{"id":27682,"date":"2023-04-24T14:10:19","date_gmt":"2023-04-24T07:10:19","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27682"},"modified":"2023-04-24T14:10:19","modified_gmt":"2023-04-24T07:10:19","slug":"roi-loan-toan-kiem-va-nhung-khai-niem-co-ban","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/roi-loan-toan-kiem-va-nhung-khai-niem-co-ban\/","title":{"rendered":"R\u1ed1i lo\u1ea1n toan ki\u1ec1m v\u00e0 nh\u1eefng kh\u00e1i ni\u1ec7m c\u01a1 b\u1ea3n"},"content":{"rendered":"

Toan hay ki\u1ec1m \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 r\u1ed1i lo\u1ea1n toan ki\u1ec1m chuy\u1ec3n ho\u00e1 khi s\u01b0 thay \u0111\u1ed5i c\u1ee7a pH l\u00e0 do HCO3- v\u00e0 r\u1ed1i lo\u1ea1n toan hay ki\u1ec1m h\u00f4 h\u1ea5p khi pH thay \u0111\u1ed5i do CO2 <\/sub>. Nhi\u1ec5m toan l\u00e0 t\u00ecnh tr\u1ea1ng t\u0103ng n\u1ed3ng \u0111\u1ed9 ion H+<\/sup> c\u1ee7a d\u1ecbch ngo\u1ea1i b\u00e0o l\u00e0m cho pH m\u00e1u c\u00f3 khuynh h\u01b0\u1edbng gi\u1ea3m, Nhi\u1ec5m ki\u1ec1m l\u00e0 t\u00ecnh tr\u1ea1ng t\u0103ng HCO3<\/sub>–<\/sup> \u1edf d\u1ecbch ngo\u1ea1i b\u00e0o l\u00e0m cho pH m\u00e1u c\u00f3 khuynh h\u01b0\u1edbng t\u0103ng. \u00a0<\/strong><\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng<\/h2>\n

Ba h\u1ec7 th\u1ed1ng ch\u00ednh \u0111i\u1ec1u h\u00f2a n\u1ed3ng \u0111\u1ed9 H+ c\u1ee7a c\u00e1c ch\u1ea5t d\u1ecbch trong c\u01a1 th\u1ec3 ng\u0103n ng\u1eeba s\u1ef1 nhi\u1ec5m toan ho\u1eb7c nhi\u1ec5m ki\u1ec1m:<\/p>\n

(1) h\u1ec7 th\u1ed1ng \u0111\u1ec7m acid-base trong c\u00e1c d\u1ecbch c\u01a1 th\u1ec3, \u1edf \u0111\u00f3 c\u00e1c ch\u1ea5t \u0111\u1ec7m s\u1ebd k\u1ebft h\u1ee3p ngay v\u1edbi 1 acid ho\u1eb7c m\u1ed9t base \u0111\u1ec3 ng\u0103n ch\u1eb7n s\u1ef1 thay \u0111\u1ed5i qu\u00e1 l\u1edbn n\u1ed3ng \u0111\u1ed9 H+;<\/p>\n

(2) c\u01a1 quan h\u00f4 h\u1ea5p l\u00e0 n\u01a1i \u0111\u00e0o th\u1ea3i CO2 t\u1eeb d\u1ecbch ngo\u1ea1i b\u00e0o ra kh\u1ecfi c\u01a1 th\u1ebf ( H2CO3).;<\/p>\n

(3) th\u1eadn, c\u01a1 quan b\u00e0i ti\u1ebft acid ho\u1eb7c ki\u1ec1m qua n\u01b0\u1edbc ti\u1ec3u nh\u1edd \u0111\u00f3 \u0111i\u1ec1u h\u00f2a n\u1ed3ng \u0111\u1ed9 H+ trong d\u1ecbch c\u01a1 th\u1ec3 trong m\u1ee9c \u0111\u1ed9 b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng nhi\u1ec5m toan ho\u1eb7c nhi\u1ec5m ki\u1ec1m.<\/p>\n

