ʻO nā pilikia pilikia o ka potassium: Hyperkalemic Cardiac Arrest and Hypokalemic Paralysis¶

pālima (K+) ʻo ia ka cation intracellular mua i loko o ke kino kanaka, me 98 pākēneka o ka nui o ka potassium kino (3,500 to 4,000 mEq) mālama ʻia i loko o ka ʻiʻo iwi a me nā pūnaewele okana a ʻo 2 pākēneka wale nō e kaa ana i loko o ke kahe koko extracellular. No ka mea, ʻo ka hiki ke hoʻomaha ʻana o ka membrane uila (-90 millivolts) a me ka repolarization o kēlā me kēia puʻuwai ʻiʻo puʻuwai a me nā ʻiʻo ʻiʻo ʻiʻo iwi e hilinaʻi ʻia ma ka ratio kiʻekiʻe ma waena o ka potassium intracellular (140 to 150 mEq/L) a me ka potassium serum extracellular (3.5 to 5.0 mEq/L), ʻo kahi hoʻololi liʻiliʻi o ka potassium i loko a i waho paha o ke kahe koko hiki ke hoʻōki i ka puʻuwai a i ʻole ka lolo i ke kino i loko o nā minuke.

Hoʻopilikia ʻia nā pilikia pilikia o ka potassium ma nā ʻaoʻao ʻelua ʻē aʻe: ** Hiperkalemia Koʻikoʻi (Serum K+ > 6.0 to 6.5 mEq/L)**, i kapa pinepine ʻia ʻo "silent killer" no ka mea, ʻo ka poʻe maʻi me ka hōʻino ʻole o ka puʻupaʻa, nele i ka hemodialysis, nā ʻeha ʻeha, rhabdomyolysis, a i ʻole nā pilina ma waena o ACE inhibitors / ARBs, spironolactone, trimethoprim-sulfamethoxazole (Bactrim), a me nā pani paʻakai potassium hiki ke hele mai ka nawaliwali a hiki i ka loaʻa ʻana o **syntricular fibrillation a i ʻole ka ʻōlelo aʻo ʻana. a me Hikokalemia koʻikoʻi (Serum K+ < 2.5 mEq/L), hoʻoulu ʻia e ka luaʻi nui/ka maʻi paʻa, loop a thiazide diuretics, ka mālama ʻana i ka ketoacidosis diabetic, a i ʻole Hypokalemic Periodic Paralysis (me Thyrotoxic Periodic Paralysis ma hope o ka pāʻina kiʻekiʻe-carbohydrate a i ʻole ka hoʻoikaika kino), ka mea e hoʻomaka ai ka piʻi wikiwiki ʻana o nā wāwae a me nā lima a me nā lima. arrhythmias. Inā manaʻo ʻoe i kahi pilikia nui o ka potassium, e kelepona i kāu helu pilikia kūloko (911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ʻEulopa, 999 ma United Kingdom) ma o kā mākou helu pilikia papa kuhikuhi koke, a nānā ka hoʻōla ʻana o ka puʻuwai puʻuwai (CPR), ʻeha ʻeha a me ka maʻi compartment, a ʻeha ʻeha a me ka rhabdomyolysis.

