{"id":30817,"date":"2023-05-07T14:05:02","date_gmt":"2023-05-07T07:05:02","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30817"},"modified":"2023-05-07T14:05:02","modified_gmt":"2023-05-07T07:05:02","slug":"roi-loan-nuoc-dien-giai-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/roi-loan-nuoc-dien-giai-o-tre-em\/","title":{"rendered":"R\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i \u1edf tr\u1ebb em"},"content":{"rendered":"

R\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i \u1edf tr\u1ebb em l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa n\u01b0\u1edbc v\u00e0 c\u00e1c ion trong c\u01a1 th\u1ec3. N\u01b0\u1edbc v\u00e0 c\u00e1c ion nh\u01b0 natri, kali v\u00e0 clorua r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c duy tr\u00ec ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o v\u00e0 c\u00e1c c\u01a1 quan trong c\u01a1 th\u1ec3. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i \u1edf tr\u1ebb em ph\u1ee5 thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n g\u00e2y ra t\u00ecnh tr\u1ea1ng n\u00e0y.<\/strong><\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng r\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i:<\/h2>\n

R\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i \u1edf tr\u1ebb em l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa n\u01b0\u1edbc v\u00e0 c\u00e1c ion trong c\u01a1 th\u1ec3. N\u01b0\u1edbc v\u00e0 c\u00e1c ion nh\u01b0 natri, kali v\u00e0 clorua r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c duy tr\u00ec ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o v\u00e0 c\u00e1c c\u01a1 quan trong c\u01a1 th\u1ec3.<\/p>\n

B\u1ea3ng 1. Th\u00e0nh ph\u1ea7n m\u1ed9t s\u1ed1 dung d\u1ecbch \u0111\u1eb3ng tr\u01b0\u01a1ng th\u01b0\u1eddng d\u00f9ng truy\u1ec1n TM<\/p>\n\n\n\n\n
\n

Lo\u1ea1i d\u1ecbch<\/b><\/p>\n<\/td>\n

\n

Na<\/b>+<\/b><\/p>\n<\/td>\n

\n

Cl<\/b>–<\/b><\/p>\n<\/td>\n

\n

K<\/b>+<\/b><\/p>\n<\/td>\n

\n

Lactate<\/b><\/p>\n<\/td>\n<\/tr>\n

Natriclorua 0,9%<\/p>\n

Natriclorua 0,45% trong Dextrose 5%<\/p>\n

NatricClorua 0,2% trong Dextrose 5%<\/p>\n

Lactate Ringer<\/p>\n

Lactate Ringer in Dextrose 5%<\/td>\n

\n

154<\/p>\n

77<\/p>\n

34<\/p>\n

130<\/p>\n

130<\/p>\n<\/td>\n

\n

154<\/p>\n

77<\/p>\n

34<\/p>\n

109<\/p>\n

109<\/p>\n<\/td>\n

\n

0<\/p>\n

0<\/p>\n

0<\/p>\n

4<\/p>\n

4<\/p>\n<\/td>\n

\n

0<\/p>\n

0<\/p>\n

0<\/p>\n

28<\/p>\n

28<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

B\u1ea3ng 2. N\u1ed3ng \u0111\u1ed9 c\u1ee7a m\u1ed9t s\u1ed1 \u0111i\u1ec7n gi\u1ea3i trong m\u1ed9t s\u1ed1 dung d\u1ecbch \u01b0u tr\u01b0\u01a1ng th\u01b0\u1eddng d\u00f9ng truy\u1ec1n t\u0129nh m\u1ea1ch<\/p>\n\n\n\n\n
\n

Lo\u1ea1i d\u1ecbch<\/b><\/p>\n<\/td>\n

\n

N\u1ed3ng \u0111\u1ed9 \u0111i\u1ec7n gi\u1ea3i\/ml<\/b><\/p>\n<\/td>\n<\/tr>\n

Natriclorua 3%<\/p>\n

Kaliclorua 10%<\/p>\n

Calcigluconate 10%<\/p>\n

Calciclorua 10%<\/p>\n

Natribicarbonate 4,2%<\/td>\n

0,5 mEq Na+<\/sup>\/ml<\/p>\n

1,3 mEq K+<\/sup>\/ml<\/p>\n

0,45 mEq Ca++<\/sup>\/ml<\/p>\n

1,36 mEq Ca++<\/sup>\/ml<\/p>\n

0,5 mEq Na+<\/sup>\/ml, 0,5 mEq HCO3–<\/sup>\/ml<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

2. Nguy\u00ean nh\u00e2n r\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i<\/h2>\n

Nguy\u00ean nh\u00e2n r\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i \u1edf tr\u1ebb em th\u01b0\u1eddng do ti\u00eau ch\u1ea3y, n\u00f4n \u00f3i hay nu\u00f4i \u0103n qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Khi c\u00f3 r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i khai th\u00e1c b\u1ec7nh s\u1eed, kh\u00e1m l\u00e2m s\u00e0ng, x\u00e9t nghi\u1ec7m c\u1ea7n ch\u00fa \u00fd t\u1edbi c\u00e1c y\u1ebfu t\u1ed1 sau:<\/p>\n

