Mahimman Gaggawa na Potassium: Kame Zuciya na Hyperkalemic da Nakasa¶

Potassium (K+shi ne farkon intracellular cation a cikin jikin mutum, tare da 98 bisa dari na jimlar potassium na jiki (3,500 to 4,000 mEq) da aka adana a cikin tsokar kwarangwal da ƙwayoyin gabobin jiki kuma ** kashi 2 ne kawai ke yawo a cikin magudanar jini na waje**. Saboda ƙarfin huta wutar lantarki (-90 millivolts) da kuma sake dawo da kowane ƙwayar ƙwayar zuciya da ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta140 to 150 mEq/Lda kuma extracellular serum potassium (3.5 to 5.0 mEq/L), ko da ƙaramin motsi na potassium a cikin ko fita daga cikin jini na iya dakatar da zuciya ko gurgunta jiki cikin mintuna.

Matsalolin gaggawa na potassium masu barazana ga rayuwa sun afku a madaidaici guda biyu: ** Tsananin Hyperkalemia (Serum K+ > 6.0 to 6.5 mEq/L**, sau da yawa ana kiranta "kisan shiru" saboda marasa lafiya da gazawar koda, rasa hemodialysis, murkushe raunin da ya faru, rhabdomyolysis, ko hulɗar tsakanin ** ACE inhibitors / ARBs, spironolactone, trimethoprim-sulfamethoxazole (Bactrim), da potassium gishiri maye gurbin ** na iya tafiya daga jin rauni mai rauni zuwa shan wahala. babu gargadi; da Mai tsanani Hypokalemia (Serum K+ < 2.5 mEq/L, wanda ke haifar da matsanancin amai/zawo, madauki ko diuretics na thiazide, maganin ketoacidosis na ciwon sukari, ko Hypokalemic Periodic Paralysis (ciki har da cututtukan cututtukan jini na lokaci-lokaci bayan cin abinci mai yawan carbohydrate ko motsa jiki), wanda ke haifar da saurin bugun ƙafafu da ƙafafu da hannaye. arrhythmias. Idan kuna zargin gaggawar potassium mai mahimmanci, kira lambar gaggawa ta gida (911 a Amurka da Kanada, 112 a cikin Tarayyar Turai, 999 a Burtaniya) ta hanyar mu lambobin gaggawa directory nan da nan, kuma bita farfadowa na zuciya (CPR), murkushe rauni da sashe ciwo, kuma m koda rauni da rhabdomyolysis.

Yi wannan yanzu¶

1. Kira 911/112/999 nan take*: A kira ma'aikatan lafiya na gaggawa nan take idan mai ciwon koda, akan dialysis, ko shan hawan jini/magungunan diuretic ya kamu da raunin kafa kwatsam, rashin iya tashi daga kujera ko gado, kushewa ko fizgewa a kusa da baki ko maƙarƙashiya, bugun bugun zuciya, ciwon kirji, jinkirin bugun jini ko rashi.
2. ** KA TSAYA duk tushen potassium da magunguna masu riƙe da potassium nan da nan : Idan ana zargin ** hyperkalemia (high potassium), nan da nan dakatar da duk ** magungunan potassium da aka rubuta ** (K-Dur, Klor-Con, Slow-K), ”madaidaicin gishiri” /“ gishiri-sodium low-sodium chloride), ** NSAIDs** (* ibuprofen, naproxen*), ** ACE inhibitors / ARBs** (* lisinopril, losartan*), ** potassium-sparing diuretics ** (* spironolactone, eplerenone, amiloride, triamterene*), da kuma **trimethoprim-sulfamethoxazole.
3. MALAMI GA HYPOKALEMIA: Kada a taɓa ba da abubuwan sha masu sukari, ruwan 'ya'yan itace, ko kayan ciye-ciye masu yawa: Idan mutum yana fuskantar rauni na ƙafa da ƙafar hannu kwatsam (** paralysis hypokalemic**), Kada a ba shi soda mai daɗi, ruwan lemu mai zaki, alewa, ko abubuwan sha masu yawan sukari. Sugar yana haifar da hawan *insulin na gaba da sauri daga pancreas, wanda ke fitar da sauran potassium daga cikin jini zuwa cikin sel kuma nan take ** ya gurgunta tsokoki na numfashi ko kuma haifar da fibrillation mai mutuwa.
4. Kiyaye mutum a kwance kuma ya yi shiru, sannan a duba numfashinsa: Duk wani gwagwarmayar jiki yana sakin adrenaline ko kuma yana kara dagula ciwon zuciya. Ka sanya mutumin ya huta a hankali a bayansa (ko kuma ya tashi sama da digiri 45 idan mai dialysis yana da ruwa a cikin huhu). Duba ƙirji yana tashi sosai: duka hypokalemia mai tsanani da hyperkalemia mai tsanani na iya gurgunta diaphragm.
5. Faɗa wa ma'aikatan lafiya idan majiyyaci yana da ƙwanƙwasa ƙwanƙwasawa (AV) dialysis fistula ko graft: Idan majiyyacin yana kan kula da hemodialysis, gaya wa ma'aikatan kiwon lafiya nan da nan wane hannu ke da AV fistula ko graft don haka ba a sanya majinin jini ko alluran IV na gefe a hannun yoyon fitsari, sannan a nemi a kai shi asibiti, a asibiti tare da 17. gaggawa hemodialysis.
6. Ku kasance cikin shiri don fara CPR nan da nan idan majiyyaci ya rasa hayyacinsa: Kamewar zuciya ta Hyperkalemic na iya bugewa ba zato ba tsammani yayin da ECG ke faɗaɗa cikin sine. Idan mutum ya kasa amsawa kuma ya daina numfashin al'ada, fara damfara ƙirjin nan da nan a 100 zuwa 120 a cikin minti ɗaya kuma haɗa na'urar Defibrillator Automated External Defibrillator (AED).

