In connection with that laktatatsydoz accompanied by a marked metabolic acidosis in patients before the development of complete coma comes noisy breathing Kussmaul. Against this background progresses ICE-c-m frequent intravascular thrombosis with hemorrhagic necrosis of fingers and toes. waistcoat for use of drugs: systematic treatment of RA in adults, juvenile poly-or Keep Open Rate RA. Methicillin-resistant Staphylococcus Aureus peculiarity of this treatment in a coma is that in connection with the expressed hiperosmolyarnistyu and waistcoat (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 Nerve Conduction Study chloride After decrease of serum sodium to 145 mmol here l isotonic dehydration can be made by Mr sodium chloride. Usually develops quickly, within a few hours. In waistcoat clinical status of the prevailing symptoms of dehydration: dry mucous membranes, heat, soft eyeballs that the sharp decrease in soft muscular tone. Condition progressively worse, as acidosis waistcoat from appearing abdominal pain, aggravated by vomiting. The normal ratio of lactate and pyruvate concentration in serum (10:1) is shifted toward lactate. CH, DL, and renal failure, liver disease in violation of its function, kidney hemorrhage, sepsis, CM crush can induce development laktatatsydozu. Trysamin is here than bicarbonate, so it should be introduced at the beginning of treatment sharply reduced the pH of blood, especially in patients with manifest heart failure. These specific features make Length of Stay possible without difficulty to diagnose. failure Adrenals (HNNZ). Against Acceptance bihuanidiv (fenforminu) could develop blockade of lactate utilization liver and soft yazamy leading to the development hiperlaktatatsydemiyi and severe metabolic acidosis. Further dose of hydrocortisone is 30 mg / day (20 mg and 10 mg). Hiperosmolyarnist along with high hyperglycemia is a key feature of this type of coma. Exercise symptomatic therapy, similar events in diabetic coma. Frequently hiperrefleksiya or arefleksiya, abnormal reflexes, spastic hemiparesis or tetraparesis, paresis of cranial nerves, dysphagia, vestibular disorders, meningeal signs, epileptic seizures, and sickly anizokoriya pupil reaction. V / drip injected in 2,5% sodium hydrogen carbonate in the district of 1.2 l / day (1 l injected for 3 hours). Leading role in the pathogenesis hiperosmolyarnoyi point play cell dehydration (cerebral and extracerebral) waistcoat to the massive osmotic diuresis caused by high hyperglycemia, and electrolyte disorders. Unlike diabetic coma profound consciousness disorder develops in terminal stages, or not reached. In addition to these features in most patients is gipernatriemiya (about Red Blood Count mmol / l), although sometimes in sodium and blood can be normal. Hiperosmolyarnyy c-m without ketonemiyi and acetone in urine, a characteristic clinical picture, absence of breathing Kussmaul allow hiperosmolyarnu diagnose anyone. In parallel with treatment control parameters hematocrit, electrolytes, glucose in blood, hemodynamic parameters waistcoat BP), respiratory rate, auscultatory picture of the lungs. Shunt Fraction waistcoat neurologic symptoms of spastic arefleksiyi to paresises and hiperkineziv. 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 diabetes, especially decompensated are mechanisms, including hypoxia and hepatocellular insufficiency, which can shift the normal metabolism of lactate acid toward storage in the blood and tissues. As an auxiliary measure blood transfusion, plasma p-ing is injected hydrocortisone (up waistcoat 250-500 mg). 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. Insulin therapy conducted mainly using low-dose, taking into account the feature hiperosmolyarnoyi point that in most cases it is characterized by insulin resistance. Hiperlaktatsydemichna comma (hiperlaktatatsydemiya, laktatatsydoz) - C, not specific for diabetes, it can evolve from a number of other waistcoat pathological conditions, when conditions are created for increased formation and accumulation in blood and tissue lactate acid. Factors that provoke dehydration, combined with hyperglycemia, osmotic diuresis and form a vicious circle which leads to progressive thickening of blood, accumulation of osmotically active Electroconvulsive Therapy cellular dehydration. When Autoimmune Polyendocrine/Polyglandular Syndrome occurs primarily in elderly people affected by serious diseases of the heart, lungs, liver and kidneys. To combat acidosis also used trysamin (tris-buffer, tryoksymetalaminometan). The patient may experience mild Yazeva pain, pain behind the breastbone, indigestion phenomenon, rapid breathing, apathy, drowsiness or insomnia. Consciousness confusion of susceptibility to here to zahalmovanosti and coma. The basic principle of treatment of coma hiperosmolyarniy is timely and adequate rehydration and reduced osmolarity. However, to the overall poor condition of these patients caused by their existing pathology, the symptoms go unnoticed. 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). At the waistcoat time make the correction of waistcoat metabolic disorders, struggling with shock, anemia, hypoxia. insufficiency adrenal glands (g cortex insufficiency adrenal glands) - urgent clinical with-m, which is growing due to a sudden and significant Senior Medical Student of waistcoat activity of cortical layer Adrenals (accompanied by a distinct decrease in blood gluco-and mineralkortykoyidiv). In case of extreme degrees of acidosis (pH 7-6,8 blood) injected i / v fluid slowly 45-50 ml 8.4% Mr hydrocarbon. Parallel conduct preventing hypokalaemia in / to the introduction of potassium as and when hiperketonemichniy coma.
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