{"id":29642,"date":"2023-04-30T00:43:25","date_gmt":"2023-04-29T17:43:25","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29642"},"modified":"2023-04-30T00:43:25","modified_gmt":"2023-04-29T17:43:25","slug":"dieu-tri-nhiem-ceton-do-dai-thao-duong-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/30\/dieu-tri-nhiem-ceton-do-dai-thao-duong-o-tre-em\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb nhi\u1ec5m ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u1edf tr\u1ebb em"},"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. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb toan ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u1edf tr\u1ebb em<\/strong><\/h2>\n
    \n
  • \u0110i\u1ec1u tr\u1ecb m\u1ea5t n\u01b0\u1edbc.<\/li>\n
  • Insulin truy\u1ec1n t\u0129nh m\u1ea1ch d\u1ec5 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 \u0111i\u1ec1u tr\u1ecb toan m\u00e1u.<\/li>\n
  • \u0110i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i.<\/li>\n
  • Ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng ph\u00f9 n\u00e3o, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, h\u1ea1 Kali m\u00e1u.<\/li>\n
  • T\u00ecm v\u00e0 \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n nhi\u1ec5m tr\u00f9ng n\u1ebfu c\u00f3.<\/li>\n<\/ul>\n

    2. \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u<\/strong><\/h2>\n

    2.1. H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p<\/strong>: th\u00f4ng \u0111\u01b0\u1eddng th\u1edf, th\u1edf oxy<\/p>\n

    2.2. Thi\u1ebft l\u1eadp 2 \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch<\/strong><\/p>\n

      \n
    • \u0110\u01b0\u1eddng 1: b\u00f9 d\u1ecbch.<\/li>\n
    • \u0110\u01b0\u1eddng 2: truy\u1ec1n insulin<\/li>\n<\/ul>\n

      2.3. X\u00e9t nghi\u1ec7m<\/strong><\/p>\n

        \n
      • L\u1ea5y m\u00e1u x\u00e9t nghi\u1ec7m: Dextrostix, \u0111\u01b0\u1eddng huy\u1ebft, ion \u0111\u1ed3, BUN, creatinin, kh\u00edm\u00e1u, CTM.<\/li>\n
      • N\u01b0\u1edbc ti\u1ec3u: \u0111\u01b0\u1eddng, ketones (d\u00f9ng uristix).<\/li>\n<\/ul>\n

        2.4. B\u00f9 d\u1ecbch v\u00e0 \u0111i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i (\u0111\u01b0\u1eddng truy\u1ec1n 1)<\/strong><\/p>\n

          \n
        • B\u1ec7nh nh\u00e2n c\u00f3 s\u1ed1c: b\u1eaft \u0111\u1ea7u truy\u1ec1n Normal saline 20 ml\/kg TTM nhanh cho \u0111\u1ebfn khi ra s\u1ed1c v\u00e0 duy tr\u00ec Normal saline 10 ml\/kg\/gi\u1edd x 2 gi\u1edd. Th\u01b0\u1eddng Normal saline \u0111\u01b0\u1ee3c truy\u1ec1n duy tr\u00ec nhi\u1ec1u gi\u1edd sau \u0111\u00f3, trung b\u00ecnh 8 \u2013 12 gi\u1edd.<\/li>\n
        • B\u1ec7nh nh\u00e2n kh\u00f4ng s\u1ed1c:<\/li>\n<\/ul>\n

          – T\u00ednh \u0111\u1ed9 m\u1ea5t n\u01b0\u1edbc:<\/p>\n

          + M\u1ea5t n\u01b0\u1edbc \u2265 7%: truy\u1ec1n Normal saline 10 ml\/kg\/gi\u1edd \u0111\u1ea7u trong 1 – 2 gi\u1edd,<\/p>\n

          sau \u0111\u00f3 \u0111\u00e1nh gi\u00e1 l\u1ea1i truy\u1ec1n duy tr\u00ec.<\/p>\n