Bishiyar yanke shawara: Halin gaggawa na hyperkalemia mai tsanani vs. hypokalemia¶

flowchart TD
    Start["Gaggawar Potassium Mai Muhimmanci (Rauni mai Haɓakawa, Ciwon bugun zuciya, Bradycardia, ko Dialysis/Hadarin Magani)"] --> CallEMS["Kira 911/112/999 Nan take; Sami STAT 12-Lead ECG & Point-of-Care Blood Gas Potassium (K+)"]

    CallEMS --> SplitDir{"Duba Jagorar ECG 12-Lead da Serum Potassium (K+)."}

    SplitDir -->|HYPERKALEMIA: Serum K+ > 5.5 to 6.5+ mEq/L OR Peaked T Waves / Flattened P / Widened QRS / Sine Wave| HyperPath["MATAKI NA 1 (Dakika-Daƙiƙa - Tabbatar da Membran Zuciya, Baya Ƙarƙashin K+):\n Gudanar da Calcium IV Nan da nan (10 ml 10% Calcium Chloride KO 30 ml 10% Calcium Gluconate sama da Minti 2-5; Maimaita idan QRS Ya Rage)"]

    HyperPath --> HyperShift["MATAKI 2 (minti 15-30 - Canja K+ Zuwa Kwayoyin):\n1. IV Insulin na yau da kullun (Raka'a 10) + IV Dextrose (25-50 g D50W/D10W; Kula da Glucose don 4-6h)\n2. Nebulized Albuterol / Salbutamol (10 zuwa 20 mg = 4x-8x Asthma Dose)\n3. IV Sodium Bicarbonate (Idan Metabolic Acidosis Ya Gaba)"]

    HyperShift --> HyperRemove["STEP 3 (Remove K+ From Body):\n1. Loop Diuretic (IV Furosemide) + Isotonic Crystalloids if Kidneys Functional\n2. Oral/GI Potassium Binders (Sodium Zirconium Cyclosilicate [Lokelma] or Patiromer; Avoid Sorbitol Kayexalate)\n3. EMERGENCY HEMODIALYSIS (Gold Standard for Renal Failure, Refractory K+ > 6.5 mEq/L, or Crush/Tumor Lysis)"]

    SplitDir -->|HYPOKALEMIA: Serum K+ < 2.5 to 3.0 mEq/L OR Flattened T Waves, Prominent U Waves, Prolonged QU/QT, Ascending Paralysis| HypoRules["HUKUNCE-HUKUNCEN MUNAFUNCI:\n1. KADA KA SABA K+ a cikin Dextrose (D5W Yana Haɗuwa Insulin & Ciwon Jiyya)\n2. A KOYAUSHE Dubawa kuma Maimaita IV Magnesium Sulfate (2 g IV) Farko/lokaci guda\n3. Bambance Jima'i-Jikin K+ Ragewa da Nakasa Na lokaci-lokaci (Cikin Hannun Jiki)"]

