He nui rawa te waikawa o tō tinana? Me ako tātou mō te waikawa lactic!

Kua pāngia koe e te ngenge, te mamae, te poto rānei o te manawa i a koe e ngenge ana? He maha ngā take pea i puta ai ēnei. Heoi, i tēnei rā ka kōrero tātou mō tētahi āhuatanga ka puta mai i te wā e kohia ana te waikawa lactic i roto i ō tātou tinana. Koinei te mea e kīia ana e ngā tākuta ko te lactic acidosis . Kaua e manukanuka, me kōrero noa tātou mō tēnei.

He aha te waikawa lactic?

He māmā noa iho, ko te waikawa lactic he āhuatanga e nui rawa ai te waikawa lactic i roto i ō toto. Ka puta pea tēnei ina nui rawa te waikawa lactic e hangaia ana e tō tinana, ina kore rānei e taea e tō tinana te tango tika i te waikawa lactic e hangaia ana e ia.

Ko te tikanga, ko te ate me ngā whatukuhu ngā mea e tango ana i te waikawa lactic nui rawa atu i roto i ō tātou tinana. Heoi, ki te nui rawa te waikawa lactic, ki te ngoikore rānei ēnei whekau pēnei i te ate me ngā whatukuhu, kāore e taea e rātou te mahi tika i tēnei mahi. Ko te wā tēnā ka tīmata te kohikohi o te waikawa lactic i roto i te toto.

Ina piki ake te taumata o te waikawa lactic i roto i tō toto, ka kiia tēnei he hyperlactatemia . Heoi, ki te piki haere tonu tēnei, ā, ka nui rawa te waikawa o te pH o te tinana (arā, te toenga waikawa-pūtake), ka kiia tēnā he lactic acidosis .

He aha te take e puta ai te waikawa lactic i roto i ō tātou tinana?

Ko te waikawa lactic, e kiia ana i ētahi wā ko te lactate , he hua ā-taiao o te pākia o te pūtau. Ka whakamahia e ā tātou pūtau te kurukose (huka) hei whakaputa pūngao. Ka kiia tēnei tukanga ko te glycolysis anaerobic . Ka puta tēnei ina hiahia wawe ngā pūtau ki te pūngao, engari kāore i te nui te hāora hei mahi pēnā.

I te nuinga o te wā, ka whiwhi tātou i te pūngao mā te tukanga e whakamahi ana i te hāora. Ka kiia tēnei ko te pākia o te tinana i roto i te tinana (aerobic metabolism ). Heoi, ko te glycolysis anaerobic he rite ki te pūtake pūngao e whakamahia ana e tātou i ngā wā ohorere. Whakaarohia, ina oma tere koe, ina hiki rānei i tētahi taumaha, ka ngaro ohorere te hāora i ō uaua. Koinei te wā e whakamahia ai tēnei tikanga. Waihoki, ina kore ō tātou kiko e whiwhi hāora nā ētahi mate, ka puta hoki te waikawa lactic i tēnei ara.

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He aha te mea ka tupu ina puta te waikawa lactic?

Ko te kaha o te waikawa lactic ka pā ki ētahi tāngata. Tērā pea ka pāngia rātou e tēnei mate mō te wā poto, inā koa i muri i te whakakori tinana taumaha. Ka mamae pea tō tinana mō ētahi rā. Engari ki te ora pai tō ate me ō whatukuhu, ka ngaro te waikawa lactic i roto i ētahi rā.

Heoi, ki te nui rawa te waikawa lactic e hangaia ana e tō tinana, ki te kore rānei e taea e tō ate me ō whatukuhu te tukatuka tika, ka kino rawa atu te āhua. He maha ngā wā ka pā tēnei ki tētahi momo mate. I te piki haere tonu o te taumata lactate i roto i tō toto, ka heke te taumata pH , ā, ka heke haere te putanga o te ngākau. Ka taea e tēnei te arahi ki te ngoikore o ētahi atu okana, tae atu ki te mate. Nō reira, he mea nui kia mōhio koe ki tēnei.