E hana i kēia i kēia manawa¶

1. Kahea koke iā 911 / 112 / 999: E kāhea koke i nā lawelawe lapaʻau pilikia inā loaʻa i ke kanaka me ka maʻi kīkī, ma ka dialysis, a i ʻole ka lawe ʻana i ke koko / nā lāʻau diuretic e hoʻomohala koke i ka nāwaliwali o ka wāwae, hiki ʻole ke kū i luna mai kahi noho a i ʻole kahi moe, ʻeha a ʻuʻi paha a puni ka waha a i ʻole ka ʻāʻī, palpitations, ʻeha o ka umauma, lohi a pōkole paha o ka hanu.
2. HOʻOKI koke i nā kumu potassium a me nā lāʻau mālama potassium: Inā kānalua ʻia ʻo hyperkalemia (kiʻekiʻe potassium), e hoʻōki koke i nā ** mea hoʻohui pāpaʻi i kauoha ʻia ** (K-Dur, Klor-Con, Slow-K), "paʻakai pani" / "nā paʻakai haʻahaʻa sodium" (*NoSalt, Nu-Salt, Morton Salt Substitute, **) NSAIDs (ibuprofen, naproxen), ACE inhibitors / ARBs (lisinopril, losartan), potassium-sparing diuretics (spironolactone, eplerenone, amiloride, triamterene), a me trimethoprim-sulfamethoxazole (Bactrim / Septra).
3. KULA NO KA HYPOKALEMIA: Mai hāʻawi i nā mea inu kō, ka wai huaʻai, a i ʻole nā ​​ʻai meaʻai momona nui: Inā loaʻa ke kanaka i ka nāwaliwali o ka wāwae a me ka lima (hypokalemic paralysis), ** ʻAʻole e hāʻawi iā ia i ka soda, ka wai ʻalani momona, ka candy, a i ʻole nā ​​mea inu haʻuki kiʻekiʻe ke kō**. Hoʻoulu koke ke kō i ka ** insulin endogenous ** mai ka pancreas, kahi e hoʻokuke aku ai i ke koena o ka potassium mai ke kahe koko i loko o nā cell a hiki ke ** hoʻopale koke i ko lākou mau ʻiʻo hanu a i ʻole e hoʻoulu i ka fibrillation ventricular fatal**.
4. E hoʻomoe i ke kanaka me ka haʻahaʻa, a e nānā i kona hanu ʻana: ʻO kēlā me kēia hakakā kino e hoʻokuʻu i ka adrenaline a i ʻole e hoʻonui i ka huhū o ka naʻau. E hoʻomaha mālie ke kanaka ma kona kua (a i ʻole e hoʻopaʻa ʻia ma ke 45 degere inā he wai ka maʻi dialysis i loko o kona māmā). E nānā pono i ka piʻi ʻana o ka umauma: hiki i ka hypokalemia koʻikoʻi a me ka hyperkalemia koʻikoʻi ke hoʻopale i ka diaphragm.
5. ** E haʻi i nā mea lapaʻau inā he arteriovenous (AV) dialysis fistula a i ʻole graft ka mea maʻi**: Inā mālama ka mea maʻi i ka hemodialysis, e haʻi koke i ka paramedics i ka lima i loaʻa i kā lākou AV fistula a i ʻole graft no laila ʻaʻole kau ʻia nā cuffs koko a i ʻole nā ​​nila IV peripheral i loko o ka lima fistula, a noi i ka lawe ʻana i kahi haukapila me **12-lead ECG.
6. E mākaukau e hoʻomaka koke i ka CPR inā nalowale ka ʻike o ka mea maʻi: Hiki ke paʻi koke ka hopu ʻana i ka naʻau Hyperkalemic i ka wā e hoʻonui ai ka ECG i loko o kahi hawewe sine. Inā lilo ke kanaka i mea pane ʻole a pau ka hanu maʻamau, e hoʻomaka koke i ka hoʻopaʻa ʻana i ka umauma ma 100 a 120 i kēlā me kēia minuke a hoʻopili i kahi Automated External Defibrillator (AED).

lāʻau hoʻoholo: ka hoʻāʻo pilikia o ka hyperkalemia koʻikoʻi vs. hypokalemia¶

flowchart TD
    Start["Manaʻo ʻia ʻo Potassium Koʻikoʻi Koʻikoʻi (Ke piʻi ʻana o Flaccid Weakness, Palpitations, Bradycardia, a i ʻole Dialysis/Medication Risk)"] --> CallEMS["E kelepona iā 911 / 112 / 999 koke; Loaʻa iā STAT 12-Lead ECG & Point-of-care Blood Gas Potassium (K+)"]