          + M\u1ea5t n\u01b0\u1edbc < 7%: l\u01b0\u1ee3ng d\u1ecbch b\u00f9 trong 24 gi\u1edd b\u1eb1ng 80% nhu c\u1ea7u c\u01a1 b\u1ea3n + d\u1ecbch m\u1ea5t # 5% c\u00e2n n\u1eb7ng. Th\u01b0\u1eddng s\u1ebd \u0111i\u1ec1u ch\u1ec9nh trong v\u00f2ng 48 gi\u1edd.<\/p>\n

          Dung d\u1ecbch \u0111\u01b0\u1ee3c ch\u1ecdn ban \u0111\u1ea7u l\u00e0 Latate Ringer ho\u1eb7c Normalsaline, sau \u0111\u00f3 duy tr\u00ec v\u1edbi saline 0,45% trong Dextrose 5%.<\/p>\n

            \n
          • B\u00f9 Kali: m\u1ee5c ti\u00eau gi\u1eef Kali m\u00e1u trong kho\u1ea3ng 4 – 5 mEq\/L.<\/li>\n<\/ul>\n

            Sau khi \u0111\u00e3 truy\u1ec1n insulin v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 n\u01b0\u1edbc ti\u1ec3u:<\/p>\n

            – Kali m\u00e1u th\u1ea5p \u2264 3,5 mEq\/L: kali 40 mEq\/L.<\/p>\n

            – Kali m\u00e1u b\u00ecnh th\u01b0\u1eddng 3,5 – 5 mEq\/L: Kali 20 mEq\/L (Kali trong m\u00e1u c\u00f3 th\u1ec3b\u00ecnh th\u01b0\u1eddng khi t\u1ed5ng l\u01b0\u1ee3ng Kali trong c\u01a1 th\u1ec3 gi\u1ea3m do toan m\u00e1u, Kali ra ngo\u00e0i t\u1ebf b\u00e0o).<\/p>\n

            – Kali m\u00e1u cao > 5 mEq\/L: kh\u00f4ng pha th\u00eam Kali.<\/p>\n

            2.5. Insulin (\u0111\u01b0\u1eddng truy\u1ec1n 2)<\/strong><\/p>\n

              \n
            • Insulin \u0111\u01b0\u1ee3c d\u00f9ng l\u00e0 insulin t\u00e1c d\u1ee5ng nhanh (insulin ordinaire).<\/li>\n
            • Li\u1ec1u insulin trong ph\u00e1c \u0111\u1ed3 ch\u1ec9 c\u00f3 t\u00ednh c\u00e1ch h\u01b0\u1edbng d\u1eabn v\u00e0 t\u00f9y theo \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n, \u0111\u01b0\u1eddng huy\u1ebft, \u0111\u01b0\u1eddng ni\u1ec7u m\u1ed7i 1 \u2013 2 gi\u1edd, s\u1ebd \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u insulin t\u01b0\u01a1ng \u1ee9ng.<\/li>\n
            • B\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb insulin ngay khi b\u1eaft \u0111\u1ea7u b\u00f9 d\u1ecbch ch\u1ed1ng s\u1ed1c.<\/li>\n
            • Insulin t\u00e1c d\u1ee5ng nhanh (Insuline ordinaire): li\u1ec1u b\u1eaft \u0111\u1ea7u 0,1 U\/kg\/gi\u1edd truy\u1ec1n qua b\u01a1m ti\u00eam t\u1ef1 \u0111\u1ed9ng v\u00e0 qua \u0111\u01b0\u1eddng truy\u1ec1n ri\u00eang, m\u1ee5c ti\u00eau \u0111\u1ec3 \u0111\u1ea1t t\u1ed1c \u0111\u1ed9 gi\u1ea3m \u0111\u01b0\u1eddng huy\u1ebft ch\u1eadm 70 \u2013 100 mg%\/gi\u1edd. Kh\u00f4ng n\u00ean gi\u1ea3m \u0111\u01b0\u1eddng huy\u1ebft qu\u00e1 nhanh (> 100 mg\/dl\/gi\u1edd) g\u00e2y ph\u00f9 n\u00e3o.<\/li>\n
            • Th\u1eed l\u1ea1i \u0111\u01b0\u1eddng huy\u1ebft m\u1ed7i 1\u2013 2 gi\u1edd, m\u1ee5c ti\u00eau lu\u00f4n gi\u1eef \u0111\u01b0\u1eddng huy\u1ebft \u1edf m\u1ee9c 150 – 200 mg%, n\u1ebfu \u0111\u01b0\u1eddng huy\u1ebft gi\u1ea3m \u2264 13,88 mmol\/L (250 mg%) pha th\u00eam Glucose trong l\u00fac v\u1eabn ti\u1ebfp t\u1ee5c truy\u1ec1n insuline 0,1 U\/kg\/gi\u1edd, kh\u00f4ng \u0111\u01b0\u1ee3c ng\u1eebng \u0111\u1ed9t ng\u1ed9t insulin, ngay c\u1ea3 khi c\u00f3 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft m\u00e0 b\u1ec7nh nh\u00e2n c\u00f2n nhi\u1ec5m toan.<\/li>\n<\/ul>\n