He aha ngā tohu o te waikawa lactic?

Ka rerekē pea ngā tohu o tēnei mate i te tīmatanga, me te wā hoki ka kino haere te mate.

Ngā tohu tōmua

I te tīmatanga, ka pā pea ēnei āhuatanga ki a koe:

• Whakapairuaki me te ruaki.
• Te ngenge nui me te ngenge rawa.
• Te manawa tere, te manawa hōhonu (e kiia ana tēnei ko te utu manawa , he ngana ki te whakaiti i te waikawa o te tinana mā te manawa).
• Te wiri o ngā uaua me te mamae o te tinana.

Ngā tohu ina kino haere te āhua

I te kino haere o te āhua, ka puta pea ngā tohu e whai ake nei:

• Te ngoikore me te piki haere o te hiamoe.
• Te pōrangi me te pōhēhē.
• Te uaua ki te whakahaere i ngā nekehanga, pērā i te hikoi ( ataxia ).
• Te hekenga o te mimi ( Oliguria ).

Ētahi atu tohu

Tērā pea ka pāngia koe e ngā tohu o tētahi mate hauora e pāngia ana e te waikawa lactic . Hei tauira, ko ngā mate pēnei i te sepsis ( he mate toto), te ohorere ( he whiu), te ngoikore rānei o te ate . Ko ētahi o ēnei ko:

• Te pāmahana tinana iti.
• Te toto toto iti.
• Te kirika.
• Te kōwhai o te kiri me te mā o ngā kanohi ( jaundice ).

He aha te tino take o te waikawa lactic?

He maha ngā take mō tēnei. Ko te tino take ko te iti o te hāora i roto i tō toto (hypoxemia) te kore rānei o te hāora ki ō kiko (hypoxia). Ko te tikanga ka puta mai tēnei i tētahi mate hauora.

Kua wehea e ngā tākuta tēnei āhua o te waikawa lactic ki ētahi momo i runga i ōna pūtake:

Momo A

Ka puta te waikawa waikawa lactic Momo A ina kore e nui te hāora e whiwhi ana i ō kiko. He maha ngā wā ka kitea i roto i ngā āhuatanga hauora kino. Ka taea hoki te noho rangitahi, nā te nui rawa o te whakakori tinana.

Ko ētahi o ngā āhuatanga ka nui ake te hanga lactate:

• Nā ngā mate pūkahukahu ka kore e nui te hāora e whiwhi ana te toto.
• Ka puhoi te rere o te toto me te kore o te hāora ki ngā kiko e ngā mate tohanga toto.
• Ka pāngia te kaha o ngā toto toto whero e ngā mate o te hemoglobin ki te kawe hāora.
• Ngā āhuatanga ohorere pērā i te ohorere septic , te ohorere hypovolemic, te ohorere cardiogenic rānei.
• Te mate ischemic o te puku .
• Ngā hopukanga me ngā wiri roa.
• Te paihana waro haukini.

Momo B

Ka puta te momo waikawa lactic momo B, kāore he hypoxemia , he hypoxia rānei. E toru ngā momo momo.

Momo B1

Ko te take o tēnei ko ngā mate huna e whakararuraru ana i te kaha ki te tukatuka i te lactate.

Ka taea e rātou:

• Mate ate .
• Mate whatukuhu.
• Te korenga o te thiamine (huaora B1) .
• Matepukupuku.
• Te tūnga o te HIV/AIDS .
• Ngā mate mitochondrial .
• Te ketoacidosis e pā ana ki te mate huka .
• Te waranga ki te waipiro ( Te mate whakamahi waipiro ).