– R\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i l\u00e0 t\u0103ng hay gi\u1ea3m<\/p>\n

– T\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng h\u1ecdc, m\u1ea5t n\u01b0\u1edbc, tri gi\u00e1c.<\/p>\n

– B\u1ec7nh l\u00fd hi\u1ec7n t\u1ea1i, d\u1ecbch nh\u1eadp, d\u1ecbch xu\u1ea5t<\/p>\n

– K\u1ebft qu\u1ea3 \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 ph\u00f9 h\u1ee3p l\u00e2m s\u00e0ng<\/p>\n

3. R\u1ed1i lo\u1ea1n natri m\u00e1u:<\/h2>\n

3.1. H\u1ea1 Natri m\u00e1u: Khi Natri m\u00e1u < 135 mEq\/l.<\/h3>\n

– Nh\u1eb9: 130-134 mEq\/l<\/p>\n

– Trung b\u00ecnh: 120-129 mEq\/l<\/p>\n

– N\u1eb7ng: <120 mEq\/l<\/p>\n

C\u00f3 tri\u1ec7u ch\u1ee9ng khi <125 mEq\/l ho\u1eb7c khi gi\u1ea3m natri m\u00e1u nhanh<\/p>\n

3.1.1. Nguy\u00ean nh\u00e2n<\/h4>\n

– Ng\u1ed9 \u0111\u1ed9c n\u01b0\u1edbc:<\/p>\n

+ Ti\u00eau ch\u1ea3y b\u00f9 b\u1eb1ng n\u01b0\u1edbc th\u01b0\u1eddng kh\u00f4ng d\u00f9ng ORS.<\/p>\n

+ R\u1eeda d\u1ea1 d\u00e0y, th\u1ee5t th\u00e1o ru\u1ed9t gi\u00e0 d\u00f9ng n\u01b0\u1edbc th\u01b0\u1eddng.<\/p>\n

+ B\u00f9 d\u1ecbch, nu\u00f4i d\u01b0\u1ee1ng t\u0129nh m\u1ea1ch ch\u1ec9 v\u1edbi Dextrose 5%.<\/p>\n

– Suy th\u1eadn, suy tim, t\u0103ng sinh tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn b\u1ea9m sinh.<\/p>\n

– H\u1ed9i ch\u1ee9ng t\u0103ng ti\u1ebft ADH kh\u00f4ng th\u00edch h\u1ee3p (Trong ti\u1ebft ADH kh\u00f4ng th\u00edch h\u1ee3p c\u1ea7n: h\u1ea1n ch\u1ebf d\u1ecbch \u00be nhu c\u1ea7u, d\u1ecbch Natrichlorua 0,9% trong Dextrose 5% thay cho dung d\u1ecbch Natrichlorua 1,8% trong Dextrose 5%).<\/p>\n

– \u0110i\u1ec1u tr\u1ecb l\u1ee3i ti\u1ec3u.<\/p>\n

\"R\u1ed1i
R\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i<\/figcaption><\/figure>\n

3.1.2. L\u00e2m s\u00e0ng<\/h4>\n

– N\u1ebfu h\u1ea1 Natri m\u00e1u nh\u1eb9 ho\u1eb7c v\u1eeba th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng \u1ea3u b\u1ec7nh ch\u00ednh<\/p>\n

– N\u1ebfu h\u1ea1 Natri m\u00e1u n\u1eb7ng (<120 mEq\/L): bi\u1ec3u hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh nh\u01b0 \u0111au \u0111\u1ea7u, bu\u1ed3n n\u00f4n, n\u00f4n, m\u1ec7t m\u1ecfi k\u00edch th\u00edch, li b\u00ec, co gi\u1eadt, h\u00f4n m\u00ea<\/p>\n

3.1.3. \u0110i\u1ec1u tr\u1ecb<\/h4>\n
    \n
  • \u00a0Nguy\u00ean t\u1eafc<\/strong><\/li>\n<\/ul>\n

    \u0110i\u1ec1u tr\u1ecb h\u1ea1 Natri m\u00e1u song song b\u1ed3i ho\u00e0n th\u1ec3 t\u00edch d\u1ecbch ngo\u1ea1i b\u00e0o.<\/p>\n

      \n
    • \u00a0B\u1ec7nh nh\u00e2n c\u00f3 s\u1ed1c m\u1ea5t n\u01b0\u1edbc<\/strong><\/li>\n<\/ul>\n

      Natriclorua 0,9% t\u1ed1c \u0111\u1ed9 20 ml\/kg\/h truy\u1ec1n t\u0129nh m\u1ea1ch cho \u0111\u1ebfn khi \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng h\u1ecdc.<\/p>\n

        \n
      • \u00a0B\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u m\u1ea5t n\u01b0\u1edbc n\u1eb7ng v\u00e0 natri < 130mEq\/L<\/strong><\/li>\n<\/ul>\n