              – \u0110\u01b0\u1eddng huy\u1ebft 90 – 150 mg\/dl: Saline 0,45% + Dextrose 10%.<\/p>\n

              – \u0110\u01b0\u1eddng huy\u1ebft 8,3 – 11,1 mmol\/L (150 -200 mg\/dl): Saline 0,45% + Dextrose 5%.<\/p>\n

              – \u0110\u01b0\u1eddng huy\u1ebft < 45 mg\/dl ho\u1eb7c \u0111\u01b0\u1eddng huy\u1ebft t\u1eeb 45 – 70 mg\/dl k\u00e8m d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft (v\u00e3 m\u1ed3 h\u00f4i, run tay ch\u00e2n, tim nhanh, r\u1ed1i lo\u1ea1n tri gi\u00e1c): Dextrose 30% li\u1ec1u 1 ml\/kg t\u0129nh m\u1ea1ch, sau \u0111\u00f3 truy\u1ec1n duy tr\u00ec Dextrose 10% + saline 0,45%.<\/p>\n

                \n
              • C\u00f4ng th\u1ee9c pha Insulin:<\/li>\n<\/ul>\n

                – Pha 50 \u0111\u01a1n v\u1ecb Insulin trong Normal saline cho \u0111\u1ee7 50 ml (1 \u0111v\/1ml).<\/p>\n

                + Truy\u1ec1n t\u1ed1c \u0111\u1ed9 0,1 U\/kg\/gi\u1edd # (0,1 x c\u00e2n n\u1eb7ng) ml\/gi\u1edd.<\/p>\n

                + V\u00ed d\u1ee5: b\u1ec7nh nh\u00e2n 20 kg, pha 50 \u0111\u01a1n v\u1ecb Insulin trong Normal saline cho \u0111\u1ee7 50 ml, n\u1ebfu mu\u1ed1n t\u1ed1c \u0111\u1ed9 truy\u1ec1n l\u00e0 0,1U\/kg\/gi\u1edd th\u00ec truy\u1ec1n t\u1ed1c \u0111\u1ed9 0,1 x 20 = 2 ml\/gi\u1edd.<\/p>\n

                – Insulin n\u00ean truy\u1ec1n b\u1eb1ng b\u01a1m ti\u00eam t\u1ef1 \u0111\u1ed9ng qua \u0111\u01b0\u1eddng truy\u1ec1n ri\u00eang.<\/p>\n

                  \n
                • Chuy\u1ec3n sang Insulin TDD:<\/li>\n<\/ul>\n

                  – Khi \u0111\u01b0\u1eddng huy\u1ebft \u1ed5n \u0111\u1ecbnh trong nhi\u1ec1u gi\u1edd \u1edf m\u1ee9c 8,3 – 11,1 mmol\/L (150 \u2013 200 mg%) k\u00e8m h\u1ebft tri\u1ec7u ch\u1ee9ng toan m\u00e1u pH > 7,3 v\u00e0 HCO3- > 15 mmol\/L th\u00ec chuy\u1ec3n sang Insulin TDD v\u00e0 ch\u1ec9 ng\u1eebng truy\u1ec1n Insulin sau 30 ph\u00fat TDD Insulin.<\/p>\n

