canh giac duoc nghiên cứu khoa học

Mot so bien chdng tim mach lien quan den nhiem toan ceton la had qua cua mat can bang dien giai, bao gom loan nhip tim, bat thudng tren dien tarn do, nhip nhanh that va ngdng tim, co [r]

(1)

• • • • • • • • • • • • • • a • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

• • ^ • " • • S S S S S S S S S S S S S S S S S S M

• • • • • • • • • • • • • • •

Nghien cuudupc

S

Thong tin thudc

JOURNAL OF PHARMACEUTICAL RESEARCH AND DRUG INFORMATION

TRl/CfNG DAI HOC Dl/CfC HA NQI

D|a chi: 13-15 LeThanh Tong - Hoan Kiem - Ha Noi

Website: http://hup.edu.vn

(2)

Nghien

cuU

dirge &

Thong tin thudc 2017,

Tap 8, So

Journal of pharmaceutical Research and Drug information 2017, Vol 8, N°1

MUC LUC

So 1,2017

BAI NGHIEN CUU

2 Tong quan he thong va phan ti'ch gop cac nghien ciiu quan sat ve bien co bat Igi cua thudc dieu tri lao da khang/lao sieu khang

Nguyen IN Thuy1, Nguyen Hong Duong', CaoThi Thu Huyen', VO Binh Hoa', Nguyen Hoang Anh!, Nguyen Viet Nhung'

'Benh Wen Phoi Jning wng, 'truing Bgi hoc Dux Ha Hoi

CONTENTS

No 1,2017

RESEARCH

Adverse drug events in the treatment of multidrug and extensively drug - resistant tuberculosis: a systematic review and meta-analysis

Nguyen Thi Thuy, Nguyen Hong Duong, Cao Thi Thu Huyen, Vu Dinh Hoa, Nguyen Hoang Anh, Nguyen Viet Nhung ! national lung Hospital, ''Ha Hoi University of Pharmacy

1 Loai bd anh hudmg nen phan tich khang sinh doramphenicol bang cot sac kyailtfc mien dich

Nguyen BufcThjnh'•', Chu Pham Nggc Son2, Tran Linh Thuoc' 'Wen Yfeting rang FhinhphoHoChiMinh, 'Tnttlng Bgi hoc Khoa hoc Junhien (BHK-HCHIj, 'Trmg torn Sic ky Hai Sing

Removal of sample matrix effects for chloramphenicol analysis by affinity immunochromatography column

Nguyen DucThinh, Chu Pham Ngoc Son, Iran Linh Thuoc

'Institute of Public Health 'University ofSciencestVietnam national University Ho Chi MM GfyJ

'lighthouse Chromatography Center

1 Xay difng quy trinh dinh litcrng ddng thdri paracetamol, ibuprofen va tap Simultaneous determination of paracetamol, ibuprofen and related C cua ibuprofen bang phuong phap UPLC/DAD impurity of ibuprofen by UPLC/DAD

Nguyen Thj Nggt Van, Tran Ihi Tiet NghTa Nguyen Thi Ngoc Van, Tran Thi Tiet Nghia

Hhoo DUX, IrUing Bgi hoc Y Dirge Con Tha Faculty of Pharmacy - Can Iho University otMeiicine ani Pharmacy

21 Tong hop va thu tac dung tic che enzym glutaminyl cyclase cua mot so dan chat pyrimidin cua N-(5-methyl-1 H-imidazol-1 -yl) propyl-N' - (3-methoxy-4-alkyloxyphenyl) thiourea

Tran Phaong Thao', Tran Thj Thu Hien' 1 truing Bgi hoc Dux Ha Hoi,'Hoc vienY Dux hoc Co truyen Viet Ham

Synthesis and evaluation of human glutaminylcyclase inhibition activity of new pyrimidine derivatives bearing N-(5-methyl-1 H-imidazol-1 -yl) propyl-N'-(3-methoxy-4-alkyloxyphenyl) thiourea

Tran Phuong Thao, Tran Thi ThuHien 'Honor University at Pharmacy, 'Institute of JnSM Ueiieine ani Pharmacy Vietnam

2 Nghien cult dac diem hinh thai va xac dinh lai ten khoa hoc cua cay thudc Tomanh

Nghiem D&Trgng", Tran Van On', Nguyen Van Hieu'