        Natriclorua 0,9% trong Dextrose 5% truy\u1ec1n t\u0129nh m\u1ea1ch theo ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb m\u1ea5t n\u01b0\u1edbc cho \u0111\u1ebfn khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh b\u00f9 d\u1ecbch b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n

        Theo d\u00f5i \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 m\u1ed7i 4 gi\u1edd cho \u0111\u1ebfn \u1ed5n \u0111\u1ecbnh ho\u1eb7c b\u00f9 \u0111\u01b0\u1eddng u\u1ed1ng<\/p>\n

          \n
        • \u00a0B\u1ec7nh nh\u00e2n kh\u00f4ng s\u1ed1c, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u m\u1ea5t n\u01b0\u1edbc n\u1eb7ng<\/strong><\/li>\n<\/ul>\n

          \u00b7\u00a0H\u1ea1 natri m\u00e1u c\u00f3 bi\u1ec3u hi\u1ec7n th\u1ea7n kinh:<\/strong><\/em><\/p>\n

          – Truy\u1ec1n Natri Chlorua 3% 4 ml\/kg qua b\u01a1m ti\u00eam trong 30 ph\u00fat (4 ml\/kg Natri Chlorua 3% t\u0103ng Na+\u00a03mmol\/L)<\/p>\n

          – Sau \u0111\u00f3 ki\u1ec3m tra ion \u0111\u1ed3, n\u1ebfu Natri m\u00e1u c\u00f2n th\u1ea5p th\u00ec l\u1eb7p l\u1ea1i li\u1ec1u th\u1ee9 2 cho \u0111\u1ebfn khi Natri m\u00e1u \u0111\u1ea1t 125 mEq\/l t\u1ed5ng li\u1ec1u kh\u00f4ng qu\u00e1 10ml\/kg.<\/p>\n

          \u00b7\u00a0H\u1ea1 natri m\u00e1u kh\u00f4ng bi\u1ec3u hi\u1ec7n th\u1ea7n kinh:<\/p>\n

          – \u0110i\u1ec1u ch\u1ec9nh th\u01b0\u1eddng trong v\u00f2ng 48 gi\u1edd ti\u1ebfp.<\/p>\n

          – Kh\u00f4ng t\u0103ng natri m\u00e1u qu\u00e1 nhanh, kh\u00f4ng qu\u00e1 <0,5 mEq\/l\/gi\u1edd<\/p>\n

          – L\u01b0\u1ee3ng natri thi\u1ebfu c\u1ea7n b\u00f9:<\/p>\n\n\n\n
          Na+<\/sup>\u00a0thi\u1ebfu = 0,6 x c\u00e2n n\u1eb7ng (kg) x (135 – Na+\u00a0\u0111o \u0111\u01b0\u1ee3c)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

          – Na+<\/sup>\u00a0cho trong 24 gi\u1edd = Na thi\u1ebfu + nhu c\u1ea7u natri<\/p>\n

          – L\u01b0\u1ee3ng natri theo nhu c\u1ea7u: 3 mEq\/ 100 mL d\u1ecbch<\/p>\n

          – C\u00e1ch d\u00f9ng: 1\/2 truy\u1ec1n TM trong 8 gi\u1edd \u0111\u1ea7u, 1\/2 truy\u1ec1n trong 16 gi\u1edd k\u1ebf ti\u1ebfp<\/p>\n

          \u00b7\u00a0N\u1ebfu h\u1ea1 natri do qu\u00e1 t\u1ea3i d\u1ecbch ho\u1eb7c ti\u1ebft ADH kh\u00f4ng th\u00edch h\u1ee3p<\/strong><\/em> (Natri\/n\u01b0\u1edbc ti\u1ec3u >20mEq\/L v\u00e0 n\u1ed3ng \u0111\u1ed9 Osmol m\u00e1u th\u1ea5p <280 mosm\/L, Osmol n\u01b0\u1edbc ti\u1ec3u cao >100 mosm\/L, t\u1ec9 tr\u1ecdng n\u01b0\u1edbc ti\u1ec3u t\u0103ng >1020 )<\/p>\n

          – Kh\u00f4ng c\u1ea7n b\u00f9 Natri (tr\u1eeb khi h\u1ea1 natri m\u00e1u c\u00f3 bi\u1ec3u hi\u1ec7n th\u1ea7n kinh)<\/p>\n

          – H\u1ea1n ch\u1ebf d\u1ecbch 50% nhu c\u1ea7u<\/p>\n

          – D\u1ecbch Natriclorua 0,9% trong Dextrose 5%<\/p>\n

          – Furosemide 0,5 mg\/kg TM<\/p>\n

          \u00b7\u00a0Nhu c\u1ea7u c\u01a1 b\u1ea3n:<\/strong><\/em><\/p>\n

          B\u1ea3ng 3. Nhu c\u1ea7u d\u1ecbch c\u01a1 b\u1ea3n h\u00e0ng ng\u00e0y \u1edf tr\u1ebb<\/p>\n\n\n\n\n
          \n

