How does old people diabetic lactic acid sex poison do?

summary

Conventional treatment of lactic acidosis is still lack of satisfactory treatment, once it occurs, its mortality is very high. It has been reported that the mortality of severe lactic acidosis is about 50%. When the blood lactic acid level exceeds 25 mmol / L, there are few survivors. Therefore, we must pay more attention to this disease and prevent it seriously in order to find it as soon as possible and treat it effectively. How to deal with diabetic lactic acid poisoning in the elderly? Let's talk about it now.

How does old people diabetic lactic acid sex poison do?

Fluid replacement: fluid replacement and volume expansion can improve tissue perfusion, correct shock, diuresis and acid excretion, which is one of the important means for the treatment of lactic acidosis. Normal saline is often used for infusion, and 5% glucose or sugar saline can also be used. When necessary, plasma or whole blood should be supplemented. Preparations containing lactic acid should be avoided. In order to avoid aggravating lactic acidosis. When using vasoactive substances to correct shock, we should try to avoid using drugs that can strongly constrict blood vessels, such as epinephrine or norepinephrine, so as to avoid further reduction of tissue perfusion. Isoproterenol can be used to correct shock.

Alkali supplement: lactic acidosis causes serious damage to the body, which must be corrected timely and effectively. Sodium bicarbonate is most commonly used * so long as the lung can maintain effective ventilation and exhaust large amounts of carbon dioxide, and the kidney is able to avoid sodium retention. Sodium bicarbonate preparation can be used. 5-1.0g sodium bicarbonate. 3 times a day, encourage more drinking water; Moderate or severe patients need intravenous infusion and alkali supplement, and isotonic sodium bicarbonate solution can be supplemented until the blood pH value reaches 7.2. However, alkali supplement should not be too much or too fast, otherwise it can aggravate hypoxia and intracranial acidosis. Most people advocate low-dose sodium bicarbonate. It is also suggested that dichloroacetic acid (DCA), a strong pyruvate decarboxylase agonist, can rapidly enhance the metabolism of lactic acid and inhibit the production of lactic acid to a certain extent. The general dosage of dichloroacetic acid is 35 ~ 50mg / time, and the daily dosage is not more than 4G. Methylene blue preparation can also be used for lactic acidosis, the general dosage of 1 ~ 5mg / kg body weight, intravenous injection.

Insulin: absolute or relative deficiency of insulin is one of the causes of lactic acidosis in patients with diabetes mellitus, and insulin therapy is often needed for such patients. Even in non-diabetic patients, some people advocate the combination of insulin and glucose to reduce the anaerobic glycolysis and facilitate the elimination of blood lactic acid.

matters needing attention

For primary diabetes, we should give systematic and standardized treatment, strictly control diet, choose appropriate exercise, choose appropriate hypoglycemic drugs, and control blood glucose in an ideal range. However, the standard of blood glucose control for the elderly can be relaxed, and blood glucose, blood lipid, glycosylated hemoglobin, blood pressure, body mass index, etc. should be reviewed regularly. After discharge to regular review and follow-up.