{"id":35205,"date":"2023-02-22T08:03:14","date_gmt":"2023-02-22T01:03:14","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=35205"},"modified":"2023-02-22T08:04:04","modified_gmt":"2023-02-22T01:04:04","slug":"roi-loan-dien-giai-va-roi-loan-duong-huyet","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/roi-loan-dien-giai-va-roi-loan-duong-huyet\/","title":{"rendered":"R\u1ed0I LO\u1ea0N \u0110I\u1ec6N GI\u1ea2I V\u00c0 R\u1ed0I LO\u1ea0N \u0110\u01af\u1edcNG HUY\u1ebeT"},"content":{"rendered":"

R\u1ed0I LO\u1ea0N \u0110I\u1ec6N GI\u1ea2I V\u00c0 R\u1ed0I LO\u1ea0N \u0110\u01af\u1edcNG HUY\u1ebeT<\/a>. T\u1ea3i file PDF T\u1ea1i \u0111\u00e2y<\/a>.<\/span><\/strong><\/p>\n

NATRI<\/h2>\n
Natri l\u00e0 cation ch\u00ednh khoang d\u1ecbch ngo\u1ea1i b\u00e0o (ECF). Natri \u0111\u00f3ng vai tr\u00f2 ch\u00ednh trong vi\u1ec7c x\u00e1c\u00a0 \u0111\u1ecbnh th\u1ec3 t\u00edch t\u1ebf b\u00e0o v\u00e0 duy tr\u00ec th\u1ec3 t\u00edch d\u1ecbch ngo\u1ea1i b\u00e0o th\u00f4ng qua duy tr\u00ec \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u m\u00e1u.\u00a0 M\u1ea5t c\u00e2n b\u1eb1ng natri v\u00e0 n\u01b0\u1edbc th\u01b0\u1eddng x\u1ea3y ra c\u00f9ng nhau v\u00e0 \u0111\u01b0\u1ee3c \u0111\u00e1nh \u0111\u1ed3ng v\u1edbi s\u1ef1 thay \u0111\u1ed5i \u00e1p\u00a0 su\u1ea5t th\u1ea9m th\u1ea5u huy\u1ebft thanh. Natri \u0111\u01b0\u1ee3c h\u1ea5p thu ch\u1ee7 \u0111\u1ed9ng \u1edf ru\u1ed9t v\u00e0 b\u00e0i ti\u1ebft qua th\u1eadn v\u00e0 da.\u00a0 Th\u1eadn ch\u1ee7 y\u1ebfu \u0111i\u1ec1u h\u00f2a natri d\u01b0\u1edbi t\u00e1c \u0111\u1ed9ng c\u1ee7a h\u1ec7 th\u1ed1ng renin-angiotensin-aldosterone.\u00a0 Renin \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng t\u1eeb c\u00e1c t\u1ebf b\u00e0o c\u1ea1nh c\u1ea7u th\u1eadn khi \u0111\u00e1p \u1ee9ng v\u1edbi s\u1ef1 thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 natri\u00a0 trong d\u1ecbch \u1ed1ng th\u1eadn. C\u00e1c y\u1ebfu t\u1ed1 ch\u00ednh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1ea3 n\u0103ng b\u00e0i ti\u1ebft natri l\u00e0 \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn\u00a0 v\u00e0 aldosterone. S\u1ef1 thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 natri trong c\u01a1 th\u1ec3 th\u01b0\u1eddng l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c b\u1ec7nh l\u00fd li\u00ean\u00a0 quan \u0111\u1ebfn th\u1eeba n\u01b0\u1edbc ho\u1eb7c thi\u1ebfu h\u1ee5t natri.\u00a0\u00a0<\/span><\/p>\n
H\u1ea1 natri m\u00e1u<\/h3>\n
Nguy\u00ean nh\u00e2n<\/h4>\n
H\u1ea1 natri m\u00e1u \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 n\u1ed3ng \u0111\u1ed9 natri d\u01b0\u1edbi 135 mEq\/L. N\u00f3 th\u01b0\u1eddng l\u00e0 th\u1ee9 ph\u00e1t sau\u00a0 t\u00ecnh tr\u1ea1ng b\u1ec7nh kh\u00e1c. \u1ede tr\u1ebb b\u1ec7nh n\u1eb7ng, h\u1ea1 natri m\u00e1u c\u00f3 th\u1ec3 x\u1ea3y ra do th\u1eeba n\u01b0\u1edbc trong khoang\u00a0 ngo\u1ea1i b\u00e0o, m\u1ea5t natri t\u1eeb khoang ngo\u1ea1i b\u00e0o ho\u1eb7c c\u1ea3 hai. H\u1ea1 natri m\u00e1u c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn gi\u1ea3m\u00a0 th\u1ec3 t\u00edch m\u00e1u, th\u1ec3 t\u00edch b\u00ecnh th\u01b0\u1eddng ho\u1eb7c t\u0103ng th\u1ec3 t\u00edch m\u00e1u. Nguy\u00ean nh\u00e2n c\u1ee7a h\u1ea1 natri m\u00e1u\u00a0 th\u01b0\u1eddng c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh th\u00f4ng qua m\u1ed9t s\u1ed1 th\u0103m d\u00f2 \u0111\u01a1n gi\u1ea3n k\u1ebft h\u1ee3p v\u1edbi th\u0103m kh\u00e1m l\u00e2m s\u00e0ng.\u00a0 Vai tr\u00f2 trung t\u00e2m c\u1ee7a vi\u1ec7c x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng th\u1ec3 t\u00edch tr\u00ean l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong\u00a0 H\u00ecnh 1. Nguy\u00ean nh\u00e2n c\u1ee7a h\u1ea1 natri m\u00e1u gi\u1ea3m \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u kh\u00f4ng th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh t\u1eeb c\u00e1c\u00a0 th\u0103m d\u00f2 \u0111\u01a1n gi\u1ea3n m\u00e0 kh\u00f4ng c\u1ea7n th\u0103m kh\u00e1m l\u00e2m s\u00e0ng.\u00a0<\/span><\/p>\n
$\"Nguy\u00ean$
Nguy\u00ean nh\u00e2n c\u1ee7a h\u1ea1 natri m\u00e1u gi\u1ea3m \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u kh\u00f4ng th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh t\u1eeb c\u00e1c
th\u0103m d\u00f2 \u0111\u01a1n gi\u1ea3n m\u00e0 kh\u00f4ng c\u1ea7n th\u0103m kh\u00e1m l\u00e2m s\u00e0ng.<\/figcaption><\/figure>\n
\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/h4>\n
M\u1ee9c \u0111\u1ed9 h\u1ea1 natri m\u00e1u v\u00e0 t\u1ed1c \u0111\u1ed9 l\u00e0 c\u00e1c y\u1ebfu t\u1ed1 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng tr\u00ean\u00a0 l\u00e2m s\u00e0ng. Natri huy\u1ebft thanh < 120 mEq\/L li\u00ean quan \u0111\u1ebfn co gi\u1eadt v\u00e0 h\u00f4n m\u00ea. \u0110\u1ee9a tr\u1ebb h\u1ea1 natri\u00a0 m\u00e1u \u00edt c\u1ea5p t\u00ednh h\u01a1n c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c bi\u1ec3u hi\u1ec7n l\u01a1 m\u01a1, bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n \u00f3i.\u00a0 R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea7n kinh l\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p v\u1edbi l\u01a1 m\u01a1, l\u00fa l\u1eabn v\u00e0 h\u00f4n m\u00ea.\u00a0 N\u1ebfu h\u1ea1 natri m\u00e1u ti\u1ebfn tri\u1ec3n nhanh c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng t\u0103ng k\u00edch th\u00edch (eg, rung\u00a0 gi\u1eadt c\u01a1, co gi\u1eadt, k\u00edch th\u00edch). Ph\u00f9 n\u00e3o c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n g\u00e2y t\u1ee5t k\u1eb9t v\u00e0 t\u1eed vong.\u00a0\u00a0<\/span><\/p>\n
\u0110i\u1ec1u tr\u1ecb h\u1ea1 natri m\u00e1u ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ed1i t\u01b0\u01a1ng quan v\u1edbi th\u1ec3 t\u00edch d\u1ecbch. N\u1ebfu tri\u1ec7u ch\u1ee9ng h\u1ea1 natri m\u00e1u n\u1eb7ng k\u00e8m gi\u1ea3m th\u1ec3 t\u00edch, b\u00f9 d\u1ecbch bolus NaCl 0.9% \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Sau h\u1ed3i s\u1ee9c,\u00a0 natri huy\u1ebft thanh n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra, v\u00e0 n\u1ebfu v\u1eabn c\u00f2n tri\u1ec7u ch\u1ee9ng th\u00ec cho NaCl 3% t\u0129nh m\u1ea1ch\u00a0 d\u1ef1a v\u00e0o \u0111\u00edch natri huy\u1ebft thanh c\u1ea7n \u0111\u1ea1t \u0111\u01b0\u1ee3c (th\u01b0\u1eddng l\u00e0 ~ 120 mmol\/L). L\u01b0\u1ee3ng natri thi\u1ebfu\u00a0 h\u1ee5t c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u01b0\u1edbc t\u00ednh theo c\u00f4ng th\u1ee9c sau:\u00a0<\/span><\/p>\n
(120 mEq\/L \u2013 Na+ \u0111o \u0111\u01b0\u1ee3c) x c\u00e2n n\u1eb7ng (kg) x 0.6 L\/kg\u00a0<\/span><\/p>\n