          C\u00e2n n\u1eb7ng<\/b><\/p>\n<\/td>\n

          		\n

          Nhu c\u1ea7u ml\/ng\u00e0y<\/b><\/p>\n<\/td>\n<\/tr>\n

          \n

          3 \u2013 10 kg<\/p>\n

          10 \u2013 20 kg<\/p>\n

          > 20 kg<\/p>\n<\/td>\n

          		\n

          100 ml x c\u00e2n n\u1eb7ng<\/p>\n

          1000 ml + [50 ml x (c\u00e2n n\u1eb7ng \u2013 10)]<\/p>\n

          1500ml + [ 20 ml x (c\u00e2n n\u1eb7ng \u2013 20)]<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

          \"L\u01b0u
          L\u01b0u \u0111\u1ed3 x\u1eed tr\u00ed h\u1ea1 Natri m\u00e1u<\/figcaption><\/figure>\n

          3.2. T\u0103ng Natri m\u00e1u: khi Natri m\u00e1u \u2265 150 mEq\/L<\/h3>\n

          – T\u0103ng natri m\u00e1u trung b\u00ecnh: 150 \u2013 169 mEq\/L<\/p>\n

          – T\u0103ng natri m\u00e1u n\u1eb7ng: > 169 mEq\/L<\/p>\n

          – T\u0103ng Natri m\u00e1u \u00edt g\u1eb7p \u1edf tr\u1ebb em<\/p>\n

          3.2.1. Nguy\u00ean nh\u00e2n<\/h4>\n

          – Ti\u00eau ch\u1ea3y \u1edf tr\u1ebb nh\u0169 nhi ch\u1ec9 b\u00f9 b\u1eb1ng ORS.<\/p>\n

          – Truy\u1ec1n qu\u00e1 nhi\u1ec1u d\u1ecbch ch\u1ee9a Natribicarbonate.<\/p>\n

          – \u0110\u00e1i th\u00e1o nh\u1ea1t.<\/p>\n

          3.2.2. L\u00e2m s\u00e0ng<\/h4>\n

          T\u0103ng Natri m\u00e1u n\u1eb7ng c\u00f3 bi\u1ec3u hi\u1ec7n th\u1ea7n kinh: l\u01a1 m\u01a1, k\u00edch th\u00edch, t\u0103ng ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng, h\u00f4n m\u00ea, co gi\u1eadt.<\/p>\n

          3.2.3. \u0110i\u1ec1u tr\u1ecb<\/h4>\n

          \u00b7\u00a0Nguy\u00ean t\u1eafc<\/strong><\/em><\/p>\n

          – Ch\u1ec9 l\u00e0m gi\u1ea3m Natri m\u00e1u v\u1edbi t\u1ed1c \u0111\u1ed9 ch\u1eadm kh\u00f4ng qu\u00e1 12 mEq\/L\/ng\u00e0y \u0111\u1ec3 tr\u00e1nh nguy c\u01a1 ph\u00f9 n\u00e3o.<\/p>\n

          – \u0110i\u1ec1u ch\u1ec9nh th\u01b0\u1eddng trong v\u00f2ng 48 gi\u1edd.<\/p>\n

          \u00b7\u00a0B\u1ec7nh nh\u00e2n c\u00f3 s\u1ed1c m\u1ea5t n\u01b0\u1edbc:<\/p>\n

          – Lactate Ringer’s 20 ml\/kg\/gi\u1edd truy\u1ec1n t\u0129nh m\u1ea1ch cho \u0111\u1ebfn khi \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng h\u1ecdc.<\/p>\n

          – Sau \u0111\u00f3 truy\u1ec1n Dextrose 5% trong Natriclorua 0,45%<\/p>\n

          – T\u1ed1c \u0111\u1ed9 gi\u1ea3m natri m\u00e1u kh\u00f4ng qu\u00e1 0,5-1 mEq\/L\/gi\u1edd. N\u1ebfu t\u1ed1c \u0111\u1ed9 Natri m\u00e1u gi\u1ea3m >1 mEq\/L\/gi\u1edd s\u1ebd gi\u1ea3m t\u1ed1c \u0111\u1ed9 truy\u1ec1n 25%<\/p>\n

          – Sau \u0111\u00f3 n\u1ebfu n\u01b0\u1edbc ti\u1ec3u t\u1ed1t c\u00f3 th\u1ec3 truy\u1ec1n Dextrose 5% trong Natriclorua 0,2%.<\/p>\n

          \u00b7\u00a0B\u1ec7nh nh\u00e2n kh\u00f4ng s\u1ed1c:<\/strong><\/em><\/p>\n

          – Tr\u00e1nh h\u1ea1 natri m\u00e1u qu\u00e1 nhanh s\u1ebd c\u00f3 nguy c\u01a1 ph\u00f9 n\u00e3o.<\/p>\n

          – Dung d\u1ecbch n\u00ean ch\u1ecdn l\u00e0 Dextrose 5% trong Natriclorua 0,2%.<\/p>\n

