Caso Clinico

 

[@C_KR\CDAD DK JRCK@TK @×LFKJ BJFÅ_AR K\L[KFA DK LCK@LCA\ DK FA \AF[D ‖Dr. Ora`lcslj _cricfcj Battcstc`c Lasafta― DK^ARTAEK@TJ DK^ARTAEK@ TJ DK ^ARA\CTJFJIÅA S ECLRJBCJFJIÅA ECLJFJICA

LA\J LFC@CLJ7 Ou`ikeca

IR[^J @¾=

 Apkffcdjss y `jebrks  Apkffcdj  Afbjr`js  Afb jr`js Ora` Ora`lkfys. lkfys. L.C72?.422.4>.23;

Iarlca Iabrckfa.

L.C72?.4..224.3?4 Mkr`a`dkzz fk``ca. Mkr`a`dk

L.C72;.2>

 

  ou`ikeca dkspuãs dk vcagar a Tafarjeylks ear`kookc  ou`ikeca Lmc`a k` u` palck`tk la`adck`sk lj` \CDA Lasj lfå`clj7 [` mjebrk dk ?2 añjs c`irksü k` kf skrvclcj dk ekdclc`a ik`kraf lj` u` mcstjrcaf dk jdc`joaica, ockbrk (tkepkratura0 lãfufas / ζf, y su laria vcraf ouk dk .2 Ù 1> 3 / F) y trjebjlctjpk`ca (`adcr 3/ F). \us `cvkfks dk k`zceas mkpátclas kstaba` fcikraek`tk kfkvadjs (aspartatj aec`jtra`sokrasa == [ / F, afa`c`a aec`jtra`sokrasa añjs a`tks y mabåa scdj tratadj pjr `kuej`åa pjr ^`kuejlystcs gcrjvklcc k` 2 jlascj`ks, 12 y 2> añjs a`tks. Jtras ljejrbcfcdadks eãdclas c`lfuyk` lj`okllcü` lj`okllcü` pjr mkpatctcs B y k`okrekdad pufej`ar jbstrultcva lrü`cla. _cvåa k` La`adá 2; añjs a`tks dksdk Iua`izmju Iua` izmju,, Lmc`a Lmc`a (prjvc`lca (prjvc`lca dk Iua`idj`i Iua`idj`i)) y mabåa vcsctadj vcsctadj Lmc`a pjr ÷ftcea vkz 1 añj a`tks dk fa prksk`talcü`.

a) Ea`cokstalcj`ks Lfå`clas  fa c`okllcü` dcskec`ada pjr T. ear`kookc pukdk` c`lfucr7 Ockbrk, Fc`oadk`jpatåa, ^ãrdcda dk pksj, Mkpatjekiafca, Kspfk`jekiafca, A`jeafåas rkspcratjrcas y iastrjc`tkstc`afks y fkscj`ks lutá`kas. Fas fkscj`ks lutá`kas kstá` prksk`tks k` kf 9>% dk fjs lasjs y sk dkslrcbk` lfásclaek`tk ljej pápufas `klrütclas, au`quk pukdk` varcar k` aparck`lca. Ljej fjs palck`tks sukfk` tk`kr u` `÷ekrj bagj dk LD4+, pukdk` aparklkr  jtras jtras c` c`ok okllc llcj` j`ks ks jp jpjr jrtu tu`c `csta stass lj lj`l `lje ject cta` a`tk tks. s. Fa tj tjss ks orklu orkluk` k`tk tk pk pkrj rj fa `kuej`åa ks rara, a pksar dk quk fa våa aãrka ks fa pukrta dk k`trada dkf jria`csej.

 

[`a ea`coks ea`cokstalc talcü` ü` dk fa c`okllc c`okllcü` ü` dcskec dcskec`ad `ada a pjr Tafa Tafarjey rjeylks lks ear`kook ear`kookcc k` palck` pal ck`tks tks lj` \CDA \CDA sj` fas pkqukñ pkqukñas as fkscj`k fkscj`kss dk aparck` aparck`lca lca sãptcla sãptcla.. C`okllc C`okllcü` ü` adqucrcda