'IrUingBgihgcOuacHaHii,

'Wen fhilcvithgc, Vienhinlim khoa hoc FwngQuoc

Study on morphological characteristics and identify scientific name of the medicinal plant named "To manh"

Nghiem Due Trong', Tran Van On', Nguyen Van Hieu' Honor University of Pharmacy 'Institute of Botany, Chinese kaiemyot Sciences, Beijing 100093, China

3 Tac dung giamho, long derm cua cao dac bai thudc AZK tren md hinh thUc nghiem

Nguyen Manh Tuyen, Phitng Hoa Binh, Bo Thj Thu Thuy, Nguyen Thuy Duong

JrUingBgihgcDitocHhHpi

Antitussive and expectorant effects of the soft extracts made from AZK remedy on experiment models

Nguyen Manh Tuyen, Ptiung Hoa Binh, Do Thi Thu Thuy, Nguyen Thuy Duong

Hanoi University of Pharmacy

THONG TIN THUOC - CANH GIAC DUOC

34 bien chufng tim mach cua nhiem toan ceton

DIEM TIN HOAT DONG

Nguon: US/tan 2016; 41(21:39-42 NgUifi djch: Le Thj Quynh Giang, Luong Anh Tung

3 H9C l?P' Ru^n tr>9{ Nghj quyet Hoi nghi Ian thur to Ban Chap hanh Trung uong Dang (khda XII) va "NhQng ndi dung co ban cua tif tudmg, dao dik,

(3)

Nghien cuu diicfc

& Thong tin thuoc

2017,

Tap

8,

So

1

, trang

34-37

4f

THONG TIN THUOC ~ *

Cdc bien chung lim mgch cua

nhiem loan celon

Nhiem toan ceton la mot cap cdu ngi khoa nghiem trpng can nhap vien de dieu trj Nhiem toan ceton thudng gap nhat lien quan den dai thao dddng va nghien rudu, moi loai co each xdtri khac Mot so bien phap dieu trj nhiem toan ceton, nhdsddung insulin va kali, la cac thuoc co nguy co cao, va cac bien phap khac co the gay mat can bang dien giai Mot so bien chdng tim mach lien quan den nhiem toan ceton la had qua cua mat can bang dien giai, bao gom loan nhip tim, bat thudng tren dien tarn do, nhip nhanh that va ngdng tim, co the dd phdng thong qua dieu trj ban dau thi'ch hop Nhoi mad co tim cap co the dan den nhiem toan ceton benh nhan dai thao dddng va lam tram trpng them cac hau qua tren tim mach Cac bien chdng tim -phoi nhd phu -phoi va suy ho hap cung ddpc ghi nhan nhiem toan ceton Nhin chung, ty le td vong nhiem toan ceton la thap trddng hop benh nhan dupe dieu trj dung va kjp thdi Dupe si benh vien co the giup dam bao phac dieu tri ddpc chuan hoa va tang eddng dp an toan sir dung thuoc dieu trj nhiem toan ceton Vdi benh nhan ngoai tru, dupe si co the giao due benh nhan ve dd phong nhiem toan ceton va nao benh nhan can den kham tai co sd y te

Nhiem toan chuyen hoa la ket qua cua sd gia tang san xuat acid npi sinh, giam bicarbonat, hoac tich luy acid npi sinh Nhiem toan ceton la roi loan chuyen hoa, sd died hoa ceton bj pha vd, dan den san sinh ceton qua mdc, gay tich luy va giam pH mau Nhiem toan ddpc djnh nghia la pH huyet < 7,35, pH < 6,8 ddpc coi la khdng phu hpp vdi sd song Ceton ddpc hinh sd phan giai cac acid beo.lnsulin dc che qua trinh beta-oxy hoa cua cac acid beo; vi vay, nong dp insulin thap lam tang hinh ceton, co the thay d nhdng benh nhan dai thao dddng Nong dp

Nguon: US Pharm. 2016; 41 (2):39-42 Ngddi djch: LeThj Quynh Giang, Luang Anh Tung

glucose mau tang qua cao dan den bai nieu tham thau, tang bai tiet Cortisol va catecholamin, thuc day qua trinh oxy hoa acid beo va hinh ceton Tang nong dp glucagon, bj kich thich bdi dddng huyet va thieu hut insulin, dan den phan giai lipid, lam tang san xuat acid beo td va hinh the ceton