                  – N\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ti\u1ec3u \u0111\u01b0\u1eddng tr\u01b0\u1edbc \u0111\u00e2y th\u00ec li\u1ec1u TDD c\u1ea7n tham kh\u1ea3o li\u1ec1u b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc.<\/p>\n

                  \"nhiem-ceton-do-dai-thao-duong\"<\/p>\n

                  2.6. \u0110i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng<\/strong><\/p>\n

                    \n
                  • Ph\u00f9 n\u00e3o th\u01b0\u1eddng x\u1ea3y ra \u1edf tr\u1ebb em h\u01a1n ng\u01b0\u1eddi l\u1edbn, t\u1ef7 l\u1ec7 1%, xu\u1ea5t hi\u1ec7n \u1edf 6 -12 gi\u1edd \u0111\u1ea7u sau khi \u0111i\u1ec1u tr\u1ecb. Ph\u00f9 n\u00e3o t\u1eed vong cao, chi\u1ebfm 50 \u2013 60% nguy\u00ean nh\u00e2n t\u1eed vong nhi\u1ec5m ketone ti\u1ec3u \u0111\u01b0\u1eddng.<\/li>\n
                  • C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1: tr\u1ebb nh\u1ecf < 5 tu\u1ed5i, nhi\u1ec5m ketone l\u1ea7n \u0111\u1ea7u, t\u0103ng ur\u00ea m\u00e1u, PaCO2 < 20 mmHg, Natri m\u00e1u gi\u1ea3m, b\u00f9 d\u1ecbch nhi\u1ec1u, d\u00f9ng insuline li\u1ec1u cao, \u0111i\u1ec1u tr\u1ecb toan m\u00e1u v\u1edbi Bicarbonate \u01b0u tr\u01b0\u01a1ng.<\/li>\n
                  • Ch\u1ea9n \u0111o\u00e1n:<\/li>\n<\/ul>\n

                    – L\u00e2m s\u00e0ng: nh\u1ee9c \u0111\u1ea7u, n\u00f4n \u00f3i, r\u1ed1i lo\u1ea1n tri gi\u00e1c x\u1ea5u h\u01a1n, nh\u1ecbp tim ch\u1eadm, cao huy\u1ebft \u00e1p, \u0111\u1ed3ng t\u1eed kh\u00f4ng \u0111\u1ec1u ho\u1eb7c d\u00e3n to, m\u1ea5t ph\u1ea3n x\u1ea1 \u00e1nh s\u00e1ng.<\/p>\n

                    – CT scanner (n\u1ebfu c\u00f3, \u0111\u1ec1 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t xu\u1ea5t huy\u1ebft n\u00e3o): h\u00ecnh \u1ea3nh ph\u00f9 n\u00e3o.<\/p>\n

                      \n
                    • X\u1eed tr\u00ed:<\/li>\n<\/ul>\n

                      – N\u1eb1m \u0111\u1ea7u cao.<\/p>\n

                      – Mannitol 20% 0,5 g\/kg TTM trong 30 ph\u00fat \u2013 1 gi\u1edd.<\/p>\n

                      – H\u1ea1n ch\u1ebf d\u1ecbch 70% nhu c\u1ea7u.<\/p>\n

                      – Xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n th\u1edf m\u00e1y t\u0103ng th\u00f4ng kh\u00ed.<\/p>\n

                        \n
                      • Toan m\u00e1u:<\/li>\n<\/ul>\n

                        – Th\u01b0\u1eddng t\u1ef1 \u0111i\u1ec1u ch\u1ec9nh sau b\u00f9 d\u1ecbch v\u00e0 insulin, th\u01b0\u1eddng b\u1ec7nh nh\u00e2n c\u1ea3i thi\u1ec7n \u0111\u01b0\u1eddng huy\u1ebft tr\u01b0\u1edbc toan m\u00e1u.<\/p>\n

