So wo nipadua no yɛ acid dodo? Momma yensua lactic acidosis ho ade!

So woate nka pɛn sɛ woabrɛ, wo ho ayɛ wo yaw, anaasɛ wo home yɛ wo yaw bere a woabrɛ kakra no? Eyinom betumi afi nneɛma ahorow bi mu. Nanso, ɛnnɛ yɛbɛka tebea bi a ebetumi aba bere a nnuru bi a wɔfrɛ no lactic acid boaboa ano wɔ yɛn nipadua mu ho asɛm. Eyi ne nea nnuruyɛfo frɛ no lactic acidosis . Mma ɛnhaw wo, momma yɛnka eyi ho asɛm tiawa.

Dɛn ne Lactic Acidosis?

Sɛ yɛbɛka no tiawa a, lactic acidosis yɛ tebea a ɛma lactic acid dɔɔso dodo wɔ wo mogya mu. Eyi betumi aba bere a wo nipadua no ma lactic acid pii, anaasɛ bere a wo nipadua no ntumi nyi lactic acid a ɛyɛ no yiye no.

Mpɛn pii no, yɛn mmerɛbo ne yɛn asaabo na eyi lactic acid a ɛboro so no fi yɛn nipadua mu. Nanso, sɛ lactic acid dodow dɔɔso dodo, anaasɛ mmerɛwyɛ bi wɔ saa akwaa yi te sɛ mmerɛbo ne asaabo mu a, wontumi nyɛ adwuma yi yiye. Ɛno ne bere a lactic acid fi ase boaboa ano wɔ mogya no mu.

Sɛ lactic acid dodow a ɛwɔ wo mogya mu no kɔ soro kakra a, yɛfrɛ no hyperlactatemia . Nanso, sɛ eyi kɔ soro bio na nipadua no pH (i.e. acid-base kari pɛ) yɛ acid dodo a, wɔfrɛ no lactic acidosis .

Dɛn nti na lactic acid ba yɛn nipadua mu?

Lactic acid a ɛtɔ mmere bi a wɔfrɛ no lactate , yɛ abɔde mu ade a efi nkwammoaa mu nneɛma a ɛsakra mu ba. Yɛn nkwammoaa de glucose (asikre) di dwuma de yɛ ahoɔden. Wɔfrɛ saa adeyɛ yi anaerobic glycolysis . Eyi ba bere a nkwammoaa hia ahoɔden ntɛmntɛm, nanso wonni oxygen a ɛdɔɔso a wɔde bɛyɛ saa no.

Mpɛn pii no, yenya ahoɔden denam adeyɛ bi a yɛde oxygen di dwuma so. Wɔfrɛ eyi sɛ Aerobic Metabolism . Nanso, Anaerobic Glycolysis te sɛ ahoɔden fibea a yɛde di dwuma wɔ tebea horow a egye ntɛmpɛ mu. Fa no sɛ, sɛ wutu mmirika denneennen mpofirim anaa woma adesoa a emu yɛ duru so a, mframa pa nni wo ntini mu mpofirim. Ɛno na wɔde saa kwan yi di dwuma. Saa ara na sɛ yɛn ntini no nnya mframa pa esiane nyarewa bi nti a, saa kwan yi so nso yɛ lactic acid.

Dɛn na ɛba bere a lactic acidosis aba no?

Nea ɛba bere a wowɔ lactic acidosis no gyina sɛnea emu yɛ den so. Ebia nnipa binom benya saa tebea yi bere tiaa bi, titiriw bere a wɔateɛteɛ wɔn apɔw mu denneennen akyi. Ebetumi ama wo nipadua ayɛ wo yaw nna kakraa bi. Nanso sɛ wo mmerɛbo ne w’asaabo yɛ yiye a, lactic acid no befi hɔ wɔ nna kakraa bi mu.

Nanso, sɛ wo nipadua kɔ so yɛ lactic acid pii, anaasɛ wo mmerɛbo ne w’asaabo ntumi nyɛ ho adwuma yiye a, tebea no betumi ayɛ nea emu yɛ den kɛse. Eyi taa ba wɔ yare bi ho. Bere a lactate dodow a ɛwɔ wo mogya mu kɔ so kɔ soro no, pH dodow no so tew, na koma no mu nsu a efi mu ba no so tew nkakrankakra. Eyi betumi ama akwaa afoforo adi huammɔ na owu mpo. Enti ɛho hia sɛ wohu eyi.

Dɛn ne Lactic Acidosis ho sɛnkyerɛnne ahorow?

Saa tebea yi ho sɛnkyerɛnne betumi ayɛ soronko wɔ mfiase ne bere a tebea no mu yɛ den no.