Khi c\u00f3 s\u1ef1 thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 H+, c\u00e1c h\u1ec7 th\u1ed1ng \u0111\u1ec7m trong d\u1ecbch c\u01a1 th\u1ec3 s\u1ebd ph\u1ea3n \u1ee9ng ngay trong v\u00f2ng v\u00e0i gi\u00e2y \u0111\u1ec3 gi\u1ea3m thi\u1ec3u s\u1ef1 thay \u0111\u1ed5i n\u00e0y. H\u1ec7 th\u1ed1ng \u0111\u1ec7m kh\u00f4ng th\u1ec3 lo\u1ea1i b\u1ecf H+ ho\u1eb7c th\u00eam H+ cho c\u01a1 th\u1ec3 nh\u01b0ng n\u00f3 c\u00f3 kh\u1ea3 n\u0103ng g\u1eafn v\u1edbi c\u00e1c acid ho\u1eb7c base \u0111\u1ec3 t\u00e1i l\u1eadp tr\u1ea1ng th\u00e1i c\u00e2n b\u1eb1ng c\u1ee7a c\u01a1 th\u1ec3.<\/p>\n

C\u01a1 ch\u1ebf \u0111i\u1ec1u h\u00f2a th\u1ee9 hai l\u00e0 h\u1ec7 th\u1ed1ng h\u00f4 h\u1ea5p, n\u00f3 s\u1ebd ho\u1ea1t \u0111\u1ed9ng trong v\u00f2ng v\u00e0i ph\u00fat \u0111\u1ec3 lo\u1ea1i b\u1ecf CO2 v\u00e0 qua \u0111\u00f3 lo\u1ea1i b\u1ecf H2CO3 ra kh\u1ecfi c\u01a1 th\u1ec3. Hai c\u01a1 ch\u1ebf \u0111\u1ea7u ti\u00ean gi\u1eef cho n\u1ed3ng \u0111\u1ed9 H+ kh\u00f4ng bi\u1ebfn \u0111\u1ed5i qu\u00e1 nhi\u1ec1u.<\/p>\n

Cho \u0111\u1ebfn khi c\u01a1 ch\u1ebf th\u1ee9 3 \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ed9ng \u0111\u00f3 l\u00e0 th\u1eadn. th\u1eadn lo\u1ea1i b\u1ecf acid ho\u1eb7c base d\u01b0 th\u1eeba ra kh\u1ecfi c\u01a1 th\u1ec3. M\u1eb7c d\u00f9 \u0111\u00e1p \u1ee9ng \u1edf th\u1eadn l\u00e0 t\u01b0\u01a1ng \u0111\u00f3i ch\u1eadm so v\u1edbi c\u00e1c c\u01a1 ch\u1ebf \u0111i\u1ec1u h\u00f2a kh\u00e1c, trong 1 gi\u1edd \u0111\u1ebfn v\u00e0i ng\u00e0y, nh\u01b0ng \u0111\u1ea5y l\u00e0 c\u01a1 ch\u1ebf \u0111i\u1ec1u h\u00f2a m\u1ea1nh nh\u1ea5t trong c\u00e1c c\u01a1 ch\u1ebf \u0111i\u1ec1u h\u00f2a c\u00e2n b\u1eb1ng acid-base trong c\u01a1 th\u1ec3.<\/p>\n