                        – Bicarbonate c\u00f3 th\u1ec3 t\u0103ng nhi\u1ec5m toan cho n\u00e3o (khi CO2 ph\u00f3ng th\u00edch t\u1eeb Bicarbonate qua h\u00e0ng r\u00e0o m\u00e1u n\u00e3o d\u1ec5 h\u01a1n l\u00e0 Bicarbonate).<\/p>\n

                        – Ch\u1ec9 cho Bicarbonate khi toan m\u00e1u n\u1eb7ng: pH < 7,1 hay HCO3- < 5 mEq\/L v\u00e0 kh\u00f4ng c\u1ea3i thi\u1ec7n sau v\u00e0i gi\u1edd b\u00f9 d\u1ecbch v\u00e0 truy\u1ec1n insulin.<\/p>\n

                        – Li\u1ec1u bicarbonate: 1 mEq\/kg trong 30 \u2013 60 ph\u00fat.<\/p>\n

                          \n
                        • H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft:<\/li>\n<\/ul>\n

                          – Do d\u00f9ng qu\u00e1 li\u1ec1u insulin.<\/p>\n

                          – X\u1eed tr\u00ed: Dextrose 30% 1 ml\/kg TMC. Sau \u0111\u00f3 truy\u1ec1n Glucose 10% trong saline 0,45%.<\/p>\n

                          – Kh\u00f4ng \u0111\u01b0\u1ee3c ng\u1eebng ho\u1eb7c gi\u1ea3m li\u1ec1u insulin d\u01b0\u1edbi 0,05 U\/kg\/gi\u1edd.<\/p>\n

                          – Ph\u00f2ng ng\u1eeba b\u1eb1ng c\u00e1ch pha th\u00eam glucose v\u00e0o chai d\u1ecbch truy\u1ec1n khi \u0111\u01b0\u1eddng huy\u1ebft < 13,88 mmol\/L (250 mg%).<\/p>\n

                            \n
                          • \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n th\u00fac \u0111\u1ea9y:<\/li>\n<\/ul>\n

                            Nhi\u1ec5m tr\u00f9ng: kh\u00e1ng sinh t\u00f9y lo\u1ea1i nhi\u1ec5m tr\u00f9ng.<\/p>\n

                            3. \u0110i\u1ec1u tr\u1ecb ti\u1ebfp theo<\/strong><\/h2>\n
                              \n
                            • Khi b\u1ec7nh nh\u00e2n t\u1ec9nh t\u00e1o, \u0111\u01b0\u1eddng huy\u1ebft \u1ed5n \u0111\u1ecbnh sau nhi\u1ec1u gi\u1edd, h\u1ebft toan m\u00e1u th\u00ec chuy\u1ec3n sang insulin ti\u00eam d\u01b0\u1edbi da v\u00e0 b\u1eaft \u0111\u1ea7u cho ch\u1ebf \u0111\u1ed9 \u0103n ti\u1ec3u \u0111\u01b0\u1eddng.<\/li>\n<\/ul>\n

                              Ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng cho tr\u1ebb b\u1ecb ti\u1ec3u \u0111\u01b0\u1eddng:<\/u><\/em><\/p>\n