Nsɛnkyerɛnne a edi kan

Mfiase no, ebia wobɛte nneɛma a ɛte sɛɛ nka:

• Akisikuru ne ɔfe.
• Ɔbrɛ ne ɔbrɛ a ɛtra so.
• Ahome a wɔhome ntɛmntɛm na emu dɔ (wɔfrɛ eyi respiratory compensation , mmɔden a wɔbɔ sɛ wɔbɛtew nipadua no mu acid so denam ahome a wɔhome so).
• Ntini a ɛtwetwe ne nipadua mu yaw.

Nsɛnkyerɛnne bere a tebea no mu yɛ den no

Bere a tebea no mu yɛ den no, sɛnkyerɛnne ahorow a edidi so yi nso betumi ada adi:

• Mmerewa ne nna a ɛkɔ soro.
• Delirium ne adwene mu naayɛ.
• Ɛyɛ den sɛ wubedi kankyee so, te sɛ bere a wonam ( ataxia ).
• Nsu a ɛba no so tew ( Oliguria ).

Nsɛnkyerɛnne afoforo

Ebia wubenya aduruyɛ mu tebea bi a ɛda adi a ɛde lactic acidosis reba no ho sɛnkyerɛnne nso . Sɛ nhwɛso no, tebea horow te sɛ sepsis ( mogya mu yare), ahodwiriw ( akisikuru), anaa mmerɛbo a entumi nyɛ adwuma yiye . Ebia eyi ho sɛnkyerɛnne ahorow bi ne:

• Nipadua mu hyew a ɛba fam.
• Mogya mmoroso a ɛba fam.
• Huraeɛ.
• Jaundice (honam ani yɛ kɔkɔɔ ne aniwa fitaa).

Dɛn ne ade titiriw a ɛde lactic acidosis ba?

Ntease pii betumi ama eyi aba. Nea ɛtaa de ba ne oxygen a ɛba wo mogya mu (hypoxemia) anaasɛ oxygen a enni wo ntini mu (hypoxia). Mpɛn pii no, aduruyɛ tebea bi na ɛde eyi ba.

Nnuruyɛfo akyekyɛ lactic acidosis tebea yi mu ahorow pii a egyina nea ɛde ba so:

Ɔkwan a wɔfa so yɛ A

Type A lactic acidosis ba bere a wo ntini ahorow no nnya oxygen a ɛdɔɔso no. Wɔtaa hu no wɔ aduruyɛ mu tebea horow a emu yɛ den mu. Ebetumi ayɛ bere tiaa mu de nso, a apɔw-mu-teɛteɛ a ɛtra so na ɛde ba.

Tebea horow bi a ebetumi ama lactate ayɛ kɛse dodo no bi ne:

• Ahurututu mu yare ma mogya no nnya mframa pa a ɛdɔɔso.
• Nkwammoaa mu yare ma mogya no nkɔ brɛoo na mframa pa nkɔ ntini ahorow no mu.
• Hemoglobin mu yare ka tumi a mogya mu nkwammoaa kɔkɔɔ tumi fa mframa pa.
• Tebea horow a ɛma obi ho popo te sɛ septic shock , hypovolemic shock, anaa koma mu ahodwiriw .
• Intestinal ischemic syndrome a ɛma obi ho yɛ hyew .
• Akisikuru ne akisikuru a ɛkyɛ.
• Carbon monoxide a wɔde awuduru gu nipadua mu.

Ɔkwan B so

Type B lactic acidosis ba a hypoxemia anaa hypoxia nni mu . Nneɛma nketewa abiɛsa na ɛwɔ hɔ.

Ɔkwan B1

Eyi fi nyarewa a ɛwɔ ase a ɛmma wontumi nsakra lactate no.

Wobetumi ayɛ:

• Mmɛn mu yare .
• Asaabo mu yare .
• Thiamine (vitamin B1) a enni nipadua mu.
• Kokoram.
• HIV/AIDS tebea.
• Mitochondrial nyarewa ahorow .
• Asikreyare- a ɛfa ketoacidosis ho.
• Asanom a wɔde di dwuma ɔkwammɔne so ( Nsã a wɔde di dwuma ho haw ).