Natri huy\u1ebft thanh ph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i s\u00e1t. Natri huy\u1ebft thanh t\u0103ng l\u00ean kh\u00f4ng qu\u00e1 1-2\u00a0 mmol\/L\/gi\u1edd sau khi \u0111\u1ea1t \u0111\u00edch \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u v\u1edbi mu\u1ed1i 3%. N\u1ebfu kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, b\u00f9\u00a0 ch\u1eadm lu\u00f4n an to\u00e0n h\u01a1n. N\u1ebfu m\u1ea1n t\u00ednh, t\u0103ng natri huy\u1ebft thanh kh\u00f4ng qu\u00e1 0.5 mmol\/L\/gi\u1edd.\u00a0 Kh\u00f4ng n\u00e2ng natri qu\u00e1 12 mmol\/l trong 24 gi\u1edd \u0111\u1ea7u. T\u0103ng n\u1ed3ng \u0111\u1ed9 natri qu\u00e1 nhanh c\u00f3 th\u1ec3 li\u00ean\u00a0 quan \u0111\u1ebfn kh\u1eed myelin do \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u v\u00e0 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh l\u00e2u d\u00e0i.\u00a0\u00a0<\/span><\/p>\n
\u0110i\u1ec1u ch\u1ec9nh h\u1ea1 natri m\u00e1u c\u00f3 t\u0103ng th\u1ec3 t\u00edch l\u00e0 tr\u1ef1c ti\u1ebfp \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n (c\u00f3 th\u1ec3 do truy\u1ec1n\u00a0 dung d\u1ecbch nh\u01b0\u1ee3c tr\u01b0\u01a1ng trong b\u1ec7nh c\u1ea3nh t\u0103ng ADH). Cho l\u1ee3i ti\u1ec3u v\u00e0 h\u1ea1n ch\u1ebf d\u1ecbch \u0111\u1ec3 gi\u1ea3m\u00a0 t\u1ed5ng th\u1ec3 t\u00edch d\u1ecbch c\u01a1 th\u1ec3. Tr\u1eeb khi natri ti\u1ebfp t\u1ee5c h\u1ea1 d\u00f9 \u0111\u00e3 d\u00f9ng l\u1ee3i ti\u1ec3u v\u00e0 h\u1ea1n ch\u1ebf d\u1ecbch, n\u01b0\u1edbc\u00a0 mu\u1ed1i \u01b0u tr\u01b0\u01a1ng th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng v\u00ec t\u1ed5ng natri c\u01a1 th\u1ec3 n\u00ean b\u00ecnh th\u01b0\u1eddng.\u00a0\u00a0<\/span><\/p>\n
T\u0103ng natri m\u00e1u<\/h3>\n
Nguy\u00ean nh\u00e2n<\/h4>\n
T\u0103ng natri m\u00e1u (natri huy\u1ebft thanh tr\u00ean 145 mEq\/L) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u0103ng natri m\u00e1u trong\u00a0 khoang ngo\u1ea1i b\u00e0o. N\u00f3 c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n do qu\u00e1 nhi\u1ec1u natri ho\u1eb7c thi\u1ebfu d\u1ecbch ho\u1eb7c c\u1ea3 hai. Qu\u00e1\u00a0 nhi\u1ec1u natri \u0111\u01b0\u1ee3c cho l\u00e0 do truy\u1ec1n qu\u00e1 nhi\u1ec1u NaCl 0.9% trong d\u1ecbch duy tr\u00ec. N\u00f3 c\u00f3 th\u1ec3 do truy\u1ec1n\u00a0 qu\u00e1 nhi\u1ec1u natri bicarbonate trong qu\u00e1 tr\u00ecnh h\u1ed3i s\u1ee9c.\u00a0\u00a0<\/span><\/p>\n
Thi\u1ebfu n\u01b0\u1edbc c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong c\u00e1c b\u1ec7nh l\u00fd: \u0111\u00e1i th\u00e1o nh\u1ea1t, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, v\u00e3 m\u1ed3 h\u00f4i, ti\u00eau\u00a0 ch\u1ea3y, m\u1ea5t n\u01b0\u1edbc, t\u0103ng l\u01b0\u1ee3ng n\u01b0\u1edbc m\u1ea5t kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c.\u00a0\u00a0<\/span><\/p>\n
Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 x\u1eed tr\u00ed<\/h4>\n
T\u0103ng natri m\u00e1u c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c v\u1ea5n \u0111\u1ec1 nghi\u00eam tr\u1ecdng li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng. M\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ban \u0111\u1ea7u kh\u00f4ng d\u1ef1 \u0111o\u00e1n \u0111\u01b0\u1ee3c m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh. Theo d\u00f5i c\u1ea9n th\u1eadn nh\u1eefng \u0111\u1ee9a tr\u1ebb t\u0103ng natri m\u00e1u\u00a0 ho\u1eb7c c\u00f3 nguy c\u01a1 l\u00e0 \u0111i\u1ec1u quan tr\u1ecdng \u0111\u1ec3 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh. \u0110\u00e1nh gi\u00e1 bao g\u1ed3m tri\u00a0 gi\u00e1c, l\u01b0\u1ee3ng d\u1ecbch xu\u1ea5t nh\u1eadp v\u00e0 \u0111o n\u1ed3ng \u0111\u1ed9 natri huy\u1ebft thanh trong su\u1ed1t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.\u00a0<\/span><\/p>\n
\u0110i\u1ec1u tr\u1ecb b\u00f9 d\u1ecbch \u0111\u01b0a v\u00e0o t\u1ebf b\u00e0o v\u1edbi t\u1ed1c \u0111\u1ed9 thay th\u1ebf l\u01b0\u1ee3ng n\u01b0\u1edbc m\u1ea5t ch\u1eadm, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u\u00a0 tr\u1ecb b\u1ec7nh l\u00fd n\u1ec1n (eg, \u0111\u00e1i th\u00e1o nh\u1ea1t). N\u1ebfu th\u1ec3 t\u00edch d\u1ecbch thi\u1ebfu nhi\u1ec1u v\u00e0 c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a shock,\u00a0 l\u1ef1a ch\u1ecdn d\u1ecbch ban \u0111\u1ea7u l\u00e0 d\u1ecbch tinh th\u1ec3 \u0111\u1eb3ng tr\u01b0\u01a1ng. Sau khi h\u1ed3i s\u1ee9c ban \u0111\u1ea7u, d\u1ecbch nh\u01b0\u1ee3c\u00a0 tr\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c cho \u0111\u1ec3 l\u00e0m gi\u1ea3m natri 0.5 mEq\/L\/gi\u1edd. L\u01b0\u1ee3ng d\u1ecbch thi\u1ebfu n\u00ean \u0111\u01b0\u1ee3c b\u00f9\u00a0 ch\u1eadm (trong 48-72 gi\u1edd) sau h\u1ed3i s\u1ee9c ban \u0111\u1ea7u. T\u1ed1c \u0111\u1ed9 r\u01a1i qu\u00e1 nhanh li\u00ean quan \u0111\u1ebfn t\u0103ng nguy\u00a0 c\u01a1 ph\u00f9 n\u00e3o, xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n, co gi\u1eadt v\u00e0 bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh v\u1ec1 l\u00e2u v\u1ec1 d\u00e0i. Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh d\u1ecbch kh\u00f4ng c\u00f3 natri. \u0110\u1ed1i v\u1edbi tr\u1ebb t\u0103ng t\u1ed5ng l\u01b0\u1ee3ng natri c\u01a1 th\u1ec3 v\u00e0 qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch, lo\u1ea1i b\u1ecf nhi\u1ec1u natri th\u00f4ng qua vi\u1ec7c d\u00f9ng l\u1ee3i ti\u1ec3u v\u00e0 gi\u1ea3m l\u01b0\u1ee3ng natri nh\u1eadp v\u00e0o (n\u1ebfu ch\u1ee9c n\u0103ng th\u1eadn\u00a0 b\u00ecnh th\u01b0\u1eddng). N\u1ebfu ch\u1ee9c n\u0103ng th\u1eadn b\u1ecb suy c\u1ea7n \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn.\u00a0\u00a0<\/span><\/p>\n
KALI<\/h2>\n
Kali l\u00e0 cation ch\u1ee7 y\u1ebfu \u1edf n\u1ed9i b\u00e0o v\u00e0 chi\u1ebfm ph\u1ea7n nh\u1ecf trong huy\u1ebft thanh v\u00e0 d\u1ecbch ngo\u1ea1i b\u00e0o. N\u00f3\u00a0 \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong \u0111i\u1ec7n th\u1ebf \u0111\u1ed9ng \u1edf h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, da, c\u01a1 tr\u01a1n v\u00e0 h\u1ec7 th\u1ed1ng d\u1eabn truy\u1ec1n tim.\u00a0\u00a0<\/span><\/p>\n
H\u1ea1 kali m\u00e1u<\/h3>\n
Nguy\u00ean nh\u00e2n<\/h4>\n
H\u1ea1 kali m\u00e1u \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 kali m\u00e1u d\u01b0\u1edbi 3.5 mEq\/L. N\u00f3 c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n do h\u1ea1 kali m\u00e1u\u00a0 th\u1eadt s\u1ef1 ho\u1eb7c do kali b\u1ecb k\u00e9o ra kh\u1ecfi l\u00f2ng m\u1ea1ch v\u00e0o b\u00ean trong t\u1ebf b\u00e0o. Thi\u1ebfu th\u1eadt s\u1ef1 c\u00f3 th\u1ec3 do\u00a0 m\u1ea5t qu\u00e1 nhi\u1ec1u : \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, m\u1ed3 h\u00f4i, b\u00e0i ti\u1ebft qua th\u1eadn ho\u1eb7c gi\u1ea3m kali \u0103n v\u00e0o. Kali b\u1ecb k\u00e9o\u00a0 ra kh\u1ecfi l\u00f2ng m\u1ea1ch v\u00e0o trong t\u1ebf b\u00e0o c\u00f3 th\u1ec3 g\u1eb7p trong b\u1ec7nh c\u1ea3nh ki\u1ec1m m\u00e1u, qu\u00e1 nhi\u1ec1u insulin).\u00a0 Kali huy\u1ebft thanh c\u00f3 th\u1ec3 v\u1eabn trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng d\u00f9 kali to\u00e0n ph\u1ea7n trong c\u01a1 th\u1ec3 b\u1ecb gi\u1ea3m. Khi l\u01b0\u1ee3ng kali d\u1ef1 tr\u1eef b\u1ecb thi\u1ebfu h\u1ee5t, gi\u1ea3m kali huy\u1ebft thanh l\u00e0 ch\u1ec9 \u0111i\u1ec3m c\u1ee7a gi\u1ea3m kali to\u00e0n\u00a0 ph\u1ea7n trong c\u01a1 th\u1ec3.\u00a0\u00a0<\/span><\/p>\n
