Ua nui loa anei ka waikawa o kou kino? E aʻo kākou e pili ana i ka lactic acidosis!

Ua manaʻo paha ʻoe i ka luhi, ka ʻeha, a i ʻole ka pōkole o ka hanu i kou luhi iki ʻana? Hiki ke loaʻa kēia ma muli o kekahi mau kumu. Eia nō naʻe, i kēia lā e kamaʻilio mākou e pili ana i kahi kūlana e hiki ke hana i ka wā e hōʻiliʻili ai kahi kemika i kapa ʻia ʻo ka lactic acidosis i loko o ko mākou kino. ʻO kēia ka mea a nā kauka e kapa nei he lactic acidosis . Mai hopohopo, e kamaʻilio maʻalahi kākou e pili ana i kēia.

He aha ka Lactic Acidosis?

I ka ʻōlelo maʻalahi, ʻo ka lactic acidosis kahi kūlana kahi i nui loa ai ka waikawa lactic i loko o kou koko. Hiki ke hana kēia i ka wā e hana ai kou kino i ka nui o ka waikawa lactic, a i ʻole i ka wā ʻaʻole hiki i kou kino ke wehe pono i ka waikawa lactic āna e hana ai.

ʻO ka maʻamau, ʻo ko kākou akepaʻa a me nā puʻupaʻa nā mea e wehe i ka waikawa lactic keu mai ko kākou kino. Eia nō naʻe, inā kiʻekiʻe loa ka nui o ka waikawa lactic, a inā paha he nāwaliwali i loko o kēia mau ʻōkana e like me ke akepaʻa a me nā puʻupaʻa, ʻaʻole hiki iā lākou ke hana pono i kēia hana. ʻO ia ka manawa e hoʻomaka ai ka waikawa lactic e hōʻiliʻili i loko o ke koko.

Ke piʻi iki ka pae o ka waikawa lactic i loko o kou koko, kapa mākou ia he hyperlactatemia . Eia nō naʻe, inā piʻi hou kēia a lilo ka pH o ke kino (ʻo ia hoʻi ke kaulike acid-base) i acidic loa, ua kapa ʻia kēlā he lactic acidosis .

No ke aha i hana ʻia ai ka waikawa lactic i loko o ko mākou kino?

ʻO ka waikawa lactic, i kapa ʻia i kekahi manawa he lactate , he huahana kūlohelohe ia o ka metabolism cellular. Hoʻohana kā mākou mau cell i ka glucose (sugar) e hana i ka ikehu. Ua kapa ʻia kēia kaʻina hana he anaerobic glycolysis . Hana ʻia kēia ke pono koke nā cell i ka ikehu, akā ʻaʻole lawa ka oxygen e hana pēlā.

ʻO ka maʻamau, loaʻa iā mākou ka ikehu ma o kahi kaʻina hana e hoʻohana ana i ka oxygen. Ua kapa ʻia kēia he metabolism aerobic . Eia nō naʻe, ua like ka glycolysis anaerobic me kahi kumu ikehu a mākou e hoʻohana ai i nā pilikia. E noʻonoʻo, i ka wā e holo wikiwiki ai ʻoe a hāpai paha i kahi mea kaumaha, nele koke kou mau ʻiʻo i ka oxygen. ʻO ia ka manawa e hoʻohana ʻia ai kēia ʻano hana. Pēlā nō, i ka wā ʻaʻole loaʻa i ko mākou mau ʻiʻo ka oxygen ma muli o kekahi mau maʻi, hana ʻia ka waikawa lactic ma kēia ʻano.

He aha ka mea e hana ai inā loaʻa ka lactic acidosis?

ʻO ka mea e hana ʻia ke loaʻa iā ʻoe ka lactic acidosis ma muli o kona koʻikoʻi. Hiki i kekahi poʻe ke ʻike i kēia kūlana no kekahi manawa, ʻoiai ma hope o ka hoʻoikaika kino nui. Hiki iā ia ke hoʻomaʻamaʻa i kou kino no kekahi mau lā. Akā inā olakino maikaʻi kou akepaʻa a me kou mau puʻupaʻa, e nalo aku ka lactic acid i loko o kekahi mau lā.

Eia nō naʻe, inā hoʻomau kou kino i ka hana ʻana i ka nui o ka waikawa lactic, a inā ʻaʻole hiki i kou ake a me kou mau puʻupaʻa ke hana pono iā ia, hiki i ke kūlana ke lilo i mea koʻikoʻi. Hana pinepine kēia me kekahi ʻano maʻi. Ke piʻi mau nei ka pae lactate i loko o kou koko, emi iho ka pae pH , a emi mālie ka puka o ka puʻuwai. Hiki i kēia ke alakaʻi i ka hāʻule ʻana o nā ʻōkana ʻē aʻe a me ka make. No laila he mea nui e makaʻala i kēia.