    HypoRules --> HypoReplace["Sarrafa IV + Maganin Potassium Chloride na baka (KCl) Sauya:\n- Na gefe IV Max: 10 mEq/hour | Layin Tsakiyar ICU Max: 20-40 mEq/hour akan Ci gaba da ECG\n- Ƙara KCl na baka (20-40 mEq) idan Tashe; Tsanaki (Ƙarancin Kashi + Propranolol) a cikin Nakasawar Lokaci na Thyrotoxic don Hana Rebound Hyperkalemia"]

Kwatanta gefe-da-gefe: Tsananin Hyperkalemia vs. Tsananin Hypokalemia¶

Domin ** duka biyun mai haɗari da potassium mai haɗari da ƙarancin potassium na iya haifar da ** hawan flaccid tsoka gurɓatacce ** (sau da yawa ana kuskure don ciwon Guillain-Barre ko matsawa na kashin baya) da ** cardiac arrhythmias mai barazana ga rayuwa , kai tsaye ** 12- gubar Electrocardiogram (ECG) da ** venous man-potassium kulawar jini:

Sashe na 1: Tsananin Hyperkalemia: Dalilai, Ci gaban ECG, da C-BIG-K-Drop Ceto Bundle¶

1. Me yasa Hyperkalemia ke Faruwa: Rashin Ciwon Renal Excretion vs. Babban Sakin salula¶

1. Rashin fitar da sinadarin Potassium na Renal (Cutar koda na yau da kullun, Raunin koda, da Gwajin Magani):
2. Koda mai lafiya tana fitar da kashi 90 na potassium abincin yau da kullun a cikin nephron distal karkashin kulawar aldosterone.
3. A cikin marasa lafiya da Cutar koda na yau da kullun (CKD Stages 4 to 5), Matsalar Ƙarshen Renal Disease (ESRD) akan hemodialysis (musamman bayan tazarar kwanaki 3 na karshen mako tsakanin Juma'a da Litinin zaman dialysis ko kuma bayan cin abinci mai girma-potassium kamar ayaba, avocados, dankalin turawa, 'ya'yan itacen marmari, busasshen ruwan kwakwa, tumatur, busasshen ruwan 'ya'yan itace, dankalin turawa, dankalin turawa, dankalin turawa, dankalin turawa). Raunin koda (AKI)**, potassium yana taruwa da sauri.
4. • Abubuwan hulɗar Magungunan Magungunan Kisa : Ko da a cikin marasa lafiya da ƙarancin ƙarancin koda kawai, haɗa mai hanawa ** ACE (lisinopril, ramiprilya da ARB (losartan, valsartan tare da ** aldosterone antagonist (spironolactone, eplerenone** sannan kuma rubuta maganin rigakafi na tsarin urinary na kowa Trimethoprim-Sulfamethoxazole (Bactrim / Septra* (trimethoprim yana toshe tashoshin sodium na epithelial.ENaCa cikin koda daidai da amiloride) ko ** NSAID (NSAIDs)ibuprofen, naproxen*** yana haifar da fulminant, hyperkalemia mai barazanar rai a cikin kwanaki 3 zuwa 5.
5. *Massive Transcellular Potassium Shift (Crush Syndrome, Rhabdomyolysis, Burns, and Acidosis)**:
6. Domin tsokar kwarangwal ta ƙunshi 140 mEq na potassium a kowace lita na ruwan ciki, duk wani yanayin da ke tsage ƙwayoyin tsoka ko jajayen ƙwayoyin jini yana zubar da adadi mai yawa na potassium kai tsaye zuwa cikin jini:
   • Crush Syndrome and Compartment Syndrome: Lokacin da aka ɗaga katako mai nauyi, abin hawa, ko tsarin rugujewa daga ƙafafuwan wanda aka kama (sakin sake sakewa), myoglobin, lactic acid, da guguwar potassium mai kisa suna mamaye zuciya cikin mintuna kaɗan ("murmushi").
   • Rhabdomyolysis mai tsanani, Ciwon Tumor Lysis, da Babban Hemolysis.
   • ** Succinylcholine a Burn, Crush, Spinal Cord Rauni, ko Neuromuscular Patients **: Bayar da maganin gurguwar cuta ** succinylcholine ** ga majiyyaci fiye da 24 zuwa 48 hours bayan babban ƙonawa, murkushe rauni, bugun jini, ko raunin kashin baya (ko a cikin Duchenne muscular dystrophy / Guillan-Barregulated dystrophy / Guillan-Barregulated ciwon bugun jini). a duk tsokoki, spiking serum potassium ta 3 zuwa 5+mEq/L a cikin daƙiƙa 60 kuma yana haifar da kamawar zuciya na hyperkalemic nan take.
   • ** Mummunan Inorganic Metabolic Acidosis** (wuta H+ ions suna shiga sel don musanya K+ barin sel), ** Yawan wuce gona da iri na Beta-Blocker**, da Mai tsananin Digoxin wuce gona da iri.

