, zafin ciki, canje-canjen halaye (haushi ko tashin hankali), ƙyalli, pallor, gumi, magana da kuma wahalar hangen nesa. A cikin jarirai da jarirai, hypoglycemia yana bayyana ta hanyar damuwa, kukan da ba a motsa shi, halayyar tashin hankali,

• mai tsanani (digiri na III): rashin tausayi, disorientation, asarar hankali, giya mai fahariya, tachycardia, hypotension, jijiyoyin mucous, cramps, trismus na tsokoki masticatory, alamun Babinsky.

Mai tsananin, tsawon lokaci wanda ba a magance matsalar rashin lafiyar haila ba ya ci gaba zuwa wata doguwar jinya: jijiyoyi da gurnani mai gushewa, areflexia, hauhawar jijiya, da kuma jijiyoyin mahaifa na haɓaka. Samun Normoglycemia har ma da hyperglycemia a wannan mataki na hypoglycemic state ba ya haifar da nasara. Idan ko coma ya kwashe sama da awa daya, to rikicewar zai zama babu wahala.

A cikin wasu marasa lafiya da ciwon sukari, abin da ake kira atypical hypoglycemia syndrome na iya faruwa, sakamakon abin da hypoglycemic coma na iya haɓaka ba tare da alamun farko na kunnawa na tsarin juyayi ba (wannan cutar ana ɗaukarsa ne akan doguwar cutar, autonomic neuropathy, tarihin tarihin rashin ƙarfi na hypoglycemia, kuma ana lura da shi a cikin yara masu ƙananan yara da tsarin tsari mai inganci mai inganci). Gaskiya ne gaskiyar abin da ya shafi rashin ƙarfi a cikin jini, kawai alamar wacce take karancin glucose da safe a kan komai a ciki. Dalilin shine mafi yawan lokuta shine ɗaukar ƙwayar insulin na tsawon lokaci-don aiki don guje wa hauhawar asuba da safe.

Rashin daidaituwa na hypoglycemia: Cutar cuta

Bayyanar cututtukan hypoglycemia yawanci ba mai wahala bane idan mai haƙuri yana da hankali, akwai alamun halaye da tarihin. Duk da cewa yanayin matakan glucose na jini ba a kafa yake ba a sarari kuma yana dogara da shekaru da jinsi, ana fahimtar mafi yawan jini a matsayin raguwar matakin glucose na jini - Bambancin ganewar asali

An gudanar da shi tare da sauran nau'in cutar sankara mai cutar sankara, amai

Tsarin ilimin Pathology

Yana da lambar hypoglycemia bisa ga ICD 10 - 16.0. Amma wannan ilimin yana da azuzuwan da yawa:

wanda ba'a tantance shi ba - E2,
cutar rashin ruwa na haila da rashin ciwon sukari - E15,
4 - cin zarafin hadaddun gastrin,
8 - sauran keta hakki wanda mai haƙuri ya iya fayyace yayin binciken,
sauran siffofin - E1.

Sauran nau'ikan hypoglycemia bisa ga ICD sune maganin hyperinsulinism da encephalopathy, wanda ke haɓaka bayan rashin lafiyar da ke haifar da karancin sukari na jini.

Duk da gaskiyar cewa bisa ga rarrabuwa da ICD, hypoglycemia yana da daidai lambobin da aka lissafa, lokacin zabar magunguna don taimako da warkewa, likitoci ya kamata su kasance masu jagora ta hanyar lambobin dalilai na waje (aji XX).

Rashin daidaituwa

Akwai digiri uku na tsananin matsalar hypoglycemia:

mai sauki. Idan hakan ta faru, hankalin mai haƙuri ba ya girgiza, kuma yana iya gyara kansa yanayin: kira motar asibiti ko, idan wannan ba farkon abu ba, ɗauki magunguna masu mahimmanci,
nauyi. Idan hakan ta faru, mutum yana da hankali, amma ba zai iya dakatar da bayyanar cututtuka ba saboda tsananin zaluntar sa da / ko rikicewar dabi'a,
rashin lafiyar hailala. An kwatanta shi da asarar hankali da rashin dawowarsa na dogon lokaci. Ana iya haifar da mummunan lahani ba tare da taimako ga mutum a wannan yanayin ba - har ma da mutuwa.

Dalilai na ci gaba

Hypoglycemia na iya faruwa saboda dalilai da yawa, duka biyu (na waje) da kuma endogenous (na ciki). Mafi yawan lokuta yana tasowa:

saboda rashin abinci mai kyau (musamman, tare da amfani da carbohydrates mai yawa) na yau da kullun),
a cikin mata yayin haila,
da isasshen ruwan sha,
in babu isasshen aikin motsa jiki,
a bango daga cututtukan da ke ɗaukar cutar,
a sakamakon bayyanar neoplasms,
a matsayin amsa ga masu cutar sukari,
saboda cututtuka na tsarin zuciya da jijiyoyin jini,
saboda raunin jiki (a cikin jarirai),
saboda cin zarafin giya da wasu nau'ikan kwayoyi,
tare da hepatic, renal, cardiac da sauran nau'ikan rashin nasara,
tare da gudanar cikin jiyya na zahiri na zahiri.

Dalilan da aka jera sune don abubuwan haɗari. Abinda daidai zai iya zama mai ƙarfafawa don haɓakar haɓakar raunin ƙwayar cuta ta jiki shine ƙayyadaddun halayen jikin mutum: ƙaddarawar ƙwayar cuta, rauni, da sauransu. Hakanan, wannan yanayin na iya zama sakamakon canji mai ƙarfi a cikin haɗuwar glucose plasma daga sama zuwa al'ada. Irin wannan cutar ta glycemia ba karamar haɗari ba ce kuma tana iya haifar da nakasa ko mutuwar mai haƙuri.

Yawancin karatu sun nuna cewa mafi yawan lokuta cututtukan cututtukan cututtukan da ke karkashin kulawa suna bayyana ne a cikin mutanen da ke fama da buguwa. Wannan ya faru ne saboda gaskiyar cewa saboda yawan shan giya na ethyl, jikin ya fara kashe NAD cikin sauri. Hakanan, aiwatar da gluconeogenesis yana fara raguwa a cikin hanta.

Alcoholic hypoglycemia na iya faruwa ba kawai a bango na asalin cin zarafin giya ba, amma kuma tare da amfani guda daya na manyan allurai.