Cdc dang nhiem toan ceton

Hai dang bien cua nhiem toan ceton la

nhiem toan ceton ddi thao dddng (DKA) vd nhiem toan ceton rugu (AKA) Ty le td vong cua DKA td 1% den 10%, vdi nguyen nhan td vong bien la nhiem trdng hoac bien co lien quan den tim mach nhu truy tuan hoan va kali mau Cac trddng hpp tdvong AKA cung da ddpc bao cao, nhdng ty le t d vong nhin chung thap trUdng hpp benh nhan dupe dieu trj kjp thdi DKA va AKA dddc coi la cap cdu npi khoa nghiem trpng va can ddpc xdtri khan cap So sanh gida dang nhiem toan ceton ddpc trinh bay trong bang

Nhi6m toan ceton ddi thdo duong

Nhiem toan ceton thddng xay d benh nhan dai thao dddng phu thupc insulin bj thieu hut insulin hoac tang nhu cau insulin giai doan cap cda benh, dan den phan giai cac acid beo va hinh ceton Thieu hut insulin lam tang cac hormon doi khang nhd glucagon, catecholamin, Cortisol va hormon tang trddng Dd thda glucagon va catecholamin cung vdi ndng dp insulin thap lam thuc day hinh ceton DKA dac trdng vdi bied hien tang dddng huyet, pH mau dpng mach < 7,3, cd ceton huyet va nhiem toan cd khoang anion cao Kali huyet cd the tang mac du tong Idpng kali co the giam, va giam the tich tuan hoan va tang dddng huyet che giau sd thieu hut natri, clorid, phospho va magnesi

(4)

Nghien

cull

di

/cfc &

Thong tin thuoc

2017,

Tap

8,

So 1, trang

34-37

THONG TIN THUOC

Bang / So sdnh DKA va AKA

DKA AKA

Trieu chilng

-Buon non -Budnndn

-Non -Non

-Bail bung Bauhung

- Khat/tieu nhieu -Kieu thoi Kussmaul - Hoi thdco mui trai cay -Tang huyet ap -Nhip tim nhanh

Nguyennhan

- Si dung khdng du lieu insulin - Cai rupu dot ngpt d benh nhan

-Nhiem trung nghien rupu man tinh ket hpp vdi

- Sidung cac thudc hcfdng than bj cam che dp dinh dudng kem - Thieu mau cue bd is md tai tim hoac nao - Lan dau udng bia rupu qua mic

Dieu trj

- Bu djch: 2-3I dung djch natri clorid 0,9% 1-3 - Bu dich va glucose: dextrose gid, tiep theo dung dung djch natri clorid 0,45% 250- 5% dung dich natri clorid 500 ml/gid; glucose flat 13,9 mmol/L, chuyen sang 0,9% cho den bu du cac glucose 5% va dung djch natri clorid 0,45% 150-250 chat dien giai, sau chuyen

ml/gib sang dextrose 5% dung

- Si dung insulin tac dung ngan dudng tinh mach 0,1 djch natri clorid 0,45% cho den U/kg, sau truyen lien tuc (0,1 U/kg/gid) Cd the lupng nap qua dudng udng tang lieu len 2-3 Ian neu khdng cd dap ing 2-4 duoc dam bao

gid va giam lieu insulin xudng 0,05-0,1 U/kg de - Bu magnesi va kali tri glucose mau khoang 8,3-13,9 mmol/L - Cd the si dung 50-100 mg - Ndng kali huyet phai > 3,3 mtq/L trddc thiamin (vitamin B1) va mg

dung insulin acid folic dudng tinh mach

- Si dung 10-20 mEq kali tddng ing moi lit djch truyen (nging truyen kali neu nong dp kali ban dau tang den ndng dp kali trd ve binh thudng)

Benh nhan co the buon non, non, khat nUdc qua muC, di tieu thudng xuyen va dau bung, xuat hien vong 24 gid.Tang dudng huyet cd the dan den bai nieu tham thau va nhip tim nhanh, giam the ti'ch cung gian mach ngoai vi cd the gay huyet ap Benh nhan cd the cd hoi thd mui trai cay, thd sau va nang nhpc (kieu thd Kussmaul) thuf phat toan chuyen hda