T\u0103ng b\u00e0i ti\u1ebft \u1edf th\u1eadn c\u00f3 th\u1ec3 g\u1eb7p do t\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a mineralocorticoid, r\u1ed1i lo\u1ea1n th\u0103ng b\u1eb1ng\u00a0 toan ki\u1ec1m, ho\u1eb7c t\u0103ng l\u01b0\u1ee3ng natri \u0111\u01b0a \u0111\u1ebfn nephron (d\u00f9ng l\u1ee3i ti\u1ec3u). Kali to\u00e0n ph\u1ea7n trong c\u01a1\u00a0 th\u1ec3 c\u00f3 b\u1ecb che l\u1ea5p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n toan chuy\u1ec3n h\u00f3a n\u1eb7ng (eg, trong DKA kali m\u1ea5t qua n\u01b0\u1edbc\u00a0 ti\u1ec3u nh\u01b0ng n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft thanh b\u00ecnh th\u01b0\u1eddng ho\u1eb7c cao c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n trong x\u00e9t nghi\u1ec7m\u00a0 ban \u0111\u1ea7u). M\u1ea5t qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p g\u00e2y h\u1ea1 kali m\u00e1u. Tri\u1ec7u ch\u1ee9ng\u00a0 li\u00ean quan \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 v\u00e0 th\u1eddi gian h\u1ea1 kali m\u00e1u.\u00a0\u00a0<\/span><\/p>\n
\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 x\u1eed tr\u00ed<\/h4>\n
B\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 h\u1ea1 kali m\u00e1u c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ECG (k\u00e9o d\u00e0i PR, s\u00f3ng T \u0111\u1ea3o ng\u01b0\u1ee3c v\u00e0\u00a0 s\u00f3ng U), b\u1ea5t th\u01b0\u1eddng ch\u1ee9c n\u0103ng th\u1ea7n kinh c\u01a1 (y\u1ebfu c\u01a1, ch\u01b0\u1edbng b\u1ee5ng, li\u1ec7t ru\u1ed9t, l\u01a1 m\u01a1, k\u00edch th\u00edch,\u00a0 t\u0103ng ph\u1ea3n x\u1ea1, g\u1ed3ng c\u1ee9ng). V\u1ea5n \u0111\u1ec1 quan tr\u1ecdng nh\u1ea5t l\u00e0 li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim v\u00e0\u00a0 li\u1ec7t c\u01a1.\u00a0\u00a0<\/span><\/p>\n
\u0110i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi kali huy\u1ebft thanh < 3 mEq\/L ho\u1eb7c \u0111\u1ee9a tr\u1ebb c\u00f3 bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng\u00a0 c\u1ee7a h\u1ea1 kali m\u00e1u. B\u00f9 \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u01b0\u1ee3c \u01b0u ti\u00ean h\u01a1n n\u1ebfu t\u00ecnh tr\u1ea1ng \u0111\u1ee9a tr\u1ebb cho ph\u00e9p. Li\u1ec1u 0.5- 1 mEq\/kg (l\u1eb7p l\u1ea1i m\u1ed7i 4-8 gi\u1edd) l\u00e0 th\u00edch h\u1ee3p n\u1ebfu ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c l\u01b0\u1ee3ng kali \u0111ang m\u1ea5t. N\u1ebfu c\u1ea7n\u00a0 b\u00f9 kali \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, truy\u1ec1n v\u1edbi t\u1ed1c \u0111\u1ed9 < 0.5 mEq\/kg\/gi\u1edd. Theo d\u00f5i ECG li\u00ean t\u1ee5c v\u00e0 \u0111o\u00a0<\/span><\/p>\n
n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft thanh th\u01b0\u1eddng xuy\u00ean l\u00e0 \u0111i\u1ec1u c\u1ea7n thi\u1ebft \u0111\u1ec3 ph\u00e1t hi\u1ec7n r\u1ed1i lo\u1ea1n nh\u1ecbp v\u00e0 tr\u00e1nh\u00a0 bi\u1ebfn ch\u1ee9ng. N\u1ebfu c\u1ea7n b\u00f9 \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch n\u00ean truy\u1ec1n qua vein trung t\u00e2m v\u00ec dung d\u1ecbch g\u00e2y\u00a0 k\u00edch \u1ee9ng vein ngo\u1ea1i bi\u00ean, g\u00e2y \u0111au v\u00e0 vi\u00eam t\u0129nh m\u1ea1ch. N\u1ebfu c\u00f3 th\u1ec3, tr\u00e1nh truy\u1ec1n dung d\u1ecbch ch\u1ee9a\u00a0 KCl > 40 mEq\/L qua vein ngo\u1ea1i bi\u00ean.\u00a0\u00a0<\/span><\/p>\n
T\u0103ng kali m\u00e1u<\/h3>\n
Nguy\u00ean nh\u00e2n<\/h4>\n
T\u0103ng kali m\u00e1u \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 kali huy\u1ebft thanh > 5.5 mEq\/L. Nguy\u00ean nh\u00e2n bao g\u1ed3m c\u00e1c\u00a0 thay \u0111\u1ed5i b\u00e0i ti\u1ebft qua th\u1eadn (r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn ho\u1eb7c l\u1ee3i ti\u1ec3u gi\u1eef kali), suy ch\u1ee9c n\u0103ng \u0111i\u1ec1u\u00a0 h\u00f2a ngo\u00e0i th\u1eadn (suy tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn, thu\u1ed1c), s\u1ef1 d\u1ecbch chuy\u1ec3n t\u1eeb n\u1ed9i b\u00e0o ra ngo\u1ea1i b\u00e0o (t\u1ebf b\u00e0o b\u1ecb ph\u00e1 h\u1ee7y nhanh ch\u00f3ng \u2013 h\u00f3a tr\u1ecb, b\u1ecfng, ch\u1ea5n th\u01b0\u01a1ng, ti\u00eau c\u01a1 v\u00e2n, succinylcholine) v\u00e0\u00a0 t\u0103ng l\u01b0\u1ee3ng kali nh\u1eadp v\u00e0o (truy\u1ec1n TM, \u0103n u\u1ed1ng ho\u1eb7c thu\u1ed1c ch\u1ee9a h\u00e0m l\u01b0\u1ee3ng cao kali).\u00a0\u00a0<\/span><\/p>\n
Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 x\u1eed tr\u00ed<\/h4>\n
T\u0103ng kali m\u00e1u l\u00e0 m\u1ed9t trong nh\u1eefng r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i nguy hi\u1ec3m nh\u1ea5t v\u00ec ti\u1ec1m \u1ea9n nguy c\u01a1 g\u00e2y\u00a0 \u0111\u1ed9t t\u1eed. R\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t v\u00e0 ng\u1eebng tim c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng bao g\u1ed3m y\u1ebfu\u00a0 c\u01a1, l\u00fa l\u1eabn, li\u1ec7t, thay \u0111\u1ed5i ch\u1ee9c n\u0103ng tim, t\u1ee5t huy\u1ebft \u00e1p, tim ch\u1eadm, bu\u1ed3n n\u00f4n, ti\u00eau ch\u1ea3y, t\u0103ng nhu\u00a0 \u0111\u1ed9ng ru\u1ed9t. Thay \u0111\u1ed5i tr\u00ean ECG bao g\u1ed3m s\u00f3ng T cao nh\u1ecdn, s\u00f3ng P ph\u1eb3ng, k\u00e9o d\u00e0i PR, ng\u01b0ng\u00a0 xoang ho\u1eb7c nodal rhythm, QRS r\u1ed9ng, s\u00f3ng S s\u00e2u, s\u00f3ng h\u00ecnh sine, v\u00f4 t\u00e2m thu ho\u1eb7c rung th\u1ea5t.\u00a0 (\u0110i\u1ec1u tr\u1ecb : \u0111\u1ecdc \u1edf ch\u01b0\u01a1ng\u00a0<\/span>\u0110i\u1ec1u tr\u1ecb thi\u1ec3u ni\u1ec7u v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn c\u1ea5p t\u00ednh<\/span><\/i>).\u00a0<\/span><\/p>\n
GLUCOSE<\/h2>\n
H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft<\/h3>\n
Nguy\u00ean nh\u00e2n<\/h4>\n
H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 BGL (blood glucose level) hay \u0111\u01b0\u1eddng m\u00e1u th\u1ea5p g\u00e2y ra\u00a0 bi\u1ec3u hi\u1ec7n v\u00e0\/ho\u1eb7c tri\u1ec7u ch\u1ee9ng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea7n kinh \u2013 nh\u00ecn chung < 3.3 mmol\/L \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 tr\u1ebb nh\u1ecf. Tr\u1ebb s\u01a1 sinh c\u00f3 BGL < 2.6 mmol\/l v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c t\u0103ng nguy c\u01a1\u00a0 \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng th\u1eadn kinh c\u1ea5p t\u00ednh v\u00e0 v\u1ec1 l\u00e2u v\u1ec1 d\u00e0i. Tr\u1ebb suy dinh d\u01b0\u1ee1ng ho\u1eb7c tr\u1ebb m\u1eafc c\u00e1c b\u1ec7nh\u00a0 l\u00fd di truy\u1ec1n nh\u1ea5t \u0111\u1ecbnh c\u00f3 nguy c\u01a1 cao h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft trong b\u1ec7nh \u0111\u1ee3t c\u1ea5p v\u00e0 n\u00ean \u0111\u01b0\u1ee3c theo\u00a0 d\u00f5i s\u00e1t.\u00a0\u00a0<\/span><\/p>\n
Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 x\u1eed tr\u00ed<\/h4>\n
K\u00edch th\u00edch th\u1ea7n kinh giao c\u1ea3m g\u00e2y y\u1ebfu, tim nhanh, run r\u1ea9y v\u00e0 v\u00e3 m\u1ed3 h\u00f4i. T\u00e1c \u0111\u1ed9ng l\u00ean h\u1ec7 th\u1ea7n\u00a0 kinh trung \u01b0\u01a1ng bao g\u1ed3m \u0111au \u0111\u1ea7u, co gi\u1eadt, \u1ee9c ch\u1ebf nh\u1eadn th\u1ee9c.\u00a0\u00a0<\/span><\/p>\n
\u0110i\u1ec1u tr\u1ecb bao g\u1ed3m ph\u00e1t hi\u1ec7n c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1, v\u00e0 k\u1ecbp th\u1eddi \u0111i\u1ec1u ch\u1ec9nh t\u00ecnh tr\u1ea1ng h\u1ea1 \u0111\u01b0\u1eddng\u00a0 huy\u1ebft. B\u00f9 d\u1ecbch ch\u1ee9a carbohydrate \u0111\u01b0\u1eddng u\u1ed1ng l\u00e0 th\u00edch h\u1ee3p n\u1ebfu \u0111\u1ee9a tr\u1ebb u\u1ed1ng \u0111\u01b0\u1ee3c. Cho\u00a0 glucose 10% li\u1ec1u 2 ml\/kg t\u0129nh m\u1ea1ch sau \u0111\u00f3 truy\u1ec1n glucose duy tr\u00ec n\u1ebfu \u0111\u1ee9a tr\u1ebb h\u1ea1 \u0111\u01b0\u1eddng\u00a0 huy\u1ebft v\u00e0 kh\u00f4ng th\u1ec3 dung n\u1ea1p \u0111\u01b0\u1eddng u\u1ed1ng. \u0110\u00e1nh gi\u00e1 th\u01b0\u1eddng xuy\u00ean tri gi\u00e1c, ph\u00e1t hi\u1ec7n k\u1ecbp th\u1eddi\u00a0 co gi\u1eadt v\u00e0 \u0111o l\u1ea1i \u0111\u01b0\u1eddng m\u00e1u l\u00e0 c\u1ea7n thi\u1ebft.\u00a0<\/span><\/p>\n
T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft<\/h3>\n
Nguy\u00ean nh\u00e2n<\/h4>\n
T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u0111\u01b0\u1eddng m\u00e1u > 7 mmol\/L. Gi\u00e1 tr\u1ecb v\u01b0\u1ee3t qu\u00e1 ng\u01b0\u1ee1ng l\u1ecdc\u00a0 t\u1ea1i th\u1eadn c\u00f3 th\u1ec3 g\u00e2y t\u0103ng glucose ni\u1ec7u v\u00e0 ti\u1ec3u nhi\u1ec1u do l\u1ee3i ti\u1ec3u th\u1ea9m th\u1ea5u. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 g\u00e2y\u00a0 m\u1ea5t n\u01b0\u1edbc v\u00e0 shock. C\u00e1c nguy\u00ean nh\u00e2n bao g\u1ed3m h\u1ed9i ch\u1ee9ng Cushing ho\u1eb7c thi\u1ebfu h\u1ee5t insulin ho\u1eb7c\u00a0 \u0111\u1ec1 kh\u00e1ng insulin (\u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng).\u00a0\u00a0<\/span><\/p>\n
Toan cetone \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (DKA)<\/h4>\n
DKA l\u00e0 b\u1ec7nh l\u00fd n\u1ed9i ti\u1ebft th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf tr\u1ebb nh\u1ecf v\u00e0 thanh thi\u1ebfu ni\u00ean, li\u00ean quan \u0111\u1ebfn thi\u1ebfu\u00a0 insulin t\u01b0\u01a1ng \u0111\u1ed1i ho\u1eb7c tuy\u1ec7t \u0111\u1ed1i. N\u00f3 c\u00f3 th\u1ec3 g\u1eb7p \u1edf tr\u1ebb v\u1edbi \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type I bi\u1ec3u hi\u1ec7n l\u1ea7n\u00a0 \u0111\u1ea7u ti\u00ean, nh\u1eefng tr\u1ebb kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb insulin, ho\u1eb7c do c\u00e1c y\u1ebfu t\u1ed1 stress\/nhi\u1ec5m tr\u00f9ng\u00a0 kh\u1edfi ph\u00e1t. Thi\u1ebfu h\u1ee5t insulin v\u00e0 ho\u1ea1t \u0111\u1ed9ng glucagon kh\u00f4ng c\u00e2n b\u1eb1ng d\u1eabn \u0111\u1ebfn b\u1ea5t th\u01b0\u1eddng\u00a0 chuy\u1ec3n h\u00f3a carbohydrate, protein v\u00e0 ch\u1ea5t b\u00e9o.\u00a0\u00a0<\/span><\/p>\n
\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 x\u1eed tr\u00ed<\/h4>\n
S\u1ea3n xu\u1ea5t qu\u00e1 nhi\u1ec1u glucose v\u00e0 kh\u00f4ng th\u1ec3 d\u00f9ng ch\u00fang g\u00e2y t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 ti\u1ec3u glucose\u00a0 khi v\u01b0\u1ee3t qu\u00e1 ng\u01b0\u1ee1ng l\u1ecdc \u1edf th\u1eadn. L\u1ee3i ti\u1ec3u th\u1ea9m th\u1ea5u qu\u00e1 m\u1ee9c g\u00e2y \u0111a ni\u1ec7u, m\u1ea5t \u0111i\u1ec7n gi\u1ea3i qua\u00a0 n\u01b0\u1edbc ti\u1ec3u, m\u1ea5t n\u01b0\u1edbc v\u00e0 u\u1ed1ng nhi\u1ec1u b\u00f9 tr\u1eeb. Toan ketone g\u00e2y r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i v\u00e0 m\u1ea5t n\u01b0\u1edbc c\u00f3\u00a0 th\u1ec3 \u0111\u1ee7 n\u1eb7ng \u0111\u1ec3 g\u00e2y suy tu\u1ea7n ho\u00e0n. Toan lactic g\u00f3p ph\u1ea7n g\u00e2y h\u1ea1 pH.\u00a0\u00a0<\/span><\/p>\n
Ph\u00f9 n\u00e3o l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng c\u1ee7a DKA. C\u00e1c d\u1ea5u hi\u1ec7u t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n t\u1ea1i ph\u00f2ng\u00a0 c\u1ea5p c\u1ee9u ho\u1eb7c sau \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u v\u00e0 th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf tr\u1ebb em so v\u1edbi ng\u01b0\u1eddi l\u1edbn. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 li\u00ean quan v\u1edbi pH d\u01b0\u1edbi 7, t\u0103ng \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u, t\u0103ng natri m\u00e1u, d\u00f9ng bicarbonate,\u00a0 \u0111i\u1ec1u ch\u1ec9nh \u0111\u01b0\u1eddng qu\u00e1 nhanh, b\u00f9 d\u1ecbch t\u00edch c\u1ef1c qu\u00e1 m\u1ee9c v\u00e0 \u1edf tr\u1ebb qu\u00e1 nh\u1ecf. Tr\u00e1nh thay \u0111\u1ed5i \u00e1p\u00a0 su\u1ea5t th\u1ea9m th\u1ea5u qu\u00e1 nhanh trong \u0111i\u1ec1u tr\u1ecb l\u00e0 m\u1ed9t xem x\u00e9t quan tr\u1ecdng \u0111\u1ec3 ng\u0103n ng\u1eeba ph\u00f9 n\u00e3o.\u00a0\u00a0<\/span><\/p>\n
M\u1ee5c ti\u00eau ch\u00ednh trong qu\u1ea3n l\u00fd \u0111\u1ee9a tr\u1ebb DKA l\u00e0 \u0111i\u1ec1u ch\u1ec9nh t\u00ecnh tr\u1ea1ng toan chuy\u1ec3n h\u00f3a, r\u1ed1i lo\u1ea1n\u00a0 \u0111i\u1ec7n gi\u1ea3i, b\u00f9 d\u1ecbch ch\u1eadm v\u00e0 tr\u00e1nh gi\u1ea3m \u00e1p su\u1ea5t th\u1ea9m th\u1ea5u v\u00e0 ph\u00f9 n\u00e3o.\u00a0\u00a0<\/span><\/p>\n
T\u1ed5ng quan<\/h4>\n
DKA (t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, toan chuy\u1ec3n h\u00f3a v\u00e0 t\u0103ng ketone m\u00e1u) c\u00f3 th\u1ec3 l\u00e0 bi\u1ec3u hi\u1ec7n \u0111\u1ea7u ti\u00ean \u1edf m\u1ed9t \u0111\u1ee9a tr\u1ebb ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. DKA c\u0169ng c\u00f3 th\u1ec3 do c\u00e1c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y\u00a0 nh\u01b0 c\u1ea3m c\u00fam ho\u1eb7c kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb insulin.\u00a0\u00a0<\/span><\/p>\n
T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n bi\u1ec3u hi\u1ec7n \u0111\u01b0\u1eddng m\u00e1u \u2265 11 mmol\/l (200 mg\/dl) n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra ketone\u00a0 m\u00e1u m\u1eabu m\u00e1u mao m\u1ea1ch ho\u1eb7c m\u1eabu m\u00e1u t\u0129nh m\u1ea1ch, n\u1ebfu c\u00f3 th\u1ec3. N\u1ebfu ketone m\u00e1u > 0.6 mmol\/l,\u00a0 \u0111\u00e1nh gi\u00e1 toan m\u00e1u \u0111\u1ec3 c\u00f3 h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb ti\u1ebfp theo. Ketone trong ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng trong \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u n\u1ebfu ketone m\u00e1u kh\u00f4ng l\u00e0m \u0111\u01b0\u1ee3c.\u00a0\u00a0<\/span><\/p>\n