S\u1ef1 b\u00f9 tr\u1eeb hay \u0111\u00e1p \u1ee9ng th\u1ee9 ph\u00e1t ch\u1ec9 qu\u00e1 tr\u00ecnh toan hay ki\u1ec1m do c\u01a1 ch\u1ebf th\u0103ng b\u1eb1ng n\u1ed9i m\u00f4i c\u1ee7a c\u01a1 th\u1ec3 g\u00e2y ra \u0111\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c r\u1ed1i lo\u1ea1n toan ki\u1ec1m b\u1ec7nh l\u00fd. \u0110\u00e1p \u1ee9ng n\u00e0y x\u1ea3y ra b\u1eb1ng c\u00e1ch thay \u0111\u1ed5i th\u00e0nh ph\u1ea7n c\u00f2n l\u1ea1i trong t\u1ec9 l\u1ec7 gi\u1eefa PCO2 v\u00e0 HCO3 theo c\u00f9ng chi\u1ec1u v\u1edbi r\u1ed1i lo\u1ea1n nguy\u00ean ph\u00e1t. C\u1ea7n l\u01b0u \u00fd, hi\u1ec7n t\u01b0\u1ee3ng b\u00f9 tr\u1eeb kh\u00f4ng bao gi\u1edd \u0111\u01b0a pH tr\u1edf v\u1ec1 \u0111\u00fang gi\u00e1 tr\u1ecb trung t\u00ednh c\u1ee7a n\u00f3 ( t\u1ee9c m\u1ed9t r\u1ed1i lo\u1ea1n toan chuy\u1ec3n ho\u00e1 c\u00f3 b\u00f9 tr\u1eeb b\u1eb1ng ki\u1ec1m h\u00f4 h\u1ea5p s\u1ebd lu\u00f4n c\u00f3 pH < 7.4)<\/p>\n

2. C\u00e1c kh\u00e1i ni\u1ec7m trong r\u1ed1i lo\u1ea1n toan ki\u1ec1m\u00a0<\/strong><\/h2>\n

2.1 C\u00e1c \u0111\u00e1p \u1ee9ng trong r\u1ed1i lo\u1ea1n toan ki\u1ec1m chuy\u1ec3n h\u00f3a<\/strong><\/p>\n

C\u00e1c \u0111\u00e1p \u1ee9ng v\u1edbi toan hay ki\u1ec1m chuy\u1ec3n ho\u00e1 l\u00e0 s\u1ef1 thay \u0111\u1ed5i c\u1ee7a th\u00f4ng kh\u00ed ph\u00fat x\u1ea3y ra qua trung gian c\u1ee7a c\u00e1c th\u1ee5 th\u1ec3 ho\u00e1 h\u1ecdc n\u1eb1m t\u1ea1i th\u1ec3 c\u1ea3nh.<\/p>\n

    \n
  • Toan chuy\u1ec3n ho\u00e1<\/li>\n<\/ul>\n

    \u0110\u00e1p \u1ee9ng b\u00f9 tr\u1eeb trong toan chuy\u1ec3n ho\u00e1 l\u00e0 s\u1ef1 tang th\u00f4ng kh\u00ed ph\u00fat ( qua t\u1ea7n s\u1ed1 v\u00e0 th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng). C\u00e1c b\u1ec7nh nh\u00e2n toan chuy\u1ec3n ho\u00e1 s\u1ebd th\u1edf nhanh v\u00e0 s\u00e2u. \u0110\u00e1p \u1ee9ng n\u00e0y th\u01b0\u1eddng x\u1ea3y ra nhanh trong 30-120 ph\u00fat v\u00e0 \u0111\u1ea1t \u0111\u1ec9nh sau 12 \u0111\u1ebfn 24 gi\u1edd<\/p>\n

    M\u1ee9c \u0111\u1ed9 b\u00f9 tr\u1eeb \u0111\u01b0\u1ee3c t\u00ednh theo c\u00f4ng th\u1ee9c sau:<\/p>\n

    \u2206PaCO2 = 1.2x\u2206HCO3<\/p>\n

      \n
    • Ki\u1ec1m chuy\u1ec3n ho\u00e1<\/li>\n<\/ul>\n

      \u0110\u00e1p \u1ee9ng b\u00f9 tr\u1eeb trong ki\u1ec1m chuy\u1ec3n ho\u00e1 l\u00e0 s\u1ef1 gi\u1ea3m th\u00f4ng kh\u00ed ph\u00fat. \u0110\u00e1p \u1ee9ng n\u00e0y y\u1ebfu h\u01a1n so v\u1edbi \u0111\u00e1p \u1ee9ng c\u1ee7a toan chuy\u1ec3n h\u00e1o v\u00ec c\u00e1c th\u1ee5 th\u1ec3 ngo\u1ea1i bi\u1ebfn d\u1ec5 k\u00edch th\u00edch h\u01a1n l\u00e0 \u1ee9c ch\u1ebf.<\/p>\n