    CallEMS --> SplitDir{"E nānā i ka 12-Lead ECG a me ka Serum Potassium (K+) kuhikuhi"}

    SplitDir -->|HYPERKALEMIA: Serum K+ > 5.5 to 6.5+ mEq/L OR Peaked T Waves / Flattened P / Widened QRS / Sine Wave| HyperPath["ʻAʻAnu 1 (Kekona - Hoʻopaʻa i ka Membrane Puʻuwai, ʻAʻole i hoʻohaʻahaʻa i ka K+):\nHoʻopono koke i ka IV Calcium (10 mL 10% Calcium Chloride A i ʻole 30 mL 10% Calcium Gluconate ma luna o 2-5 Min; E hana hou inā e mau ana ka QRS)"]

    HyperPath --> HyperShift["KANAWAI 2 (15-30 Min - Ho'ololi K+ I loko o nā Pūnaewele):\n1. IV Insulin maʻamau (10 Units) + IV Dextrose (25-50 g D50W/D10W; Nānā i ka Glucose no 4-6h)\n2. Albuterol / Salbutamol (10 a 20 mg = 4x-8x Asthma Dose)\n3. IV Sodium Bicarbonate (Inā loaʻa ka Metabolic Acidosis)"]

    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["RULES HYPOKALEMIA CRITICAL HYPOKALEMIA:\n1. Mai hoʻokomo i ka K+ i loko o ka Dextrose (D5W Triggers Insulin & Worsens Hypokalemia)\n2. E nānā mau a hoʻopiha i ka IV Magnesium Sulfate (2 g IV) Mua/I ka manawa like\n3. Hoʻokaʻawale i ke kino holoʻokoʻa K+ Depletion vs Periodic Paralysis (Intracellular Shift)"]

    HypoRules --> HypoReplace["Manaʻo IV + Oral Potassium Chloride (KCl) Hoʻololi:\n- Peripheral IV Max: 10 mEq / hola | Laina Waena ICU Max: 20-40 mEq/hola ma ECG mau \n- Hoʻohui i ka KCl waha (20-40 mEq) inā Ala; E akahele (Lower Dose + Propranolol) i ka Thyrotoxic Periodic Paralysis e pale aku i ka Rebound Hyperkalemia"]

Hoʻohālikelike ʻaoʻao: Severe Hyperkalemia vs. Severe Hypokalemia¶

No ka mea ** hiki i ka ** ʻelua** ka pāpaʻa kiʻekiʻe a me ka haʻahaʻa haʻahaʻa haʻahaʻa hiki ke hoʻoulu i ka ** piʻi ʻana i ka ʻiʻo flaccid maʻi ** (ke kuhi hewa pinepine ʻia ʻo Guillain-Barre syndrome a i ʻole ka hoʻopaʻa ʻana o ka spinal cord) a me ka ** arrhythmias puʻuwai weliweli i ke ola **, he 12-lead Electrocardiogram (ECG) a me **point-of-care venous venous.

Mahele 1: Koʻikoʻi Hyperkalemia: Nā kumu, ECG Progression, a me ka C-BIG-K-Drop Rescue Bundle¶

