Hyperkalemia
General consideration :
Usually develops in patient with advanced renal dysfunction .It is also associated with acidosis.
Mineralocorticoid deficiency from Addison disease(high renin) or chronic kidney disease
(low rennin) is another cause of hyperkalemia.
ACE inhibitors ,ARBs and potassium –sparing diuretics ,commonly used with congestive heart failure or chronic kidney disease may cause hyperkalemia .
Heparin, trimethoprim,amiloride,triamterene and immunosuppressive drugs such as cyclosporine and tacrolimus can induce hyperkalemia.
Clinical findings:
Muscle weakness,rarely,flaccid paralysis ,abdominal distention and diarrhea may occure.
ECG is not a sensitive method for detecting hyperkalemia.ECG changes include peaked Twaves of increased amplitude , widening of QRS<and biphasic QRS-T complex.
The heart rate may be slow ,ventricular fibrillation and cardiac arrest are terminal events.
Treatment:
Emergency:
Calcium :antagonizes cardiac conduction abnormalities .
Bicarbonate ,insulin ,albuterol:distributes K into cells .
Nonemergency:
Loop diuretic:(furosemide)increase renal K excretion.
Sodium polystyrene sulfonate.
Hemodialysis or peritoneal dialysis.
التعليقات
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as you say this is my adding
Pseudohyperkalemia
Pseudohyperkalemia is a rise in the amount of potassium that occurs due to excessive leakage of potassium from cells, during or after blood is drawn. It is a laboratory artifact rather than a biological abnormality and can be misleading to caregivers.Pseudohyperkalemia is typically caused by hemolysis during venipuncture (by either excessive vacuum of the blood draw or by a collection needle that is of too fine a gauge); excessive tournequet time or fist clenching during phlebotomy (which presumably leads to efflux of potassium from the muscle cells into the bloodstream); or by a delay in the processing of the blood specimen. It can also occur in specimens from patients with abnormally high numbers of platelets (>1,000,000/mm³), leukocytes (> 100 000/mm³), or erythrocytes (hematocrit > 55%). People with "leakier" cell membranes have been found, whose blood must be separated immediately to avoid pseudohyperkalemia.