Dieu tri DKA: bien phap chinh dieu tri DKA la sd

dung insulin dudng tinh mach va bu dich, va DKA dupe dieu tri tot nhat thong qua each tiep can dieu trj theo protocol phdng Hoi sdc ti'ch cdc (ICU) Ngay lap tdc, nen dung mot lieu nap tiem tinh mach 0,1 U/kg insulin tac dung ngan, sau truyen lien tuc insulin 0,1 U/kg/gid va tang lieu neu benh nhan khdng cd dap dng 2-4 gid Lieu insulin cd the giam xudng 0,05-0,1 U/kg de tri glucose huyet tuong d mdc 8,3-13,9 mmol/l va ngan ngda dudng huyet Khi tinh trang nhiem toan ddpc giai quyet va benh nhan on djnh, cd the

an dupe, cd the chuyen sang tiem goi dau insulin tac dung keo dai qua dddng tinh mach 2-4 gid trade truyen tinh mach lien tuc va tiem dddi da insulin de ngan ngda tai phat DKA Insulin tac dung ngan cung nen ddpc dung vao trddc cac bda an Neu nong dp kali ban dau < 3,3 mEq/L, insulin nen dupe tarn ngdng cho den nong dp kali tang len Ngoai insulin, ban dau nen nap 2-3L natri clorid 0,9% 1-3 gid Khi benh nhan on djnh huyet dpng va co the bai nieu, chuyen sang natri clorid 0,45% se lam giam nguy co tang d o mau

Insulin dc che hinh cac the ceton, thuc day sd dung ceton va tang eddng san xuat bicarbonat Tuy nhien, tang dddng huyet hoi phuc nhanh hdn so vdi nhiem toan ceton, vi vay glucose mau dat 13,9 mmol/l, dextrose ddpc bo sung de tri glucose mau khoang td8,3-13,9 mmol/l tiep tuc truyen insulin Kali toan phan co the bj thieu hut d benh nhan DKA, va nong dp kali ban dau khdng tang, nen bo sung 10-20 mEq kali moi lit djch truyen tinh mach Natri bicarbonat khdng dope khuyen cao trd pH giam xudng dddi 7,0, vi viec dao chieu nhanh chdng nhiem toan cd the dan den suy tim Bu phosphat va magnesi nen dupe ca the hda tren tdng benh nhan dUa tren cac ket qua xet nghiem

Nhiem loan celon ruou

Nghien rdpu cung cd the gay nhiem toan ceton cai rupu dot ngpt ket hpp vdi dinh dudng kem, co the khdng cd du glucose lam ngudn nang lupng phuc vu cho cac hoat dpng Trong tinh trang nay, ca the tang chuyen hda acid beo, va cang tang them thong qua giam tiet insulin va tang glucagon AKA thudng di kem vdi nhiem toan cd khoang trdng anion cao va tang ndng dp lactat huyet Mot so benh nhan cd the cd pH mau binh thudng vi cd rdi loan acid-base hdn hpp ndn va nhiem kiem hd hap Cac trieu chdng cua benh nhan bao gdm budn ndn, ndn va dau bung

Dieu tri AKA: bien phap dieu trj tieu chuan cho

(5)

Nghien ciiu duttc

2017,

Tap 8, So 1, trang 34-37

it

THONGTINTHUOC

ket qua xet nghiem Thiamin va folat co the dupe sd dung neu benh nhan dupe xac dinh hoac co nguy CO thieu vitamin de ngan ngda benh nao Wernicke Insulin khdng dupe sd dung vi co the gay dudng huyet mud glycogen thap va nong dp glucose thap hoac d mdc binh thudng Giong vdi DKA, natri bicarbonat chi dupe chi djnh nhiem toan nang vdi pH < 7,0 Bu phosphat chi dupe ap dung nong dp phosphor < mg/dL Trong cac trudng hpp nay, thudng cd yeu to khac gop phan gay nhiem toan, nhu cac thuoc dupe dung dong thdi

Cdc bien chung tim mgch

Co nhieu bien chdng tim mach nhiem toan ceton thd phat roi loan dien giai va giai phdng catecholamin Nhiem toan ceton cd the gay phu phoi, va benh nhan nhoi mau cotim cap cd the dan den nhiem toan ceton, tiep tuc gay ton thUdng CO tim