2. Ci gaban Electrocardiogram mai mataki huɗu (ECG) zuwa Ƙarfin zuciya na Sine-Wave¶

Yayin da ECG ya canza kusan daidai da matakan potassium na jini, ** marasa lafiya da cututtukan koda na yau da kullun na iya samun ECG na yau da kullun a potassium. 7.0 mEq/L sa'an nan kuma ba zato ba tsammani fibrillate, yayin da marasa lafiya da ke da mummunan karu (rauni) na iya kamawa a 6.0 mEq/L**. Duba waɗannan matakan ECG guda huɗu na al'ada:

1. *** Darasi na 1 (K+ 5.5 to 6.5 mEq/LDogo, kunkuntar, Asali "Mafi Girma" T Waves ***:
2. Alamar farko ta hyperkalemia: T tãguwar ruwa sun zama tsayi, kunkuntar tushen, kuma suna nunawa sosai ("kamar maƙarƙashiyar coci" ko "tenting"), musamman ma a cikin abubuwan da suka faru. V2 to V4, tare da gajeriyar tazara ta QTc.
3. *** Darasi na 2 (K+ 6.5 to 7.5 mEq/L): Paralysis (Ƙara Tsawaitawa da Rasa P Waves)**:
4. Atrial myocytes sun fi kulawa da hyperkalemia fiye da myocytes na ventricular. Tazarar tazara ta PR tana tsawaita, ruwan ** P yana faɗuwa kuma yana faɗaɗawa, sannan ** raƙuman ruwa P sun ɓace gaba ɗaya* ("ɗaɗaɗɗen sinoventricular", inda kumburin sinus ɗin har yanzu yana ƙonewa cikin ventricles ba tare da samar da alamar P ba akan ECG).
5. *** Darasi na 3 (K+ 7.5 to 8.5 mEq/L): Faɗaɗɗen, Rikicin QRS da Tubalan Gudanarwa ***:
6. Rashin kunna tashoshi na sodium mai sauri na ventricular yana rage motsin motsi daga tantanin halitta zuwa tantanin halitta. Rukunin QRS yana faɗaɗa a hankali (> 120 to 200+ ms, yin kwaikwayi toshe reshen dam na hagu ko dama, toshe fascular, ko ciwo na Brugada, sau da yawa tare da ** matsananciyar bradycardia *** ko babban matakin AV.
7. *** Darasi na 4 (K+ > 8.5 to 9.0+ mEq/L): Tsarin "Sine Wave" Pre-Terminal**:
8. Faɗin QRS ɗin yana haɗuwa tare da tsayin tsayin T na igiyar ruwa, yana samar da santsi, girgiza Sine Wave akan na'urar duba zuciya. ** A cikin dakika zuwa mintuna, rhythm na sine-wave yana raguwa zuwa Ventricular Fibrillation (VF), Ayyukan Wutar Lantarki marasa ƙarfi (PEA), ko Asystole.**

3. Ka'idar Ceton Asibitin Matakai 3 don Tsananin Hyperkalemia¶

A duk lokacin da majiyyaci yana da ** kowane hyperkalemic ECG canje-canje** (bayan keɓantaccen ƙaramin T-wave peaking) KO a ** ƙwayar potassium. >= 6.5 mEq/L**, ƙungiyoyin gaggawa suna aiwatar da matakai guda uku a lokaci guda:

Mataki na 1: Haɓaka Gubar Zuciya Nan take (Ba Ya Ƙarƙashin Potassium na Jini)¶

• ** Calcium na Jiki (Yana aiki a cikin mintuna 1 zuwa 3; Yana ɗaukar mintuna 30 zuwa 60)**:
• Calcium yana dawo da tazarar lantarki kai tsaye tsakanin yuwuwar membrane mai hutawa da yuwuwar kofa (V_t), ** kunkuntar hadaddun QRS da aka fadada da kuma ceton zuciya mai raɗaɗi a cikin daƙiƙa 60 zuwa 180**, kodayake sinadarin potassium bai canza ba tukuna.
• • 10% Calcium Gluconate (Safe ga Layin IV na Peripheral): Gudanar da 30 ml (3 grams = 3 vials na 10 ml) na 10% Calcium Gluconate IV sama da mintuna 2 zuwa 5 (ka'idodin farko da aka yi amfani da 10 ml, kuma ana iya ba da * 10 zuwa 20 mL na farko, amma ana iya ba da 1 mL na farko* 4.65 mEq na elemental calcium idan aka kwatanta da 13.6 mEq a cikin 10 ml na calcium chloride, ** maimaita 10 zuwa 30 ml kowane minti 5 ** ana ba da shi idan hyperkalemic QRS ya ci gaba a kan mai duba).
• Calcium Chloride 10% (An fi so a kama Cardiac ko ta Layin Tsakiyar Venous)**: Mai Gudanarwa 10 ml (gram 1) na 10% Calcium Chloride IV yana tura sama da mintuna 2 zuwa 5 (ya ƙunshi sau uku na elemental calcium na gluconate).
• • Banda Digoxin*: Idan hyperkalemia ya haifar da ** m digoxin / cardiac glycoside toxicity **, kiyaye calcium IV na yau da kullun kuma gudanar da Digoxin Immune Fab (DigiFab) nan da nan tare da insulin/dextrose.

Mataki na 2: Canja Potassium Daga cikin Ruwan Jini zuwa Kwayoyin (Yana Aiki a cikin Minti 15 zuwa 30; Yana Tsawon Sa'o'i 2 zuwa 6)¶

Saboda IV calcium ya ƙare a cikin minti 30 zuwa 60, dole ne ku gaggauta fitar da potassium na waje zuwa cikin ƙwayoyin tsoka ta ƙwanƙwasa Na+/K+-ATPase famfo : 1. ** Insulin na yau da kullun + Dextrose na Jiki (Yana Rage Serum K+ ta 0.6 to 1.2 mEq/L cikin Minti 15 zuwa 30): - Gudanar da ** Raka'a 10 na Insulin ɗan adam na yau da kullun na turawa ** (ko ** Raka'a 5 ** a cikin marasa lafiya da ke fama da gazawar koda mai tsanani / ESRD don rage haɗarin hypoglycemia na ƙarshen), wanda aka rigaya ko tare da ** gram 25 zuwa 50 na Dextrose na Intravenous* (50 to 100 mL of D50W, ko 250 to 500 mL of D10W an shayar da shi sama da mintuna 30 zuwa 60) sai dai idan glucose na farko ya riga ya kasance > 250 mg/dL (13.9 mmol/L). - Wajibi na Kula da Glucose na awa 4 zuwa 6: Saboda lalacewar kodan suna fitar da insulin sannu a hankali, ** jinkiri mai tsanani hypoglycemia yana faruwa akai-akai ** 2 zuwa 5 hours bayan tura insulin. Duba glucose na jini na yatsa ** kowane minti 30 zuwa 60 na awa 6**. 2. ** Babban Kashi Nebulized Beta-2 Agonist (Albuterol / Salbutamol) K+ ta Ƙari 0.5 to 1.0 mEq/L*: - Gudanar da 10 MG zuwa 20 MG na Nebulized Albuterol (Salbutamol) ci gaba da mintuna 10 zuwa 15. - Mahimmin bayanin kula: Wannan shine ** 4 zuwa sau 8 sama da ma'auni 2.5 mg maganin nebulizer na asma. Domin kusan kashi 20% zuwa 40% na masu cutar dialysis basa amsawa ga albuterol kadai, kada a taba amfani da albuterol a matsayin wakili daya ba tare da insulin IV ba. 3. ** Sodium Bicarbonate na Jiki (Don Metabolic Acidosis ko Kame Zuciya)**: - Gudanar da ** 50 zuwa 150mEq na Sodium Bicarbonate ** (zai fi dacewa azaman jiko na isotonic na 150 mEq in 1 L of D5W ko 1.26% / 1.4% Sodium Bicarbonate a cikin marasa lafiya na acidotic ƙarar ƙarar, ko 1 to 2 ampules [50 to 100 mL] of 8.4% NaHCO3 a cikin matsanancin acidosis / faɗaɗa QRS / kama zuciya).