1. No ke aha e hiki mai ai ka Hyperkalemia: ʻAʻole i hoʻokuʻu ʻia ka Renal Excretion vs. Massive Cellular Release¶

1. ** Hoʻopau ʻia ka Potassium Renal (Ka maʻi maʻi maʻi maʻi, ʻeha ʻeha o ka maʻi maʻi, a me ka Triad Laau Laau Laau Lapaʻau)**:
2. Hoʻokuʻu ʻia e nā puʻupaʻa olakino he 90 pākēneka o ka pālolo meaʻai i kēlā me kēia lā i ka nephron distal ma lalo o ka mana o aldosterone.
3. I nā poʻe maʻi me Chronic Kidney Disease (CKD Stages 4 to 5), End-Stage Renal Disease (ESRD) ma ka hemodialysis (ʻoi loa ma hope o 3 mau lā hopena pule ma waena o ka lā Pōʻalima a me ka Pōʻakahi a i ʻole ma hope o ka ʻai ʻana i nā meaʻai kiʻekiʻe-potassium e like me ka maiʻa, avocados, ʻuala, ʻōmato, wai maloʻo, a i ʻole ka paʻakai. ʻO ka ʻeha (AKI)**, hōʻiliʻili koke ka potassium.
4. The Lethal Prescription Drug Interactions: ʻOiai i nā poʻe maʻi me ka hōʻino ʻino ʻana o ka puʻupaʻa haʻahaʻa wale nō, e hui pū ana i kahi ACE Inhibitor (lisinopril, ramipril) a i ʻole ARB (losartan, valsartan) me ka aldosterone antagonist (spironolactone, eplerenone) a laila kau ʻana i ka lāʻau antibiotic maʻamau maʻamau Trimethoprim-Sulfamethoxazole (Bactrim / Septra) (pākaʻi ʻo trimethoprim i nā kahawai sodium epithelial [ENaC] i loko o ka puʻupaʻa e like me ka amiloride) a i ʻole kahi NSAID (ibuprofen, naproxen) hoʻoulu i ka hyperkalemia fulminant, weliweli i ke ola i loko o 3 a 5 mau lā.
5. Ka Hoʻololi Potassium Transcellular Nui (Crush Syndrome, Rhabdomyolysis, Burns, and Acidosis):
6. No ka mea, aia ka ʻiʻo iwi 140 mEq ʻO ka pāhare pāpaʻa no ka lita o ka wai intracellular, ʻo kēlā me kēia ʻano e wāwahi ai i nā ʻiʻo ʻiʻo a i ʻole ke koko ʻulaʻula e hoʻolei i ka nui o ka potassium i loko o ke kahe koko:
   • Crush Syndrome and Compartment Syndrome: Ke huki ʻia ka lāʻau kaumaha, kaʻa, a i ʻole ka hale i hiolo ʻia mai nā wāwae o ka mea i paʻa ʻia (reperfusion release), myoglobin, lactic acid, a me ka nalu make o ka potassium e kahe ana ka puʻuwai i loko o nā minuke ("make ʻakaʻaka").
   • ** Rhabdomyolysis koʻikoʻi, Tumor Lysis Syndrome, a me Massive Hemolysis**.
   • Succinylcholine in Burn, Crush, Spinal Cord Injury, or Neuromuscular Patients: Hāʻawi i ka lāʻau paralytic succinylcholine i ka mea maʻi ma mua o 24 a i 48 mau hola ma hope o kahi kuni nui, ʻeha ʻeha, ʻeha, a i ʻole ʻeha spinal cord (a i ʻole ma Duchenne muscular dystrophy / Guillain-Barre Syndrome) wehe i ka acetyl extrachojunctions upregulated muscle receptors a pau. potassium e 3 a 5+ mEq/L i loko o 60 kekona a hoʻopio koke i ka hyperkalemic cardiac.
   • Acidosis Metabolic Inorganic Koʻikoʻi (ʻoi aku H+ komo nā ion i nā pūnaewele e pani ai K+ e waiho ana i nā pūnaewele), Beta-Blocker Overdose, a me Acute Digoxin Overdose.

2. ʻO ka holomua o ka Electrocardiogram (ECG) ʻEhā i ka hopu ʻia ʻana o ka naʻau.¶

ʻOiai ka hoʻololi ʻana o ka ECG e pili pono ana me nā pae serum potassium, ** hiki i nā poʻe maʻi me ka maʻi maʻi maʻi maʻi ke loaʻa kahi ECG maʻamau i kahi pāpaʻi o 7.0 mEq/L a laila fibrillate hikiwawe, akā hiki i nā poʻe maʻi me kahi spike koʻikoʻi (ʻeha ʻeha) hiki ke hopu i 6.0 mEq/L**. E nānā no kēia mau ʻanuʻu ECG maʻamau ʻehā:

1. Ka Papa 1 (K+ 5.5 to 6.5 mEq/L): Kiʻekiʻe, ʻokiʻoki, ʻano like me nā hawewe T "Peaked":
2. ʻO ka hōʻailona mua loa o ka hyperkalemia: lilo nā nalu T i kiʻekiʻe, haiki, a ʻoi aku ka ʻoi ("like me ka hale pule" a i ʻole "tenting"), ʻoi aku ka nui ma nā alakaʻi precordial V2 to V4, i hui pū ʻia me kahi manawa pōkole QTc.
3. Ka Papa 2 (K+ 6.5 to 7.5 mEq/L): Atrial Paralysis (Hoʻoloihi PR a me ka Nalo ʻana o nā hawewe P):
4. ʻOi aku ka maʻalahi o nā myocytes atrial i ka hyperkalemia ma mua o nā myocytes ventricular. Hoʻoloihi ka PR interval, ʻo ka P hawewe palahalaha a palahalaha, a laila ** nalo loa nā hawewe P** ("sinoventricular rhythm", kahi o ka sinus node e puhi malie ana i na ventricles me ka hana ole i ka hawewe P i ike ia ma ka ECG).
5. Ka Papa 3 (K+ 7.5 to 8.5 mEq/L): Hoʻonui ʻia, Paʻipaʻi QRS ʻanoʻano a me nā poloka alakaʻi:
6. ʻO ka hoʻokō ʻole ʻana o nā awāwa sodium wikiwiki ventricular e hoʻolōʻihi i ka hoʻoiho ʻana mai ka cell a cell. Hoʻonui ka ** QRS paʻakikī (> 120 to 200+ ms)**, e hoʻolike ana me ka ʻāpana lālā pūʻolo hema a ʻākau paha, poloka fascicular, a i ʻole maʻi Brugada, i hele pinepine ʻia me severe bradycardia a i ʻole poloka AV kiʻekiʻe.
7. Ka Papa 4 (K+ > 8.5 to 9.0+ mEq/L): ʻO ke ʻano hoʻohālike "Sine Wave" mua:
8. Hoʻohui mau ʻia ka paʻakikī QRS ākea me ka hawewe T kiʻekiʻe kiʻekiʻe, e hana ana i ka Sine Wave ʻōniʻoniʻo me ka ʻoluʻolu ma ka nānā naʻau. Ma loko o nā kekona a i mau minuke, ua hoʻohaʻahaʻa ʻia kahi kani-wave i loko o Ventricular Fibrillation (VF), Pulseless Electrical Activity (PEA), a i ʻole Asystole.

3. ʻO ka 3-Step Hospital Rescue Protocol for Severe Hyperkalemia¶

Ke loaʻa i ka mea maʻi kekahi hoʻololi ECG hyperkalemic (ma waho aʻe o ka hawewe T haʻahaʻa kaʻawale) A i ʻole he serum potassium >= 6.5 mEq/L, hoʻokō nā hui pilikia i ʻekolu mau ʻanuʻu like:

KaʻAnuʻu Hana 1: Antagonize Cardiac Membrane Toxicity koke (ʻAʻole e hoʻohaʻahaʻa i ke koko potassium)¶