Ɔkwan B2

Eyi ba sɛ nnuru ne awuduru bi mu nsunsuanso bɔne. Nhwɛso ahorow:

• Cyanide a wɔde awuduru ayɛ.
• Carbon monoxide a wɔde awuduru gu nipadua mu.
• Nsã a wɔde awuduru ayɛ.
• Cocaine a wɔde di dwuma.
• Nnuru bi a wɔde sa HIV ( Nucleoside reverse transcriptase inhibitors (aduru a wɔde ko tia ɔyare mmoawa) ).
• Nnuru ahorow bi a wɔde home a wɔde di dwuma ma nyarewa te sɛ ayamtu ( Beta-adrenergic agonist inhalers ).
• Epinephrine a wɔde twitwiw nipadua no mu ma akisikuru a emu yɛ den.
• Aduru a ekum ɔyare mmoawa a wɔfrɛ no linezolid .
• Propofol a wɔde yɛ nnuru a wɔde kum nipadua no.
• Metformin, aduru a wɔde sa asikreyare (wɔde eyi di dwuma kɛse wɔ Sri Lanka, enti ɛsɛ sɛ wuhu eyi titiriw).

Ɔkwan a wɔfa so yɛ B3

Eyi fi enzymes pɔtee a ehia na ama lactate ayɛ adwuma wɔ nipadua mu no a enni awo mu. Eyinom ho yɛ na koraa. Nhwɛso ahorow:

• Glycogen a wɔkora so yare .
• Fructose-1,6-diphosphatase a enni nipadua mu .
• Pyruvate carboxylase a enni nipadua no mu .
• Pyruvate dehydrogenase a enni nipadua mu .
• Oxidative phosphorylation a enni hɔ .
• Methylmalonic aciduria a ɛma nipadua no yɛ adwuma .

D-lactic acidosis a ɛwɔ nipadua no mu

A ne B ahorow a yɛadi kan aka ho asɛm no fa L-lactate a ɛboaboa ano wɔ wo mogya mu no ho. Saa L-lactate yi yɛ lactic acid bi a wɔtaa yɛ na wɔsakra no wɔ onipa nipadua mu.

Nanso, lactic acidosis foforo bi wɔ hɔ a ɛntaa nsi koraa, a D-lactate a ɛboaboa ano na ɛde ba. Mmoawa bi a ɛwɔ wo dwensɔtwaa kɛse mu na ɛyɛ saa lactic acid yi. Wɔyɛ D-lactate sɛ ade a ɛka ho bere a saa mmoawa yi sesa carbohydrates bere a wɔreyɛ aduan no.

D-lactic acidosis ba bere a saa mmoawa yi nyin dodo no. Afei wɔtwe D-lactate a ɛboro so no fi dwensɔtwaa no mu kɔ mogya no mu. D-lactate ntumi mfa yɛn asaabo anaa mmerɛbo ntumi nyɛ adwuma. Enti ɛkɔ so boaboa ano wɔ mogya no mu. Wɔtaa bu eyi sɛ ɔhaw bi a efi tebea bi a wɔfrɛ no short gut syndrome mu ba .

Ɔkwan bɛn so na wohu sɛ obi anya Lactic Acidosis?

Nnuruyɛfo gyina nneɛma a edidi so yi so hu sɛ ebia wowɔ lactic acidosis :

• Mogya mu lactate dodow a ɛboro 4 mmol/L (millimoles wɔ lita biara mu).
• Mogya mu pH nnu 7.35.

Wɔnam mogya a wogye fi wo hɔ na wɔsɔ hwɛ so na esusuw saa gyinapɛn ahorow yi.

Sɔhwɛ ahorow bɛn na wɔyɛ ma eyi?

Wɔyɛ nhwehwɛmu ahorow a edidi so yi de hu lactic acidosis :

• Comprehensive metabolic panel (CMP) : Eyi yɛ mogya mu nhwehwɛmu a ɛnyɛ den a ɛsusuw nneɛma ahorow a ɛwɔ wo mogya mu na ama woanya w’akwahosan ho nsɛm atitiriw.
• Mogya mu lactate nhwehwɛmu : Wɔ nneɛma a wɔsusuw wɔ CMP mu akyi no, wɔsusuw lactate dodow a ɛwɔ wo mogya mu no pɔtee.
• Anion gap blood test : Saa nhwehwɛmu yi susuw pH ne electrolyte a ɛkari pɛ wɔ wo mogya mu.
• Arterial blood gas test : Eyi kyerɛ oxygen a ɛwɔ wo ntini mu, ne pH ne electrolyte a ɛkari pɛ.

Ɔkwan bɛn so na wɔsa Lactic Acidosis?

Sɛ wowɔ lactic acidosis esiane bere tiaa mu ade bi te sɛ apɔw-mu-teɛteɛ a ɛtra so, wowosow, anaasɛ akisikuru nti a, mpɛn pii no, bere kɔ so no, ebefi hɔ. Wubetumi anya ahotɔ denam fie a wobɛtra na woatra nsu mu no so.