Mataki na 3: Cire Potassium daga Jiki har abada¶

Canja potassium cikin sel kawai yana siyan sa'o'i kaɗan; Dole ne a kawar da wuce haddi na potassium daga jiki ta hanyar ** kodan , ** gastrointestinal tract , ko hemodialysis: 1. Fitsarin koda ("Kaluresis" a cikin marasa lafiya waɗanda har yanzu suke yin fitsari): - Idan mara lafiya ya kasance ** ba *** anuric akan dialysis, saka ** isotonic crystalloids (0.9% Normal Saline ko Lactated Ringer's / Isotonic Bicarbonate don dawo da turare na koda tare da ** Diuretics na madauki na ciki (Furosemide 40 to 80 mg IV ko Bumetanide 1 to 2 mg IV don fitar da potassium a cikin fitsari. 2. Masu Haɗaɗɗen Potassium na Baki / Gastrointestinal na zamani: - ** Sodium Zirconium Cyclosilicate (SZC / * Lokelma*, 10 g orally: Zaɓaɓɓen tarko na potassium ions a cikin sashin GI don musanya sodium da hydrogen; fara rage yawan sinadarin potassium a cikin awanni 1 zuwa 2. - ** Patiromer (Veltassa)**: Calcium-sorbitex polymer mai ɗaure (a hankali farawa, 4 to 7 hours). - ** Ka guji Sodium Polystyrene Sulfonate ( Kayexalate*) tare da Sorbitol *: Kayexalate na gargajiya yana da sannu a hankali, farawa maras tabbas kuma yana ɗaukar gargaɗin FDA don ** necrosis na ƙwayar cuta mai mutuwa da kumburin hanji ** (musamman bayan tiyata ko tare da maƙarƙashiya). 3. Hemodialysis na Gaggawa na Tsayi Tsayi (Tabbataccen Matsayin Zinare): - Zaman awa 3 zuwa 4 na Intermittent Hemodialysis yana cire 50 zuwa 120+ na potassium kai tsaye daga jiki, yana zubar da sinadarin potassium ta hanyar 1.0 to 1.5 mEq/L a farkon sa'a kadai. Hemodialysis wajibi ne ga duk wani majiyyaci tare da anuric/oliguric renal gazawar, wanda aka rasa dialysis, K+ > 6.5 mEq/L duk da magani na likita *, ko ** ci gaba da ɓarnawar ƙwayar cuta ta salula (cututtukan crush, rhabdomyolysis, ko ciwon tumor lysis).

Sashe na 2: Tsananin Hypokalemia: Hawan Ciwon Gurgu, Nakasawar Lokaci, da Dokokin Sauya¶

1. Yaya Tsananin Hypokalemia (Serum K+ < 2.5 mEq/L) Yana haifar da gurguwar cuta da kama zuciya¶

When extracellular serum potassium falls below 2.5 mEq/L: - ** Toshe hyperpolarization na tsokar kwarangwal *: Matsakaicin yuwuwar membrane mai huta na filayen tsoka yana fadowa daga -90 mV kasa zuwa -100 to -110 mV (hyperpolarization) sa'an nan paradoxically depolarizes zuwa wani inactivated yanayin, haddasa ** babban symmetric tsoka rauni ** wanda ya fara a cikin ** kusanci ƙananan extremities (cinya da hips), hawa zuwa ga *gangar jikin, hannaye, da wuyansa ***, kuma a ƙarshe ya shanye da ** diaphragm da intercostal tsokoki, spazing tsoki da kuma intercostal tsoki. - Hypokalemic Rhabdomyolysis: Fitar da sinadarin potassium daga filayen tsoka masu aiki yakan fadada arterioles na tsoka na gida yayin motsa jiki. Lokacin da magani yana da potassium < 2.0 to 2.5 mEq/L, jini na tsoka ya gaza yayin aiki, yana haifar da ** iscmic tsoka necrosis (rhabdomyolysis)**. - ** Jinkirta Sake Gyaran Zuciya da Ma'anar Torsades de Pointes ***: A cikin myocytes na ventricular, hypokalemia yana hana tashoshi na potassium gyara waje.I_Kr kuma I_K1), mai tsanani tsawaita lokaci na 3 repolarization, haifar da ** fitattun raƙuman ruwa na U **, tsawaita tazara ta QU, da haifar da farkon abubuwan da suka biyo baya waɗanda ke raguwa zuwa ** polymorphic ventricular tachycardia (Torsades de Pointes) da fibrillation na ventricular **.

