How to treat metabolic acidosis?

summary

CKD patients often complicated with metabolic acidosis, if suffering from this disease, it is very uncomfortable, especially in patients with GFR less than 45 ml / min / 1.73m2. It is reported that the prevalence of metabolic acidosis in ckd3 is about 2.3% - 13%, and that in ckd4 is about 19% - 37%. Ajkd published a review on the pathological mechanism and treatment of CKD metabolic acidosis. Next, how to treat metabolic acidosis? Let me tell you this.

How to treat metabolic acidosis?

First, the pathogenesis of DKA is due to the lack of insulin and the increase of insulin anti regulatory hormone (i.e. glucose raising hormone), which leads to the disorder of glucose metabolism, the abnormal utilization of blood glucose, the increase of blood glucose, the increase of lipolysis, the increase of blood ketone, the secondary metabolic acidosis and the disorder of water and electrolyte balance. Glucagon includes glucagon, adrenaline, glucocorticoid and growth hormone. Excessive secretion of glucagon is the main cause of DKA. Due to the double dysfunction of insulin and glucocorticoid secretion, the function of glucose transporter in patients decreased, the glycogen synthesis and utilization rate decreased, the glycogen decomposition and gluconeogenesis strengthened, and the blood glucose increased significantly. At the same time, due to the disorder of fat metabolism, the level of free fatty acids increased, which provided a large number of precursors for the production of ketones, and eventually formed ketoacidosis.

Second: in the differential diagnosis of diabetes, type I diabetes has the tendency of DKA without obvious inducement, but the common inducements in type 2 diabetes are acute infection, inappropriate reduction of insulin or sudden interruption of treatment, improper diet, gastrointestinal diseases, stroke, myocardial infarction, trauma, surgery, pregnancy and mental stimulation. In addition, improper use of drugs may also cause DHK, such as alcohol, cocaine and so on. Studies have shown that DHK accounts for 20% ~ 25% of the predisposing factors of new onset diabetes, and infection accounts for 30% ~ 40%. Most of the patients are infected and the onset of diabetic acidosis.

Third: urine ketone detection method, also known as nitroprusside salt method, is used to detect the concentration of acetoacetic acid and acetone in ketone body (qualitative or semi quantitative). The disadvantage is that it is unable to detect the highest concentration of ketosis, and β Hydroxybutyric acid level, the results can only be qualitative or semi quantitative display. Blood ketone test is also called β Hydroxybutyrate deoxygenase method, directly for β The reaction products can be measured by spectrophotometry and electrochemical method.

matters needing attention

1. Improper insulin treatment: type I diabetes without treatment, interrupted insulin treatment or insufficient insulin dosage 2. Poor blood glucose control: random blood glucose ≥ 13mmol / L3, severe infection: respiratory system infection such as pneumonia, pulmonary tuberculosis, urinary system infection such as acute pyelonephritis, cystitis, appendicitis, peritonitis, pelvic inflammatory disease, etc