{"id":27684,"date":"2023-04-24T10:58:15","date_gmt":"2023-04-24T03:58:15","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27684"},"modified":"2023-04-24T10:58:15","modified_gmt":"2023-04-24T03:58:15","slug":"cac-buoc-phan-tich-roi-loan-toan-kiem","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/cac-buoc-phan-tich-roi-loan-toan-kiem\/","title":{"rendered":"C\u00e1c b\u01b0\u1edbc ph\u00e2n t\u00edch r\u1ed1i lo\u1ea1n toan ki\u1ec1m"},"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.<\/strong><\/p>\n

1. C\u00e1c v\u1ea5n \u0111\u1ec1 c\u1ea7n l\u01b0u \u00fd\u00a0 tr\u00ean l\u00e2m s\u00e0ng<\/strong><\/h2>\n

Tr\u00ean l\u00e2m s\u00e0ng, th\u1ed1ng nh\u1ea5t th\u1ee9 t\u1ef1 ghi c\u1ee7a kh\u00ed m\u00e1u l\u00e0 pH\/pCO2\/PaO2\/HCO3-\/BE<\/p>\n

C\u00e1c gi\u00e1 tr\u1ecb kh\u00ed m\u00e1u \u0111\u01b0\u1ee3c \u0111o tr\u1ef1c ti\u1ebfp g\u1ed3m<\/p>\n

    \n
  • pH<\/li>\n
  • PaCo2<\/li>\n
  • PaO2<\/li>\n<\/ul>\n

    C\u00e1c gi\u00e1 tr\u1ecb kh\u00e1c \u0111\u1ec1u \u0111\u01b0\u1ee3c t\u00ednh to\u00e0n t\u1eeb 3 gi\u00e1 tr\u1ecb n\u00e0y.<\/p>\n

    Nhi\u1ec7t \u0111\u1ed9, FiO2 v\u00e0 Hemoglobin c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c gi\u00e1 tr\u1ecb c\u1ee7a kh\u00ed m\u00e1u. N\u1ebfu kh\u00f4ng ghi m\u00e1y th\u1ef1c hi\u1ec7n \u1edf \u0111i\u1ec1u ki\u1ec7n: Hb 15g\/dl, FiO2<\/sub> 21%, N\u0110 37.<\/p>\n

    Kh\u00ed m\u00e1u \u0111\u1ec3 qu\u00e1 l\u00e2u s\u1ebd g\u00e2y khu\u1ebfch t\u00e1n kh\u00ed v\u00e0o syringe nh\u1ef1a d\u1eabn \u0111\u1ebfn sai l\u1ec7ch k\u1ebft qu\u1ea3 \u00e0 th\u1ef1c hi\u1ec7n s\u1edbm trong v\u00f2ng 15 ph\u00fat sau khi l\u1ea5y m\u1eabu m\u00e1u. N\u1ebfu trong m\u1eabu m\u00e1u l\u1ea5y c\u00f3 b\u00f3ng kh\u00ed s\u1ebd g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 PaO2. S\u1eed d\u1ee5ng heparin ch\u1ed1ng \u0111\u00f4ng c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m PaCo2 n\u1ebfu th\u1ec3 t\u00edch m\u00e1u kh\u00f4ng \u0111\u1ee7 ( t\u1ed1i thi\u1ec3u 0,6ml). B\u1ea1ch c\u1ea7u m\u00e1u t\u0103ng cao c\u00f3 th\u00ea g\u00e2y gi\u1ea3m PaO2 gi\u1ea3.<\/p>\n

    Kh\u00ed m\u00e1u t\u0129nh m\u1ea1ch: d\u1ec5 l\u1ea5y h\u01a1n kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch. pH v\u00e0 PCO2 \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 t\u01b0\u01a1ng quan v\u1edbi kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch.<\/p>\n

    2. C\u00e1c b\u01b0\u1edbc ph\u00e2n t\u00edch r\u1ed1i lo\u1ea1n toan ki\u1ec1m<\/strong><\/h2>\n

    B\u01b0\u1edbc 1. <\/strong>\u00a0\u0110\u1ecdc pH \u0111\u1ebf x\u00e1c \u0111\u1ecbnh r\u1ed1i lo\u1ea1n nguy\u00ean ph\u00e1t<\/p>\n