• Kalekauma Intravenous (E hana ana i loko o 1 a 3 mau minuke; mau 30 a 60 mau minuke):
• Hoʻihoʻi pololei ka calcium i ke āpau uila ma waena o ka hiki ke hoʻomaha me ka hiki ke paepae (V_t), e hōʻemi ana i kahi paʻakikī QRS ākea a hoʻopakele i kahi puʻuwai hawewe-sinin i loko o 60 a 180 kekona, ʻoiai ʻaʻole i loli iki ka serum potassium.
• 10% Calcium Gluconate (Safe for Peripheral IV Lines): Hoʻohana 30 mL (3 grams = 3 vials o 10 mL) o 10% Calcium Gluconate IV ma luna o 2 a 5 minuke (nā alakaʻi mua i hoʻohana ʻia he 10 mL, a ʻo 10 a 20 mL hiki ke hāʻawi mua ʻia, akā no ka mea, hiki ke hāʻawi mua ʻia ka calcium Gluconate. 4.65 mEq o ka calcium elemental e hoohalikeia me 13.6 mEq i loko o 10 mL o ka calcium chloride, ** e hana hou i ka 10 a i ka 30 mL i kēlā me kēia 5 mau minuke ** inā hoʻomau ka hyperkalemic QRS widening ma ka nānā).
• 10% Calcium Chloride (Makemake ʻia i ka hopu ʻana i ka naʻau a i ʻole ma o ka Central Venous Line): E hāʻawi i ka 10 mL (1 gram) o 10% Calcium Chloride IV e paʻi ma luna o 2 a 5 mau minuke (loaʻa ʻekolu manawa o ka calcium elemental o ka gluconate).
• Digoxin Exception: Inā loaʻa ka hyperkalemia ma muli o ka ** digoxin acute / cardiac glycoside toxicity**, e ʻauʻa i ka calcium IV maʻamau a hāʻawi koke iā Digoxin Immune Fab (DigiFab) me ka insulin/dextrose.

KaʻAnuʻu Hana 2: E hoʻoneʻe i ka pāpaʻa mai ke kahe koko i loko o nā pūnaewele (e hana ana ma 15 a 30 mau minuke; mau hola 2 a 6)¶

No ka pau ʻana o ka calcium IV i loko o 30 a 60 mau minuke, pono ʻoe e hoʻihoʻi i ka potassium extracellular i loko o nā ʻiʻo ʻiʻo iwi ma ka hoʻoulu ʻana i ka Na+/K+-ATPase pamu: 1. ** Insulin Maʻamau Intravenous + Dextrose (Lowers Serum K+ na 0.6 to 1.2 mEq/L i loko o 15 a 30 mau minuke)**: - Hāʻawi i ka 10 mau ʻāpana o ka Insulin Insulin IV maʻamau ** (a i ʻole 5 Units i nā mea maʻi me ka hiki ʻole o ka renal koʻikoʻi / ESRD e hōʻemi i ka hopena o ka hypoglycemia hope), ma mua a i hele pū ʻia e 25 grams a 50 grams o Intravenous Dextrose (50 to 100 mL of D50W, a i ʻole 250 to 500 mL of D10W hoʻokomo ʻia ma luna o 30 a 60 mau minuke) ke ʻole ka pae mua o ka glucose koko > 250 mg/dL (13.9 mmol/L). - Mandatory 4-a-6-Hour Glucose Surveillance: No ka mea, hoʻomaʻemaʻe mālie nā puʻupaʻa i poino i ka insulin, loaʻa i ka hypoglycemia koʻikoʻi hahau pinepine 2 a 5 mau hola ma hope o ka pana ʻana o ka insulin. E nānā i ka glucose koko i ka manamana lima i kēlā me kēia 30 a 60 mau minuke no 6 mau hola. 2. Agonist Beta-2 Nebulized kiʻekiʻe (Albuterol / Salbutamol) (Lowers Serum K+ e kekahi mea hou 0.5 to 1.0 mEq/L): - Hāʻawi i ka 10 mg a hiki i ka 20 mg o Nebulized Albuterol (Salbutamol) mau i ka 10 a 15 mau minuke. - Nā Manaʻo Dosing Koʻikoʻi: ʻO kēia ka 4 a 8 mau manawa kiʻekiʻe ma mua o kahi maʻamau 2.5 mg lapaʻau nebulizer hānō. No ka mea a hiki i ka 20% a hiki i ka 40% o nā maʻi dialysis ʻaʻole i pane i ka albuterol wale nō, ʻaʻole loa e hoʻohana i ka albuterol ma ke ʻano he mea hoʻokahi me ka ʻole o ka insulin IV. 3. ** Intravenous Sodium Bicarbonate (No ka Concurrent Metabolic Acidosis or Cardiac Arrest): - Hāʻawi iā 50 a 150 mEq o Sodium Bicarbonate (ʻoi aku ka maikaʻi ma ke ʻano he infusion isotonic o 150 mEq in 1 L of D5W a i ʻole 1.26% / 1.4% Sodium Bicarbonate i nā maʻi acidotic i hoʻemi nui ʻia, a i ʻole 1 to 2 ampules [50 to 100 mL] of 8.4% NaHCO3 i ka acidosis koʻikoʻi / ākea QRS / hopu ʻana i ka naʻau).

