{"id":29631,"date":"2023-04-30T00:43:44","date_gmt":"2023-04-29T17:43:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29631"},"modified":"2023-04-30T00:43:44","modified_gmt":"2023-04-29T17:43:44","slug":"tiep-can-lam-sang-tre-nhiem-ceton-do-dai-thao-duong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/30\/tiep-can-lam-sang-tre-nhiem-ceton-do-dai-thao-duong\/","title":{"rendered":"Ti\u1ebfp c\u1eadn l\u00e2m s\u00e0ng tr\u1ebb nhi\u1ec5m ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng"},"content":{"rendered":"

Nhi\u1ec5m toan ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (Diabetic ketoacidosis – DKA) l\u00e0 m\u1ed9t trong c\u00e1c c\u1ea5p c\u1ee9u n\u1ed9i ti\u1ebft th\u01b0\u1eddng g\u1eb7p nh\u1ea5t. Nhi\u1ec5m toan ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (\u0110T\u0110)<\/a> l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng c\u1ea5p t\u00ednh, nguy hi\u1ec3m, \u0111e d\u1ecda t\u00ednh m\u1ea1ng b\u1ec7nh nhi, g\u00e2y ra do thi\u1ebfu h\u1ee5t insulin. Ba b\u1ea5t th\u01b0\u1eddng sinh h\u1ecdc, k\u1ebft h\u1ee3p ch\u1eb7t ch\u1ebd v\u1edbi nhau \u0111\u01b0\u1ee3c th\u1ea5y ch\u1ec9 ri\u00eang trong t\u00ecnh tr\u1ea1ng nhi\u1ec5m toan ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, nhi\u1ec5m ceton v\u00e0 nhi\u1ec5m toan chuy\u1ec3n h\u00f3a.<\/strong><\/p>\n

1. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng nhi\u1ec5m toan ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/strong><\/h2>\n

– Th\u01b0\u1eddng ti\u1ebfn tri\u1ec3n nhanh qua m\u1ed9t kho\u1ea3ng th\u1eddi gian 24 gi\u1edd tr\u01b0\u1edbc khi t\u1edbi vi\u1ec7n<\/p>\n

– C\u00e1c tri\u1ec7u ch\u1ee9ng s\u1edbm nh\u1ea5t c\u1ee7a t\u0103ng \u0111\u01b0\u1eddng m\u00e1u nh\u01b0 \u0111\u00e1i nhi\u1ec1u, kh\u00e1t nhi\u1ec1u, \u0103n nhi\u1ec1u v\u00e0 s\u00fat c\u00e2n<\/p>\n

– C\u00e1c d\u1ea5u hi\u1ec7u s\u1edbm c\u1ee7a nhi\u1ec5m toan ceton bao g\u1ed3m bu\u1ed3n n\u00f4n, n\u00f4n, \u0111au b\u1ee5ng, \u1ec9a ch\u1ea3y v\u00e0 t\u0103ng th\u00f4ng kh\u00ed (th\u1edf nhanh v\u00e0 s\u00e2u, ki\u1ec3u th\u1edf Kussmaul). \u0110au b\u1ee5ng, bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n c\u00f3 th\u1ec3 do vi\u00eam t\u1ee5y ho\u1eb7c nhi\u1ec5m tr\u00f9ng \u1ed5 b\u1ee5ng, c\u1ea3 hai nguy\u00ean nh\u00e2n n\u00e0y \u0111\u1ec1u c\u00f3 kh\u1ea3 n\u0103ng kh\u1edfi ph\u00e1t nhi\u1ec5m toan ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n

– M\u1ea5t n\u01b0\u1edbc to\u00e0n th\u1ec3 n\u1eb7ng v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n da kh\u00f4, gi\u1ea3m \u0111\u1ed9 chun gi\u00e3n da, kh\u00f4 c\u00e1c m\u00e0ng ni\u00eam m\u1ea1c, nh\u00e3n c\u1ea7u nh\u1ebdo, m\u1ea1ch nhanh, t\u1ee5t huy\u1ebft \u00e1p hay t\u00ecnh tr\u1ea1ng s\u1ed1c.<\/p>\n

– Th\u01b0\u1eddng c\u00f3 gi\u1ea3m th\u00e2n nhi\u1ec7t (song c\u00f3 th\u1ec3 t\u0103ng th\u00e2n nhi\u1ec7t khi y\u1ebfu t\u1ed1 g\u00e2y m\u1ea5t b\u00f9 l\u00e0 nhi\u1ec5m khu\u1ea9n ho\u1eb7c khi c\u00f3 t\u00ecnh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc trong t\u1ebf b\u00e0o n\u1eb7ng)<\/p>\n