    N\u1ebfu pH <7.35: r\u1ed1i lo\u1ea1n nguy\u00ean ph\u00e1t l\u00e0 toan<\/p>\n

    N\u1ebfu pH >7.45 r\u1ed1i lo\u1ea1n nguy\u00ean ph\u00e1t l\u00e0 ki\u1ec1m<\/p>\n

    B\u01b0\u1edbc 2<\/strong>. X\u00e1c \u0111\u1ecbnh r\u1ed1i lo\u1ea1n nguy\u00ean ph\u00e1t l\u00e0 h\u00f4 h\u1ea5p hay chuy\u1ec3n ho\u00e1<\/p>\n

    D\u1ef1a tr\u00ean s\u1ef1 thay \u0111\u1ed5i c\u1ee7a PaCO2 so v\u1edbi pH. N\u1ebfu thay \u0111\u1ed5i c\u00f9ng chi\u1ec1u: r\u1ed1i lo\u1ea1n toan ki\u1ec1m chuy\u1ec3n ho\u00e1, n\u1ebfu thay \u0111\u1ed5i ng\u01b0\u1ee3c chi\u1ec1u l\u00e0 r\u1ed1i lo\u1ea1n toan ki\u1ec1m h\u00f4 h\u1ea5p.<\/p>\n

    Trong tr\u01b0\u1eddng h\u1ee3p pH b\u00ecnh th\u01b0\u1eddng, pCO2 thay \u0111\u1ed5i, s\u1ef1 thay \u0111\u1ed5i c\u1ee7a pCO2 cho bi\u1ebft lo\u1ea1i r\u1ed1i lo\u1ea1n toan ki\u1ec1m h\u00f4 h\u1ea5p, v\u00e0 t\u1eeb \u0111\u00f3 suy ra laoi5 r\u1ed1i lo\u1ea1n toan ki\u1ec1m chuy\u1ec3n ho\u00e1. C\u1ea3 hai r\u1ed1i lo\u1ea1n toan ki\u1ec1m chuy\u1ec3n ho\u00e1 v\u00e0 h\u00f4 h\u1ea5p trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y \u0111\u1ec1u l\u00e0 nguy\u00ean ph\u00e1t v\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u1eddng nhau<\/p>\n

    Trong tr\u01b0\u1eddng h\u1ee3p pCO2 b\u00ecnh th\u01b0\u1eddng, pH thay \u0111\u1ed5i, s\u1ef1 thay \u0111\u1ed5i c\u1ee7a pH cho bi\u1ebft lo\u1ea1i r\u1ed1i lo\u1ea1n toan ki\u1ec1m chuy\u1ec3n ho\u00e1, t\u1eeb \u0111\u00f3 suy ra r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p t\u01b0\u01a1ng \u1ee9ng. C\u1ea3 hai r\u1ed1i lo\u1ea1n toan ki\u1ec1m chuy\u1ec3n ho\u00e1 v\u00e0 h\u00f4 h\u1ea5p trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y \u0111\u1ec1u l\u00e0 nguy\u00ean ph\u00e1t v\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau.<\/p>\n

    Hay c\u00f3 th\u1ec3 d\u1ef1a tr\u00ean ch\u1ec9 s\u1ed1 BE. N\u1ebfu BE <-5: toan chuy\u1ec3n ho\u00e1, BE >5 ki\u1ec1m chuy\u1ec3n ho\u00e1.<\/p>\n\n\n\n\n\n\n
    <\/td>\nPH t\u0103ng<\/strong><\/td>\nPH b\u00ecnh th\u01b0\u1eddng<\/strong><\/td>\nPH gi\u1ea3m<\/strong><\/td>\n<\/tr>\n
    PCO2<\/sub>\u00a0t\u0103ng<\/td>\nKi\u1ec1m chuy\u1ec3n h\u00f3a<\/td>\nToan ki\u1ec1m h\u1ed7n h\u1ee3p<\/td>\nToan h\u00f4 h\u1ea5p<\/td>\n<\/tr>\n
    PaCO2<\/sub>\u00a0b\u00ecnh th\u01b0\u1eddng<\/td>\nKi\u1ec1m chuy\u1ec3n h\u00f3a<\/td>\n\u00a0\u00a0\u00a0 B\u00ecnh th\u01b0\u1eddng<\/td>\nToan chuy\u1ec3n h\u00f3a<\/td>\n<\/tr>\n
    PaCO2<\/sub>\u00a0gi\u1ea3m<\/td>\nKi\u1ec1m h\u00f4 h\u1ea5p<\/td>\nToan ki\u1ec1m h\u1ed7n h\u1ee3p<\/td>\nToan chuy\u1ec3n h\u00f3a<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n