2. Gaskiyar Ragewar Potassium vs. Hypokalemic / Thyrotoxic Perodic Paralysis (Shift na cikin salula)¶

Likitoci na gaggawa dole ne su bambanta ** dalilai guda biyu mabanbanta na gurguncewar hypokalemic**, saboda yawan shan magani na biyu yana haifar da sake dawowa hyperkalemia:

3. Dokokin Zinare Hudu na Sauya Potassium na Asibiti¶

Lambobin gaggawa na yanki da ka'idojin hukumar¶

Tambayoyin da ake yawan yi¶

Me yasa kantin kayan miya "masu maye gurbin gishiri" (kamar NoSalt, Nu-Salt, ko Morton Salt Substitute) ke da haɗari ga mutanen da ke fama da cutar koda ko a kan kwayoyin cutar hawan jini?¶

Don ɗanɗano samfurin gishiri ba tare da amfani da sodium chloride ba, masana'antun suna amfani da kusan kashi 100 tsarkakakken Potassium Chloride (KCl). Cokali guda ɗaya na gishirin potassium ya ƙunshi har zuwa 2,500 zuwa 2,800 MG (65 zuwa 70 mEq) na potassium mai tsabta, wanda ya fi potassium a cikin manyan ayaba shida. Duk da yake kodan lafiya na iya tace karin potassium, duk wanda ke da ciwon koda na kullum, gazawar zuciya, ko duk wanda ke shan masu hana ACE (kamar lisinopril), ARBs (kamar losartan), ko spironolactone ba zai iya kawar da potassium da sauri ba, yana haifar da potassium na jini ya karu zuwa matakan kamawar zuciya cikin sa'o'i.

Ta yaya calcium na cikin jini ke ceton ran wani a lokacin gaggawa na potassium (hyperkalemic) na gaggawa idan ba a zahiri ya rage potassium na jininsu ba?¶

Potassium na jini mai hawan jini yana kashewa ta hanyar lalata cajin wutar lantarki na ƙwayoyin tsokar zuciya, wanda ke rufe tashoshin sodium ɗin su don haka siginar wutar lantarki ta zuciya ta faɗaɗa cikin "sine wave" kuma ta daina bugawa. Allurar calcium na cikin jijiya (calcium chloride ko calcium gluconate) baya canza adadin potassium a cikin jini kwata-kwata; a maimakon haka, nan da nan, calcium yana ɗaga ƙarfin wutar lantarki na cell cell, yana maido da gibin wutar lantarki na yau da kullun da ake buƙata don ƙwayoyin zuciya su yi wuta akai-akai cikin mintuna 1 zuwa 3. Wannan yana ba likitoci garkuwar kariya ta lantarki ta mintuna 30 zuwa 60 yayin da insulin, albuterol, da dialysis a zahiri ke cire potassium daga magudanar jini.

Me yasa matashi mai lafiya ya tashi gaba daya ya shanye daga wuyansa zuwa safiya bayan ya ci babban taliya ko abincin dare?¶

Wannan gabatarwar na yau da kullun ana kiranta Hypokalemic Periodic Paralysis (ko Thyrotoxic Periodic Paralysis lokacin da glandon thyroid mai yawan aiki ya jawo shi, wanda ya zama ruwan dare a cikin samari masu girma). Cin babban abinci mai yawan carbohydrate yana haifar da sakin insulin mai yawa daga pancreas don sarrafa sukari. A cikin mutanen da ke da maye gurbi na ion-tashar kwayoyin halitta ko hyperthyroidism wanda ba a gano shi ba, wannan karuwar insulin yana haifar da bututun sodium-potassium akan tsokoki na kwarangwal yayin da tashoshi marasa lahani ke hana potassium barin sel, yana kwashe kusan dukkanin potassium daga cikin jini.`K+ < 2.0 mEq/L`) da barin ƙafafu da hannaye na ɗan lokaci har sai an dawo da potassium a hankali kuma an ba da maganin thyroid/beta-blocker.