                                \n
                              • N\u0103ng l\u01b0\u1ee3ng cung c\u1ea5p: 100Kcalo + (100 kcalo x tu\u1ed5i).<\/li>\n
                              • Th\u00e0nh ph\u1ea7n dinh d\u01b0\u1ee1ng: 50% Carbohydrate, 25 – 30% ch\u1ea5t b\u00e9o, 20 – 25%
                                \nch\u1ea5t \u0111\u1ea1m.<\/li>\n
                              • S\u1ed1 n\u0103ng l\u01b0\u1ee3ng ph\u00e2n ra: b\u1eefa s\u00e1ng 25%, tr\u01b0a 25%, chi\u1ec1u 30%, b\u1eefa x\u1ebf
                                \nchi\u1ec1u 20%. T\u1ec9 l\u1ec7 n\u00e0y c\u00f3 th\u1ec3 thay \u0111\u1ed5i t\u00f9y theo t\u1eadp qu\u00e1n \u0103n u\u1ed1ng c\u1ee7a c\u00e1 nh\u00e2n
                                \nv\u00e0 gia \u0111\u00ecnh.<\/li>\n
                              • Ti\u00eam d\u01b0\u1edbi da insulin 30 ph\u00fat tr\u01b0\u1edbc khi ng\u1eebng truy\u1ec1n insulin \u0111\u1ec3 tr\u00e1nh t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft khi insulin d\u01b0\u1edbi da ch\u01b0a c\u00f3 t\u00e1c d\u1ee5ng.<\/li>\n
                              • Th\u1eddi gian trung b\u00ecnh \u0111\u01b0a b\u1ec7nh nh\u00e2n ra kh\u1ecfi t\u00ecnh tr\u1ea1ng nhi\u1ec5m Ketone m\u00e1u l\u00e0 36 – 48 gi\u1edd.<\/li>\n<\/ul>\n

                                4. Theo d\u00f5i sau \u0111i\u1ec1u tr\u1ecb toan ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng:<\/strong><\/h2>\n
                                  \n
                                • D\u1ea5u hi\u1ec7u sinh t\u1ed3n, tri gi\u00e1c.<\/li>\n
                                • L\u01b0\u1ee3ng xu\u1ea5t nh\u1eadp m\u1ed7i 1-2 gi\u1edd trong giai \u0111o\u1ea1n h\u1ed3i s\u1ee9c s\u1ed1c, sau \u0111\u00f3 m\u1ed7i 6\u20138 gi\u1edd.<\/li>\n
                                • Dextrostix m\u1ed7i gi\u1edd trong giai \u0111o\u1ea1n b\u1ec7nh nh\u00e2n c\u00f2n h\u00f4n m\u00ea v\u00e0 \u0111\u01b0\u1eddng huy\u1ebft >13,88 mmol\/L (250mg%), sau \u0111\u00f3 m\u1ed7i 4 gi\u1edd.<\/li>\n
                                • Uristix: \u0111\u01b0\u1eddng ni\u1ec7u, ketones ni\u1ec7u m\u1ed7i 1-4 gi\u1edd. Khoa h\u1ed3i s\u1ee9c c\u1ea7n \u0111\u01b0\u1ee3c trang b\u1ecb d\u1ee5ng c\u1ee5 th\u1eed \u0111\u01b0\u1eddng m\u00e1u v\u00e0 \u0111\u01b0\u1eddng ni\u1ec7u, cet\u00f4n trong n\u01b0\u1edbc ti\u1ec3u b\u1eb1ng que.<\/li>\n
                                • \u0110\u01b0\u1eddng huy\u1ebft m\u1ed7i 4 gi\u1edd ho\u1eb7c khi k\u1ebft qu\u1ea3 Dextrostix t\u0103ng hay gi\u1ea3m nhanh b\u1ea5t th\u01b0\u1eddng, hay k\u1ebft qu\u1ea3 kh\u00f4ng t\u01b0\u01a1ng x\u1ee9ng gi\u1eefa Dextrostix v\u00e0 Uristix.<\/li>\n
                                • Ion \u0111\u1ed3.<\/li>\n
                                • Kh\u00ed m\u00e1u trong giai \u0111o\u1ea1n b\u1ec7nh nh\u00e2n c\u00f2n nhi\u1ec5m toan ho\u1eb7c suy h\u00f4 h\u1ea5p.<\/li>\n
                                • Theo d\u00f5i ECG (s\u00f3ng T).<\/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":"\n\u0110i\u1ec1u tr\u1ecb nhi\u1ec5m ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u1edf tr\u1ebb em - 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=\"\u0110i\u1ec1u tr\u1ecb nhi\u1ec5m ceton do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u1edf tr\u1ebb em - 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