      M\u1ee9c \u0111\u1ed9 b\u00f9 tr\u1eeb \u0111\u01b0\u1ee3c t\u00ednh nh\u01b0 sau<\/p>\n

      \u2206PaCO2 = 0.7x\u2206HCO3<\/p>\n

      \"roi-loan-toan-kien\"<\/p>\n

      2.2 C\u00e1c \u0111\u00e1p \u1ee9ng trong toan ki\u1ec1m h\u00f4 h\u1ea5p<\/strong><\/p>\n

      \u0110\u00e1p \u1ee9ng \u0111\u1ed1i v\u1edbi thay \u0111\u1ed5i c\u1ee7a PaCO2 x\u1ea3y ra t\u1ea1i th\u1eadn, v\u1edbi s\u1ef1 thay \u0111\u1ed5i m\u1ee9c \u0111\u1ed9 h\u1ea5p thu HCO3- t\u1ea1i \u1ed1ng l\u01b0\u1ee3n g\u1ea7n t\u01b0\u01a1ng \u1ee9ng v\u1edbi m\u1ee9c \u0111\u1ed9 thay \u0111\u1ed5i PaCO2. \u0110\u00e1p \u1ee9ng n\u00e0y di\u1ec5n ra ch\u1eadm, c\u1ea7n 2-3 ng\u00e0y \u0111\u1ec3 \u0111\u1ea1t m\u1ee9c t\u1ed1i \u0111a; v\u00ec th\u1ebf, toan ki\u1ec1m h\u00f4 h\u1ea5p \u0111\u01b0\u1ee3c chia ra th\u00e0nh hai lo\u1ea1i: c\u1ea5p v\u00e0 m\u1ea1n.<\/p>\n

      \u00a0<\/strong><\/p>\n

        \n
      • R\u1ed1i lo\u1ea1n toan ki\u1ec1m h\u00f4 h\u1ea5p c\u1ea5p<\/strong><\/li>\n<\/ul>\n

        Toan hay ki\u1ec1m h\u00f4 h\u1ea5p c\u1ea5p c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m r\u1ea5t \u00edt g\u00e2y thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 HCO3, th\u1ec3 hi\u1ec7n qua c\u00f4ng th\u1ee9c sau:<\/p>\n

        Toan h\u00f4 h\u1ea5p c\u1ea5p:<\/p>\n

        \u2206HCO3- = 0.1x\u2206PaCO2<\/p>\n

        Ki\u1ec1m h\u00f4 h\u1ea5p c\u1ea5p:<\/p>\n

        \u2206HCO3- = 0.2x\u2206PaCO2<\/p>\n

          \n
        • R\u1ed1i lo\u1ea1n toan ki\u1ec1m h\u00f4 h\u1ea5p m\u1ea1n<\/strong><\/li>\n<\/ul>\n

          Toan hay ki\u1ec1m h\u00f4 h\u1ea5p m\u1ea1n \u0111\u01b0\u1ee3c b\u00f9 tr\u1eeb qua s\u1ef1 gia tang hay gi\u1ea3m h\u1ea5p thu HCO3- \u1edf \u1ed1ng th\u1eadn theo c\u00f9ng chi\u1ec1u c\u1ee7a s\u1ef1 thay \u0111\u1ed5i PaCO2. S\u1ef1 b\u00f9 tr\u1eeb trong toan v\u00e0 ki\u1ec1m h\u00f4 h\u1ea5p m\u1ea1n t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau, qua c\u00f4ng th\u1ee9c:<\/p>\n

          \u2206HCO3- = 0.4x\u2206PaCO2<\/p>\n

          2.3 Kho\u1ea3ng tr\u1ed1ng anion<\/strong><\/p>\n

          Kho\u1ea3ng tr\u1ed1ng anion l\u00e0 tr\u1ecb s\u1ed1 \u01b0\u1edbc l\u01b0\u1ee3ng t\u01b0\u01a1ng \u0111\u1ed1i c\u1ee7a c\u00e1c anion kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c. Trong r\u1ed1i lo\u1ea1n toan ki\u1ec1m, tr\u1ecb s\u1ed1 n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111inh s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a toan chuy\u1ec3n ho\u00e1 c\u00f3 ph\u1ea3i do c\u00e1c acid c\u1ed1 \u0111\u1ecbnh (v\u00ed d\u1ee5 nh\u01b0 acid lactic) g\u00e2y ra hay do m\u1ea5t ion bicarbonat.<\/p>\n