Momo B2

Ka puta tēnei hei pānga taha o ētahi rongoā me ngā paitini. Hei tauira:

• Te paihana cyanide .
• Te paihana waro haukini.
• Te paitini waipiro .
• Te whakamahinga o te kōkāine .
• Ko ētahi rongoā mō te HIV ( Nucleoside reverse transcriptase inhibitors (rongoā antiretroviral) ).
• Ko ētahi momo inhaler e whakamahia ana mō ngā mate pēnei i te huango ( ngā inhaler Beta-adrenergic agonist ).
• Werohanga epinephrine mō ngā mate pāwera kino.
• Ko te paturopi linezolid .
• Propofol mō te rongoā whakangote.
• Ko te Metformin, he rongoā e whakamahia ana mō te mate huka (he whānuitia tēnei e whakamahia ana i Sri Lanka, nō reira me tino mōhio koe ki tēnei).

Momo B3

Nā te korenga whānau mai o ngā whākōkī motuhake e hiahiatia ana hei whakapūmau i te lactate tēnei. He tino onge ēnei. Hei tauira:

• Te mate rokiroki glycogen .
• Te ngoikore o te fructose-1,6-diphosphatase .
• Te korenga o te pyruvate carboxylase .
• Te ngoikore o te pyruvate dehydrogenase .
• Te ngoikore o te phosphorylation waikura .
• Te waikawa Methylmalonic .

Te waikawa waikawa D-lactic

Ko ngā momo A me B i kōrerotia e tātou i mua ake nei e pā ana ki te kohikohinga o te L-lactate i roto i ō toto. Ko tēnei L-lactate he momo waikawa lactic e hangaia ana, e whakapūngaohia ana hoki i roto i te tinana tangata.

Heoi anō, tētahi atu momo tino onge o te waikawa lactic, e puta mai ana i te kohikohinga o te D-lactate . Ka hangaia tēnei momo waikawa lactic e tētahi momo huakita i roto i tō whekau nui. Ka hangaia te D-lactate hei hua taha ina tukatukahia e ēnei huakita ngā warowaihā i te wā e nakunaku ana.

Ka puta te waikawa D-lactic ina nui rawa atu ēnei huakita. Kātahi ka mimitihia te D -lactate nui rawa atu mai i ngā whekau ki roto i te toto. Kāore e taea e ō tātou whatukuhu, e ō tātou ate rānei te whakapūngao i te D-lactate . Nō reira, ka haere tonu te kohikohi i roto i te toto. He maha ngā wā ka kitea tēnei hei raruraru o tētahi āhuatanga e kiia nei ko te short gut syndrome .

Me pēhea te tautuhi i te waikawa lactic?

Ka whakatauhia e ngā tākuta mēnā kei a koe te waikawa lactic i runga i ngā āhuatanga e whai ake nei:

• He nui ake ngā taumata lactate i roto i te toto i te 4 mmol/L (milimol ia rita).
• Te pH toto i raro iho i te 7.35.

Ka inehia ēnei uara mā te tango i tētahi tauira toto mai i a koe, ka whakamātautau.

He aha ngā whakamātautau e mahia ana mō tēnei?

Hei tautuhi i te waikawa lactic, ka mahia ngā whakamātautau e whai ake nei:

• Paewhiri Pūmua Whānui (CMP) : He whakamātautau toto māmā tēnei e ine ana i ngā mea maha i roto i tō toto hei tiki i ngā mōhiohio taketake mō tō hauora.
• Whakamātautau toto mō te lactate : Haunga ngā mea e inehia ana i roto i te CMP, ka inehia anō hoki te taumata lactate i roto i tō toto.
• Whakamātautau toto āputa anion : Ka inehia e tēnei whakamātautau te pH me te toenga electrolyte o tō toto.
• Whakamātautau hau toto uaua : Mā tēnei ka ine i te mākū o te hāora o ō uaua, tae atu ki te taurite pH me te electrolyte.

Me pēhea te rongoā i te waikawa lactic?

Mena he take rangitahi tō te waikawa lactic , pērā i te nui rawa o te whakakori tinana, te wiri, te mate hopuhopu rānei, ka memeha haere i roto i te wā. Ka taea e koe te whakaora mā te noho ki te kāinga me te inu wai.