KaʻAnuʻu Hana 3: Wehe mau i ka pāpaʻa mai ke kino¶

ʻO ka hoʻololi ʻana i ka pālolo i loko o nā cell e kūʻai wale i kekahi mau hola; Pono e hoʻopau ʻia ka nui o ka potassium mai ke kino ma o ka pūʻai, ** ʻāpana ʻōpū , a i ʻole hemodialysis: 1. Renal Excretion ("Kaluresis" i loko o nā maʻi e hana mau ana i ka mimi): - Inā ʻaʻole ** anuric ka mea maʻi ma ka dialysis, hoʻokomo i ka isotonic crystalloids (0.9% Normal Saline a i ʻole Lactated Ringer's / Isotonic Bicarbonate) e hoʻihoʻi hou i ka hoʻoheheʻe ʻana me ka ʻaoʻao o Intravenous Loop Diuretics (Furosemide 40 to 80 mg IV a i ʻole Bumetanide 1 to 2 mg IV) e hoʻokahe i ka pāpaʻa ma ka mimi. 2. Nā Hoʻopaʻa Puka Waʻa / Gastrointestinal Potassium Hou: - Sodium Zirconium Cyclosilicate (SZC / Lokelma, 10 g orally): Hoʻopahele koho i nā ion potassium ma ka ʻāpana GI no ka hoʻololi ʻana i ka sodium a me ka hydrogen; hoʻomaka e hoʻohaʻahaʻa i ka serum potassium i loko o 1 a 2 hola. - Patiromer (Veltassa): Mea hoʻopaʻa polimer calcium-sorbitex (hoʻomaka mālie, 4 to 7 hours). - ** Hōʻalo i ka Sodium Polystyrene Sulfonate (Kayexalate) me Sorbitol: ʻO Kayexalate maʻamau he lohi loa, hiki ʻole ke ʻike ʻia ka hoʻomaka ʻana a lawe ʻia kahi ʻōlelo aʻoaʻo FDA no ** fatal colonic necrosis and bowel perforation** (ma hope o ka hana ʻana a me ka constipation). 3. Emergency Intermittent Hemodialysis (The Definitive Gold Standard): - Hoʻokahi hola 3-a-4-hola o Intermittent Hemodialysis e hoʻoneʻe i ka 50 a 120+ mEq o ka potassium mai ke kino aku, e hāʻule ana i ka serum potassium e 1.0 to 1.5 mEq/L i ka hora mua wale no. Pono ka hemodialysis no kēlā me kēia maʻi me anuric/oliguric renal failure, haole dialysis, ** hoʻomau K+ > 6.5 mEq/L ʻoiai ʻo ka lāʻau lapaʻau**, a i ʻole ke hoʻomau nei i ka haki ʻana o ke kelepona nui (crush syndrome, rhabdomyolysis, a i ʻole lysis tumor).