          V\u1ec1 sinh l\u00fd, \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c c\u00e2n b\u1eb1ng ho\u00e1 \u0111i\u1ec7n (electrochemical balance), c\u00e1c anion mang \u0111i\u1ec7n t\u00edch \u00e2m ph\u1ea3i c\u00e2n b\u1eb1ng v\u1edbi c\u00e1c cation t\u00edch \u0111i\u1ec7n d\u01b0\u01a1ng . S\u1ef1 c\u00e2n b\u1eb1ng n\u00e0y th\u1ec3 hi\u1ec7n qua c\u00f4ng th\u1ee9c:<\/p>\n

          Na+UC = Cl+ HCO3-+UA<\/p>\n

          (UC: unmeasured cation, UA: unmeasured anion)<\/p>\n

          Chuy\u1ec3n v\u1ebf c\u00f4ng th\u1ee9c n\u00e0y, ta \u0111\u01b0\u1ee3c<\/p>\n

          UA-UC= Na-Cl-HCO3-<\/p>\n

          UA-UC ch\u00ednh l\u00e0 anion gap (AG), \u0111\u1ea1i di\u1ec7n cho c\u00e1c anion d\u01b0 th\u1eeba kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c.<\/p>\n

          Gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng c\u1ee7a anion gap thay \u0111\u1ed5i tu\u1ef3 theo thi\u1ebft b\u1ecb \u0111o l\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, v\u1edbi ch\u1ec9 s\u1ed1 b\u00ecnh th\u01b0\u1eddng l\u00e0 12 \u00b1 4<\/p>\n

          T\u1ea1i sao ph\u1ea3i hi\u1ec7u h\u1ec9nh AG theo albumin: Albumin l\u00e0 protein t\u00edch \u0111i\u1ec7n \u00e2m ch\u1ee7 y\u1ebfu trong m\u00e1u, v\u00e0 l\u00e0 m\u1ed9t anion kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p gi\u1ea3m albumin m\u00e1u, tr\u1ecb s\u1ed1 AG t\u00ednh \u0111\u01b0\u1ee3c c\u00f3 th\u1ec3 gi\u1ea3m do albumin m\u00e1u gi\u1ea3m, do \u0111\u00f3 ph\u1ea3i hi\u1ec7u ch\u1ec9nh AG theo c\u00f4ng th\u1ee9c:<\/p>\n

          AGc= AG + 2.5 x (4.5-Albumin \u0111o \u0111\u01b0\u1ee3c[g\/l])<\/p>\n

          Trong l\u00e2m s\u00e0ng, AG d\u00f9ng \u0111\u1ec3 ph\u00e2n bi\u1ec7t toan chuy\u1ec3n ho\u00e1 do acid c\u1ed1 \u0111\u1ecbnh hay do m\u1ea5t bicarbonate g\u00e2y ra:<\/p>\n