          – N\u1ebfu th\u1ec3 t\u00edch d\u1ecbch ngo\u1ea1i b\u00e0o b\u00ecnh th\u01b0\u1eddng c\u00f3 th\u1ec3 cho Furosemide 1 mg\/kg TM ho\u1eb7c ti\u00eam b\u1eafp l\u1ea7n \u0111\u1ea7u v\u00e0 l\u1eb7p l\u1ea1i m\u1ed7i 6 gi\u1edd n\u1ebfu c\u1ea7n.<\/p>\n

          4. R\u1ed1i lo\u1ea1n Kali m\u00e1u:<\/h2>\n

          4.1. H\u1ea1 Kali m\u00e1u: khi kali m\u00e1u < 3,5 mEq\/L<\/h3>\n

          4.1.1. Nguy\u00ean nh\u00e2n<\/h4>\n

          – Ti\u00eau ch\u1ea3y, n\u00f4n<\/p>\n

          – D\u1eabn l\u01b0u d\u1ea1 d\u00e0y ru\u1ed9t, d\u1ecbch m\u1eadt<\/p>\n

          – \u0110i\u1ec1u tr\u1ecb l\u1ee3i ti\u1ec3u, corticoit<\/p>\n

          – Nhi\u1ec5m toan xeton trong b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng<\/p>\n

          4.1.2.L\u00e2m s\u00e0ng<\/h4>\n

          – Li\u1ec7t ru\u1ed9t, b\u1ee5ng ch\u01b0\u1edbng.<\/p>\n

          – N\u1eb7ng: y\u1ebfu li\u1ec7t chi, li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p, r\u1ed1i lo\u1ea1n nh\u1ecbp tim: bloc nh\u0129 th\u1ea5t.<\/p>\n

          – \u0110i\u1ec7n tim: ST x\u1eb9p, T gi\u1ea3m bi\u00ean \u0111\u1ed9, xu\u1ea5t hi\u1ec7n s\u00f3ng U, Bloc nh\u0129 th\u1ea5t, ngo\u1ea1i t\u00e2m thu th\u1ea5t.<\/p>\n

          4.1.3. \u0110i\u1ec1u tr\u1ecb<\/h4>\n

          \u00b7\u00a0H\u1ea1 kali m\u00e1u kh\u00f4ng y\u1ebfu li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p, kh\u00f4ng r\u1ed1i lo\u1ea1n nh\u1ecbp tim<\/strong><\/em><\/p>\n

          – Kh\u00f4ng c\u00f3 c\u00f4ng th\u1ee9c chung \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh h\u1ea1 Kali m\u00e1u, do Kali l\u00e0 ion n\u1ed9i b\u00e0o v\u00e0 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi t\u00ecnh tr\u1ea1ng toan ki\u1ec1m.<\/p>\n

          – C\u1ea7n theo d\u00f5i s\u00e1t \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 v\u00e0 \u0111i\u1ec7n tim trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u ch\u1ec9nh.<\/p>\n

          \u00b7\u00a0H\u1ea1 kali m\u00e1u kh\u00f4ng y\u1ebfu li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p, kh\u00f4ng r\u1ed1i lo\u1ea1n nh\u1ecbp tim<\/strong><\/em><\/p>\n

          – B\u00f9 kali b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n

          – Ho\u1eb7c b\u00f9 b\u1eb1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch:<\/p>\n

          + N\u1ed3ng \u0111\u1ed9 kali trong d\u1ecbch truy\u1ec1n t\u1ed1i \u0111a 40 mEq\/l.<\/p>\n

          + T\u1ed1c \u0111\u1ed9 truy\u1ec1n t\u1ed1i \u0111a 0,3 mEq\/kg\/gi\u1edd.<\/p>\n

          Theo d\u00f5i \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 v\u00e0 \u0111i\u1ec7n tim<\/p>\n

          \u00b7\u00a0H\u1ea1 Kali m\u00e1u n\u1eb7ng < 2 mEq\/l k\u00e8m c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp tim, li\u1ec7t c\u01a1 h\u00f4 h\u1ea5p<\/strong><\/em><\/p>\n

          B\u00f9 b\u1eb1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch:<\/p>\n

          + KCl pha trong d\u1ecbch truy\u1ec1n, n\u1ed3ng \u0111\u1ed9 Kali t\u1ed1i \u0111a 80 mEq\/L.<\/p>\n

          + T\u1ed1c \u0111\u1ed9 truy\u1ec1n 0,5 mEq\/kg\/gi\u1edd, t\u1ed1i \u0111a 1 mEq\/kg\/gi\u1edd.<\/p>\n

          + Ph\u1ea3i d\u00f9ng m\u00e1y truy\u1ec1n d\u1ecbch ho\u1eb7c b\u01a1m ti\u00eam.<\/p>\n

          + Truy\u1ec1n 0,5-1 mEq\/kg s\u1ebd t\u0103ng kali m\u00e1u t\u1eeb 0,5-1 mEq\/l.<\/p>\n

          Theo d\u00f5i s\u00e1t \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 v\u00e0 \u0111i\u1ec7n tim, theo d\u00f5i nh\u1ecbp tim trong su\u1ed1t th\u1eddi gian b\u00f9 kali.<\/p>\n