    B\u01b0\u1edbc 3 <\/strong>N\u1ebfu r\u1ed1i lo\u1ea1n nguy\u00ean ph\u00e1t l\u00e0 toan hay ki\u1ec1m h\u00f4 h\u1ea5p \u00e0 x\u00e1c \u0111\u1ecbnh c\u1ea5p hay m\u1ea1n<\/p>\n

      \n
    • N\u1ebfu l\u00e0 toan h\u00f4 h\u1ea5p: t\u00ednh t\u1ec9 l\u1ec7 \u2206pH\/\u2206PCO2<\/li>\n<\/ul>\n

      \u2206pH\/\u2206PCO2 < 0.003: S\u1ef1 thay \u0111\u1ed5i c\u1ee7a pH qu\u00e1 \u00edt\u00e0 c\u00f3 r\u1ed1i lo\u1ea1n ki\u1ec1m chuy\u1ec3n ho\u00e1 k\u00e8m theo<\/p>\n

      \u2206pH\/\u2206PCO2=0.003: toan h\u00f4 h\u1ea5p m\u1ea1n<\/p>\n

      \u2206pH\/\u2206PCO2 >0.003 – <0.008: toan h\u00f4 h\u1ea5p c\u1ea5p tr\u00ean n\u1ec1n m\u1ea1n<\/p>\n

      \u2206pH\/\u2206PCO2 =0.008: toan h\u00f4 h\u1ea5p c\u1ea5p<\/p>\n

      \u2206pH\/\u2206PCO2 >0.008: S\u1ef1 thay \u0111\u1ed5i pH qu\u00e1 nhi\u1ec1u \u00e0 c\u00f3 r\u1ed1i lo\u1ea1n toan chuy\u1ec3n ho\u00e1 k\u00e8m theo<\/p>\n

        \n
      • N\u1ebfu l\u00e0 ki\u1ec1m h\u00f4 h\u1ea5p: t\u00ednh t\u1ec9 l\u1ec7 \u2206pH\/\u2206PCO2<\/li>\n<\/ul>\n

        \u2206pH\/\u2206PCO2 < 0.003: S\u1ef1 thay \u0111\u1ed5i c\u1ee7a pH qu\u00e1 \u00edt\u00e0 c\u00f3 r\u1ed1i lo\u1ea1n toan chuy\u1ec3n ho\u00e1 k\u00e8m theo<\/p>\n

        \u2206pH\/\u2206PCO2=0.003: ki\u1ec1m h\u00f4 h\u1ea5p m\u1ea1n<\/p>\n

        \u2206pH\/\u2206PCO2 >0.003 – <0.008: ki\u1ec1m h\u00f4 h\u1ea5p c\u1ea5p tr\u00ean n\u1ec1n m\u1ea1n<\/p>\n

        \u2206pH\/\u2206PCO2 =0.008: ki\u1ec1m h\u00f4 h\u1ea5p c\u1ea5p<\/p>\n

        \u2206pH\/\u2206PCO2 >0.008: S\u1ef1 thay \u0111\u1ed5i pH qu\u00e1 nhi\u1ec1u \u00e0 c\u00f3 r\u1ed1i lo\u1ea1n ki\u1ec1m chuy\u1ec3n ho\u00e1 k\u00e8m theo<\/p>\n