Hakanan likitocin suna bincikar lokuta inda ake samun sukari mai ƙarancin jini a cikin mutanen da a baya suka ɗan sha kaɗan na barasa. Babban haɗarin haɓakar wannan cutar bayan amfani da ethanol yana nan a cikin yara.

Hypoglycemia yana da halin hadaddun alamu. Lokacin da sukari ya faɗi cikin jiki, mai haƙuri mafi yawan lokuta yana fuskantar tashin hankali, saboda abin da zai iya zama mai zafin rai da / ko damuwa, damuwa da tsoro.

Kari akan haka, yana iya rasa rasa ikon yin kewayawa a sarari da kuma jin ciwon kai. Haskakawa ta fannin kimiyyar lissafi ma halayyar wannan jiha ce.

Mai haƙuri kusan koyaushe yana fara yin gumi mai yawa, fatarsa ta zaƙuƙuƙuwa, ƙafafunsa kuma suna rawar jiki. A layi daya tare da wannan, ya ɗanɗana jin zafin yunwar, wanda kuwa, zai iya (amma ba koyaushe ba) tare da tashin zuciya. Hoto na asibiti an cika shi da rauni gaba ɗaya.

Ationsarancin bayyanannu na wannan yanayin su ne: raunin gani, ƙwarewar gani har zuwa gajiya, daga abin da mutum zai iya faɗaɗa cikin farji, fashewar cututtukan jiki, rikicewar halayen mutum.

Hyma na jini

Lambar ICD na hypoglycemic coma shine E15. Wannan yanayin ciwo ne, wanda tare da raguwa sosai a cikin sukarin jini ya tashi cikin sauri.

Bayyananinta na farko asara ce. Amma, sabanin baƙin da aka saba, mara lafiya ba ya fita daga ciki bayan secondsan mintuna / mintuna, amma ya kasance a ciki aƙalla har sai an samar da ingantaccen kulawar likita.

Yawancin lokaci tsakanin alamomin farko na hypoglycemia da syncope da kanta gajere ne. Hakanan mara lafiya ko waɗanda ke kewaye da shi ba su lura da lalata ba, kuma ga alama kwatsam garesu. Launin rashin daidaituwa shine babban matsayin wannan yanayin ilimin.

Duk da cewa bayyanannin asibiti da ke gaban coma sau da yawa ba a kula da su ba, suna nan kuma an bayyana su a cikin abubuwa masu zuwa: gumi mai zafi, vasospasm, canjin bugun zuciya, jin tashin hankali, da dai sauransu.

Tare da haɓakawarsa, da farko akwai cin zarafi a cikin neocortex, sannan a cikin cerebellum, bayan wannan matsalar ta shafi tsarin tsarin ƙasa, kuma, a ƙarshe, ya kai ga medulla oblongata.

Mafi sau da yawa, coma yakan faru ne sakamakon ƙaddamar da ƙwayar insulin da ba daidai ba a cikin jiki (idan mai haƙuri yana da ciwon sukari mellitus). Idan mutum bai sha wahala daga wannan cutar ba, to yana iya haɓaka sakamakon cin abinci ko magungunan sulfa.

Epidemiology

Halin rashin daidaituwa na yanayi mai saurin canzawa sau da yawa yakan haifar da duka marasa lafiya tare da nau'in 1 da nau'in ciwon sukari na 2, kuma a cikin mutane ba tare da ciwon sukari ba. Ba a san ainihin musabbabin cutar hypoglycemia ba, amma hypoglycemic coma yana haifar da mutuwar 3-4% na marasa lafiya da ciwon sukari.

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Sanadin cututtukan jini da na jini

Hypoglycemia yana dogara da insulin wuce haddi tare da rashi kusancin carbohydrates ko kuma saurin amfani dasu.

Babban abubuwanda ke haifar da haɓakar ƙwanƙwasawa a cikin cututtukan sukari:

Abin haɗari ko niyya overdose na insulin ko PSSS,
tsallake cin abinci na gaba ko isasshen kuɗi,
increasedara yawan aiki na jiki (yayin ɗaukar matakan PSSS akai akai),
barasa mai amfani (hanawa na gluconeogenesis da barasa),
canji a cikin kantin magunguna na insulin ko PSSS lokacin da aka gudanar da shi ba daidai ba (alal misali, hanzarta ɗaukar insulin tare da allurar intramuscular maimakon subcutaneous), gazawar renal (tarin PSSS a cikin jini), hulɗa da miyagun ƙwayoyi (alal misali, beta-blockers, salicylates, MAO inhibitors da sauransu ƙarfin tasirin PSS,
autonomic neuropathy (Rashin iya fuskantar tsokar jini).

Rashin Sanadin cututtukan hypoglycemia (ba wai kawai a cikin ciwon suga ba) sun haɗa da:

insulinoma (wata cutuka da ke samar da insulinoma daga ƙwayoyin beta na pancreatic),
cututtukan da ba na beta-cell ba (galibi manyan ciwace-ciwacen ƙwayar mesenchymal, mai yiwuwa suna haifar da abubuwan insulin-kamar), lahani cikin enzymes metabolism na metabolism (tare da glycogenoses, galactosemia, rashin haƙuri na fructose),
gazawar hanta (saboda lalacewar gluconeogenesis tare da lalata lalacewar hanta),
kasawar karancin ciki (saboda karuwar hankalinsa ga insulin da rashin isasshen sakin kwayoyin halittar mahaifa a cikin martani ga hawan jini).

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Glucose shine babban tushen samar da makamashi ga sel cortex, sel tsoka da kwayoyin jini. Yawancin sauran kyallen takarda suna amfani da FFA a cikin yanayin azumi.

A yadda aka saba, glycogenolysis da gluconeogenesis suna kula da tattarawar glucose a cikin jini ko da tare da tsawan azumi. A wannan yanayin, an rage yawan abubuwan insulin kuma ana kiyaye su a matakin ƙasa. A wani matakin glycemic na 3.8 mmol / L, karuwa a cikin ɓoyewar ƙwayoyin cuta na ciki - an lura da glucagon, adrenaline, hormone girma da kuma cortisol (kuma an sami girman girma da cortisol na haɓaka kawai tare da tsawan hypoglycemia). Bayan bayyanar cututtukan ciyayi, waɗanda ke cikin neuroglycopenic sun bayyana (saboda ƙarancin glucose a cikin kwakwalwa).