          4.2. T\u0103ng kali m\u00e1u: Khi Kali m\u00e1u > 5 mEq\/l<\/h3>\n

          4.2.1. Nguy\u00ean nh\u00e2n:<\/h4>\n

          – Suy th\u1eadn<\/p>\n

          – Toan huy\u1ebft<\/p>\n

          – T\u00e1n huy\u1ebft, hu\u1ef7 c\u01a1<\/p>\n

          4.2.2. Tri\u1ec7u ch\u1ee9ng<\/h4>\n

          – Gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1, b\u1ee5ng ch\u01b0\u1edbng do li\u1ec7t ru\u1ed9t c\u01a1 n\u0103ng<\/p>\n

          – \u0110i\u1ec7n tim: s\u00f3ng T cao nh\u1ecdn, QRS d\u00e3n, k\u00e9o d\u00e0i PR, r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t.<\/p>\n

          4.2.3. \u0110i\u1ec1u tr\u1ecb<\/h4>\n

          \u00b7\u00a0Nguy\u00ean t\u1eafc:<\/strong><\/em><\/p>\n

          – T\u1ea5t c\u1ea3 c\u00e1c \u0111i\u1ec1u tr\u1ecb \u0111\u1ec1u c\u00f3 t\u00ednh ch\u1ea5t t\u1ea1m th\u1eddi<\/p>\n

          – L\u1ea5y b\u1edbt Kali khi c\u00f3 th\u1ec3<\/p>\n

          – T\u1ea1i t\u1ebf b\u00e0o: d\u00f9ng thu\u1ed1c \u0111\u1ed1i kh\u00e1ng t\u00e1c d\u1ee5ng Kali t\u1ea1i t\u1ebf b\u00e0o.<\/p>\n

          \u00b7\u00a0Kali m\u00e1u \u2265 6 mEq\/L, kh\u00f4ng r\u1ed1i lo\u1ea1n nh\u1ecbp tim<\/strong><\/em><\/p>\n

          – Resin trao \u0111\u1ed5i ion: Kayexalate 1 g\/kg pha v\u1edbi Sorbitol 70% 3 mL\/kg (U), hay pha trong 10 mL\/kg n\u01b0\u1edbc th\u1ee5t th\u00e1o m\u1ed7i 4-6 gi\u1edd.<\/p>\n

          – Theo d\u00f5i nh\u1ecbp tim v\u00e0 \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 m\u1ed7i 6 gi\u1edd.<\/p>\n

          \u00b7\u00a0Kali m\u00e1u > 6mEq\/l, c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp tim<\/strong><\/em><\/p>\n

          – Calcium gluconate 10% 0,5 mL\/kg hay Calcichlorua 10% 0,2 ml\/kg ti\u00eam t\u0129nh m\u1ea1ch trong 3 \u2013 5 ph\u00fat.<\/p>\n

          – Glucose 30% 2 mL\/kg ti\u00eam t\u0129nh m\u1ea1ch ch\u1eadm\u00a0\u00b1\u00a0Insulin 0,1 UI\/kg<\/p>\n

          – Natribicarbonate 8,4% 1-2 ml\/kg ti\u00eam t\u0129nh m\u1ea1ch ch\u1eadm<\/p>\n

          – Resine trao \u0111\u1ed5i ion: Kayexalate<\/p>\n

          – Truy\u1ec1n salbutamol v\u1edbi li\u1ec1u 4 \u00b5g\/kg pha v\u1edbi Dextrose 10% truy\u1ec1n t\u0129nh m\u1ea1ch trong 30ph, ho\u1eb7c kh\u00ed dung salbutamol v\u1edbi li\u1ec1u sau:<\/p>\n\n\n\n\n\n\n
          \n

          Tu\u1ed5i (n\u0103m)<\/b><\/p>\n<\/td>\n

          		\n

          Li\u1ec1u Salbutamol (mg)<\/b><\/p>\n<\/td>\n<\/tr>\n

          \n

          \u22642,5<\/p>\n<\/td>\n

          		\n

          2,5<\/p>\n<\/td>\n<\/tr>\n

          \n

          2,5-7,5<\/p>\n<\/td>\n

          		\n

          5<\/p>\n<\/td>\n<\/tr>\n

          \n

          > 7,5<\/p>\n<\/td>\n

          		\n

          10<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

          – L\u1ecdc th\u1eadn hay th\u1ea9m ph\u00e2n ph\u00fac m\u1ea1c: khi th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/p>\n

          5. H\u1ea1 Canxi m\u00e1u<\/h2>\n

          5.1. \u0110\u1ecbnh ngh\u0129a<\/h3>\n

          Trong c\u01a1 th\u1ec3 can xi ion h\u00f3a chi\u1ebfm 40% calcium to\u00e0n ph\u1ea7n v\u00e0 gi\u1eef nhi\u1ec7m v\u1ee5 \u0111i\u1ec1u h\u00f2a ch\u1ee9c n\u0103ng c\u1ee7a enzyme, \u1ed5n \u0111\u1ecbnh mang th\u1ea7n kinh-c\u01a1, ti\u1ebfn tr\u00ecnh \u0111\u00f4ng m\u00e1u v\u00e0 t\u1ea1o x\u01b0\u01a1ng.<\/p>\n