Ti\u00eau chu\u1ea9n sinh h\u00f3a trong DKA:\u00a0<\/span><\/p>\n
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T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft (\u0111\u01b0\u1eddng m\u00e1u \u2265 11 mmol\/l)\u00a0<\/span><\/li>\n
pH m\u00e1u t\u0129nh m\u1ea1ch < 7.3 ho\u1eb7c bicarbonate < 15 mmol\/l<\/span><\/li>\n
S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a ketone m\u00e1u ho\u1eb7c ketone ni\u1ec7u\u00a0<\/span><\/li>\n<\/ul>\n
N\u1ebfu ketones \u00e2m t\u00ednh, ho\u1eb7c pH b\u00ecnh th\u01b0\u1eddng trong s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a ketones, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi insulin ti\u00eam d\u01b0\u1edbi da.\u00a0\u00a0<\/span><\/p>\n
\u0110\u00e1nh gi\u00e1 \u0111\u1ee9a tr\u1ebb DKA<\/h4>\n
1 \u2013 M\u1ee9c \u0111\u1ed9 m\u1ea5t n\u01b0\u1edbc\/shock\u00a0\u00a0<\/strong><\/p>\n
\n
Nh\u1eb9 (< 4%): kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng\u00a0<\/span><\/li>\n
V\u1eeba (4-7%): d\u1ea5u hi\u1ec7u m\u1ea5t n\u01b0\u1edbc d\u1ec5 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c (eg, d\u1ea5u v\u00e9o da, \u0111\u1ed5 \u0111\u1ea7y mao m\u1ea1ch\u00a0 k\u00e9m)\u00a0<\/span><\/li>\n
N\u1eb7ng (> 7%): da ni\u00eam kh\u00f4, m\u1eaft tr\u0169n, d\u1ea5u v\u00e9o da, CRT k\u00e9o d\u00e0i\u00a0<\/span><\/li>\n
Shock \u2013 t\u01b0\u1edbi m\u00e1u k\u00e9m, m\u1ea1ch nhanh, t\u1ee5t huy\u1ebft \u00e1p\u00a0<\/span><\/li>\n<\/ul>\n
L\u01b0u \u00fd: T\u01b0\u1edbi m\u00e1u v\u00e0 huy\u1ebft \u00e1p ph\u1ea3n \u00e1nh th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch. N\u00f3 c\u00f3 th\u1ec3 do m\u1ea5t n\u01b0\u1edbc kh\u00f4ng\u00a0 c\u00f3 shock, ho\u1eb7c c\u00f3 shock v\u00e0 kh\u00f4ng m\u1ea5t n\u01b0\u1edbc. Shock c\u1ea7n b\u00f9 d\u1ecbch (li\u1ec1u 20 mL\/kg) trong\u00a0 khi m\u1ea5t n\u01b0\u1edbc li\u00ean quan \u0111\u1ebfn b\u00f9 t\u1ed5ng th\u1ec3 t\u00edch d\u1ecbch c\u01a1 th\u1ec3 (k\u1ec3 c\u1ea3 m\u1ea5t n\u01b0\u1edbc 5% c\u00f3 th\u1ec3 c\u1ea7n b\u00f9 50 mL\/kg nh\u01b0ng v\u1edbi t\u1ed1c \u0111\u1ed9 ch\u1eadm h\u01a1n, eg. 48 gi\u1edd). C\u1ea7n th\u1eadn tr\u1ecdng nh\u1ecbp tim\u00a0 nhanh th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n \u1edf tr\u1ebb DKA v\u00e0 n\u00f3 kh\u00f4ng ph\u1ea3i l\u00e0 ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 bolus d\u1ecbch khi\u00a0 kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng n\u00e0o kh\u00e1c c\u1ee7a shock.\u00a0\u00a0<\/span><\/p>\n
2 \u2013 Tri gi\u00e1c \u2013 thang \u0111i\u1ec3m Glasgow\u00a0<\/strong><\/p>\n
GCS l\u00e0 thang \u0111i\u1ec3m \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 tri gi\u00e1c. GCS bi\u1ebfn \u0111\u1ed9ng l\u00e0 th\u01b0\u1eddng g\u1eb7p; con s\u1ed1 tuy\u1ec7t\u00a0 \u0111\u1ed1i c\u00f3 th\u1ec3 sai \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n ki\u1ec7t s\u1ee9c v\u1edbi ki\u1ec3u th\u1edf Kussmaul. \u0110i\u1ec3m v\u1eadn \u0111\u1ed9ng l\u00e0 th\u00f4ng\u00a0 s\u1ed1 t\u1ed1t nh\u1ea5t \u0111\u1ec3 \u0111\u00e1nh gi\u00e1.\u00a0\u00a0<\/span><\/p>\n
3 \u2013 X\u00e9t nghi\u1ec7m\u00a0<\/strong><\/p>\n
M\u1eabu m\u00e1u t\u0129nh m\u1ea1ch:\u00a0<\/span><\/p>\n
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\u0110\u01b0\u1eddng huy\u1ebft, urea, \u0111i\u1ec7n gi\u1ea3i (natri, kali, canxi, magie, phosphate), c\u00f4ng th\u1ee9c m\u00e1u\u00a0<\/span>\u2022\u00a0<\/span>Ketones m\u00e1u (x\u00e9t nghi\u1ec7m t\u1ea1i gi\u01b0\u1eddng)\u00a0<\/span><\/li>\n
Kh\u00ed m\u00e1u t\u0129nh m\u1ea1ch (bao g\u1ed3m bicarbonate)\u00a0<\/span><\/li>\n
Ki\u1ec3m tra c\u00e1c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y (eg, nhi\u1ec5m tr\u00f9ng). N\u1ebfu l\u00e2m s\u00e0ng ch\u1ec9 \u0111i\u1ec3m, c\u1ea5y m\u00e1u v\u00e0\u00a0 xem x\u00e9t ch\u1ee5p xquang.\u00a0\u00a0<\/span><\/li>\n<\/ul>\n
N\u01b0\u1edbc ti\u1ec3u\u00a0<\/span><\/p>\n
\n
Ketones, c\u1ea5y (n\u1ebfu c\u00f3 b\u1eb1ng ch\u1ee9ng nhi\u1ec5m tr\u00f9ng tr\u00ean l\u00e2m s\u00e0ng)\u00a0<\/span><\/li>\n<\/ul>\n
Qu\u1ea3n l\u00fd DKA\u00a0<\/b><\/h4>\n
1 \u2013 \u0110\u01b0\u1eddng th\u1edf\u00a0<\/b><\/p>\n
\n
Cho b\u1ec7nh nh\u00e2n th\u1edf oxy n\u1ebfu c\u00f3 suy tu\u1ea7n ho\u00e0n n\u1eb7ng ho\u1eb7c shock.\u00a0<\/span><\/li>\n
B\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf v\u00e0 xem x\u00e9t \u0111\u1eb7t sonde d\u1ea1 d\u00e0y (\u0111\u1ec3 tr\u00e1nh h\u00edt s\u1eb7c) \u1edf tr\u1ebb r\u1ed1i lo\u1ea1n tri gi\u00e1c<\/span><\/li>\n<\/ul>\n
L\u01b0u \u00fd: M\u1ed9t b\u1ec7nh nh\u00e2n DKA n\u1eb7ng c\u1ea7n \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 th\u1edf m\u00e1y; k\u1ebft c\u1ee5c c\u1ee7a nh\u1eefng\u00a0 b\u1ec7nh nh\u00e2n n\u00e0y r\u1ea5t kh\u00f3 d\u1ef1 \u0111o\u00e1n v\u00e0 l\u00e0 ch\u1ec9 \u0111i\u1ec3m c\u1ea7n g\u1ecdi h\u1ed7 tr\u1ee3. B\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng\u00a0 ph\u00f9 n\u00e3o trong khi \u0111\u00e1nh gi\u00e1 li\u1ec7u c\u00f3 c\u1ea7n \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n \u1edf \u0111\u1ee9a tr\u1ebb gi\u1ea3m tri gi\u00e1c nh\u01b0ng\u00a0 v\u1eabn c\u00f2n n\u1ed7 l\u1ef1c th\u1edf. N\u1ebfu b\u1ec7nh nh\u00e2n m\u1ea5t \u00fd th\u1ee9c v\u00e0\/ho\u1eb7c suy h\u00f4 h\u1ea5p ti\u1ebfn tri\u1ec3n v\u1edbi gi\u1ea3m\u00a0 t\u1ea7n s\u1ed1 th\u1edf v\u00e0\/ho\u1eb7c ng\u01b0ng th\u1edf, ph\u1ea3i b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf. T\u0103ng th\u00f4ng kh\u00ed l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 b\u00f9 tr\u1eeb t\u00ecnh tr\u1ea1ng toan chuy\u1ec3n h\u00f3a n\u1eb7ng.\u00a0\u00a0<\/span><\/p>\n
2 \u2013 Tu\u1ea7n ho\u00e0n\u00a0<\/b><\/p>\n
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Monitor tim li\u00ean t\u1ee5c \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u00f3ng T t\u00ecm b\u1eb1ng ch\u1ee9ng c\u1ee7a t\u0103ng ho\u1eb7c h\u1ea1 kali m\u00e1u.\u00a0\u00a0<\/span>\u2022\u00a0<\/span>\u0110\u1eb7t \u0111\u01b0\u1eddng truy\u1ec1n ngo\u1ea1i vi th\u1ee9 hai \u0111\u1ec3 thu\u1eadn ti\u1ec7n v\u00e0 l\u1ea5y m\u00e1u kh\u00f4ng \u0111au cho c\u00e1c l\u1ea7n sau\u00a0<\/span><\/li>\n<\/ul>\n
3 \u2013 C\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 kh\u00e1c\u00a0<\/b><\/p>\n