He aha nā hōʻailona o ka Lactic Acidosis?

Hiki ke ʻokoʻa nā hōʻailona o kēia maʻi i nā pae mua a i ka wā e lilo ai ke ʻano i mea koʻikoʻi.

Nā hōʻailona mua

I ka wā mua, hiki iā ʻoe ke manaʻo i nā mea penei:

• Ka luaʻi a me ka luaʻi.
• Luhi loa a me ka paupauaho.
• Ka hanu wikiwiki a hohonu (ua kapa ʻia kēia he uku hanu , kahi hoʻāʻo e hoʻēmi i ka ʻakika o ke kino ma o ka hanu ʻana).
• ʻŌhūhū ʻana o nā ʻiʻo a me ka ʻeha o ke kino.

Nā hōʻailona ke lilo ke kūlana i mea koʻikoʻi

Ke ʻoi aku ka ʻino o ke kūlana, hiki ke ʻike ʻia nā hōʻailona penei:

• Ka nāwaliwali a me ka hiamoe nui.
• Delirium a me ka huikau.
• Ka paʻakikī i ka hoʻokele ʻana i nā neʻe ʻana, e like me ka wā e hele ana ( ataxia ).
• Ka emi ʻana o ka mimi i hoʻopuka ʻia ( Oliguria ).

Nā hōʻailona ʻē aʻe

Loaʻa paha iā ʻoe nā hōʻailona o kahi maʻi lapaʻau e hoʻoulu ai i ka lactic acidosis . No ka laʻana, nā kūlana e like me ka sepsis ( kahi maʻi koko), ka haʻalulu ( kahi hahau), a i ʻole ka hāʻule ʻana o ke akepaʻa . Hiki i nā hōʻailona o kēia ke komo pū me:

• Haʻahaʻa ka mahana o ke kino.
• Ke koko haʻahaʻa.
• Kuni.
• Jaundice (melemele o ka ʻili a me nā keʻokeʻo o nā maka).

He aha ke kumu nui o ka lactic acidosis?

Nui nā kumu no kēia. ʻO ke kumu maʻamau ka haʻahaʻa o ka oxygen i loko o kou koko (hypoxemia) a i ʻole ka nele o ka oxygen i kou mau ʻiʻo (hypoxia). ʻO ka maʻamau, hana ʻia kēia e kahi maʻi.

Ua hoʻokaʻawale nā ​​kauka i kēia kūlana o ka lactic acidosis i kekahi mau ʻano e pili ana i kona mau kumu:

ʻAno A

ʻIke pinepine ʻia i nā kūlana olakino koʻikoʻi. Hiki ke lilo i mea manawa pōkole, i hoʻokumu ʻia e ka hoʻoikaika kino nui.

ʻO kekahi mau kūlana e hiki ai ke hoʻonui i ka hana lactate:

• ʻO nā maʻi puʻuwai ke kumu o ka loaʻa ʻole o ka oxygen i ke koko.
• Hoʻoulu nā maʻi o ke kahe koko i ka lohi o ke kahe koko a me ka nele o ka oxygen i nā ʻiʻo.
• Hoʻopilikia nā maʻi hemoglobin i ka hiki o nā hunaola koko ʻulaʻula ke lawe i ka oxygen.
• Nā kūlana haʻalulu e like me ke haʻalulu septic , ke haʻalulu hypovolemic, a i ʻole ke haʻalulu cardiogenic .
• ʻO ka maʻi ischemic ʻōpū .
• Nā hopu a me nā ʻūlū lōʻihi.
• Ka lāʻau make kalapona monoxide .

ʻAno B

ʻIke ʻia ka ʻano B lactic acidosis me ka ʻole o ka hypoxemia a i ʻole hypoxia . ʻEkolu mau ʻano like ʻole.

ʻAno B1

ʻO kēia ke kumu o nā maʻi kumu e hoʻopilikia ai i ka hiki ke metabolize i ka lactate.

Hiki iā lākou ke:

• Maʻi akepaʻa .
• Maʻi puʻupaʻa.
• Ka nele o ka Thiamine (vitamin B1) .
• Ka maʻi ʻaʻai.
• Ke kūlana o ka maʻi HIV/AIDS .
• Nā maʻi mitochondrial .
• ʻO ke ketoacidosis e pili ana i ka maʻi diabetes .
• Ka maʻi hoʻohana ʻona ( ka maʻi hoʻohana ʻona ).