        C\u00e1ch kh\u00e1c: \u00a0<\/strong>Quan s\u00e1t s\u1ef1 thay \u0111\u1ed5i c\u1ee7a HCO3- trong c\u00e1c r\u1ed1i lo\u1ea1n toan ki\u1ec1m h\u00f4 h\u1ea5p, n\u1ebfu c\u00f3 s\u1ef1 thya \u0111\u1ed5i HCO3- \u0111\u00e1ng k\u1ec3, r\u1ed1i lo\u1ea1n toan ki\u1ec1m h\u00f4 h\u1ea5p l\u00e0 m\u1ea1n t\u00ednh v\u00e0 ng\u01b0\u1ee3c l\u1ea1i n\u1ebfu kh\u00f4ng thay \u0111\u1ed5i HCO3- \u0111\u00e1ng k\u1ec3 th\u00ec r\u1ed1i lo\u1ea1n toan ki\u1ec1m h\u00f4 h\u1ea5p l\u00e0 c\u1ea5p t\u00ednh. C\u0169ng c\u00f3 th\u1ec3 t\u00ednh \u0111\u00e1p \u1ee9ng c\u1ee7a HCO3- \u1edf c\u00f4ng th\u1ee9c \u0111\u00e3 n\u00eau tr\u00ean \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh r\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1 k\u00e8m theo.<\/em><\/p>\n

          \n
        • N\u1ebfu r\u1ed1i lo\u1ea1n nguy\u00ean ph\u00e1t l\u00e0 toan ki\u1ec1m chuy\u1ec3n ho\u00e1.<\/li>\n<\/ul>\n

          Trong r\u1ed1i lo\u1ea1n toan ki\u1ec1m chuy\u1ec3n ho\u00e1, v\u1ea5n \u0111\u1ec1 c\u1ea5p hay m\u1ea1n kh\u00f4ng quan tr\u1ecdng v\u00e0 b\u01b0\u1edbc ti\u1ebfp theo l\u00e0 x\u00e1c \u0111\u1ecbnh c\u00f3 r\u1ed1i lo\u1ea1n toan ki\u1ec1m h\u00f4 h\u1ea5p k\u00e8m theo hay kh\u00f4ng b\u1eb1ng c\u00e1ch t\u00ednh to\u00e1n PaCO2 d\u1ef1 ki\u1ebfn. N\u1ebfu PaCO2 th\u1ef1c t\u1ebf cao h\u01a1n t\u00ednh to\u00e1n, c\u00f3 toan h\u00f4 h\u1ea5p k\u00e8m theo v\u00e0 ng\u01b0\u1ee3c l\u1ea1i.<\/p>\n

            \n
          • N\u1ebfu r\u1ed1i lo\u1ea1n nguy\u00ean ph\u00e1t l\u00e0 toan chuy\u1ec3n ho\u00e1,<\/strong> \u00e1p d\u1ee5ng c\u00f4ng th\u1ee9c Winter:<\/li>\n<\/ul>\n

            PaCO2<\/sub> d\u1ef1 \u0111o\u00e1n = 1.5 HCO3<\/sub> + 8 \u00b1 2<\/p>\n

            N\u1ebfu PaCO2 th\u1ef1c t\u1ebf cao h\u01a1n t\u00ednh to\u00e1n, c\u00f3 toan h\u00f4 h\u1ea5p k\u00e8m theo v\u00e0 ng\u01b0\u1ee3c l\u1ea1i, n\u1ebfu th\u1ea5p h\u01a1n d\u1ef1 \u0111o\u00e1n ngh\u0129a l\u00e0 c\u00f3 ki\u1ec1m h\u00f4 h\u1ea5p \u0111i k\u00e8m.<\/p>\n

              \n
            • N\u1ebfu r\u1ed1i lo\u1ea1n nguy\u00ean ph\u00e1t l\u00e0 ki\u1ec1m \u00a0chuy\u1ec3n ho\u00e1,<\/strong> \u00e1p d\u1ee5ng c\u00f4ng th\u1ee9c:<\/li>\n<\/ul>\n