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Xem x\u00e9t kh\u00e1ng sinh tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 s\u1ed1t sau khi \u0111\u00e3 l\u1ea5y m\u1eabu \u0111\u1eddm, m\u00e1u v\u00e0\u00a0 n\u01b0\u1edbc ti\u1ec3u g\u1eedi \u0111i c\u1ea5y\u00a0<\/span><\/li>\n
\u0110\u1eb7t sonde ti\u1ec3u n\u1ebfu b\u1ec7nh nh\u00e2n m\u1ea5t \u00fd th\u1ee9c ho\u1eb7c kh\u00f4ng th\u1ec3 ti\u1ec3u (xem x\u00e9t \u1edf tr\u1ebb s\u01a1 sinh\u00a0 v\u00e0 tr\u1ebb nh\u1ecf)\u00a0<\/span><\/li>\n<\/ul>\n
4 \u2013 B\u00f9 d\u1ecbch\u00a0<\/b><\/p>\n
Bolus d\u1ecbch\u00a0<\/span><\/p>\n
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Kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n DKA \u0111\u1ec1u c\u1ea7n bolus d\u1ecbch. T\u01b0\u1edbi m\u00e1u ngo\u1ea1i vi s\u1ebd c\u1ea3i thi\u1ec7n\u00a0 khi \u0111i\u1ec1u ch\u1ec9nh t\u00ecnh tr\u1ea1ng toan m\u00e1u v\u00e0 b\u00f9 d\u1ecbch ch\u1eadm qua \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch.\u00a0\u00a0<\/span>\u2022\u00a0<\/span>N\u1ebfu bi\u1ec3u hi\u1ec7n gi\u1ea3m t\u01b0\u1edbi m\u00e1u, cho 10 mL\/kg NaCl 0,9% TM v\u00e0 \u0111\u00e1nh gi\u00e1 l\u1ea1i. N\u1ebfu CRT\u00a0\u00a0<\/span><\/li>\n<\/ul>\n
v\u1eabn > 2s k\u00e8m theo c\u00e1c bi\u1ec3u hi\u1ec7n kh\u00e1c c\u1ee7a shock, bolus th\u00eam NaCl 0,9% li\u1ec1u 10 mL\/kg.\u00a0\u00a0<\/span>\u2022\u00a0<\/span>B\u1ec7nh nh\u00e2n DKA hi\u1ebfm khi c\u1ea7n bolus t\u1ed5ng li\u1ec1u > 20 mL\/kg. N\u00ean tr\u00e1nh bolus qu\u00e1 nhi\u1ec1u\u00a0 d\u1ecbch b\u1edfi v\u00ec nguy c\u01a1 g\u00e2y ph\u00f9 n\u00e3o. C\u1ea7n bolus th\u00eam d\u1ecbch ( > 20 mL\/kg li\u1ec1u t\u1ed5ng) n\u00ean\u00a0 \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn v\u1edbi c\u00e1c chuy\u00ean gia l\u00e2m s\u00e0ng.\u00a0\u00a0<\/span><\/p>\n
B\u00f9 d\u1ecbch ban \u0111\u1ea7u: b\u00f9 NaCl 0,9% + kali tr\u01b0\u1edbc khi cho Insulin. Lo\u1ea1i d\u1ecbch s\u1ebd c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111i\u1ec1u\u00a0 ch\u1ec9nh theo x\u00e9t nghi\u1ec7m glucose, Na v\u00e0 K.\u00a0\u00a0<\/span><\/p>\n
L\u01b0\u1ee3ng thi\u1ebfu h\u1ee5t (% d\u1ecbch m\u1ea5t x CN x 10) v\u00e0 d\u1ecbch thay th\u1ebf trong 48 gi\u1edd v\u00e0 th\u00eam d\u1ecbch nhu c\u1ea7u\u00a0 b\u00ecnh th\u01b0\u1eddng. \u0110\u1eb7t sonde d\u1ea1 d\u00e0y n\u1ebfu b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea ho\u1eb7c c\u00f3 n\u00f4n \u00f3i nhi\u1ec1u l\u1ea7n.\u00a0\u00a0<\/span><\/p>\n
B\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft \u0111\u00e1ng k\u1ec3 c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i ti\u1ec3u th\u1ea9m th\u1ea5u l\u01b0\u1ee3ng nhi\u1ec1u. M\u1ea5t d\u1ecbch\u00a0 qua \u0111\u01b0\u1eddng n\u00e0y c\u00f3 th\u1ec3 c\u1ea7n \u0111\u01b0\u1ee3c b\u00f9, l\u00e0m cho vi\u1ec7c b\u00f9 d\u1ecbch tr\u1edf n\u00ean th\u00e1ch th\u1ee9c h\u01a1n.\u00a0\u00a0<\/span><\/p>\n
5 \u2013 Insulin\u00a0<\/b><\/p>\n
Th\u00eam 50 \u0111\u01a1n v\u1ecb insulin t\u00e1c d\u1ee5ng nhanh (Actrapid HM ho\u1eb7c Humulin R) v\u00e0o 49.5 mL NaCl\u00a0 0,9% (1 \u0111\u01a1n v\u1ecb\/mL dung d\u1ecbch).\u00a0\u00a0<\/span><\/p>\n
KH\u00d4NG bolus insulin. Truy\u1ec1n insulin v\u1edbi t\u1ed1c \u0111\u1ed9 0.05-0.1 \u0111\u01a1n v\u1ecb\/kg\/gi\u1edd \u1edf b\u1ec7nh nh\u00e2n m\u1edbi\u00a0 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u1edf nh\u1eefng tr\u1ebb \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng c\u00f3 \u0111\u01b0\u1eddng huy\u1ebft > 15 mmol\/l\u00a0 (275 mg\/dl). Tr\u1ebb \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u0111ang \u0111i\u1ec1u tr\u1ecb insulin v\u00e0 nh\u1eefng tr\u1ebb c\u00f3 \u0111\u01b0\u1eddng\u00a0<\/span><\/p>\n
huy\u1ebft < 15 mmol\/l n\u00ean d\u00f9ng li\u1ec1u 0.05 \u0111\u01a1n v\u1ecb\/kg\/gi\u1edd. Xem x\u00e9t b\u1eaft \u0111\u1ea7u truy\u1ec1n Insulin li\u1ec1u\u00a0 0.05 \u0111\u01a1n v\u1ecb\/kg\/gi\u1edd \u1edf tr\u1ebb < 5 tu\u1ed5i b\u1edfi v\u00ec nh\u00f3m n\u00e0y c\u00f3 th\u1ec3 nh\u1ea1y v\u1edbi insulin h\u01a1n d\u1eabn \u0111\u1ebfn h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft nhanh h\u01a1n. Vi\u1ec7c truy\u1ec1n insulin \u0111\u01b0\u1ee3c ch\u1ea9n \u0111\u1ed9 \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o gi\u1ea3m d\u1ea7n m\u1ee9c ketone\u00a0 v\u00e0\/ho\u1eb7c kho\u1ea3ng tr\u1ed1ng anion. \u0110i\u1ec1u ch\u1ec9nh n\u1ed3ng \u0111\u1ed9 dextrose trong d\u1ecbch truy\u1ec1n t\u0129nh m\u1ea1ch, nh\u1eb1m\u00a0 gi\u1eef \u0111\u01b0\u1eddng huy\u1ebft t\u1eeb 8-12 mmol\/l (150 \u2013 200 mg\/dl).\u00a0\u00a0<\/span><\/p>\n
N\u1ebfu ketone m\u00e1u v\u1eabn d\u01b0\u01a1ng t\u00ednh ho\u1eb7c kho\u1ea3ng tr\u1ed1ng anion v\u1eabn t\u0103ng cao, t\u0103ng t\u1ed1c \u0111\u1ed9 truy\u1ec1n\u00a0 insulin. N\u1ebfu \u0111\u01b0\u1eddng huy\u1ebft < 5.5 mmol\/l (100 mg\/dl) ho\u1eb7c \u0111ang gi\u1ea3m nhanh ch\u00f3ng t\u1eeb 5.5-15\u00a0 mmol\/l, th\u00eam dextrose 10%. Ch\u1ec9 n\u00ean gi\u1ea3m t\u1ed1c \u0111\u1ed9 truy\u1ec1n insulin n\u1ebfu glucose ti\u1ebfp t\u1ee5c gi\u1ea3m\u00a0 m\u1eb7c d\u00f9 \u0111\u00e3 th\u00eam dextrose 10%. L\u01b0u \u00fd l\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n s\u1ebd ph\u00e1t tri\u1ec3n t\u00ecnh tr\u1ea1ng toan m\u00e1u\u00a0 kh\u00f4ng t\u0103ng anion gap trong qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i. V\u00ec l\u00fd do n\u00e0y, gi\u00e1m s\u00e1t HCO3- v\u00e0 pH nh\u01b0 l\u00e0 c\u00e1c\u00a0 d\u1ea5u hi\u1ec7u ph\u1ee5c h\u1ed3i l\u00e0 kh\u00f4ng \u0111\u1ee7, v\u00e0 anion gap s\u1ebd cung c\u1ea5p b\u1eb1ng ch\u1ee9ng t\u1ed1t h\u01a1n v\u1ec1 \u0111\u1ecbnh h\u01b0\u1edbng\u00a0 l\u01b0\u1ee3ng insulin b\u1ec7nh nh\u00e2n c\u1ea7n t\u1ea1i m\u1ed9t th\u1eddi \u0111i\u1ec3m nh\u1ea5t \u0111\u1ecbnh.\u00a0\u00a0<\/span><\/p>\n
Th\u1ec3 ketone ni\u1ec7u kh\u00f4ng ph\u1ea3i l\u00e0 marker t\u1ed1t \u0111\u1ec3 theo d\u00f5i ph\u1ee5c h\u1ed3i chuy\u1ec3n h\u00f3a v\u00ec ch\u00fang c\u00f3 th\u1ec3 v\u1eabn d\u01b0\u01a1ng t\u00ednh ho\u1eb7c t\u0103ng d\u00f9 \u0111\u00e3 gi\u1ea3i quy\u1ebft \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng t\u0103ng ketone m\u00e1u. C\u00f3 th\u1ec3 ng\u01b0ng\u00a0 truy\u1ec1n insulin \u1edf tr\u1ebb t\u1ec9nh t\u00e1o v\u00e0 chuy\u1ec3n h\u00f3a \u1ed5n \u0111\u1ecbnh. Th\u1eddi \u0111i\u1ec3m t\u1ed1t nh\u1ea5t \u0111\u1ec3 b\u1eaft \u0111\u1ea7u ti\u00eam insulin\u00a0 d\u01b0\u1edbi da l\u00e0 ngay tr\u01b0\u1edbc b\u1eefa \u0103n. Truy\u1ec1n insulin ch\u1ec9 n\u00ean d\u1eebng l\u1ea1i 30 ph\u00fat sau m\u0169i ti\u00eam d\u01b0\u1edbi da\u00a0 insulin t\u00e1c d\u1ee5ng nhanh \u0111\u1ea7u ti\u00ean.\u00a0\u00a0<\/span><\/p>\n