Tare da karuwa a cikin tsawon lokacin ciwon sukari mellitus, bayan shekaru 1-3, akwai raguwa a cikin ɓoyewar glucagon a cikin amsawar hypoglycemia. A cikin shekaru masu zuwa, lalata glucagon yana ci gaba da raguwa har sai an daina dakatarwa. Daga baya, asirin mai rikitarwa na adrenaline ya ragu har ma a cikin marasa lafiya ba tare da maganin neuropathy na kai tsaye ba. Rage ɓoyewar glucagon da adrenaline hypoglycemia yana ƙara haɗarin mummunan hypoglycemia.

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Bayyanar cututtukan hypoglycemia da cututtukan mahaifa

Bayyanar cututtukan cututtukan jini suna da yawa. Da sauri matakin glucose na jini zai ragu, mafi kyawun bayyanancen asibiti. Resarshen glycemic wanda a bayyane yake bayyananne na asibiti shine mutum ɗaya.A cikin marasa lafiya tare da tsawan tsawa na ciwon sukari mellitus, alamun hypoglycemia yana yiwuwa har ma da matakin sukari na jini na 6-8 mmol / L.

Alamar farkon haihuwar hypoglycemia alamomin ganye ne. Wadannan sun hada da alamu:

kunnawa cikin ƙwayar jijiya mara nauyi:
- yunwa
- tashin zuciya, amai,
- rauni
kunnawa tsarin juyayi mai juyayi:
- tashin hankali, tashin hankali,
- gumi
- samarin
- rawar jiki
- mydriasis
- ƙwayar tsoka.

Daga baya, bayyanar cututtuka na lalacewar tsarin juyayi na tsakiya, ko alamun neuroglycopenic suka bayyana. Wadannan sun hada da:

haushi, rage karfin maida hankali, disorientation,
ciwon kai, tsananin farin ciki,
mai illa ga yanayin motsawa,
kayan aiki na farko (grimaces, grasping reflex),
tsaurara, bayyanar cututtuka na jijiya (hemiplegia, aphasia, hangen nesa biyu),
amnesia
bacci, rashin fahimta, ga wa,
tashin hankali da jijiyoyin jini na asali.

Abubuwan da ke tattare da hoto na asibiti na giya mai narkewa shine yanayin jinkiri na faruwar hakan da kuma yiwuwar sake dawowar jini (saboda ƙin gluconeogenesis a cikin hanta), kazalika da yawanci alamun cututtukan neuroglycemia akan alamun ciyayi.

Nocturnal hypoglycemia na iya zama asymptomatic. Alamun su na kaikaice suna yin zagi, daddare, bacci mai daci, ciwon kai na safe, wani lokacin kuma posthypoglycemic hyperglycemia a sanyin safiya (Somoji sabon abu). Irin wannan cututtukan posthypoglycemic hyperglycemia yana haɓakawa don mayar da martani ga hypoglycemia a cikin marasa lafiya tare da tsarin ƙwaƙwalwar ƙwayar cuta mai ƙwari. Koyaya, mafi yawan lokuta cututtukan asuba suna faruwa ne sakamakon karancin maraice na tsawon insulin.

Bayyananun abubuwan da ke faruwa na cututtukan jini suna ƙarewa koyaushe ta matakan suga na jini. Don haka, marasa lafiya masu ciwon sukari mellitus masu rikitarwa ta hanyar autonomic neuropathy na iya jin ƙarancin raguwar matakan glucose na jini na 6.7 mmol / L.

Rashin daidaituwa na hypoglycemia: Jiyya

- Ba da taimakon gaggawa na likita a matakin prehospital:

Jiyya yana dogara da tsananin tsananin hypoglycemia.

• Matsakaici hypoglycemia (I digiri).

Mai haƙuri zai iya dakatar da abin da ke faruwa ta kansa yana ɗaukar 10-20 g na carbohydrates a cikin nau'i na allunan dextrose (glucose), ruwan 'ya'yan itace, abin sha mai dadi. Yara ƙanana da yawa ba za su iya taimakon kansu ba, saboda haka, yaran da ke ƙasa da shekaru 5-6 ba su da cututtukan jini, wanda za'a iya ɗauka kamar huhu.

• Matsakaici hypoglycemia (Digiri na II)

an dakatar da shi ta gabatarwar 10-20 g na dextrose (glucose) a ciki, amma tare da taimakon mutanen da ba a ba su izini ba, bayan wannan ya kamata a ba da shayi mai dadi tare da farin burodi.

• Ciwon jini mai tsananin ƙarfi (aji III).

- A allurar 20, 40, 60, na 20xt% dextrose bayani (glucose, kashi daya na 200 MG / kg, 1 ml na 20% glucose bayani = 200 MG) a cikin kwayar cutar ta wucin gadi har sai mara lafiya ya bar coma, cramps tsaya. Matakan glucose na jini yakamata ya kai 10-15 mmol / L. Rashin hankali a cikin mintina 30 bayan daidaitawar glycemia yana nuna cututtukan hanji, wanda ke buƙatar magani da ya dace.

Mahimmanci! Gudanar da glucose na hanzari na iya haifar da hypokalemia. Cessarancin sarrafawa na 40% na dextrose (glucose) na iya haifar da haɓakar edema. Tare da tsawan hypoglycemia, lalacewar kwakwalwa na iya faruwa - ana bada shawara don yin allurar 10% na dextrose (glucose).

- Idan ƙwaƙwalwar ƙwaƙwalwar ƙwayar cuta, tashin zuciya ya ci gaba, ana magance 5% na dextrose (glucose) a cikin ƙwayar ciki a kashi na 10-15 ml / kg / h (10 mg / kg / min, 1 ml na 5% dextrose bayani = 50 MG) a hanya asibiti. Bayan dawo da hankali, gudanarwar cikin ciki na maganin 5% na dextrose (glucose) a cikin kashi 5 ml / kg / h ya kamata ya ci gaba cikin tsawon lokacin da ake tsammanin aiwatar da insulin ko maganin ƙwayar cuta na baka wanda ya haifar da wannan kwayar don hana sake dawowa.

- Tare da gabatarwar dextrose (glucose), a cikin wasu yanayi, ana gudanar da glucagon (ga yara 'yan ƙasa da shekara 10 a kashi na 0.5 ml, ga yara sama da shekaru 10 - 1 ml intramuscularly), wanda ke taimakawa sauya glycogen hanta zuwa glucose. Sakewar sani yana faruwa tsakanin mintuna 5 - 10. Glucagon na iya haifar da amai, don haka ya kamata a hana muradi.

- Prednisone a kashi biyu na MG / kg a ciki.

- Gaggawar asibiti na gaggawa na haƙuri tare da mummunan hypoglycemia a cikin ICU na asibiti tare da sashen endocrinology. Tare da dawo da hankali - asibiti a cikin sassan endocrinology.

