Hyperkalemia

1、Pathogeny

1.Decreased renal potassium excretion

(1) Acute renal failure : late stage of oliguria or chronic renal failure

(2) Adrenal cortical hormone synthesis and secretion deficiencies : such as adrenal hypofunction , low aldosterone .

(3) The potassium sparing diuretics : long-term use of chlorobenzene pteridine and spironolactone and amlodipine .

2.Intracellular potassium migration

(1) Hemolysis , tissue damage , tumor or inflammatory cells necrosis , hypoxia , shock , burn , muscle contracture and so on

(2) Acidosis

(3) Hyperkalemic periodic paralysis

(4) After injection of hypertonic saline and mannitol , intracellular dehydration causes changes in cell membrane permeability or cell metabolism , resulting in intracellular potassium migration .

3.Excessive input of potassium containing drugs

Penicillin ( 1 million per unit K 1.5 mmol ) big dose of potassium solution or input too much .

4.Excessive input of banked blood

5.Digitalis intoxication

Overdose of digitalis can reduce the activity of ion pump and affect potassium into cells .

2、Treatment

Hyperkalemia patients should take emergency measures , but also should be based on the severity of the disease to take different treatment methods .

(1)Calcium

Hyperkalemia can make the myocardial cells and reduce the resting potential threshold potential unchanged , the gap between the two , it increase the excitability of myocardial cells . Ca2+ may widen the gap between the resting potential and the threshold potential of the myocardial cell membrance .

(2)The plasma and extracellular potassium were temporarily transferred into the cells

(3)Promoting potassium ion excretion in vitro

Removal of potassium and cation exchange resins from the spinal cord or thiazide and hemodialysis .

(4)Diet

Stop taking food containing potassium .

(5)Stop induced drugs

Stop all drugs that might cause blood potassium levels to rise .

(6)Removal motivation

The cause of hyperkalemia or the treatment of hyperkalemia .

3、Symptoms

The severity of symptoms in the cardiovascular system and neuromuscular system depends on the degree and speed of blood potassium elevation , and there were other plasma eletrolytes and disorders of water metabolism coexisting .

(1)Cardiovascular symptom

The high potassium myocardial depression, reduce the myocardial tension, bradycardia and cardiac enlargement, heart sound weakened, prone to arrhythmia, but without heart failure. Electrocardiogram has characteristic change, and is related to the degree of blood potassium increase.

(2)Neuromuscular symptoms

Early often have limbs and perioral numbness, extreme fatigue, muscle aches, pale and clammy limbs. When the serum potassium concentration reached 7mmol/L, the limbs were numb and flaccid paralysis, the first was the trunk, the back was the limbs, and finally the respiratory muscle was affected, and asphyxia occurred. The central nervous system can be manifested as irritability or confusion.

(3)Other symptoms

Because of the increase of acetylcholine release caused by hyperkalemia, nausea, vomiting and abdominal pain can be induced. The toxicity of high potassium to muscles can cause paralysis of limbs and respiratory arrest . All hyperkalemia have different degrees of nitrogen metabolism and metabolic acidosis. The latter can aggravate hyperkalemia .

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