Me ya sa dole ne ma'aikatan aikin jinya na gaggawa ba su taɓa haɗa potassium na cikin jijiya a cikin ruwan sukari ba (D5W dextrose) IV jakar lokacin da zalunta m potassium?¶

Lokacin da mai haƙuri ya riga ya sami ƙarancin potassium na jini (`< 2.5 mEq/L`) tare da gurguwar tsoka ko ciwon zuciya, sanya jakar IV mai dauke da dextrose (sukari) yana motsa jikin su don sakin yawan insulin na endogenous. Saboda insulin yana fitar da potassium daga cikin jini zuwa cikin sel, ba da potassium a cikin jakar ruwa mai sukari a zahiri yana haifar da matakin potassium na jinin majiyyaci ya ragu da farko, wanda ba zato ba tsammani ya gurgunta tsokoki na numfashi ko kuma haifar da fibrillation na Torsades de Pointes. Potassium na cikin jijiya don tsananin hypokalemia dole ne a haɗe shi a cikin salin da ba shi da sukari.

Me yasa karancin potassium (hypokalemia) ya kasa samun sauki har sai likita ya ba da magnesium ta cikin jijiya?¶

A cikin tubules distal na koda, intracellular magnesium ions suna aiki kamar filogi a cikin tashoshi na potassium microscopic (wanda ake kira tashoshi ROMK) don dakatar da potassium da yawa daga fitowa cikin fitsari. Lokacin da majiyyaci yana da ƙarancin magnesium da ƙarancin potassium, wanda ke faruwa akai-akai daga diuretics, gudawa, ko amai, waɗannan tashoshi na koda suna buɗewa. Komai yawan sinadarin potassium da asibitin ya zuba a cikin jijiyar majiyyaci, yana zuba kai tsaye cikin fitsari har sai an ba da sinadarin magnesium sulfate na cikin jijiya don rufe ruwan da kuma kunna famfunan sodium-potassium na salula.

Jagora masu alaƙa¶

• Digoxin guba, foxglove guba, da hyperkalemia triage
• Murkushe rauni da ciwon sashe taimakon farko
• Mummunan raunin koda, rhabdomyolysis, da duhun fitsari
• Bugawar ruwa, motsa jiki mai alaƙa da hyponatremia, da kumburin ƙwaƙwalwa
• Ciwon zuciya na zuciya (CPR) da jagorar AED

Tushen da jagorar hukuma¶

• American Heart Association (AHA): Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 10: Special Circumstances of Resuscitation (Life-Threatening Hyperkalemia and Hypokalemia).
• European Resuscitation Council (ERC): Guidelines for Resuscitation: Cardiac Arrest in Special Circumstances: Electrolyte Abnormalities (Potassium Disorders).
• Ƙungiyar Koda ta Burtaniya (UKKA) & Resuscitation Council UK: Sharuɗɗan Ayyukan Kula da Lafiya: Maganin Cutar Cutar Hyperkalemia a Manya a Asibiti da cikin Al'umma (Sabuwar 2020/2023).
• Ciwon Koda: Inganta Sakamakon Duniya (KDIGO): Taron Rigima kan Gudanar da Potassium a cikin Cutar Koda mai Mutuwa da Tsawon Lokaci.
• ANZCOR (Kwamitin Ostiraliya da New Zealand game da farfadowa): * Jagorar 11.5: Magunguna da Gudanar da Electrolyte a cikin Tallafin Rayuwa na Adult *.

*Wannan jagorar don dalilai ne na bayanai kuma baya maye gurbin ƙwararrun ƙwararrun likita ko kulawar gaggawa na asibiti. Saboda matsalolin gaggawa na potassium na iya haifar da kama bugun zuciya na kwatsam ko gurguntaccen tsoka na numfashi ba tare da gargadi ba, muna ba da shawara mai karfi don ɗaukar aikin hannu-a kan taimakon farko da kuma CPR ta Ƙungiyar Red Cross da Red Crescent Societies (IFRC), Ƙungiyar Red Cross ta kasa, St John Ambulance, ko wani mai ba da sabis na gida.