- Ba da taimakon gaggawa na likita a matakin marasa lafiya:

Administration Bolus na cikin jijiya na 1 ml / kilogiram na mafitsarar 20% (glucose, 1 ml na maganin 20% = 200 mg / ml) na mintuna 3.

• Gwanin ruwa mai gudana yana gudana tare da mafita Na 1 da No. 2 (duba magani na hyperglycemic coma) ba tare da ƙara insulin a ƙarƙashin kula da matakan sukari na jini ba.

• Adadin adadin kumburin ciki na dextrose (glucose) shine 10 mg / kg / min (a 5% bayani - 0.2 ml / kg / min).

• Idan ya cancanta, ana sarrafa kwayoyin hormones (glucagon, adrenaline ko prednisone).

• Don dawo da metabolism na metabolism, ascorbic acid, nitamine (bitamin B1), pyridoxine (bitamin B6) ana amfani da su.

• Yin rigakafin maimaita yawan haila, wanda zai haifar da lalacewar kwakwalwa.

Sauran

Hypoglycemia a cikin jarirai da manyan yara

Hypoglycemia a cikin yara na waɗannan rukunin shekarun ba su da yawa fiye da a cikin jarirai.

1. Mafi yuwuwar haddasa cututtukan hyperglycemia a cikin jarirai sune nau'i mai laushi na hyperinsulinemia, rashi na haihuwar haila, ko cuta na rayuwa. Hypoglycemia wanda ya haifar da waɗannan rikice-rikice yawanci yakan faru ne a cikin shekaru 3-6, lokacin da bacci na dare ya yi tsawo (tsaka-tsakin tsakanin ciyarwa ya fi tsayi, kuma azumin dare na yara ya kai 8 hours).

2. A cikin yara da suka girmi shekara guda, yawan haila yana haifar da rashin ƙarfi lokacin kula da lafiyar Normoglycemia yayin yin azumi ko kuma rashi kwayoyin hormones.

3. Yawan shayar da jarirai nono na tsawon rai, na baya bayannan yana faruwa.

Ana nuna tsananin rashin ƙarfi a cikin jini ta hanyar ruɗani, asarar sani, ko kuma coma. Tare da hypoglycemia mai laushi ko matsakaici, alamomin jijiyoyin jiki ba su iya faɗi (rashin ƙarfi, jijiyoyi, nutsuwa, lalacewar daidaituwa da motsi). Don ganewar asali, yana da muhimmanci a tantance daidaituwar alamomin hypoglycemia da alaƙar su da tsawon lokaci tsakanin ciyarwar.

Ka'idodin ganewar asali. Eterayyade yawan glucose, insulin da kuma maganin cututtukan hormonal a cikin jinin da aka ɗauka a lokacin bayyanar cututtuka na iya tabbatar da bayyanar cututtuka da kuma tabbatar da sanadin cututtukan hypoglycemia. Lokacin da tashin hankali ya faru a cikin jariri, da farko wajibi ne don ware hypoglycemia. Idan ba zai yiwu ba a dauki jini a lokacin fitsari, ana yin gwaji tare da matsananciyar yunwa da kuma gudanar da aikin glucagon karkashin kulawar likita koyaushe. Ta katsewa na tsawon awanni 10 zuwa 20, idan tsautsayi ya faru, ana cire su ta hanyar iv ko allurar intramuscular na glucagon. Kafin gudanar da glucagon da mintuna 30 bayan gudanarwa, an dauki jini don tantance metabolites da hormones (duba tebur. 33.3).

1. Hyperinsulinemia. Wannan shine mafi yawan dalilin cutar sanƙara a cikin farkon watanni 6 na rayuwa.

1) Mafi yawan lokuta, hyperinsulinemia yana faruwa ne ta hanyar wuce haddi na insulin wanda ya haifar da hyperplasia beta-cell, insulinoma ko non-idioblastosis. Azumin nafila yana haifar da zubar jini a cikin yara masu wadannan cututtukan.

2) Rashin haƙuri na Leucine. Wuce kima insulin na iya lalacewa ta hanyar amino acid da ke cikin madara, musamman leucine. A cikin yara masu fama da rashin haƙuri na leucine, cututtukan jini na faruwa bayan ciyar da madara ko abinci mai wadatar leucine. Sirrin insulin a cikin mayar da martani ga leucine galibi ana haɓaka shi a cikin yara tare da hyperplasia beta-cell, insulinoma, ko ba-idioblastosis.

3) Gudanar da insulin, gudanarwar jami'ai na hanawar jini da wasu magunguna na iya haifar da cututtukan hyperinsulinemia a cikin yaro da baya fama da ciwon sukari (duba Ch. 33, p. VIII).

c. Jiyya. Ba kamar jarirai ba, jarirai da tsofaffi ba sa buƙatar tsawan glucose na tsawan lokaci da alƙawarin somatropin ko cortisol. Idan hypoglycemia ya haifar da hyperplasia beta-cell, insulinoma ko nezidioblastosis, magani na dogon lokaci tare da diazoxide (5-15 mg / kg / rana a baki a cikin allurai uku) ana yin su. Yawanci, diazoxide yana ba ku damar kula da normoglycemia har tsawon watanni har ma da shekaru. Octreotide shima yana da tasiri. Tare da koma bayawar hypoglycemia yayin jiyya tare da diazoxide, haka kuma tare da bayyanar sakamako na sakamako na diazoxide (hirsutism, edema, hauhawar jijiyoyin jini, hyperuricemia), ana nuna wani ɓangare na pancreatectomy. Tare da rashin haƙuri na leucine, ana wajabta abincin da ya dace.

2. Rashin ingancin STH ko cortisol ba kasafai yake haifar da cututtukan hypoglycemia a cikin yara da suka girmi wata 1 ba. Hypoglycemia saboda rashi daga cikin wadannan kwayoyin halittar yana faruwa ne kawai bayan tsawan azumi. Ganowar ya samo asali ne sakamakon sakamakon gwajin jini da aka ɗauka yayin harin hypoglycemia, haɓakar haɗuwa da glucose bayan an rage girman glucagon ko a cikin iyakokin al'ada. Lokacin yin azumi, yawan haɗarin glucose yana raguwa, kuma yawan haɗakar kitse na jiki da jikin ketone yana ƙaruwa, kamar yadda yake a cikin hypoglycemia na azumi. Alamun asibiti na hypopituitarism ko lalacewar ƙwayar pituitary a cikin yara masu tsufa: tsinkaye, ci gaba, bayyanar cututtuka na haɓaka girma (alal misali, ƙara ICP). Alamun rashin isasshen haila: hauhawar jini, karuwar buƙatar gishiri, hyponatremia, da hyperkalemia.