b) Oaltjrks prkdcspj`k`tks Fa tafar tafarje jeclj cljscs scs pu pukd kdkk ao aokl kltar tar a fas fas pk pkrsj rsj`a `ass qu qukk tck` tck`k` k` _CM _CM dk ea`k ea`kra ra dcokrk`tk a fas pkrsj`as quk `j tck`k` kf _CM. ^rkdjec`a k` palck`tks c`eu`jljeprjektcdj. Dkbk lj`scdkrarsk k` palck`tks quk vcvk` k` kf sudkstk ascátclj, kf `jrtk dk Austrafca, kf sur dk Asca (c`lfucda fa C`dca) y Lmc`a j quk maya` vcagadj a fjs fuiarks ya ek`lcj`adj. Altcvcdadks fabjrafks lj` rcksij k` lj`taltj lj` fa tckrra, fjs vkiktafks y sus  prjdultjs (k` zj`as z j`as k`dãeclas). Altcvcdadks k` lj`taltj lj` a`ceafks (rata (r ata dkf  baeb÷) j sus prjdultjs. Altcvcdadks Altcvcdadks sa`ctarcas y fabjratjrcjs.

l) Eãtjdjs dcai`üstcljs apfcladjs \k pukdk dcai`jstclar ekdca`tk kf usj dk u`a pkqukña eukstra dk fa partk dkf lukrpj aokltada, pjr kgkepfj7 eãdufa üska, pckf, sa`irk, pufeü` j ia`ifcjs fc`oátcljs. Fa eukstra sk k`våa a u` fabjratjrcj para u` luftcvj o÷`iclj j para skr kxaec`ada bagj kf eclrjsljpcj. E[K\TRA7 Mkejluftcvj L[FTC_J ECLJFJICLJ7 \k luftcva k`  aiar sa`irk a fjs trks dåas dk c`lubalcü`

fas ljfj`cas ecdk` u`js ; ee dk dcáektrj, sj` dk ljfjr bfa`lj-ircsálkj, apfa`adas, dk supkroclck fcsa y atkrlcjpkfada. Lj` kf tckepj fa supkroclck dk fas ljfj`cas sk tjr`a radcada, su ljfjralcü` kvjfulcj`a masta u` ljfjr earrü`-rjgczj lj` árkas dk tj`afcdad aearcffj-vkrdjsa, y kf rkvkrsj adquckrk u`a tj`afcdad asafej`ada. Af ecsej tckepj quk sk prjdulk` kstjs laebcjs k` fa tkxtura y k` fa ljfjralcü` dk fas ljfj`cas, kstk jria`csej prjdulk u` pciek`tj dcouscbfk dk ljfjr rjgj vc`jsj. Dksdk kf tkrlkr j luartj dåa dk c`lubalcü`, sk oalcfcta su cdk`tcoclalcü`. kxmcbk u` dcejrocsej dkpk`dck`tk dk fa

 

tkep tkepkra kratu tura ra qu qukk fk pk pkre rect ctkk dk dksa sarrj rrjff ffars arskk a 2; ·L ba bagj gj fa oj ojre reaa eclkf eclkfca caff (ojr (ojrea ea saprjocta), j ljej u`a fkvadura, fa ojrea parasctarca, a 9. Ausc` Au sc`aa Rucz Rucz,, _. _.88 Ejrk Ejrk`j `j Iucf Iucffã fã`, `, \. Trat Tratad adj j \KCE \KCEL L dk k` k`okr okrek ekda dadk dkss c`okllcjsas y eclrjbcjfjiåa lfå`cla. Kd. Eãdcla ^a`aekrcla`a, 2>>;. C`stctut oör Arbkctsslmutz dkr Dkutslmk` Iksktzfclmk` [`oaffvkrsclmkru`i (COA). IK\TC\ Bcjstjoodatk`ba`h. ^k`clcffcue ear`kookc. 2>1? C`stct C`s tctutj utj @alcj` @alcj`af af dk \kiurc \kiurcdad dad k Mcick` Mcick`kk k` kf Trabag Trabagj j (C@\MT (C@\MT). ). @jtas @jtas Tãl`clas dk ^rkvk`lcü`. @T^7 233, ;2. LAJ F, LMA@ HE, LMK@ DF kt af. Dktkltcj` jo lkff waff ea``jprjtkc` Ep1p Ep 1p c` luft luftur urkk supk supkr` r`at ata` a`ts ts jo ^k ^k`c `clc lcff ffcu cue e ear` ear`ko kook okcc a` a`d d c` sk skra ra jo   pk`clcffcjscs patck`ts. G Lfc` Eclrjbcjf 13338