            \n
          • Toan chuy\u1ec3n ho\u00e1 c\u00f3 AG t\u0103ng: toan lactic, nhi\u1ec5m cetone \u0111\u00e1i thao \u0111\u01b0\u1eddng, suy th\u1eadn giai \u0111o\u1ea1n tr\u1ec5 (m\u1ea5t kh\u1ea3 n\u1eb7ng th\u1ea3i ion H+ \u1edf \u1ed1ng l\u01b0\u1ee3n xa), ng\u1ed9 \u0111\u1ed9c (salicylate, methanol, ethylene glycol).<\/li>\n
          • Toan chuy\u1ec3n ho\u00e1 AG b\u00ecnh th\u01b0\u1eddng: do ti\u1ec3u ch\u1ea3y, do truy\u1ec1n n\u01b0\u1edbc mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng ( t\u0103ng ion Cl- so v\u1edbi n\u1ed3ng \u0111\u1ed9 b\u00ecnh th\u01b0\u1eddng trong m\u00e1u), suy th\u1eadn giai \u0111o\u1ea1n s\u1edbm (m\u1ea5t kh\u1ea3 n\u0103ng h\u1ea5p thu HCO3 t\u1ea1i \u1ed1ng l\u01b0\u1ee3n g\u1ea7n). Toan chuy\u1ec3n ho\u00e1 kh\u00f4ng t\u0103ng AG c\u00f2n g\u1ecdi l\u00e0 toan chuy\u1ec3n ho\u00e1 t\u0103ng chlor m\u00e1u, v\u00ec khi m\u1ea5t HCO3-, ion Cl- s\u1ebd t\u0103ng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o c\u00e2n b\u1eb1ng v\u1ec1 \u0111i\u1ec7n th\u1ebf.<\/li>\n
          • Toan chuy\u1ec3n ho\u00e1 c\u00f3 AG gi\u1ea3m c\u00f3 th\u1ec3 g\u1eb7p trong c\u00e1c b\u1ec7nh l\u00fd g\u00e2y t\u0103ng chlor m\u00e1u b\u1edbi c\u00e1c cation kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c nh\u01b0 ng\u1ed9 \u0111\u1ed9c lithium, bromide, iodide, b\u1ec7nh l\u00fd IgG \u0111\u01a1n d\u00f2ng, hay c\u00e1c b\u1ec7nh g\u00e2y t\u0103ng canxi hay magie m\u00e1u.<\/li>\n<\/ul>\n

            Nhi\u1ec5m toan acid lactic chi\u1ebfm kho\u1ea3ng m\u1ed9t n\u1eeda s\u1ed1 tr\u01b0\u1eddng h\u1ee3p t\u0103ng anion gap v\u00e0 th\u01b0\u1eddng do s\u1ed1c ho\u1eb7c thi\u1ebfu oxy m\u00f4. Tuy nhi\u00ean, anion gap l\u00e0 m\u1ed9t ph\u1ea3n \u1ee9ng t\u01b0\u01a1ng \u0111\u1ed1i kh\u00f4ng nh\u1ea1y c\u1ee7a nhi\u1ec5m toan lactic. Anion gap, c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u d\u01b0\u1edbi 80% trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh n\u1ed3ng \u0111\u1ed9 lactate t\u0103ng cao, kh\u00f4ng th\u1ec3 thay th\u1ebf ph\u00e9p \u0111o m\u1ee9c lactate huy\u1ebft thanh.<\/p>\n

            Anion gap c\u00f3 th\u1ec3 gi\u00fap thi\u1ebft l\u1eadp ch\u1ea9n \u0111o\u00e1n c\u1ee7a nhi\u1ec5m ketoacidosis do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng n\u00e0y, anion gap c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 theo d\u1ecfi t\u00ecnh tr\u1ea1ng toan ceton v\u00e0 gi\u00fap v\u00e0 ch\u1ea9n \u0111o\u00e1n toan anion gap b\u00ecnh th\u01b0\u1eddng k\u00e8m theo.<\/p>\n

            2.4 T\u1ec9 s\u1ed1 gap\/gap<\/strong><\/p>\n

            Khi c\u00f3 toan chuy\u1ec3n ho\u00e1 t\u0103ng anion gap, c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c r\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1 k\u00e8m theo kh\u00e1c nh\u01b0 toan chuy\u1ec3n ho\u00e1 kh\u00f4ng t\u0103ng AG hay ki\u1ec1m chuy\u1ec3n ho\u00e1 b\u1eb1ng c\u00e1ch t\u00ednh t\u1ec9 l\u1ec7 gap\/gap:<\/p>\n