L\u01b0u \u00fd: C\u1ea9n th\u1eadn t\u0103ng \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u do t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft g\u00e2y h\u00f4n m\u00ea kh\u00f4ng t\u0103ng ketone\u00a0 m\u00e1u. N\u1ebfu nghi ng\u1edd, insulin CH\u1ec8 n\u00ean d\u00f9ng sau khi h\u1ed9i ch\u1ea9n v\u1edbi b\u00e1c s\u0129 n\u1ed9i ti\u1ebft nhi.\u00a0\u00a0<\/span><\/p>\n
6 \u2013 \u0110i\u1ec7n gi\u1ea3i\u00a0<\/b><\/p>\n
Natri\u00a0<\/b><\/em><\/p>\n
B\u1ec7nh nh\u00e2n DKA c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n h\u1ea1 natri m\u00e1u, t\u0103ng natri m\u00e1u ho\u1eb7c natri m\u00e1u b\u00ecnh th\u01b0\u1eddng.\u00a0 Natri huy\u1ebft thanh \u0111o \u0111\u01b0\u1ee3c s\u1ebd th\u1ea5p h\u01a1n do hi\u1ec7u \u1ee9ng pha lo\u00e3ng c\u1ee7a t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u01b0\u1eddng\u00a0 huy\u1ebft. Natri hi\u1ec7u ch\u00ednh \u0111\u01b0\u1ee3c this theo c\u00f4ng th\u1ee9c:\u00a0\u00a0<\/span><\/p>\n
***Natri hi\u1ec7u ch\u00ednh = Natri \u0111o \u0111\u01b0\u1ee3c + 0.3(glucose \u2013 5.5) mmol\/l\u00a0<\/span><\/i><\/p>\n
Natri \u0111o \u0111\u01b0\u1ee3c l\u00e0 natri hi\u1ec7u qu\u1ea3 th\u1ea9m th\u1ea5u. N\u1ebfu Na > 160 mmol\/l, xin t\u01b0 v\u1ea5n. N\u1ebfu natri kh\u00f4ng\u00a0 t\u0103ng khi glucose gi\u1ea3m trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb ho\u1eb7c n\u1ebfu h\u1ea1 natri m\u00e1u ph\u00e1t tri\u1ec3n, n\u00f3 c\u00f3 th\u1ec3 ch\u1ec9 \u0111i\u1ec3m t\u00ecnh tr\u1ea1ng b\u00f9 d\u1ecbch qu\u00e1 m\u1ee9c v\u00e0 b\u00f9 \u0111i\u1ec7n gi\u1ea3i kh\u00f4ng \u0111\u1ee7. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0m cho b\u1ec7nh nh\u00e2n\u00a0 c\u00f3 nguy c\u01a1 ph\u00f9 n\u00e3o v\u00e0 c\u00f3 th\u1ec3 th\u1ec3 c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng n\u01b0\u1edbc mu\u1ed1i \u01b0u tr\u01b0\u01a1ng.\u00a0\u00a0<\/span><\/p>\n
N\u01b0\u1edbc mu\u1ed1i \u01b0u tr\u01b0\u01a1ng c\u00f3 th\u1ec3 v\u1eabn \u0111\u01b0\u1ee3c d\u00f9ng ngay c\u1ea3 khi Na hi\u1ec7u ch\u1ec9nh b\u00ecnh th\u01b0\u1eddng \u1edf b\u1ec7nh\u00a0 nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u ph\u00f9 n\u00e3o.\u00a0\u00a0<\/span><\/p>\n
Kali\u00a0<\/b><\/em><\/p>\n
B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 b\u1ecb t\u0103ng kai m\u00e1u, h\u1ea1 kali m\u00e1u ho\u1eb7c kali m\u00e1u b\u00ecnh th\u01b0\u1eddng \u1edf th\u1eddi \u0111i\u1ec3m bi\u1ec3u\u00a0 hi\u1ec7n, ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 thi\u1ebfu h\u1ee5t kali to\u00e0n c\u01a1 th\u1ec3 v\u00e0 m\u1ee9c \u0111\u1ed9 toan m\u00e1u. \u0110\u1ee9a tr\u1ebb DKA h\u1ea7u nh\u01b0 lu\u00f4n c\u1ea7n b\u00f9 kali v\u00ec thi\u1ebfu h\u1ee5t kali to\u00e0n c\u01a1 th\u1ec3 do l\u1ee3i ti\u1ec3u th\u1ea9m th\u1ea5u. \u0110i\u1ec1u ch\u1ec9nh toan m\u00e1u m\u00e0\u00a0 kh\u00f4ng b\u00f9 kali s\u1ebd g\u00e2y h\u1ea1 kali m\u00e1u.\u00a0<\/span><\/p>\n
B\u1eaft \u0111\u1ea7u b\u00f9 kali trong d\u1ecbch truy\u1ec1n t\u0129nh m\u1ea1ch v\u1edbi n\u1ed3ng \u0111\u1ed9 40 mmol\/l n\u1ebfu c\u00e2n n\u1eb7ng < 30 kg,\u00a0 ho\u1eb7c 40-60 mmol\/l n\u1ebfu > 30 kg; b\u00f9 ti\u1ebfp d\u1ef1a v\u00e0o n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft thanh. Ho\u00e3n b\u00f9 kai n\u1ebfu\u00a0 n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft thanh > 5.5 mmol\/l ho\u1eb7c n\u1ebfu b\u1ec7nh nh\u00e2n v\u00f4 ni\u1ec7u (cho \u0111\u1ebfn khi kali < 5.5\u00a0 mmol\/l ho\u1eb7c c\u00f3 n\u01b0\u1edbc ti\u1ec3u \u0111\u01b0\u1ee3c ghi nh\u1eadn). B\u00f9 kali n\u00ean ti\u1ebfp t\u1ee5c trong su\u1ed1t qu\u00e1 tr\u00ecnh truy\u1ec1n\u00a0 d\u1ecbch TM v\u00e0 \u0111i\u1ec1u tr\u1ecb insulin.\u00a0\u00a0<\/span><\/p>\n
7 \u2013 Theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb ti\u1ebfp\u00a0<\/b><\/p>\n
\n
Gi\u1eef c\u00e2n b\u1eb1ng d\u1ecbch\u00a0<\/span><\/li>\n
Theo d\u00f5i m\u1ed7i gi\u1edd (th\u01b0\u1eddng xuy\u00ean h\u01a1n n\u1ebfu c\u1ea7n d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng): m\u1ea1ch, huy\u1ebft \u00e1p, nh\u1ecbp\u00a0 th\u1edf, tri gi\u00e1c (ph\u1ea3n x\u1ea1 \u0111\u1ed3ng t\u1eed, \u0111\u00e1nh gi\u00e1 \u00fd th\u1ee9c, \u0111au \u0111\u1ea7u).\u00a0\u00a0<\/span><\/li>\n
\u0110o \u0111\u01b0\u1eddng huy\u1ebft m\u1ed7i gi\u1edd, ketone m\u00e1u ho\u1eb7c ketone ni\u1ec7u trong l\u00fac truy\u1ec1n insulin.\u00a0\u00a0<\/span>\u2022\u00a0<\/span>Ki\u1ec3m tra l\u1ea1i kali trong v\u00f2ng m\u1ed9t gi\u1edd sau khi truy\u1ec1n insulin.\u00a0<\/span><\/li>\n
Kh\u00ed m\u00e1u t\u0129nh m\u1ea1ch v\u00e0 glucose m\u1ed7i 2 gi\u1edd cho \u0111\u1ebfn khi pH > 7.3 v\u00e0 bicarbonate > 15\u00a0 mmol\/l; m\u1ed7i 2-4 gi\u1edd sau \u0111\u00f3. Theo d\u00f5i th\u01b0\u1eddng xuy\u00ean h\u01a1n (h\u00e0ng gi\u1edd) c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n toan n\u1eb7ng\/l\u00e2m s\u00e0ng c\u00f3 ch\u1ec9 \u0111i\u1ec3m.\u00a0\u00a0<\/span><\/li>\n
Ure huy\u1ebft thanh v\u00e0 \u0111i\u1ec7n gi\u1ea3i (natri, kali, phosphate) n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i m\u1ed7i 2-4 gi\u1edd trong 12-24 gi\u1edd \u0111\u00e2u.\u00a0\u00a0<\/span><\/li>\n
\u0110o th\u00e2n nhi\u1ec7t m\u1ed7i 12 gi\u1edd.\u00a0\u00a0<\/span><\/li>\n
N\u1eb1m \u0111\u1ea7u cao.\u00a0\u00a0<\/span><\/li>\n<\/ul>\n
8 \u2013 B\u00f9 d\u1ecbch\u00a0<\/b><\/p>\n
B\u00f9 d\u1ecbch NaCl 0,9% v\u00e0 kali (nh\u01b0 \u1edf tr\u00ean) n\u00ean ti\u1ebfp t\u1ee5c trong \u00edt nh\u1ea5t 6 gi\u1edd \u0111\u1ea7u. N\u1ebfu glucose gi\u1ea3m\u00a0 qu\u00e1 nhanh trong v\u00e0i gi\u1edd \u0111\u1ea7u ti\u00ean, ho\u1eb7c n\u1ebfu BGL \u0111\u1ea1t 12-15 mmol\/L, chuy\u1ec3n sang NaCl 0,9%\u00a0 v\u1edbi dextrose 5% v\u00e0 kali.\u00a0\u00a0<\/span><\/p>\n
L\u01b0\u1ee3ng natri \u0111o \u0111\u01b0\u1ee3c s\u1ebd t\u0103ng l\u00ean khi \u0111\u01b0\u1eddng huy\u1ebft gi\u1ea3m xu\u1ed1ng. Tr\u00e1nh truy\u1ec1n d\u1ecbch nh\u01b0\u1ee3c\u00a0 tr\u01b0\u01a1ng tr\u1eeb khi c\u00f3 t\u00ecnh tr\u1ea1ng toan chuy\u1ec3n h\u00f3a t\u0103ng clo m\u00e1u. Ngo\u00e0i 6 gi\u1edd \u0111\u1ea7u, n\u01b0\u1edbc mu\u1ed1i 0,9%\u00a0 v\u1edbi dextrose 10% v\u00e0 kali n\u00ean ti\u1ebfp t\u1ee5c cho \u0111\u1ebfn khi c\u1ea3i thi\u1ec7n \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n toan ki\u1ec1m\u00a0 v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 dung n\u1ea1p \u0111\u01b0\u1eddng mi\u1ec7ng. N\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, x\u1eed tr\u00ed theo\u00a0 ph\u1ea7n bi\u1ebfn ch\u1ee9ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft b\u00ean d\u01b0\u1edbi. B\u00f9 d\u1ecbch c\u00f3 th\u1ec3 chuy\u1ec3n sang \u0111\u01b0\u1eddng u\u1ed1ng ho\u00e0n\u00a0 to\u00e0n sau 24-36 gi\u1edd \u0111\u1ea7u n\u1ebfu b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh v\u1ec1 m\u1eb7t chuy\u1ec3n h\u00f3a (\u0111i\u1ec1u n\u00e0y th\u01b0\u1eddng tr\u00f9ng h\u1ee3p v\u1edbi vi\u1ec7c \u0111i\u1ec1u tr\u1ecb chuy\u1ec3n sang ti\u00eam insulin d\u01b0\u1edbi da).\u00a0\u00a0<\/span><\/p>\n
