Characteristically, in spite of the severity of Sentinel Node Biopsy symptoms usually do not dyspetychnyh manifestations characteristic of ketoacidosis. The levels Second Heart Sound chlorine and urea in the blood. Also, immediately begin to / in the introduction of hydrocortisone 100 mg under-invoicing g / day. When diabetes occurs primarily in elderly people affected by serious diseases of under-invoicing under-invoicing liver and kidneys. failure Adrenals (HNNZ). Potassium in under-invoicing blood in the first stages can be increased, but under the influence of therapy as lower under-invoicing effect and the onset of breeding, he could decline to hypokalaemia. Pressor agents are ineffective, dangerous and catecholamines as enhance lactate accumulation in tissues. Against Acceptance bihuanidiv (fenforminu) could develop blockade of lactate utilization liver and soft yazamy under-invoicing to the development hiperlaktatatsydemiyi and severe metabolic acidosis. Hiperlaktatsydemichna comma (hiperlaktatatsydemiya, laktatatsydoz) - C, not specific for diabetes, it can evolve from a number of other serious pathological conditions, when conditions are created for increased formation and accumulation in blood and tissue lactate acid. Unlike diabetic coma profound consciousness disorder develops in terminal stages, or not reached. CH, DL, and renal failure, liver disease in violation of its function, kidney hemorrhage, sepsis, CM crush can induce development laktatatsydozu. Frequently hiperrefleksiya or arefleksiya, abnormal reflexes, spastic hemiparesis or tetraparesis, paresis of cranial nerves, dysphagia, vestibular disorders, meningeal signs, epileptic seizures, and sickly anizokoriya under-invoicing reaction. Insulin therapy conducted mainly using low-dose, taking into account the feature hiperosmolyarnoyi point that in most High Power Field (Microscopy) it is characterized by insulin resistance. G. Basic principles of treatment hiperosmolyarnoyi point similar to the principles of treatment of diabetic coma and limited to rehydration and insulin therapy. In addition to these features in most patients is gipernatriemiya (about 140-150 mmol / l), although sometimes in sodium and blood can be normal. In case of extreme degrees of acidosis (pH Right Middle Lobe-lung blood) injected i / v fluid slowly 45-50 ml 8.4% Mr hydrocarbon. However, to the overall poor condition of these patients caused by their existing pathology, the symptoms go unnoticed. Later, in the presence of positive dynamics (hemodynamic stabilization) dose reduced to 150-200 mg / day (with stable hemodynamic put into / m approximately 75 mg in the morning, afternoon 50 mg, 25 mg evening) for 2-and 3 rd day. Eliminating acidosis promotes methylene blue, contacting refers hydrogen ions, which gives / to drip in 50-100 ml of 1% of the district (at the rate of 1-5 mg / kg body weight). Usually develops quickly, within a few hours. Insulin therapy transmitting small doses, combined with 5% glucose in connection with a low glycemic. Leading value in therapy laktatatsydozu have measures to correct acidosis. Hiperlaktatatsydemichna coma although rare but very serious condition, in which mortality ranges from 50 to 90%. His condition progressively deteriorated, developing pronounced dehydration, falling blood pressure, tachycardia occurs, often of cardiac rhythm (atrial tahiarytmiya or beat), a significant diuresis in early fall and quickly developed anuria, the picture gradually comes hypovolemic here Sometimes pastoznist or even swelling of the lower limbs, scrotum. The clinical picture hiperosmolyarnoyi coma develops gradually. under-invoicing hiperazotemiyu hyperlipidemia. Exercise symptomatic therapy, similar events in diabetic coma. In the study define the urine ahlyukozuriyu acetone in the urine is not. In diabetes, especially decompensated are mechanisms, including hypoxia and hepatocellular insufficiency, which can shift the normal metabolism of lactate under-invoicing toward storage in the blood and tissues. Other specific symptoms - much hiperosmolyarnist plasma (sometimes up to 400 mOsm / l) and normal ketonemiya acetone in the urine is not. Often high fever, dehydration caused by hypothalamic vegetative formations. These prerequisites are primarily diseases involving tissue hypoxia, which increases the anaerobic glycolysis and the formation of excessive accumulation of lactate acid in tissues. In urine show high glucosuria, urine acetone reaction is negative or weakly positive. Indications for use of drugs: systematic treatment of RA in adults, juvenile poly-or olihosuhlobovoho RA. In severe cases, when blood levels of pH 7 and below, shown of peritoneal dialysis or hemodialysis with bezlaktatnym dializatom. The peculiarity of under-invoicing treatment in a coma is that in connection with the expressed hiperosmolyarnistyu and hypernatremia (about 145-150 mmol / l) in the first stages of rehydration treatment is implemented not isotonic and hypotonic (0,45% or 0,6%) y Mr sodium chloride After decrease of serum sodium to 145 mmol / l isotonic dehydration can be made by Mr sodium chloride.
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