3. Azumi na rashin jini. Wannan shine mafi yawancin nau'in cutar hawan jini a cikin yara masu shekaru 6 zuwa shekaru shida.

a. Etiology. Sanadin yawan zubar da jini shine rashin iya kulawa da kulawar jiki a yayin yin azumi. Ba a inganta pathogenesis na hypoglycemia na azumi (ban da hypoglycemia bayan tsawaita azumi a cikin marasa lafiya tare da rashi na hormones na ciki - STH da cortisol). Yin azumi na rashin jini a jiki sau da yawa yakan faru tare da rashin abinci mai gina jiki a cikin marasa lafiya da ke fama da mummunar cuta ko cututtukan gastrointestinal, musamman bayan dogon bacci. Wasu lokuta a irin waɗannan halayen, ana bayyana hypoglycemia ta hanyar birgima ko asarar hankali.

b. Binciken dakin gwaje-gwaje. A cikin jinin da aka ɗauka yayin farmaki na hypoglycemia, haɗuwa da glucose da insulin suna da ƙasa, kuma tattarawar jikin ketone yana da yawa. Ketonuria mai yiwuwa ne. Thearuwar yawan glucose bayan aikin glucagon yana ƙasa da al'ada. Azumi na awanni 14 zuwa 14 yana tsokanar jinin haila. Don ware rashi na kwayoyin cututtukan hormonal, tantance abun ciki na STH da cortisol.

c. Jiyya. Idan aka gano wani rashi na STH ko cortisol, ana yin maganin maye gurbin hormone. Idan babu rashi na kwayoyin tsufa na kwayoyin cuta, abinci ne mai gina jiki a cikin furotin da kuma carbohydrates, abincin da yakamata ya kasance mai gauraye (sau 6-8 a rana). Tare da ciwo mai haɗari, ana bada shawarar sha da ke kunshe da adadin glucose mai yawa. An shirya yawan tattara abubuwan jikin ketone a cikin fitsari a kai a kai. Idan ketonuria ya bayyana a kan tushen maganin rage cin abinci, ana saka glucose a cikin adadin 6-8 mg / kg / min don hana hypoglycemia mai ƙarfi. Maganin rage cin abinci yana da tasiri a yawancin marasa lafiya, a shekaru 7-8, hare-hare na hypoglycemia sun daina.

Idiopathic farfadowar hypoglycemia wani nau'in hypoglycemia ne wanda ya haifar da cin abinci (duba kuma babi na 34, p. VIII). Wannan nau'in cututtukan hypoglycemia yawanci ana zargin shi a cikin yara da matasa, amma da wuya a tabbatar da bayyanar cutar. Bayyanar cututtuka na idiopathic reactive hypoglycemia an kafa shi ne a kan sakamakon sakamakon gwajin haƙuri na glucose: sa'o'i 3-5 bayan shan glucose a kashi na 1.75 g / kg (matsakaicin 75 g) taro na glucose jini Sources (hanyoyin)

Kulawa da gaggawa na likita Lafiya na kayan lantarki: jagoranci na kasa / ed. S.F. Bagnenko, M.Sh. Khubutia, A.G. Miroshnichenko, I.P. Minnullina. - M.: GEOTAR-Media, 2015. - (Jerin "Jagororin Kasa"). - http://www.rosmedlib.ru/book/ISBN9785970433492.html

Karin karatu (da shawarar)

1. Aynsley-Green A, et al. Nesidioblastosis na cututtukan farji: Ma'anar cututtukan da ke tattare da cututtukan cututtukan jini na tsohuwar ƙwayar cuta. Arch Dis Child 56: 496, 1981.

2. Burchell A, et al. Hepatic microsomal glucose-6-phosphatase tsarin da bazuwar mutuwar jarirai. Lancet 2: 291, 1989.

3. Rashin ingancin Carnitine. Lancet 335: 631, 1990. Edita.

4. Haymond MW. Hypoglycemia a cikin jarirai da yara. Endocrinol Metab Clin ta Arewa Am 18: 211, 1989.

5. Hug G. Glycogen cuta. A cikin VC Kelley (ed), Practabilar Ilmin Lafiya. New York: Harper & Row, 1985.

6. Shapira Y, Gutman A. rashi carnitine na tsoka a cikin marasa lafiya ta amfani da acid din valproic. J Pediatr 118: 646, 1991.

7. Sperling MA. Hypoglycemia a cikin jariri da jariri. A cikin F Lifshitz (ed), Pediatric Endocrinology: Jagorar asibiti. New York: Dekker, 1990. Pp. 803.

8. Sperling MA. Hypoglycemia. A cikin R Behrman (ed), littafin rubutu na ilimin halittu na Nelson (14th ed). Philadelphia: Saunders, 1992. Pp. 409.

9. Mutuwar jariri kwatsam da cuta cuta na kizarin kiba. Lancet 2: 1073, 1986. Edita.

10. Treem WR, et al. Hypoglycemia, hypotonia, da cardiomyopathy: Hoto na asibiti na haɓakar rashin ƙarfi na rashin ƙarfi na rashin ruwa acyl-Co-A. Ilimin aikin likita na 87: 328, 1991.

11. Volpe JJ. Hypoglycemia da rauni na kwakwalwa. A cikin JJ Volpe (ed), Neurology na jariri. Philadelphia: Saunders, 1987. Pp. 364.

12. Wolfsdorf JI, et al. Harkokin glucose na nau'in glycogenosis I a cikin jarirai: Kwatantawa da ƙarancin masara da ba a iya ci gaba ba da kuma ciwan glucose na dare. J Pediatr 117: 384, 1990.

Waɗanne cututtuka ne ke haɗuwa da cututtukan hyperglycemia?

Hyperglycemia syndrome wani hadaddun alamu ne na musamman, wanda ke tattare da wani ɓangare ko cikakken nonabsorption na glucose ta sel jikin. Cututtukan cututtukan ƙwaƙwalwar ƙwaƙwalwa sun sami yawa daga cututtukan:

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nau'in 1 da nau'in ciwon sukari na 2
cututtukan zuciya
Ciwon Cusus
m pancreatitis
cututtukan cututtukan cututtukan zuciya na cututtukan cututtukan zuciya,
cystic fibrosis.