              PaCO2<\/sub> d\u1ef1 \u0111o\u00e1n = 0.7 HCO3<\/sub> + 20 \u00b1 1.5<\/p>\n

              N\u1ebfu PaCO2 th\u1ef1c t\u1ebf cao h\u01a1n t\u00ednh to\u00e1n, c\u00f3 toan h\u00f4 h\u1ea5p k\u00e8m theo v\u00e0 ng\u01b0\u1ee3c l\u1ea1i, n\u1ebfu th\u1ea5p h\u01a1n d\u1ef1 \u0111o\u00e1n ngh\u0129a l\u00e0 c\u00f3 ki\u1ec1m h\u00f4 h\u1ea5p \u0111i k\u00e8m.<\/p>\n

              B\u01b0\u1edbc 4. <\/strong>\u00a0Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 toan chuy\u1ec3n ho\u00e1, x\u00e1c \u0111\u1ecbnh anion gap.<\/p>\n

              B\u01b0\u1edbc 4a:<\/strong> T\u00ednh AG<\/p>\n

              B\u01b0\u1edbc 4b:<\/strong> Hi\u1ec7u ch\u1ec9nh theo albumin n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 gi\u1ea3m albumin<\/p>\n

              B\u01b0\u1edbc 5. <\/strong>Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u0103ng anion gap, t\u00ednh gap\/gap<\/p>\n

              \u00a0<\/strong>DAG\/DHCO3<\/sub><\/p>\n

                \n
              • DAG\/DHCO3 < 1: Toan chuy\u1ec3n h\u00f3a AG b\u00ecnh th\u01b0\u1eddng ph\u1ed1i h\u1ee3p.<\/li>\n
              • 1 \u2264 D AG\/ D HCO3 \u2264 2: Toan CH anion gap t\u0103ng<\/li>\n
              • DAG\/DHCO3 > 2: Ki\u1ec1m chuy\u1ec3n h\u00f3a k\u00e8m.<\/li>\n<\/ul>\n

                3. X\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n g\u00e2y r\u1ed1i lo\u1ea1n toan ki\u1ec1m.<\/strong><\/h2>\n

                Vi\u1ec7c x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n g\u00e2y r\u1ed1i lo\u1ea1n toan ki\u1ec1m kh\u00f4ng th\u1ec3 d\u1ef1a ho\u00e0n to\u00e0n v\u00e0o ph\u00e2n t\u00edch kh\u00ed m\u00e1u m\u00e0 c\u00f2n ph\u1ea3i d\u1ef1a v\u00e0o b\u1ec7nh s\u1eed v\u00e0 th\u0103m kh\u00e1m l\u00e2m s\u00e0ng, t\u1eadp trung v\u00e0o<\/p>\n

                  \n
                • M\u1ea1ch (l\u01b0u \u00fd shock, thi\u1ebfu oxy m\u00f4)<\/li>\n
                • Tri gi\u00e1c ( \u00fd th\u1ee9c, h\u00f4n m\u00ea)<\/li>\n
                • Nhi\u1ec7t \u0111\u1ed9 (s\u1ed1t, nhi\u1ec5m tr\u00f9ng)<\/li>\n
                • Ki\u1ec3u th\u1edf (Kussmaul, t\u1ea7n s\u1ed1, ng\u00f3n tay d\u00f9i tr\u1ed1ng, t\u00edm)<\/li>\n
                • Tri\u1ec7u ch\u1ee9ng ti\u00eau ho\u00e1 (n\u00f4n \u00f3i, ti\u00eau ch\u1ea3y, d\u1eabn l\u01b0u)<\/li>\n<\/ul>\n

                  Ti\u1ec1n s\u1eed: l\u01b0u \u00fd c\u00f3 thai, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 b\u1ec7nh tim, gan, ph\u1ed5i, th\u1eadn, c\u00e1c thu\u1ed1c \u0111\u00e3 d\u00f9ng v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a ng\u1ed9 \u0111\u1ed9c<\/p>\n

                    \n
                  • Toan h\u00f4 h\u1ea5p<\/strong><\/li>\n<\/ul>\n

                    D\u1ef1a tr\u00ean ch\u00eanh \u00e1p ph\u1ebf nang mao m\u1ea1ch, c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y toan h\u00f4 h\u1ea5p (gi\u1ea3m th\u00f4ng kh\u00ed) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia th\u00e0nh t\u1ea1i ph\u1ed5i hay ngo\u00e0i ph\u1ed5i.<\/p>\n