ʻAno B2

Hana ʻia kēia ma ke ʻano he hopena ʻaoʻao o kekahi mau lāʻau lapaʻau a me nā mea ʻawahia. Nā Laʻana:

• Ka lāʻau make ʻana o ka cyanide .
• Ka lāʻau make kalapona monoxide .
• Ka lāʻau make ʻona.
• Ka hoʻohana ʻana i ka cocaine .
• Kekahi mau lāʻau lapaʻau no ka maʻi HIV ( Nucleoside reverse transcriptase inhibitors (antiretroviral therapy) ).
• ʻO kekahi mau ʻano inhalers i hoʻohana ʻia no nā maʻi e like me ka hānō ( Beta-adrenergic agonist inhalers ).
• ʻO ka inikini Epinephrine no nā maʻi allergies koʻikoʻi.
• ʻO ka lāʻau antibiotic linezolid .
• ʻO Propofol no ka anesthesia.
• ʻO Metformin, kahi lāʻau i hoʻohana ʻia no ka maʻi diabetes (hoʻohana nui ʻia kēia ma Sri Lanka, no laila pono ʻoe e makaʻala pono i kēia).

ʻAno B3

Hoʻokumu ʻia kēia e nā hemahema hānau o nā enzymes kikoʻī e pono ai e hoʻololi i ka lactate. He mea kākaʻikahi loa kēia. Nā laʻana:

• Ka maʻi mālama glycogen .
• Ka hemahema o ka Fructose-1,6-diphosphatase .
• Ka hemahema o ka pyruvate carboxylase .
• Ka nele o ka pyruvate dehydrogenase .
• Ka hemahema o ka phosphorylation oxidative .
• ʻAkiuki Methylmalonic .

ʻO ka acidosis D-lactic

ʻO nā ʻano A a me B a mākou i kamaʻilio ai ma mua e pili ana i ka hōʻiliʻili ʻana o ka L-lactate i loko o kou koko. ʻO kēia L-lactate kahi ʻano o ka waikawa lactic i hana maʻamau ʻia a hoʻopili ʻia i loko o ke kino o ke kanaka.

Eia nō naʻe, aia kekahi ʻano lactic acidosis kakaikahi loa, i hana ʻia e ka hōʻiliʻili ʻana o D-lactate . Hana ʻia kēia ʻano lactic acid e kahi ʻano bacteria i loko o kou ʻōpū nui. Hana ʻia ka D-lactate ma ke ʻano he huahana ʻaoʻao ke hoʻopili kēia mau bacteria i nā kalapona i ka wā o ka ʻai ʻana.

ʻO ka D-lactic acidosis ke ulu nui kēia mau bacteria. A laila hoʻopili ʻia ka D-lactate keu mai nā ʻōpū i loko o ke koko. ʻAʻole hiki ke hoʻololi ʻia ka D-lactate e ko kākou mau puʻupaʻa a i ʻole ke akepaʻa. No laila, ke hoʻomau nei ia i ka hōʻiliʻili ʻana i loko o ke koko. ʻIke pinepine ʻia kēia he pilikia o kahi maʻi i kapa ʻia ʻo short gut syndrome .

Pehea e ʻike ʻia ai ka Lactic Acidosis?

Hoʻoholo nā kauka inā he lactic acidosis kou ma muli o kēia mau kumu:

• ʻOi aku ka nui o ka lactate koko ma mua o 4 mmol/L (milimoles no ka lita).
• ʻOi aku ka pH koko ma mua o 7.35.

Hoʻoholo ʻia kēia mau waiwai ma ka lawe ʻana i kahi hāpana koko mai ou aku a hoʻāʻo iā ia.

He aha nā hoʻokolohua i hana ʻia no kēia?

No ka ʻike ʻana i ka lactic acidosis , hana ʻia nā hoʻokolohua aʻe: +

• ʻO ka panel metabolic piha (CMP) : He hoʻāʻo koko maʻalahi kēia e ana i nā mea like ʻole i loko o kou koko e loaʻa ai ka ʻike kumu e pili ana i kou olakino.
• Hoʻāʻo koko lactate : Ma waho aʻe o nā mea i ana ʻia ma ka CMP, ua ana kūikawā ʻia ka pae lactate i loko o kou koko.
• Hoʻāʻo koko anion gap : Ke ana kēia hoʻāʻo i ke kaulike pH a me ka electrolyte o kou koko.
• Hoʻāʻo kinoea koko arterial : Ke ana kēia i ka saturation oxygen o kou mau aʻa, a me ke kaulike pH a me ka electrolyte.

Pehea e mālama ai ka Lactic Acidosis?

Inā loaʻa iā ʻoe ka lactic acidosis ma muli o kahi kumu pōkole, e like me ka hoʻoikaika kino nui, ka haʻalulu, a i ʻole ka hopu ʻana, e hoʻopau pinepine ia i ka hala ʻana o ka manawa. Hiki iā ʻoe ke loaʻa ka hōʻoluʻolu ma ka noho ʻana ma ka home a noho hydrated.