Heoi, i roto i te hōhipera, ka rongoatia tonutia te waikawa lactic mā te whakamahi i ngā wai werohanga ( ngā wai IV , koia tā mātou e kī nei ko te saline) me ētahi atu maimoatanga whakaora, pērā i te whakaora hāora, mēnā e tika ana.

Kātahi ka whakatauhia te maimoatanga i runga i te pūtake. I runga i ō tohumate, ka mahi tō rōpū hauora ki te rongoā i te mate hauora taketake, i te paihana rānei e puta ai te waikawa lactic .

Mena kei te whakaatu koe i ngā tohu o te iti o te taumata hāora, ka whakapae te tīma hauora he momo take momo A – pērā i te ngoikore o te ngākau, te ngoikore o te manawa rānei, te sepsis , te ohorere rānei – ā, ka rongoā tuatahitia aua āhuatanga ohorere.

Mēnā kāore e tohuhia he iti te taumata hāora, ka whakaarohia e rātou ngā tino take o te momo B, ā, ka rongoā motuhaketia.

He aha ngā hua ka taea e te tangata e pāngia ana e te waikawa lactic?

Ko ngā hua ka whakawhirinaki ki te pūtake me te kaha o te mate. Ko te momo A lactic acidosis – e pā ana ki te sepsis , te ohorere, me/ranei te hekenga o te tuku hāora ki te toto – he kino ake. Ko ētahi atu momo lactic acidosis he ngawari ake, ā, he puhoi ake te whanaketanga, ka nui ake te wā me te whai wāhi ki te maimoatanga.

I te nuinga o te wā, ka piki ake ngā taumata lactate i roto i te toto, ka piki ake pea ngā reiti mate. Heoi, ka taea te ora katoa mā te maimoatanga tere me te whai hua.

Ko te waikawa lactic tētahi o ngā āhuatanga e kiia nei ko te waikawa metabolic, arā, ko te waikawa e hangai ana ki roto i ō toto. I roto i te waikawa metabolic , ka whakararuraruhia ngā tukanga metabolic noa o te tinana e whakaputa ana, e whakahaere ana hoki i te waikawa i tētahi ara. I te nuinga o te wā, ka taea e tō ate me ō whatukuhu te tātari i te waikawa nui. Engari ki te kore e mahi tika aua whekau, ka iti ake te kaha ki te whakahaere i te waikawa. Nō reira, ko te tiaki i tō ate me ō whatukuhu mā te inu i te nui o te wai, te whakawhāiti i te waipiro me te tango i ngā rongoā kino ka āwhina nui ki te pupuri i tō hauora mō te wā roa.

Ngā kōrero poto hei maumahara

Āe, me whakamahara atu tātou ki a koutou ētahi o ngā mea tino nui i kōrerohia e tātou i tēnei rā:

• Ko te waikawa lactic he pikinga o te waikawa lactic i roto i te toto.
• He maha ngā take mō tēnei. Ko te take matua he kore e nui te hāora e whiwhi ana te tinana.
• Ko ngā tohu tuatahi ko te ngenge nui, te ruaki, me te tere o te manawa.
• Ka mahia ngā whakamātautau toto hei tautuhi i tēnei mate.
• Kei te pūtake te maimoatanga. I ētahi wā he nui te okiokinga me te wai, i ētahi wā me kawe ki te hōhipera.
• Ki te kitea wawetia, ā, ka rongoātia, ka taea te whakaora.
• Mā te pupuri i te hauora o te ate me ngā whatukuhu ka āwhina i te tiaki i a koe mai i ēnei āhuatanga.

Nō reira, ki te pā mai ēnei tohu ki a koe, ki te hiahia rānei koe ki te mōhio atu mō tēnei, kaua e wareware ki te toro atu ki te tākuta. Kia ora tonu!