            \u2206AG\/\u2206HCO3-<\/p>\n

            T\u1ec9 l\u1ec7 n\u00e0y cho th\u1ea5y m\u1ee9c \u0111\u1ed9 thay \u0111\u1ed5i c\u1ee7a HCO3- so v\u1edbi anion gap. B\u00ecnh th\u01b0\u1eddng, t\u1ec9 s\u1ed1 n\u00e0y c\u00f3 gi\u00e1 tr\u1ecb t\u1eeb 1-2. N\u1ebfu <1, s\u1ef1 gi\u1ea3m c\u1ee7a HCO3- l\u00e0 qu\u00e1 nhi\u1ec1u, cho th\u1ea5y c\u00f3 toan chuy\u1ec3n ho\u00e1 kh\u00e1c k\u00e8m theo. N\u1ebfu t\u1ec9 s\u1ed1 n\u00e0y >2, c\u00f3 ki\u1ec1m chuy\u1ec3n ho\u00e1 \u0111i k\u00e8m. Trong toan chuy\u1ec3n ho\u00e1 do nhi\u1ec5m cetone \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, vi\u1ec7c truy\u1ec1n qu\u00e1 nhi\u1ec1u n\u01b0\u1edbc mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi th\u1ec3 ketone trong m\u00e1u c\u00f3 th\u1ec3 g\u00e2y toan chuy\u1ec3n ho\u00e1 t\u0103ng AG v\u00e0 toan chuy\u1ec3n ho\u00e1 kh\u00f4ng t\u0103ng AG ph\u1ed1i h\u1ee3p.<\/p>\n

            C\u00e1c t\u00e0i li\u1ec7u m\u1edbi h\u01a1n kh\u00f4ng t\u00ednh t\u1ec9 s\u1ed1 gap\/gap nh\u01b0ng s\u1eed d\u1ee5ng hi\u1ec7u s\u1ed1 gap-gap v\u1edbi c\u00f4ng th\u1ee9c ph\u00e2n bi\u1ec7t r\u00f5 r\u00e0ng gi\u1eefa toan lactic v\u00e0 nhi\u1ec5n ketone \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng:<\/p>\n

            Trong toan lactic:<\/p>\n

            0,6 \u2206AG \u2013\u2206 [HCO3\u2212] = 0 \u00b1 5 mmol\/l\u00edt<\/p>\n

            Trong toan ketone \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng:<\/p>\n

            \u2206AG – \u2206 [HCO3\u2212] = 0 \u00b1 5mmol\/l\u00edt<\/p>\n

            N\u1ebfu > 5mmol\/l\u00edt, c\u00f3 ki\u1ec1m chuy\u1ec3n ho\u00e1 k\u00e8m theo v\u00e0 n\u1ebfu < -5mmol\/l\u00edt c\u00f3 toan chuy\u1ec3n ho\u00e1 kh\u00f4ng t\u0103ng AG \u0111i k\u00e8m<\/p>\n

             <\/p>\n","protected":false},"excerpt":{"rendered":"

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Nhi\u1ec5m toan l\u00e0 t\u00ecnh tr\u1ea1ng t\u0103ng n\u1ed3ng \u0111\u1ed9 ion H+ c\u1ee7a d\u1ecbch ngo\u1ea1i b\u00e0o l\u00e0m cho pH m\u00e1u c\u00f3 […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[23,33],"tags":[],"yoast_head":"\nR\u1ed1i lo\u1ea1n toan ki\u1ec1m v\u00e0 nh\u1eefng kh\u00e1i ni\u1ec7m c\u01a1 b\u1ea3n - Vinmec<\/title>\n<meta name=\"description\" content=\"R\u1ed1i lo\u1ea1n toan ki\u1ec1m l\u00e0 do chuy\u1ec3n ho\u00e1 khi s\u01b0 thay \u0111\u1ed5i c\u1ee7a pH l\u00e0 do HCO3- v\u00e0 r\u1ed1i lo\u1ea1n toan ki\u1ec1m l\u00e0 do h\u00f4 h\u1ea5p khi pH thay \u0111\u1ed5i do CO2 .\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"R\u1ed1i lo\u1ea1n toan ki\u1ec1m v\u00e0 nh\u1eefng kh\u00e1i ni\u1ec7m c\u01a1 b\u1ea3n - 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