9 \u2013 Bicarbonate\u00a0<\/b><\/p>\n
B\u00f9 bicarbonate th\u01b0\u1eddng kh\u00f4ng c\u1ea7n thi\u1ebft v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng n\u00f3 kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o m\u1ea1nh m\u1ebd,\u00a0 b\u1edfi v\u00ec li\u00ean quan \u0111\u1ebfn ph\u00e1t tri\u1ec3n ph\u00f9 n\u00e3o. Ch\u1ec9 n\u00ean cho NaHCO3 sau khi tham kh\u1ea3o \u00fd ki\u1ebfn v\u00e0 h\u1ed9i\u00a0 ch\u1ea9n v\u1edbi c\u00e1c chuy\u00ean gia l\u00e2m s\u00e0ng c\u00f3 kinh nghi\u1ec7m.\u00a0\u00a0<\/span><\/p>\n
Bi\u1ebfn ch\u1ee9ng<\/h4>\n
1 \u2013 Ph\u00f9 n\u00e3o<\/b><\/p>\n
Ph\u00f9 n\u00e3o tr\u00ean l\u00e2m s\u00e0ng xu\u1ea5t hi\u1ec7n \u0111\u1ed9t ng\u1ed9t v\u00e0 c\u00f3 th\u1ec3 \u0111\u00e3 xu\u1ea5t hi\u1ec7n khi b\u1ec7nh nh\u00e2n \u0111\u1ebfn b\u1ec7nh vi\u1ec7n\u00a0 v\u00e0 r\u1ea5t c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong v\u00f2ng 6-12 gi\u1edd \u0111\u1ea7u sau \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u (t\u1eeb 2-24 gi\u1edd). T\u1ec9 l\u1ec7 t\u1eed vong ho\u1eb7c bi\u1ebfn ch\u1ee9ng n\u1eb7ng r\u1ea5t cao n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.\u00a0\u00a0<\/span><\/p>\n
Ph\u00f2ng ng\u1eeba<\/h4>\n
B\u00f9 d\u1ecbch v\u00e0 \u0111i\u1ec1u ch\u1ec9nh sinh h\u00f3a ch\u1eadm r\u00e3i. \u0110\u1ec3 t\u1ed1i \u01b0u, t\u1ed1c \u0111\u1ed9 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 \u00e1p su\u1ea5t th\u1ea9m\u00a0 th\u1ea5u huy\u1ebft thanh kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 5 mmol\/l\/gi\u1edd, nh\u01b0ng \u1edf tr\u1ebb em ban \u0111\u1ea7u th\u01b0\u1eddng gi\u1ea3m\u00a0 glucose nhanh h\u01a1n. B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c n\u1eb1m \u0111\u1ea7u cao.\u00a0\u00a0<\/span><\/p>\n
D\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o<\/h4>\n
\n
Bi\u1ec3u hi\u1ec7n l\u1ea7n \u0111\u1ea7u, ti\u1ec1n s\u1eed ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft k\u00e9m, tr\u1ebb nh\u1ecf (< 5 tu\u1ed5i).\u00a0\u00a0<\/span>\u2022\u00a0<\/span>Kh\u00f4ng t\u0103ng natri khi glucose gi\u1ea3m, h\u1ea1 natri m\u00e1u trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, t\u0103ng natri\u00a0 m\u00e1u hi\u1ec7u ch\u1ec9nh ban \u0111\u1ea7u.\u00a0\u00a0<\/span><\/li>\n
\u0110au \u0111\u1ea7u, qu\u1ea5y, k\u00edch th\u00edch, l\u01a1 m\u01a1, gi\u1ea3m tri gi\u00e1c, ti\u1ec3u ti\u1ec7n kh\u00f4ng t\u1ef1 ch\u1ee7, th\u00e2n nhi\u1ec7t kh\u00f4ng\u00a0 \u1ed5n \u0111\u1ecbnh.\u00a0<\/span><\/li>\n
R\u1ea5t mu\u1ed9n \u2013 tim ch\u1eadm, t\u0103ng huy\u1ebft \u00e1p, v\u00e0 suy h\u00f4 h\u1ea5p.\u00a0\u00a0<\/span><\/li>\n<\/ul>\n
\u0110i\u1ec1u tr\u1ecb<\/h4>\n
\n
Truy\u1ec1n Mannitol 20% TM li\u1ec1u 0.5 g\/kg (t\u1eeb 0.25 g \u2013 1.0 g\/kg) ho\u1eb7c n\u01b0\u1edbc mu\u1ed1i \u01b0u\u00a0 tr\u01b0\u01a1ng 3% (3 mLs\/kg). Cho nhay l\u1eadp t\u1ee9c khi nghi ng\u1edd tr\u00ean l\u00e2m s\u00e0ng \u2013 kh\u00f4ng tr\u00ec ho\u00e3n\u00a0 ch\u1edd CT n\u00e3o x\u00e1c nh\u1eadn. C\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i li\u1ec1u n\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng sau 30 ph\u00fat \u2013 2 gi\u1edd.\u00a0\u00a0<\/span>\u2022\u00a0<\/span>Gi\u1ea3m t\u1ed1c \u0111\u1ed9 truy\u1ec1n d\u1ecbch\u00a0<\/span><\/li>\n
N\u1eb1m \u0111\u1ea7u cao\u00a0<\/span><\/li>\n
Chuy\u1ec3n ngay \u0111\u1ebfn khoa \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c\u00a0<\/span><\/li>\n
Xem x\u00e9t CT \u0111\u1ea7u trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng ho\u1eb7c c\u1ea7n \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n do tri gi\u00e1c\u00a0 x\u1ea5u \u0111i\u00a0<\/span><\/li>\n
B\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf b\u1eb1ng c\u00e1ch \u0111\u1eb7t NKQ \u2013 Tr\u1ebb b\u1ecb DKA c\u1ea7n \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n c\u00f3 t\u1ec9 l\u1ec7 t\u1eed vong\u00a0 cao.\u00a0\u00a0<\/span><\/li>\n<\/ul>\n
2 \u2013 H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft\u00a0<\/b><\/p>\n
N\u1ebfu h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft d\u01b0\u1edbi 4.0 mmol\/l v\u00e0 b\u1ec7nh nh\u00e2n v\u1eabn c\u00f2n toan m\u00e1u, th\u00eam dextrose 10%\u00a0 2-5 ml\/kg bolus v\u00e0 d\u00f9ng dextrose 10% (v\u1edbi n\u01b0\u1edbc mu\u1ed1i 0,9% v\u00e0 pha kali). Kh\u00f4ng ng\u01b0ng\u00a0 truy\u1ec1n insulin.\u00a0\u00a0<\/span><\/p>\n
N\u1ebfu h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft d\u00f9 \u0111\u00e3 d\u00f9ng dextrose 10% t\u1eeb 2 gi\u1edd tr\u1edf n\u00ean, t\u1ed1c \u0111\u1ed9 truy\u1ec1n insulin c\u00f3 th\u1ec3 gi\u1ea3m xu\u1ed1ng 0.05 \u0111\u01a1n v\u1ecb\/kg\/gi\u1edd v\u1edbi \u0111i\u1ec1u ki\u1ec7n \u0111\u00e3 gi\u1ea3i quy\u1ebft \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng t\u0103ng ketone m\u00e1u\u00a0 v\u00e0 nhi\u1ec5m toan \u0111ang c\u1ea3i thi\u1ec7n. Ti\u1ebfp t\u1ee5c duy tr\u00ec dextrose 10% trong d\u1ecbch truy\u1ec1n cho \u0111\u1ebfn khi\u00a0 \u0111\u01b0\u1eddng huy\u1ebft \u1ed5n \u0111\u1ecbnh.\u00a0<\/span><\/p>\n
3 \u2013 H\u1ea1 phospho m\u00e1u\u00a0<\/b><\/p>\n
N\u1ebfu phospho th\u1ea5p, b\u00f9 phospho \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c TM.\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"**
R\u1ed0I LO\u1ea0N \u0110I\u1ec6N GI\u1ea2I V\u00c0 R\u1ed0I LO\u1ea0N \u0110\u01af\u1edcNG HUY\u1ebeT. T\u1ea3i file PDF T\u1ea1i \u0111\u00e2y. NATRI Natri l\u00e0 cation ch\u00ednh khoang d\u1ecbch ngo\u1ea1i b\u00e0o (ECF). Natri \u0111\u00f3ng vai tr\u00f2 ch\u00ednh trong vi\u1ec7c x\u00e1c\u00a0 \u0111\u1ecbnh th\u1ec3 t\u00edch t\u1ebf b\u00e0o v\u00e0 duy tr\u00ec th\u1ec3 t\u00edch d\u1ecbch ngo\u1ea1i b\u00e0o th\u00f4ng qua duy tr\u00ec \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u m\u00e1u.\u00a0 M\u1ea5t […]\n","protected":false},"author":1,"featured_media":35207,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-35205","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/35205","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=35205"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/35205\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/35207"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=35205"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=35205"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=35205"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}