– Khi t\u00ecnh tr\u1ea1ng t\u0103ng glucose m\u00e1u t\u1ed3i h\u01a1n th\u00ec c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n v\u00e0 ti\u1ebfn tri\u1ec3n t\u1edbi c\u00e1c tr\u1ea1ng th\u00e1i ng\u1ee7 g\u00e0, t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh trung \u01b0\u01a1ng, tr\u1ea1ng th\u00e1i s\u1eefng s\u1edd, co gi\u1eadt v\u00e0 h\u00f4n m\u00ea<\/p>\n

\"Nhi\u1ec5m<\/p>\n

2. Tri\u1ec7u ch\u1ee9ng c\u1eadn l\u00e2m s\u00e0ng<\/h2>\n

– T\u0103ng glucose m\u00e1u > 13,9 mmol\/L (250 mg\/dL), tuy nhi\u00ean glucose m\u00e1u kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng t\u0103ng cao > 13,9 mmol\/L trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p (\u0111\u00f3i \u0103n, c\u00f3 thai ho\u1eb7c \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng insulin tr\u01b0\u1edbc khi t\u1edbi vi\u1ec7n)<\/p>\n

– N\u1ed3ng \u0111\u1ed9 th\u1ea9m th\u1ea5u m\u00e1u r\u1ea5t thay \u0111\u1ed5i nh\u01b0ng th\u01b0\u1eddng t\u0103ng<\/p>\n

– C\u00f3 Ceton m\u00e1u\/ni\u1ec7u v\u00e0 nhi\u1ec5m toan c\u00f3 t\u0103ng kho\u1ea3ng tr\u1ed1ng anion<\/p>\n

– T\u0103ng \u0111\u01b0\u1eddng ni\u1ec7u g\u00e2y l\u1ee3i ti\u1ec3u th\u1ea9m th\u1ea5u v\u00e0 m\u1ea5t n\u01b0\u1edbc to\u00e0n th\u1ec3 n\u1eb7ng<\/p>\n

– T\u0103ng ure v\u00e0 creatinin m\u00e1u do gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn g\u00e2y r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn<\/p>\n

– K+\u00a0m\u00e1u: r\u1ea5t thay \u0111\u1ed5i, n\u1ed3ng \u0111\u1ed9 K+\u00a0m\u00e1u c\u00f3 th\u1ec3 t\u0103ng ho\u1eb7c b\u00ecnh th\u01b0\u1eddng m\u1eb7c d\u00f9 t\u1ed5ng l\u01b0\u1ee3ng kali c\u01a1 th\u1ec3 thi\u1ebfu h\u1ee5t v\u00e0o kho\u1ea3ng 3 \u2013 5 mEq\/kg (do thi\u1ebfu h\u1ee5t insulin, t\u0103ng n\u1ed3ng \u0111\u1ed9 th\u1ea9m th\u1ea5u m\u00e1u v\u00e0 toan m\u00e1u n\u1eb7ng \u0111\u00e3 k\u00e9o K+\u00a0ra kh\u1ecfi t\u1ebf b\u00e0o) ho\u1eb7c h\u1ea1 kali m\u00e1u ch\u1ee9ng t\u1ecf t\u1ed5ng l\u01b0\u1ee3ng kali c\u01a1 th\u1ec3 thi\u1ebfu h\u1ee5t r\u1ea5t l\u1edbn<\/p>\n

– Na+\u00a0m\u00e1u: th\u01b0\u1eddng c\u00f3 gi\u1ea3m n\u1ed3ng \u0111\u1ed9 Na+\u00a0m\u00e1u. Gi\u1ea3m Na+\u00a0m\u00e1u l\u00e0 do:<\/p>\n

+ M\u1ea5t Na+\u00a0do l\u1ee3i ti\u1ec3u th\u1ea9m th\u1ea5u v\u00e0 n\u00f4n<\/p>\n