          Toan m\u00e1u s\u1ebd t\u0103ng v\u00e0 ng\u01b0\u1ee3c l\u1ea1i ki\u1ec1m m\u00e1u s\u1ebd gi\u1ea3m can xi ion h\u00f3a g\u00e2y co gi\u1eadt.<\/p>\n

          B\u00ecnh th\u01b0\u1eddng N\u1ed3ng \u0111\u1ed9 can xi m\u00e1u to\u00e0n ph\u1ea7n d\u01b0\u1edbi 4,7 – 5,2 mEq\/L<\/p>\n

          H\u1ea1 can xi m\u00e1u nh\u1eb9 khi ion h\u00f3a t\u1eeb 0,8-1 mmol\/l<\/p>\n

          H\u1ea1 can xi m\u00e1u n\u1eb7ng khi can xi ion h\u00f3a d\u01b0\u1edbi 0,8 mmol\/l<\/p>\n

          5.2. Nguy\u00ean nh\u00e2n<\/h3>\n

          – Th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb s\u01a1 sinh h\u01a1n tr\u1ebb l\u1edbn.<\/p>\n

          – Thi\u1ebfu Vitamin D<\/p>\n

          – H\u1ed9i ch\u1ee9ng ru\u1ed9t ng\u1eafn<\/p>\n

          – Suy c\u1eadn gi\u00e1p<\/p>\n

          – Ki\u1ec1m h\u00f4 h\u1ea5p do th\u1edf nhanh<\/p>\n

          5.3. L\u00e2m s\u00e0ng<\/h3>\n

          K\u00edch th\u00edch, b\u00fa k\u00e9m, n\u00f4n \u00f3i, co th\u1eaft thanh qu\u1ea3n, tetany, co gi\u1eadt, d\u1ea5u hi\u1ec7u Troussau v\u00e0 Chvostek.<\/p>\n

          5.4. \u0110i\u1ec1u tr\u1ecb<\/h3>\n

          * \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u<\/strong><\/em><\/p>\n

          – Do t\u0103ng th\u00f4ng kh\u00ed: cho b\u1ec7nh nh\u00e2n th\u1edf ch\u1eadm l\u1ea1i, hay qua mask v\u1edbi t\u00fai d\u1ef1 tr\u1eef m\u1ee5c \u0111\u00edch l\u00e0 cho b\u1ec7nh nh\u00e2n h\u00edt l\u1ea1i m\u1ed9t ph\u1ea7n CO2<\/sub>\u00a0c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3 l\u00e0m gi\u1ea3m pH, v\u00ec th\u1ebf s\u1ebd l\u00e0m t\u0103ng can xi ion h\u00f3a trong m\u00e1u.<\/p>\n

          – N\u1ebfu kh\u00f4ng do t\u0103ng th\u00f4ng kh\u00ed:<\/p>\n

          + Calcium gluconate 10% li\u1ec1u 0,5-1mL\/kg TMC trong 1-2 ph\u00fat (ti\u00eam t\u0129nh m\u1ea1ch n\u00ean pha lo\u00e3ng Calcium gluconate n\u1ed3ng \u0111\u1ed9 50mg\/ml).<\/p>\n

          + Ho\u1eb7c Calcium chlorua 10% 0,1-0,2mL\/kg, t\u1ed1i \u0111a Calcium chlorua 10% 2-5 ml\/li\u1ec1u. TMC trong 1-2 ph\u00fat TMC (ti\u00eam t\u0129nh m\u1ea1ch n\u00ean pha lo\u00e3ng Calcium clorua n\u1ed3ng \u0111\u1ed9 20mg\/ml b\u1eb1ng c\u00e1ch pha lo\u00e3ng 10ml CaCl 10% trong dextrose 5% cho \u0111\u1ee7 50 ml).<\/p>\n

          + N\u00ean theo d\u00f5i d\u1ea5u hi\u1ec7u th\u00f3at m\u1ea1ch ho\u1ea1i t\u1eed n\u01a1i ti\u00eam, v\u00e0 \u0111i\u1ec7n tim trong khi ti\u00eam t\u0129nh m\u1ea1ch can xi \u0111\u1ec3 ph\u00e1t hi\u1ec7n r\u1ed1i lo\u1ea1n nh\u1ecbp n\u1ebfu c\u00f3.<\/p>\n

          + N\u1ebfu co gi\u1eadt kh\u00f4ng \u0111\u00e1p \u1ee9ng c\u1ea7n lo\u1ea1i tr\u1eeb nguy\u00ean nh\u00e2n do h\u1ea1 Ma gi\u00ea m\u00e1u.<\/p>\n

          * \u0110i\u1ec1u tr\u1ecb ti\u1ebfp theo<\/strong><\/em><\/p>\n

          – Truy\u1ec1n can xi li\u00ean t\u1ee5c: calciclorua 50 – 100mg\/kg\/ng\u00e0y (pha 2g dung d\u1ecbch calcichlorua 10%, trong 1 l\u00edt d\u1ecbch).<\/p>\n