Nhiem toan ceton dan den mat can bang dien giai, dac biet la giam kali, magnesi va phospho, cd the dan den cac bien chdng tim mach neu khdng dupe bu dien giai can than (bang 2). Ban dau, kali cd the tang su di chuyen t d npi bao huyet tuong thd phat nong dp insulin thap.Trong qua trinh dieu trj vdi bu djch va sd dung insulin, kali ngoai bao cd the di vao te bao, dan den nong dp kali thap gay nguy hiem cho benh nhan Nong dp kali rat quan trpng ca tang va kali mau deu cd the gay loan nhjp tim Nong dp kai huyet binh thudng la 3,5-5 mEq/L Nong dp kali huyet < mEq/L cd the dan den loan nhjp va ngdng tim, nong dp > 5,5 mEq/L cd the gay bat thudng tren dien tarn do, nhjp nhanh that hoac rung that

Bang Cac bien chdng tim mgch cua mat can bang dien giai

Mat can bang dien giai Cac bien chiing tiem tang

Ha kali mau Loan nhip, ngirng tim

Tang kali mau Bat thuilng dien tarn do, nhip nhanh that, rung that Ha magnesi mau Giam ho hap, dan den dp bao hda oxy thap, lam tram

trpng them tinh trang mat kali

Ha phospho mau Thay ddi trang thai tarn than, giam thong khi, ngirng tim - phoi

Nong dp magnesi cung can dupe theo ddi chat che, magnesi cd the lam tram trpng them tinh trang mat kali lam suy giam su hap thu kali cua te bao va tang bai tiet qua than Magnesi cung ddng

vai trd nhu mot chat gian ca va magnesi mau cd the dan den suy ho hap, dp bao hda oxy thap, rat nguy hiem cho benh nhan hen phe quan hoac benh phoi tac man tinh (COPD)

Mat can bang dien giai cung cd the tang nong dp phospho Mac du nong dp phospho ban dau cd the d mdc binh thudng hoac tang, nong dp chat dien giai van rat nhay cam vdi dieu trj nhiem toan ceton tieu chuan.ThUc te', da cd nhieu bao cao ve cac trudng hpp bien chdng giam manh nong dp phospho Mot bao cao ghi nhan nong dp phospho cua benh nhan giam t d 4,9 mg/dL xuong 0,6 mg/dL vdng dieu trj nhiem toan ceton Nong dp phospho binh thudng la 2,5-4,5 mg/dL Nong dp phospho giam dan den thay doi y thdc cua benh nhan Sau bd phospho, tinh trang tarn than cua benh nhan trd lai binh thudng vao thd cua lieu trinh dieu trj nhiem toan ceton Thieu hut phospho cd the lam yeu ca xUOng, giam thong khi, dan den ngdng tim - phoi Bd phosphat manh cd the lam giam calci mau, vi vay phai giam sat ca nong dp phospho va calci

Viec giai phdng catecholamin nhiem toan ceton anh hudng true tiep len he tim mach Giam pH huyet thudng dan den tang thong khi' va kieu thd Kussmaul Du tinh co that cua tim cd the suy yeu, viec giai phdng catecholamin dan den chdc nang co bop cua tim binh thudng Trong nhiem toan nhe (pH 7,2-7,35), catecholamin dupe tang cUdng giai phdng va ca the phan dng lai bang each tang cung lUpng tim thong qua tang nhjp tim va tang chdc nang co that cua tim Khi pH mau < 7,2 tim bj suy yeu true tiep ion H+, cuoi cung dan den giam cung

lugng tim va nguy CO soc nang Nong dp glucose mau tang cao dan den bai nieu tham thau, cd the lam giam the ti'ch tuan hoan Tinh trang lien quan den tang nong dp Cortisol va tiet catecholamin, dan den kich thich san xuat acid beo tu va hinh ceton

Bien chdng tim - phoi nhd phd phoi va hoi chdng suy ho hap cap da dupe ghi nhan d benh nhan nhiem toan ceton Gian dpng mach ngoai vi va co tinh mach trung tarn cd the xuat hien nhiem toan ceton, va sd co mach cd the gdp phan tien then phu phoi ca vdi qua tai tuan hoan nhe Hien tupng bu trd thong phe nang da ddpc ghi nhan d benh nhan DKA, cd the dan den dp bao

(6)

Nghien cuU

difdt

2017,

Tap 8, So 1, trang 34-37

THONGTINTHUOC

d benh nhan cd benh ho hap hoac nhiem trung ho hap cap Dieu thudng xay qua trinh dieu trj DKA nhieu hon cac trieu chdng xuat hien, vi vay can giam sat bat ky dau hieu lam sang hoac xet nghiem nao cua suy ho hap benh nhan dupe dieu trj