Halin hyperglycemia ne mai rikitarwa. Ana iya haifar da duka ta hanyar guda ɗaya na karuwa a cikin sukari na jini da kuma ta wurin tsayayyen halin wadataccen glucose.

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Baya ga ingantattun abubuwan da ke haifar da cututtukan hyperglycemia, akwai wasu maganganun cututtukan da ba a tantance su ba.

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Iri Hyperglycemia

A dabi'ar bayyanuwar, an rarraba ƙasa na yawan sukari mai jini zuwa nau'ikan da yawa:

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na kullum
na lokaci
ba a tantance ba

Kowane nau'in cututtukan hyperglycemia yana da nasa abubuwan da ke da alaƙar ci gaba.

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Ciwon mara na kullum

Wannan wata alama ce da ke tattare da bayyanar bayyanar cututtuka na rikice-rikice na rayuwa, wanda aka haɗu tare da wasu ƙwayoyin cutar neuropathies. Yana da halayyar, da farko, don kamuwa da cutar siga.

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An bambanta tsari na yau da kullun ta hanyar kasancewa mai yawan sukari mai ɗorewa, kuma idan babu matakan kawar da cutar na iya haifar da cutar hyperglycemic.

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An bincika bincike na hyperglycemia akan komai a ciki, alamomin abin da ke tantance ainihin rabo na sukari a cikin jini.

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Ba a tantance ba

Dangane da rarrabuwa na kasa da kasa, hypeglycemia wanda ba a bayyana shi ba yana alama a ƙarƙashin lambar 73.9. Zai iya bayyana kansa a daidai wannan hanyar da kowane nau'in rashin lafiyar hyperglycemia a cikin matakan uku na tsananin:

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haske - har zuwa 8 mmol / l glucose a cikin jini da aka ɗauka a kan komai a ciki,
matsakaici - har zuwa 11 mmol / l,
nauyi - fiye da 16 mmol / l.

Ba kamar sauran nau'in cutar ba, wannan cuta ba ta da dalilai bayyananniya don faruwa, kuma tana buƙatar kulawa ta kusa da kulawa ta gaggawa idan ta kasance mai ƙarfi.

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Don cikakken ganewar asali, an tsara ƙarin hanyoyin bincike:

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Duban dan tayi na ciki
MRI na kwakwalwa
ilimin halittar jini
urinalysis.

Dangane da bayanan da aka karba, likitan ya kafa tushen gaskiya kuma yana ba da magani don nufin kawar da cutar. Kamar yadda yake warkarwa, hare-haren hyperglycemia suna tafi da kansu.

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Hypoglycemia

Babu ƙarancin haɗari shine yanayin hypoglycemia (a cikin Latin - hypoglykaemia), wanda haɓakar raguwa a cikin yawan sukarin jini. An nuna hypoglycemia a karkashin lambar E15 da E16 bisa ga ICD 10.

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Mahimmanci! Tsawan lokaci na rage yawan glucose na jini na iya haifar da rashin lafiyar haila a cikin mutum.

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Sabili da haka, lokacin da adadin sukari ya ƙasa da 3.5 mmol / l, dole ne a dauki matakan gaggawa.

Hypoglycemia ciwo

Cutar Hypoglycemia wata alama ce ta musamman da ke tattare da alamun bayyanar cututtuka na rashin lafiya tare da wasu cututtukan neuropathies. Yana bayyana kanta tare da alamu masu zuwa:

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rauni
pallor na fata,
tashin zuciya
gumi
rashin daidaituwa na zuciya,
rawar jiki, an sami 'yar ragi.

A cikin mawuyacin hali, cututtukan hypoglycemia yana bayyana kanta kamar ƙuruciya da asarar hankali. Irin wannan mutumin yana buƙatar taimako nan da nan: yi allura na glucose kuma ku kula da yanayin harshe don kada ya daskarewa.

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Siffofin hypoglycemia

Akwai nau'ikan cututtukan hypoglycemia a cikin tsananin tsananin:

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digiri na farko
digiri na biyu
rashin lafiyar hailala.

Kowane ɗayan siffofin suna da nasa bayyanannun alamu. Idan mutum ya riga ya dandana mai rauni ko matsakaiciyar matsakaici, to yakamata ya kasance yana da wani abu mai daɗi a hannu don samun lokacin da zai dakatar da sabon hari cikin sauri.

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Mataki na farko

Matakin farko yana da alamomin masu zuwa:

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gumi
pallor
karuwa cikin sautin tsoka,
canji a cikin zuciya, da yawanta.

Mutum a wannan lokacin zai iya jin mummunan hari na yunwar, haushi. Bayyanar ciki yana iya haifar da sakamako.

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Coma

An ƙaddara shi da matakin sukari na jini da ƙasa da 1.6 mmol / L. Wadannan alamu na iya faruwa:

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daidaituwa ya karye
asarar hangen nesa
Yanayin mara nauyi
najasasshen maganin cuta a cikin mawuyacin hali.

Sau da yawa ko coma na tasowa cikin hanzari kuma ba da jimawa ba, irin wannan ilimin yana da haɗari musamman ga masu ciwon sukari.

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Rarraba hypoglycemia

Akwai yawancin raunin hypoglycemia. Dukkansu sun bambanta cikin sanadin da hanyar magani. An rarrabe nau'ikan cututtukan tarihin:

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Barasa ya taso tare da tsawaita amfani da giya a adadi mai yawa. Take hakkin da ke cikin hanta yana haifar da raguwar raguwar sukari cikin jini.
Halin da ke haifar da rashin haihuwa a cikin yara wanda aka haife shi ga iyayen da ke fama da cutar sankara, ko kuma a cikin jarirai. Wannan nau'in rashin lafiya yana bayyana kanta a cikin farkon lokacin rayuwar yaro kuma yana buƙatar gyara yanayin.
Wani nau'in farfadowa na cututtukan cuta yana da alaƙa da rashin abinci mai gina jiki, amma ba ya haifar da ciwon sukari. Irin waɗannan mutane suna iya cika cika, suna motsawa kaɗan.
Nau'in cututtukan cututtukan cututtukan fata na dindindin kuma suna buƙatar magani na yau da kullun. Mafi sau da yawa, wannan nau'i shine sakamakon lalacewa daga manyan ƙwayoyin endocrine - hypothalamus da pituitary gland shine yake. Abinda yake tsokanar jihar shine tsawan azumi.
Arin raguwar glucose na jini a ƙasa yana haifar da matsanancin rashin ƙarfi na hypoglycemia. Wannan nau'in cutar sau da yawa yana buƙatar taimako mai sauri ga mai haƙuri ta hanyar allurar glucose. Ciwon sukari na iya haifar da matsanancin rashin ƙarfi idan an gudanar da babban adadin insulin.
Tsarin latent yana gudana ba tare da alamun bayyanar ba, sau da yawa yakan bayyana kansa da dare. A matsayinka na mai mulkin, an kafa wannan nau'in hypoglycemia bayan mummunan hare-haren cutar. Irin latent na wannan cuta na iya zama na kullum.
Hanyar motsa jiki na cututtukan zuciya na faruwa bayan tiyata akan hanji ko ciki. An danganta shi da rashin tasirin amfani da ƙwayar jijiyoyi a cikin aikin bayan aikin.