          – U\u1ed1ng Calcium carbonate, lactate ho\u1eb7c phosphate 200 – 600 mg\/l\u1ea7n x 3-4 l\u1ea7n\/ng\u00e0y.<\/p>\n

          – K\u1ebft h\u1ee3p v\u1edbi magnesium n\u1ebfu c\u1ea7n (gi\u1ea3m can xi th\u01b0\u1eddng k\u00e8m gi\u1ea3m magnesium).<\/p>\n

          – Cho th\u00eam vitamine D trong c\u00f2i x\u01b0\u01a1ng li\u1ec1u 5000 \u0111\u01a1n v\u1ecb\/ng\u00e0y.<\/p>\n

          B\u1ea3ng 4. Th\u00e0nh ph\u1ea7n can xi nguy\u00ean t\u1ed1 trong m\u1ed9t s\u1ed1 dung d\u1ecbch th\u01b0\u1eddng d\u00f9ng<\/p>\n\n\n\n\n\n
          \n

          Ch\u1ebf ph\u1ea9m<\/b><\/p>\n<\/td>\n

          		\n

          Th\u00e0nh ph\u1ea7n can xi nguy\u00ean t\u1ed1<\/b><\/p>\n<\/td>\n<\/tr>\n

          Calcium gluconate 10%<\/td>\n1ml = 9 mg = 0,45 mEq<\/td>\n<\/tr>\n
          Calcium chloride 10%<\/td>\n1ml = 27 mg = 1,36 mEq<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

          6. D\u1ef1 ph\u00f2ng r\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i:<\/h2>\n

          \u0110\u1ec3 ph\u00f2ng ng\u1eeba r\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i \u1edf tr\u1ebb em, c\u1ea7n \u0111\u1ea3m b\u1ea3o tr\u1ebb u\u1ed1ng \u0111\u1ee7 n\u01b0\u1edbc v\u00e0 c\u00e1c ion c\u1ea7n thi\u1ebft cho c\u01a1 th\u1ec3. Tr\u1ebb c\u1ea7n \u0111\u01b0\u1ee3c cung c\u1ea5p \u0111\u1ee7 n\u01b0\u1edbc th\u00f4ng qua vi\u1ec7c u\u1ed1ng n\u01b0\u1edbc th\u01b0\u1eddng xuy\u00ean v\u00e0 \u0103n c\u00e1c lo\u1ea1i th\u1ef1c ph\u1ea9m gi\u00e0u n\u01b0\u1edbc nh\u01b0 rau xanh, hoa qu\u1ea3.\u00a0 Vi\u1ec7c t\u0103ng c\u01b0\u1eddng gi\u00e1m s\u00e1t v\u00e0 ch\u1eefa tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i c\u0169ng r\u1ea5t quan tr\u1ecdng.<\/p>\n

          T\u00f3m l\u1ea1i, ph\u00f2ng ng\u1eeba r\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i \u1edf tr\u1ebb em l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 b\u1ea3o v\u1ec7 s\u1ee9c kh\u1ecfe v\u00e0 t\u00ednh m\u1ea1ng c\u1ee7a tr\u1ebb. Vi\u1ec7c \u0111\u1ea3m b\u1ea3o \u0111\u1ee7 n\u01b0\u1edbc v\u00e0 c\u00e1c ion c\u1ea7n thi\u1ebft cho c\u01a1 th\u1ec3, c\u00f9ng vi\u1ec7c t\u0103ng c\u01b0\u1eddng gi\u00e1m s\u00e1t v\u00e0 ch\u1eefa tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i l\u00e0 nh\u1eefng bi\u1ec7n ph\u00e1p c\u1ea7n thi\u1ebft \u0111\u1ec3 ph\u00f2ng ng\u1eeba t\u00ecnh tr\u1ea1ng n\u00e0y<\/p>\n

          Ngu\u1ed3n: S\u01b0u t\u1ea7m<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

          R\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i \u1edf tr\u1ebb em l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa n\u01b0\u1edbc v\u00e0 c\u00e1c ion trong c\u01a1 th\u1ec3. N\u01b0\u1edbc v\u00e0 c\u00e1c ion nh\u01b0 natri, kali v\u00e0 clorua r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c duy tr\u00ec ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o v\u00e0 c\u00e1c c\u01a1 quan trong c\u01a1 th\u1ec3. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15,33],"tags":[],"yoast_head":"\nR\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"R\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i \u1edf tr\u1ebb em l\u00e0 t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa n\u01b0\u1edbc v\u00e0 c\u00e1c ion. Nguy\u00ean nh\u00e2n do ti\u00eau ch\u1ea3y, n\u00f4n \u00f3i, nu\u00f4i \u0103n \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch.\" \/>\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 n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i \u1edf tr\u1ebb em - Vinmec\" \/>\n<meta property=\"og:description\" content=\"R\u1ed1i lo\u1ea1n n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i \u1edf tr\u1ebb em l\u00e0 t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa n\u01b0\u1edbc v\u00e0 c\u00e1c ion. 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