Nhoi mau co tim cap benh nhan dai thao

duong

Nhoi mau CO tim cap dupe ghi nhan vdi tan sd cao hon d benh nhan dai thao dudng va cd ty le mac benh va tdvong cao hon so vdi benh nhan khdng bj dai thao dddng Mdi lien quan dupe cho la tang xo vUa dpng mach d benh nhan dai thao dudng, cd xu hudng gia tang nguy co ddi vdi cac yeu to lien quan den tim mach nhu tang huyet ap va rdi loan lipid mau

Nhdi mau co tim cap la yeu to dan den DKA d khoang 4% benh nhan dai thao dudng cd tien sd nhdi mau cotim cap DKA nhdi mau cotim cap lam tang ty le t d vong d cac benh nhan len den gan 85% Trong DKA, co tim khdng hap thu dupe glucose vi ndng dp ceton va acid beo tu d mdc cao, dan den thieu mau cue bp co tim Dieu cd the lam tram trpng them ton thUOng tim mach von da xuat hien nhdi mau co tim cap Ton thuong them cac md d tim xay tang ndng dp cac gdc t d Nhu da de cap d tren, nhiem toan cd sU gia tang giai phdng catecholamin.Oieu ngan can sUtiet insulin du trd, tang phan giai lipid va hap thu acid beo t u cua md d tim, t d lam ton thdong them co tim dpc tinh cua acid beo

Co tim nhay cam vdi nhdng thay ddi nhd ve pH djch ngoai bao, lien quan den trao ddi ion vdi djch ndi bao Trong nhiem toan, cd su gia tang ion hydro, lam tang anh hudng den cac bao quan cua cac te bao co tim pH thap lam giam ndng dp calci, dan den giam sdc cang cua cac vi spi co Tren thuc te', nhiem toan md thieu mau cue bp CP tim xuat hien trudc hoac trongluc bat dau cd bieu hien suy giam chdc nang co bop cua co tim Trong nhiem toan nang, cd the xay hoai t d co tim

Vai trd cua duo< si

Viec dieu trj nhiem toan ceton can sd dung insulin va bd sung kali, la cac thudc cd nguy co cao theo Vien Thuc hanh An toan thudc Hoa Ky (ISMP)

Cac thudc cd nguy co cao la cac thudc dupe cho la cd nguy co cao hon gay ton thuong dang ke cho benh nhan neu xay sai sot lien quan den viec sd dung thudc Cac than trpng dac biet giup giam sai sot lien quan den sd dung thudc can dupe ap dung ddi vdi cac thudc nay, nhd bd sung nhan phu de canh bao va cac canh bao t d ddng Can sd dung cac thudc vao thdi diem phu hop de ngan ngda cac bien chdng tren benh nhan Ddpc si nen trdc tiep tham gia vao qua trinh tieu chuan hda duyet don, ton trd va chuan bj cac thudc dung de dieu trj nhiem toan ceton de dam bao tinh chinh xac va giup ngan ngda sai sot sd dung thudc Ddpc si cung cd the la mot ngudn thong tin thudc quan trpng cd cac cau hoi td can bp y te

Trong cdng ddng va tai cac don vj hoi sdc tfch cdc, ddpc si cung cd the tham gia giao due benh nhan ve phdng ngda DKA va AKA Nhdng ddpc si thudng tiep xuc vdi benh nhan thddng xuyen hon va ddng vai trd quan trpng viec t d van cho benh nhan ve cac bieu hien, trieu chdng cua nhiem toan va nao benh nhan can dope cham sdc y te khan cap.Them vao do, ddpc si cd the xem cac thong tin quan trpng ve tuan thu dieu trj cua benh nhan va nao can can thiep de ngan ngda xuat hien nhiem toan ceton Benh nhan dai thao dddng nen ddpc giao due ve viec khdng tu y ngdng insulin dot ngdt ma khdng tham khao y kien cua bac si dieu trj va theo ddi cac dau hieu, trieu chdng nhiem toan ceton cac giai doan cap tinh cua benh NgOdi nghien ropu can ddpc giao due ve nguy co gap cac bien chdng nhd nhiem toan ceton va can ddpc t d van ve lam dung rdpu

Ket luan