Nanso, wɔ ayaresabea tebea mu no, wɔde nsu a wɔde fa ntini mu ( IV nsu , ɛno ne nea yɛfrɛ no nkyene) ne ayaresa afoforo a wɔde ma obi nya nkwa, te sɛ oxygen therapy , sa lactic acidosis ntɛm ara sɛ ɛho hia a.

Afei wobegyina nea ɛde ba no so akyerɛ ayaresa. Ɛdenam wo sɛnkyerɛnne ahorow so no, w’aduruyɛfo kuw no bɛyɛ adwuma de asa aduruyɛ tebea anaa awuduru a ɛde lactic acidosis no ba no .

Sɛ woreda oxygen dodow a ɛba fam ho sɛnkyerɛnne adi a, nnuruyɛfo kuw no besusuw sɛ Type A na ɛde ba – te sɛ koma anaa ɔhome a entumi nyɛ adwuma yiye, sepsis , anaasɛ ahodwiriw – na wɔadi kan asa saa tebea horow a egye ntɛmpɛ no.

Wɔ nsɛm a wɔankyerɛ sɛ oxygen dodow a ɛba fam no, wosusuw nneɛma ahorow a ɛde type B ba no ho na wɔsa no pɔtee.

Nneɛma bɛn na obi a ɔwɔ lactic acidosis betumi ahwɛ kwan sɛ ebefi mu aba?

Nea efi mu ba no gyina nea ɛde tebea no ba ne sɛnea emu yɛ den so. Type A lactic acidosis – a ɛne sepsis , ahodwiriw, ne/anaasɛ oxygen a ɛkɔ mogya no mu a ɛso tew wɔ abusuabɔ – yɛ aniberesɛm kɛse. Ebia lactic acidosis ahorow afoforo bɛyɛ nea emu nyɛ den na ɛkɔ so nkakrankakra, na ɛma wonya bere ne hokwan pii de sa yare.

Mpɛn pii no, bere a mogya mu lactate dodow kɔ soro no, nnipa dodow a wowuwu betumi akɔ soro. Nanso, sɛ wɔde ayaresa di dwuma ntɛm na etu mpɔn a, ebetumi ama obi ho atɔ no koraa.

Lactic acidosis yɛ tebea horow pii a wɔfrɛ no metabolic acidosis a acid boaboa ano wɔ wo mogya mu no mu biako. Wɔ metabolic acidosis , mu no, nipadua no mu nneɛma a ɛsakra a ɛyɛ nea ɛfata a ɛma acid yɛ na ɛhwɛ so no sɛe wɔ ɔkwan bi so. Mpɛn pii no, wo mmerɛbo ne wo asaabo tumi yi acid a ɛboro so no fi mu. Nanso sɛ saa akwaa no ntumi nyɛ adwuma yiye a, wontumi nni acidosis ho dwuma kɛse. Enti, wo mmerɛbo ne w’asaabo a wobɛhwɛ so denam nsu pii a wobɛnom, nsa a wobɛma ano abrɛ ase ne nnuru a epira a wobɛnom so no betumi aboa kɛse ma woakura w’akwahosan a ɛtra hɔ kyɛ mu.

Nsɛm ntiantiaa a ɛsɛ sɛ yɛkae

Okay, enti momma yɛnkae wo nneɛma a ɛho hia paa a yɛkaa ho asɛm nnɛ no bi:

• Lactic acidosis yɛ lactic acid a ɛkɔ soro wɔ mogya mu.
• Ntease pii betumi ama eyi aba. Nea enti titiriw ne sɛ nipadua no nnya mframa pa a ɛdɔɔso.
• Nsɛnkyerɛnne a edi kan no betumi ayɛ ɔbrɛ a ɛtra so, ɔfe, ne ɔhome ntɛmntɛm.
• Wɔyɛ mogya mu nhwehwɛmu de hu tebea yi.
• Ayaresa no gyina nea ɛde ba no so. Ɛtɔ da bi a ahomegye ne nsu dɔɔso, ɛtɔ da bi nso a ɛho hia sɛ wɔde obi kɔ ayaresabea.
• Sɛ wohu na wɔsa no ntɛm a, wobetumi asa.
• Sɛ wɔma mmerɛbo ne asaabo nya apɔwmuden a, ɛboa ma wɔbɔ wo ho ban fi tebea horow te sɛ eyinom ho.

Enti, sɛ wowɔ saa sɛnkyerɛnne yi bi, anaasɛ wopɛ sɛ wuhu eyi ho nsɛm pii a, mma wo werɛ mmfi sɛ wobɛkɔ oduruyɛfo nkyɛn. Kɔ so nya apɔwmuden!

` Lactic acidosis, lactic acidosis, lactate, mogya mu acid, nipadua mu acid kari pɛ, apɔw-mu-teɛteɛ, akwahosan