Tabbas, babban hanyar kula da cututtukan cututtukan jini shine injections na glucose da abinci mai dacewa.

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Amma yana da mahimmanci a gano cutar da ke haifar da wannan cuta, kuma a fara kula da shi cikin lokaci.

Short Short

Hypoglycemia - raguwa a cikin glucose na jini kasa da 3.33 mmol / L. Hypoglycemia na iya faruwa a cikin mutane masu lafiya bayan fewan kwanakin azumi ko hoursan awanni bayan saukar glucose, wanda ke haifar da hauhawar matakan insulin da raguwa a cikin matakan glucose a cikin rashin alamun hypoglycemia. A asibiti, hypoglycemia yana bayyana kanta tare da raguwa a cikin matakan glucose a ƙasa da 2.4-3.0 mmol / L. Mabuɗin ganewar asali shine Whipple triad: • bayyanuwar cutar neuropsychic yayin yunwar, • glucose na jini ƙasa da 2.78 mmol / l, • sauƙin kai hari ta hanyar magana ta baki ko gudanarwa cikin maganin warwarewa. Mummunar bayyanuwar hypoglycemia shine hypoglycemic coma.

Abubuwan da ke Hadarin Harkokin insulin • Gwaninta na dogon lokaci na ciwon sukari (fiye da shekaru 5) • Tsofaffi • Cutar cututtukan ƙwayar cuta • Ciwan hanta • Rashin ƙwaƙwalwar zuciya • Hypothyroidism • Ciwon ciki • Matsananciyar yunwa • Alcoholism.

Bangaren kwayoyin halitta. Hypoglycemia alama ce ta manyan alamu na hereditary fermentopathies, misali: • Hypoglycemia saboda rashi na glucagon (231530, r) - hypoglycemia na cikin gida tare da babban matakan insulin da karancin glucagon • Hypoglycemia tare da rashi na glycogen synthetase (# 240600, r) A asibiti: hypoglycemia, hypoglycemia da hyperketonemia a lokacin azumi, hyperglycemia da hyperlactatemia yayin ciyar, sanƙarar cuta ciwo. Dakin gwaje-gwaje: rashi na glycogen synthetase • rashiwar Fructose - 1.6 - phosphatase (229700, r) • Leucine - hauhawar jini a ciki (240800, r) - da yawa nau'ikan cututtukan hypoglycemia • Haɓakar hypoketlyic (# 255120, carnitine palmitoyl transferase transperase I * 600528, 11q, lahani na ƙwaƙwalwar mahaifa, r).

Etiology da pathogenesis

Ing Yin azumi hypoglycemia •• Insulinoma •• Abun jinin haila yana faruwa ne ta hanyar yin amfani da insulin ko magungunan hancin jini (na yau da kullun saboda salicylates, b - adrenoblockers ko quinine) •• Cutar ƙwayar cuta mai haifar da ƙwayar cuta na iya haifar da cututtukan jini. Yawancin lokaci waɗannan manyan ciwace-ciwace ne da ke cikin rami na ciki, galibi ana samun asali daga mesenchymal (alal misali, fibrosarcoma), kodayake ana lura da cututtukan hanta da sauran ƙwayoyin cuta. Hanyar rashin lafiyar hypoglycemia ba ta da cikakkiyar fahimta, suna ba da rahoton yawan ƙwayar glucose ta wasu ciwace-ciwacen ƙwayoyi tare da samuwar abubuwan insulin-kamar abubuwa • Ana lura da cutar hypoglycemia ta ethanol a cikin mutane tare da raguwa mai yawa a cikin shagunan glycogen saboda barasa, yawanci awanni 12 zuwa 24 bayan sha. Mutuwar ƙwayar cuta ta fi 10%, sabili da haka, saurin ganewar asali da gudanar da p - dextrose ya zama dole (a lokacin hadawar ethanol zuwa acetaldehyde da acetate, NADP ya tara kuma kasancewar NAD ya zama dole don gluconeogenesis yana raguwa). Rashin glycogenolysis da gluconeogenesis, ya zama dole don samar da glucose a cikin hanta yayin azumi, yana haifar da hypoglycemia •• Cututtukan hanta na haifar da tabarbarewa a cikin glycogenolysis da gluconeogenesis, wanda ya isa ya zama mai yawan zubar jini. Ana lura da irin wannan yanayin tare da cikakkiyar cutar hepatitis ko cutar hanta mai guba, amma ba a cikin ƙananan maganganu na cututtukan cirrhosis ko hepatitis •• Sauran abubuwan da ke haifar da rashin lafiyar hypoglycemia: rashi na cortisol da / ko GH (alal misali, tare da rashin ƙarfi ko rashin ƙarfi a hanta). Rashin zuciya da gazawar zuciya wani lokaci suna tare da hypoglycemia, amma ba a fahimci abubuwan da ke haifar da faruwarsa ba.

• Komawa mai aiki da jini yana faruwa ne a cikin 'yan awanni bayan cin abinci na carbohydrates •• Alimentary hypoglycemia yana faruwa a cikin marasa lafiya bayan gastrectomy ko wani aikin tiyata, wanda ke haifar da saurin shigar abinci cikin ƙananan hanji. Sauke abubuwa masu narkewa cikin hanzari na motsa jiki na motsa jiki wanda yake haifar da wuce haddi na insulin, yana haifar da cutar hypoglycemia wani lokaci bayan cin abinci •• Reactive hypoglycemia a cikin ciwon sukari. A wasu halaye, a cikin marasa lafiya a farkon matakan ciwon sukari, daga baya, amma ƙaddamar da wuce haddi na insulin yana faruwa. Bayan cin abinci, yawan ƙwayar glucose na jini yana tashi bayan sa'o'i 2, amma sai ya rage zuwa matakin hypoglycemia (3-5 hours bayan cin abinci) •• An gano ƙwayar cutar motsa jiki a cikin marasa lafiya da ke fama da cututtukan ƙwaƙwalwar ƙwayar cuta (alal misali, tare da raunin gajiya).