+ Quan tr\u1ecdng h\u01a1n l\u00e0 do n\u01b0\u1edbc di chuy\u1ec3n t\u1eeb trong t\u1ebf b\u00e0o ra ngo\u00e0i v\u00e0 v\u00e0o kho\u1ea3ng ngo\u1ea1i b\u00e0o\u00a0(n\u1ed3ng \u0111\u1ed9 glucose m\u00e1u t\u0103ng l\u00e0m n\u1ed3ng \u0111\u1ed9 th\u1ea9m th\u1ea5u m\u00e1u\/d\u1ecbch ngo\u1ea1i b\u00e0o t\u0103ng v\u00e0 v\u01b0\u1ee3t qu\u00e1 n\u1ed3ng \u0111\u1ed9 th\u1ea9m th\u1ea5u d\u1ecbch n\u1ed9i b\u00e0o, \u0111\u1ed3ng th\u1eddi glucose l\u1ea1i th\u00e2m nh\u1eadp v\u00e0o n\u1ed9i b\u00e0o qua m\u00e0ng t\u1ebf b\u00e0o r\u1ea5t ch\u1eadm do thi\u1ebfu h\u1ee5t insulin, \u0111\u00e3 l\u00e0m n\u01b0\u1edbc di chuy\u1ec3n t\u1eeb n\u1ed9i b\u00e0o ra ngo\u1ea1i b\u00e0o theo s\u1ef1 ch\u00eanh l\u1ec7ch th\u1ea9m th\u1ea5u)\u00a0\u0111\u00e3 l\u00e0m cho n\u1ed3ng \u0111\u1ed9 Na+\u00a0m\u00e1u h\u1ea1 do b\u1ecb h\u00f2a lo\u00e3ng. Tuy nhi\u00ean, v\u00ec n\u1ed3ng \u0111\u1ed9 glucose m\u00e1u t\u0103ng cao \u0111\u00e3 l\u00e0m cho n\u1ed3ng \u0111\u1ed9 Na+\u00a0m\u00e1u \u0111o \u0111\u01b0\u1ee3c kh\u00f4ng ch\u00ednh x\u00e1c. Do v\u1eady n\u1ed3ng \u0111\u1ed9 Na+\u00a0m\u00e1u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c hi\u1ec7u ch\u1ec9nh theo n\u1ed3ng \u0111\u1ed9 glucose m\u00e1u nh\u01b0 sau:<\/p>\n

\u25e6 M\u1ed7i 100 mg\/dL (5,55 mmol\/L) glucose m\u00e1u t\u0103ng th\u00eam s\u1ebd l\u00e0m gi\u1ea3m b\u1edbt 1,6 mEq\/L Na+\u00a0m\u00e1u. T\u1eeb \u0111\u00f3 ta c\u00f3 c\u00f4ng th\u1ee9c t\u00ednh n\u1ed3ng \u0111\u1ed9 Na+\u00a0m\u00e1u hi\u1ec7u ch\u1ec9nh<\/p>\n

[Na+\u00a0hi\u1ec7u ch\u1ec9nh] = [Na+\u00a0m\u00e1u] + 0,016 x ([glucose m\u00e1u mg\/dL] \u2013 100)<\/p>\n

ho\u1eb7c<\/p>\n

[Na+\u00a0hi\u1ec7u ch\u1ec9nh] = [Na+\u00a0m\u00e1u] + 0,016 x ([glucose m\u00e1u mmol\/L] \u2013 5,55)<\/p>\n

– H\u1ea1 ph\u1ed1t-pho m\u00e1u, h\u1ea1 magi\u00ea m\u00e1u<\/p>\n

3. \u0110\u00e1nh gi\u00e1 ban \u0111\u1ea7u<\/strong><\/h2>\n

– \u0110\u00e1nh gi\u00e1 ban \u0111\u1ea7u \u0111\u01b0\u1eddng th\u1edf, t\u00ecnh tr\u1ea1ng h\u00f4 h\u1ea5p, t\u00ecnh tr\u1ea1ng tim m\u1ea1ch, t\u00ecnh tr\u1ea1ng \u00fd th\u1ee9c v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u s\u1ed1ng, ngay sau \u0111\u00f3:<\/p>\n

– Thu th\u1eadp c\u00e1c th\u00f4ng tin v\u00e0 l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m\/th\u0103m d\u00f2 c\u1ea7n thi\u1ebft:
\n+ Ti\u1ec1n s\u1eed:<\/p>\n

\u25e6 Ti\u1ec1n s\u1eed b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/p>\n

\u25e6 Ti\u1ec1n s\u1eed \u0111i\u1ec1u tr\u1ecb v\u00e0 b\u1ea5t c\u1ee9 s\u1ef1 thay \u0111\u1ed5i n\u00e0o g\u1ea7n \u0111\u00e2y trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/p>\n

\u25e6 C\u00e1c \u0111\u1ee3t nhi\u00eam toan xeton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng tr\u01b0\u1edbc \u0111\u00e2y<\/p>\n

+ B\u1eb1ng ch\u1ee9ng nhi\u1ec5m khu\u1ea9n v\u00e0 c\u00e1c nguy\u00ean nh\u00e2n th\u00fac \u0111\u1ea9y kh\u00e1c.<\/p>\n

+ Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch, ure v\u00e0 cereatinin m\u00e1u, glucose m\u00e1u, \u0111i\u1ec7n gi\u1ea3i m\u00e1u, c\u00f4ng th\u1ee9c m\u00e1u to\u00e0n ph\u1ea7n, c\u1ea5y m\u00e1u v\u00e0 n\u01b0\u1edbc ti\u1ec3u (n\u1ebfu c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u00ec c\u1ea5y c\u1ea3 d\u1ecbch ngo\u00e1y h\u1ecdng), XQ ph\u1ed5i, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3<\/p>\n