                    A-a Gradient = (FIO2 * (pAtm – pH2O)) – (pCO2 \/ RespQuot))- paO2<\/p>\n

                    Gi\u00e1 tr\u1ecbnh b\u00ecnh th\u01b0\u1eddng c\u1ee7a ch\u00eanh \u00e1p ph\u1ebf nang mao m\u1ea1ch ph\u1ee5 thu\u1ed9c v\u00e0o n\u1ed3ng \u0111\u1ed9 FiO2 kh\u00ed h\u00edt v\u00e0o v\u00e0 \u0111\u1ed9 tu\u1ed5i, c\u00f3 th\u1ec3 \u01b0\u1edbc t\u00ednh : A-a gradient < tu\u1ed5i\/4 + 4mmHg.<\/p>\n

                    C\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p:<\/p>\n

                      \n
                    • Gi\u1ea3m th\u00f4ng kh\u00ed\n
                        \n
                      • \u1ee8c ch\u1ebf CNS: ti\u1ec1n s\u1eed thu\u1ed1c, th\u1edf ch\u1eadm, RLTG\u2026<\/li>\n
                      • B\u1ec7nh l\u00fd th\u1ea7n kinh c\u01a1: b\u1ec7nh s\u1eed, s\u1ee9c c\u01a1, c\u00f4ng th\u1edf\u2026<\/li>\n<\/ul>\n<\/li>\n
                      • B\u1ec7nh l\u00fd nhu m\u00f4 ph\u1ed5i\n
                          \n
                        • Vi\u00eam ph\u1ed5i n\u1eb7ng: b\u1ec7nh s\u1eed, th\u0103m kh\u00e1m h\u00f4 h\u1ea5p, XQ..<\/li>\n<\/ul>\n<\/li>\n
                        • T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng d\u1eabn kh\u00ed tr\u00ean\n
                            \n
                          • D\u1ecb v\u1eadt; b\u1ec7nh s\u1eed, HC x\u00e2m nh\u1eadp, XQ\/CT\/NS<\/li>\n
                          • Croup: th\u1edf r\u00edt, b\u1ec7nh s\u1eed…<\/li>\n<\/ul>\n<\/li>\n
                          • T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf d\u01b0\u1edbi\n
                              \n
                            • Hen: b\u1ec7nh s\u1eed kh\u00f2 kh\u00e8 t\u00e1i di\u1ec5n, rale ng\u00e0y r\u00edt, tu\u1ed5i\u2026<\/li>\n
                            • VTPQ: b\u1ec7nh s\u1eed, rale ng\u00e1y, kh\u00f2 kh\u00e8<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                              Toan chuy\u1ec3n ho\u00e1 t\u0103ng anion gap<\/strong><\/p>\n

                              Th\u01b0\u1eddng c\u00f3 b\u1ec7nh c\u1ea3nh v\u00e0 b\u1ec7nh s\u1eed l\u00e2m s\u00e0ng r\u00f5 r\u00e0ng ( \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, ng\u1ed9 \u0111\u1ed9c\u2026) c\u1ea7n l\u01b0u \u00fd t\u00ecm ki\u1ebfm r\u1ed1i lo\u1ea1n toan ki\u1ec1m ph\u1ed1i h\u1ee3p b\u1eb1ng vi\u1ec7c t\u00ednh t\u1ec9 s\u1ed1 gap\/gap. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, vi\u1ec7c t\u00ednh kho\u1ea3ng tr\u1ed1ng \u00e1p su\u1ea5t th\u1ea9m th\u1ea5u huy\u1ebft thanh ( serum osmolality gap) c\u00f3 th\u1ec3 gi\u00fap g\u1ee3i \u00fd ch\u1ea9n \u0111o\u00e1n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 toan AG cao kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c, hay c\u00f3 y\u1ebfu t\u1ed1 g\u1ee3i \u00fd ng\u1ed9 \u0111\u1ed9c (h\u00f4n m\u00ea):<\/p>\n

                              2 \u00d7 ([Na] [mmol\/l]) +\u00a0 (glucose [mg\/dl]) \u00f7\u00a0 18 + (BUN [mg\/dl]) \u00f7 2.8<\/p>\n