Bayyanar cututtuka (alamu)

Hoto na asibiti an ayyana shi ta hanyar yunwa hade da alamomin jijiya da cututtukan adrenergic.

• Alamomin cututtukan jijiyoyi suna gudana tare da raguwar hankali a hankali a hankali a hankali a hankali a hankali a hankali a hankali •• Cikewa •• ciwon kai •• Rashin hankali •• Rashin gani na gani (alal misali, diplopia) •• Paresthesias •• Cramps •• Cutar cututtukan zuciya da dumama (sau da yawa tana ci gaba ba zato ba tsammani).

• Alamar Adrenergic ta ci gaba da raguwa sosai a matakan glucose •• Hyperhidrosis •• Damuwa •• Tarfin ƙarshen •• Tachycardia da jijiyoyin bugun zuciya •• pressureara hauhawar jini •• Harin Angina.

Fasalin shekaru • Yara: Jigilar cututtukan jini na jinkiri na lokacin haihuwa, hypoglycemia na ƙanana da tsofaffi yara • Tsofaffi: a mafi yawan lokuta, cututtukan hypoglycemia yana da alaƙa da cututtukan haɗin gwiwa ko amfani da magungunan cututtukan jini.

Ciki galibi yakan haifar da rashin jinkiri na jiki.

Binciko

Binciken dakin gwaje-gwaje • Eterayyade matakin glucose na plasma da gwajin haƙuri na glucose • ƙayyadewa na C - peptide yana bayyana tushen asirin insulin •• gluarancin glucose da insulin, pathognomonic don insulinoma, yana tare da haɓaka matakin C - peptide •• levelarancin matakin C peptide yana nuna karuwa. tushen babban insulin insulin • Gwajin hanta na aiki, dagewar insulin insulin, cortisol.

Tasirin kwayoyi. Sulfonylurea yana haɓaka samar da insulin na insulin da C - peptide, sabili da haka, don ware hypoglycemia na wucin gadi, ana yin gwajin jini ko fitsari akan shirye-shiryen sulfonylurea.

Nazarin Musamman Plasma glucose bayan azumi na 72-hour kasa da 45 MG% (kasa da 2.5 mmol / l) a cikin mata da ƙasa da 55 mg% (3.05 mmol / l) a cikin maza • Gwaji tare da tolbutamide: lokacin da aka gudanar a cikin ciki, matakin glucose a cikin 20– 30 min an rage shi da ƙasa da 50% • Radioimmune ƙuduri na matakan insulin • CT ko duban dan tayi na gabobin ciki don keɓin kumburin.

Bambancin ganewar asali. Hypoglycemia na psychologic, ko pseudohypoglycemia. Yawancin marasa lafiya (galibi mata masu shekaru 20 zuwa 45 years) ana kamuwa da suwar ta rashin aiki, amma irin wannan alamu yawanci ana alaƙar ta da matsanancin aiki ko ganyayyaki-jijiyoyin jiki (damuwa ma yana taka muhimmiyar rawa a cikin yanayin waɗannan alamun). Irin waɗannan marasa lafiya suna da wuyar magani. Tattaunawa da likita-psychotherapist abu ne mai kyau.

GASKIYA

Dabaru • Abincin mai tsayi a cikin furotin (a cikin marasa lafiya tare da juji da cuta - low a cikin sauƙin narkewa carbohydrates). Yawancin abincin da ake ci akai akai • Lokacin da alamun farko na hypoglycemia ya faru - cin abinci na baka mai sauƙin ƙwayoyin carbohydrates (2-3 tablespoons sukari a gilashin ruwa ko ruwan 'ya'yan itace, kofuna waɗanda 1-2, madara, kukis, busasshen) Idan mai haƙuri ba zai iya ci ba, allurar glucagon a / m ko s / c (a cikin kasarmu ana yin amfani da glucagon) • Idan ana amfani da hypoglycemia da kwayoyi, cire shi daga amfani ko kuma sanya idanu sosai kan yawan maganin • Guji yawan aiki na zahiri da damuwa.

Magungunan zabi

• Kulawar gaggawa ta gaggawa •• Idan bak'in glucose na baki ya zama ba za'a iya sarrafa shi ba, to ana magance 40-60 ml na 40% na iv intravenous dextrose na mintuna 3-5 wanda zai biyo bayan samun ci gaba na 5 ko 10% na dextrose •• Idan akwai alamun bayyanar cututtuka a cikin yara magani yana farawa daga jiko na 10% dextrose bayani a cikin kudi na 3-5 mg / kg / min ko mafi girma •• Tare da hypoglycemia wanda ke haifar da ƙwayoyin maganganu na baka (alal misali, abubuwan da aka samo na sulfonylurea), ya kamata a ci gaba da dextrose kuma ya kamata a sanya haƙuri a 24 - 48 hours saboda yiwuwar Awn da komowa coma.

• Zai yiwu a gudanar da glucagon IM / SC ga mara lafiya a cikin na uku na sama na kafada ko cinya (da wuya a yi amfani da shi a ƙasarmu). Glucagon yawanci yana kawar da alamun bayyanar cututtukan zuciya a tsakanin mintuna 10-25; in babu sakamako, ba a bada shawarar maimaita allura ba. Sigogin glucagon: yara 'yan kasa da shekara 5 - 0.25-0.50 MG, yara daga shekaru 5 zuwa 10 - 0.5-1 mg, yara sama da shekaru 10 da manya - 1 mg.

Matsalar • Harshen Cerebral edema • Rashin raunin jijiyoyin jiki.

ICD-10 • E15 Rashin ciwon sukari wanda ba shi da ciwon sukari • E16 Sauran rikice-rikice na ciki na farji. P70 Tashin hankali mara amfani da ƙwayar carbohydrate metabolism takamaiman ga tayin da jariri

Bayanan kula • Over-jaddada (over-fassarar) na gwajin haƙuri haƙuri zai iya haifar da overdiagnosis na hypoglycemia. Dole ne a tuna cewa a cikin fiye da 1/3 na mutane masu lafiya, ana lura da alamun cutar asymptomatic hypoglycemia a cikin sa'o'i 4 bayan wannan gwajin • b - Adrenergic blockers yana rufe alamun bayyanar cututtukan jini.