水電解質(zhì)平衡失調(diào)的處理-資料下載頁
2025-05-10 11:29本頁面
【正文】 h intake of potassium ? Diuretics make kidney excrete potassium. ? Patient having infusion without potassium, iv. nutrition without enough potassium. ? Vomiting, persistent gastrointestinal suction, fast or bowel fistula. ? Shift into cells in alkalosis Hypokalemia Clinical manifestation ? Muscle weakness is the earliest manifestation, first extremities, then trunk, respiratory, sometimes dyspnea, even choke and cough at eating and drinking, negative or decreasing of tendon reflexes and flaccid paralysis. ? Nausea vomiting, bowel paralysis. ? Impaired heart, abnormality of conducing and rhythm .ECG: Lower and broad T wave with double summit or inversion, depression of ST segment, lengthening QT interval, U wave appearance. Some patients are without abnormal ECG. Hypokalemia Clinical manifestation ? Severe patients have diuresis because hypokalemia can block secretion of ADH. ? At serum hypopotassium state, exchange 2Na+ and 1H+ in ECF for 3K+ in ICF, H+ in ECF decreases, which causes alkalosis. ? When K+ in ECF decreases, excretion of K+ decreases while excretion of H+ increases in distal involuted tubule. As a result, the urine is acidic for alkalosis patient, which is called unusual acid urine. Hypokalemia Diagnosis ? History ? Clinical manifestation ? Decreased serum potassium mmol/L ? ECG accessory diagnostic method Hypokalemia Treatment ? Remove causes ? Give K+ ? K+=1g ? Infusion speed 20mmol/h, 100200mmol/d ? 40mmol/L (KCl ) ? Urine 40ml ? Complete correction needs long time, oral intake Hyperkalemia 高鉀血癥 Serum K+ Causes ? Oral intake, infusion, blood transfusion ? Poor renal function . acute renal failure, K+ retention diuretics (antisterone), poor adrenal cortical function ? Abnormal K+ distribution (acidosis , crush injury, haemolysis) Hyperkalemia Clinical manifestation ? Nausea and vomiting, colicky abdominal pain and diarrhea ? Circulatory disturbance, pale, cooling and bluish, hypotension, slower heart rate and/or arrhythmia, even stops ? ECG: peaking of the T waves, prolonged QT interval, widening of the QRS plex, depression of the ST segment Hyperkalemia Diagnosis ? Causes ? Clinical manifestation ? ECG ? Serum K+ Hyperkalemia Treatment ① Stop giving potassium ② Decrease serum K+ concentration A. Make K+ into cells a) 60100 ml of 5% NaHCO3 iv. to increase volume , dilute potassium, correct acidosis, K+ goes into cells, Na antagonize K+ b) 2550% glucose + RI (1u/34g glucose) 100200 ml iv c) For renal insufficiency: 10% calcium gluconate 100ml + % sodium lactate 50ml + 25% glucose 400ml + RI 30u iv for 24h at 6drops/min. Hyperkalemia Treatment B. Cation exchange resin, orally or by enema, 5080g/d, binding K+ in intestine to exchange with Na+, with oral sorbital to induce diarrhia and enhance K+ removal C. Dialysis: peritoneal dialysis or hemodialysis ③ Antiarrhythmia: 10% calcium gluconate 20ml iv injection
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