                              Gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng c\u1ee7a \u00e1p su\u1ea5t th\u1ea9m th\u1ea5u huy\u1ebft thanh l\u00e0 275-295 mosm\/kg. N\u1ebfu kho\u1ea3ng tr\u1ed1ng \u00e1p su\u1ea5t th\u1ea9m th\u1ea5u huy\u1ebft thanh > 10 mosm\/kg c\u00f3 \u00fd ngh\u0129a g\u1ee3i \u00fd ng\u1ed9 \u0111\u1ed9c ethanol hay methanol v\u00e0 m\u1ed9t v\u00e0i t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd kh\u00e1c.<\/p>\n

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

                                \n
                              • Toan chuy\u1ec3n ho\u00e1 kh\u00f4ng t\u0103ng anion gap<\/strong><\/li>\n<\/ul>\n

                                V\u1ec1 c\u01a1 b\u1ea3n, toan chuy\u1ec3n ho\u00e1 kh\u00f4ng t\u0103ng anion gap l\u00e0 s\u1ef1 m\u1ea5t ion bicarbonate trong huy\u1ebft t\u01b0\u01a1ng, v\u00e0 s\u1ef1 t\u0103ng ion Cl- t\u01b0\u01a1ng \u1ee9ng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o c\u00e2n b\u1eb1ng \u0111i\u1ec7n th\u1ebf. Khi c\u00f3 t\u0103ng n\u1ed3ng \u0111\u1ed9 ion Cl-, th\u1eadn s\u1ebd t\u0103ng th\u1ea3i Amonium \u1edf d\u1ea1ng \u00adNH\u00ad4<\/sub>Cl do \u0111\u00f3, vi\u1ec7c \u0111o l\u01b0\u1eddng n\u1ed3ng \u0111\u1ed9 Amoni trong n\u01b0\u1edbc ti\u1ec3u s\u1ebd gi\u00fap x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n t\u1ea1i th\u1eadn hay ngo\u00e0i th\u1eadn c\u1ee7a toan chuy\u1ec3n ho\u00e1 kh\u00f4ng t\u0103ng anion gap. Tuy nhi\u00ean, l\u00e2m s\u00e0ng hi\u1ebfm khi \u0111o \u0111\u01b0\u1ee3c ammonium n\u01b0\u1edbc ti\u1ec3u v\u00e0 th\u01b0\u1eddng d\u1ef1a v\u00e0o anion gap ni\u1ec7u v\u00e0 gap th\u1ea9m th\u1ea5u n\u01b0\u1edbc ti\u1ec3u nh\u01b0 l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u01b0\u1edbc \u0111o\u00e1n thay th\u1ebf.<\/p>\n

                                C\u00f4ng th\u1ee9c t\u00ednh anion gap ni\u1ec7u nh\u01b0 sau:<\/p>\n

                                UAG = UNa<\/sup> + UK<\/sup>– Ucl<\/sup><\/p>\n

                                \u00dd ngh\u0129a:<\/p>\n

                                  \n
                                • N\u1ebfu UAG \u00e2m: khi m\u1ea5t HCO3-, th\u1eadn s\u1ebd th\u1ea3i acid, c\u1ee5 th\u1ec3 l\u00e0 NH4+ (\u0111i chung v\u1edbi Cl-) \u00e0 t\u0103ng th\u1ea3i Cl- \u00e0 UAG <0<\/li>\n
                                • N\u1ebfu UAG d\u01b0\u01a1ng: th\u1eadn m\u1ea5t kh\u1ea3 n\u0103ng acid h\u00f3a n\u01b0\u1edbc ti\u1ec3u \u00e0 RTA<\/li>\n<\/ul>\n

                                   <\/p>\n","protected":false},"excerpt":{"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. 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 khuynh […]<\/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":"\nC\u00e1c b\u01b0\u1edbc ph\u00e2n t\u00edch r\u1ed1i lo\u1ea1n toan ki\u1ec1m - 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=\"C\u00e1c b\u01b0\u1edbc ph\u00e2n t\u00edch r\u1ed1i lo\u1ea1n toan ki\u1ec1m - 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