Eia nō naʻe, ma kahi hoʻonohonoho haukapila, mālama koke ʻia ka lactic acidosis me nā wai intravenous ( nā wai IV , ʻo ia ka mea a mākou e kapa nei he saline) a me nā lāʻau hoʻōla hou ʻē aʻe, e like me ka oxygen therapy , inā pono.

A laila e hoʻoholo ʻia ka lāʻau lapaʻau ma muli o ke kumu. Ma muli o kāu mau hōʻailona, ​​​​e hana kāu hui lapaʻau e mālama i ke kūlana olakino ma lalo a i ʻole ka lāʻau make e hoʻoulu ai i ka lactic acidosis .

Inā ʻoe e hōʻike ana i nā hōʻailona o ka haʻahaʻa o ka oxygen, e kānalua ke kime lapaʻau i nā kumu Type A - e like me ka puʻuwai a i ʻole ka hanu ʻole, sepsis , a i ʻole ka haʻalulu - a mālama mua i kēlā mau pilikia.

I nā hihia kahi i hōʻike ʻole ʻia ai nā pae haʻahaʻa oxygen, noʻonoʻo lākou i nā kumu like ʻole o ke ʻano B a mālama pono iā lākou.

He aha nā hopena e hiki i kekahi me ka lactic acidosis ke manaʻo?

Aia nā hopena i ke kumu a me ke koʻikoʻi o ke kūlana. ʻOi aku ka koʻikoʻi o ka lactic acidosis ʻano A - ka mea e pili ana me ka sepsis , ka haʻalulu, a/a i ʻole ka emi ʻana o ka lawe ʻana o ka oxygen i ke koko. Hiki ke ʻoluʻolu a ulu mālie nā ʻano ʻē aʻe o ka lactic acidosis , e ʻae ana i ka manawa a me ka manawa kūpono no ka mālama ʻana.

Ma keʻano laulā, i ka piʻi ʻana o nā pae lactate koko, hiki ke piʻi aʻe nā helu make. Eia nō naʻe, hiki ke ho'ōla piha ʻia me ka mālama wikiwiki a me ka maikaʻi.

ʻO ka lactic acidosis kekahi o nā kūlana i kapa ʻia ʻo metabolic acidosis, kahi e hōʻiliʻili ai ka waikawa i loko o kou koko. I ka metabolic acidosis , ua hoʻopilikia ʻia nā kaʻina hana metabolic maʻamau o ke kino e hana a mālama i ka waikawa ma kekahi ʻano. ʻO ka maʻamau, hiki i kou akepaʻa a me nā puʻupaʻa ke kānana i ka waikawa keu. Akā i ka wā e hana pono ʻole ai kēlā mau ʻōkana, ʻaʻole hiki iā lākou ke mālama i ka acidosis. No laila, ʻo ka mālama ʻana i kou akepaʻa a me nā puʻupaʻa ma ka inu ʻana i ka wai he nui, ka palena ʻana i ka waiʻona a me ka lawe ʻana i nā lāʻau lapaʻau ʻino e hiki ke hele i kahi lōʻihi i ka mālama ʻana i kou olakino lōʻihi.

Nā mea pōkole e hoʻomanaʻo ai

ʻAe, eia kekahi o nā mea nui a mākou i kamaʻilio ai i kēia lā:

• ʻO ka lactic acidosis ka hoʻonui ʻia o ka lactic acidosis i loko o ke koko.
• Nui nā kumu no kēia. ʻO ke kumu nui, ʻaʻole lawa ka oxygen i ke kino.
• Hiki i nā hōʻailona mua ke komo i ka luhi nui, ka luaʻi ʻana, a me ka hanu wikiwiki.
• Hana ʻia nā hoʻāʻo koko e ʻike ai i kēia maʻi.
• Aia ka lāʻau lapaʻau i ke kumu. I kekahi manawa ua lawa ka hoʻomaha a me nā wai, i kekahi manawa pono ka mālama ʻia ʻana i ka haukapila.
• Inā ʻike ʻia a mālama ʻia i ka wā mua, hiki ke ho'ōla ʻia.
• ʻO ka mālama ʻana i ke olakino o ke akepaʻa a me nā puʻupaʻa e kōkua i ka pale ʻana mai nā kūlana e like me kēia.

No laila, inā loaʻa iā ʻoe kekahi o kēia mau hōʻailona, ​​a inā makemake ʻoe e ʻike hou aʻe e pili ana i kēia, mai poina e nīnau i ke kauka. E noho olakino!

ʻAcidosis lactic , acidosis lactic, lactate, ka waikawa koko, ke kaulike waikawa kino, hoʻoikaika kino, olakino