+ Xeton m\u00e1u v\u00e0 ni\u1ec7u\u00a0(beta-hydroxybutyrate \u0111\u01b0\u1ee3c bi\u1ebfn \u0111\u1ed5i th\u00e0nh acetoacetate trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m toan xeton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. N\u1ebfu xeton \u0111\u01b0\u1ee3c theo d\u00f5i th\u01b0\u1eddng xuy\u00ean th\u00ec ta s\u1ebd th\u1ea5y t\u00ecnh tr\u1ea1ng nhi\u1ec5m xeton m\u00e1u s\u1ebd t\u1ed3i \u0111i h\u01a1n).<\/p>\n

+ Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh s\u1ecd n\u00e3o v\u00e0\/ho\u1eb7c ch\u1ecdc d\u1ecbch n\u00e3o t\u1ee7y n\u1ebfu c\u00f3 nghi ng\u1edd t\u1ed5n th\u01b0\u01a1ng n\u00e3o v\u00e0 m\u00e0ng n\u00e3o<\/p>\n

+ N\u1ebfu c\u00f3 t\u0103ng kho\u1ea3ng tr\u1ed1ng anion th\u00ec t\u00ecm ki\u1ebfm th\u00eam c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y nhi\u1ec5m toan chuy\u1ec3n h\u00f3a c\u00f3 t\u0103ng kho\u1ea3ng tr\u1ed1ng anion<\/p>\n

 <\/p>\n

4. Ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m toan ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/strong><\/h2>\n

Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n\u00a0 (DKA) theo h\u1ed9i \u0111\u00e1i \u0111\u01b0\u1eddng nhi khoa v\u00e0 thanh thi\u1ebfu ni\u00ean qu\u1ed1c t\u1ebf 2018:<\/p>\n

    \n
  • Hyperglycemia \u2013 Blood glucose >200 mg\/dL (11 mmol\/L)<\/li>\n
  • Metabolic acidosis \u2013 Venous pH <7.3 or serum bicarbonate <15 mEq\/L (15 mmol\/L)<\/li>\n<\/ul>\n

    Ketosis \u2013 Presence of ketones in the blood (>3 mmol\/L beta-hydroxybutyrate) or urine (“moderate or large” urine ketones)<\/p>\n

    M\u1ee9c \u0111\u1ed9<\/p>\n\n\n\n\n\n
    \u0110\u1eb7c \u0111i\u1ec3m<\/td>\nNh\u1eb9<\/td>\nTrung B\u00ecnh<\/td>\nN\u1eb7ng<\/td>\n<\/tr>\n
    PH<\/td>\n7.2-7.3<\/td>\n7.1-7.2<\/td>\n<7.1<\/td>\n<\/tr>\n
    HCO3<\/td>\n10-15<\/td>\n5-10<\/td>\n<5<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n

    5. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/strong><\/h2>\n
      \n
    • H\u00f4n m\u00ea t\u0103ng \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u m\u00e1u\/ \u0110T\u0110<\/li>\n
    • Ti\u00eau ch\u1ea3y m\u1ea5t n\u01b0\u1edbc<\/li>\n
    • Ng\u1ed9 \u0111\u1ed9c salicylate<\/li>\n
    • H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft<\/li>\n<\/ul>\n

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

      Nhi\u1ec5m toan ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (Diabetic ketoacidosis – DKA) l\u00e0 m\u1ed9t trong c\u00e1c c\u1ea5p c\u1ee9u n\u1ed9i ti\u1ebft th\u01b0\u1eddng g\u1eb7p nh\u1ea5t. Nhi\u1ec5m toan ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (\u0110T\u0110) l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng c\u1ea5p t\u00ednh, nguy hi\u1ec3m, \u0111e d\u1ecda t\u00ednh m\u1ea1ng b\u1ec7nh nhi, g\u00e2y ra do thi\u1ebfu h\u1ee5t insulin. Ba b\u1ea5t th\u01b0\u1eddng sinh h\u1ecdc, […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15,80,33],"tags":[],"yoast_head":"\nTi\u1ebfp c\u1eadn l\u00e2m s\u00e0ng tr\u1ebb nhi\u1ec5m ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng - Vinmec<\/title>\n<meta name=\"description\" content=\"Nhi\u1ec5m toan ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (Diabetic ketoacidosis - DKA) l\u00e0 m\u1ed9t trong c\u00e1c c\u1ea5p c\u1ee9u n\u1ed9i ti\u1ebft th\u01b0\u1eddng g\u1eb7p nh\u1ea5t.\" \/>\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=\"Ti\u1ebfp c\u1eadn l\u00e2m s\u00e0ng tr\u1ebb nhi\u1ec5m ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng - 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