Māhele 2: ʻO ka Hypokalemia Koʻikoʻi: Ke piʻi ʻana i ka maʻi maʻi, ka maʻi maʻi maʻamau, a me nā lula hoʻololi.¶

1. Pehea ka nui o ka Hypokalemia (Serum K+ < 2.5 mEq/L) Ke kumu o ka ma'i lolo a me ka hopu puuwai¶

Ke hāʻule ka potassium serum extracellular ma lalo o 2.5 mEq/L: - Bāloka Hoʻopolarization ʻO ka ʻiʻo iwi: Ke hāʻule nei ka hikina membrane hoʻomaha o nā ʻiʻo ʻiʻo iwi mai -90 mV iho i -100 to -110 mV (hyperpolarization) a laila depolarizes me ka paradoxically i loko o kahi kūlana i hoʻohana ʻole ʻia, e hōʻeha ai i ka ** nawaliwali i ka ʻiʻo symmetric hohonu ** e hoʻomaka ana ma ** mau ʻāpana haʻahaʻa kokoke ('ūhā a me ka pūhaka)**, piʻi i ka ** kumu, nā lima, a me ka ʻāʻī , a hoʻopau i ka diaphragm a me nā ʻiʻo intercostal hanu a me nā ʻiʻo ʻē aʻe. - Hypokalemic Rhabdomyolysis: ʻO ka hoʻokuʻu ʻia ʻana o ka pāpauma mai ka hana ʻana i nā ʻiʻo ʻiʻo e hoʻomāhuahua mau i nā arteriole ʻiʻo kūloko i ka wā hoʻoikaika kino. I ka manawa o ka serum potassium < 2.0 to 2.5 mEq/L, hāʻule ke kahe o ke koko i ka wā o ka hoʻoikaika ʻana, ke kumu o ischemic muscle necrosis (rhabdomyolysis). - ** Hoʻopaneʻe ka Repolarization Puʻuwai a me Torsades de Pointes: I loko o nā myocytes ventricular, hypokalemia ke keʻakeʻa nei i ka hoʻoponopono ʻana i waho o nā awāwa potassium (I_Kr a I_K1), e hooloihi loa ana i ka Phase 3 repolarization, e hooulu ana i ** na nalu U kaulana, e hooloihi ana i ka QU interval, a e hooulu ana i ka mua ma hope o ka depolarizations e degenerate i polymorphic ventricular tachycardia (Torsades de Pointes) a me ventricular fibrillation.

2. Hoʻemi ʻia ʻo Potassium ʻoiaʻiʻo vs. Hypokalemic / Thyrotoxic Periodic Paralysis (Intracellular Shift)¶

Pono e hoʻokaʻawale koke nā kauka ulia pōpilikia ** ʻelua kumu like ʻole o ka maʻi maʻi hypokalemic**, no ka mea, ʻo ka hoʻomaʻamaʻa ʻana i ka lua ke kumu o ka hyperkalemia rebound:

3. Na Rula Gula Eha o ka Hoololi Potassium Hospital¶

Nā helu ulia pōpilikia āpana a me nā protocols oihana¶

Nīnau pinepine¶

No ke aha e pilikia ai ka hale kūʻai "nā pani paʻakai" (e like me NoSalt, Nu-Salt, a i ʻole Morton Salt Substitute) no ka poʻe me ka maʻi kīkiʻi a i ʻole nā ​​​​lāʻau koko?¶

No ka hoʻāʻo ʻana i kahi huahana me ka hoʻohana ʻole ʻana i ka sodium chloride, hoʻohana nā mea hana ma kahi o 100 pakeneka maʻemaʻe Potassium Chloride (KCl). Aia i loko o kahi teaspoon pae hoʻokahi o ka paʻakai paʻakai pāpaʻa a hiki i ka 2,500 a hiki i ka 2,800 mg (65 a i ka 70 mEq) o ka pāhare maʻemaʻe, ʻoi aku ia ma mua o ka pāpaʻa i loko o nā maiʻa nui ʻeono. ʻOiai hiki i nā puʻupaʻa olakino ke kānana i kēlā pāpauma keu, ʻaʻole hiki i ka mea me ka maʻi maʻi maʻi maʻi, ka puʻuwai ʻole, a i ʻole kekahi mea e lawe ana i ka ACE inhibitors (e like me lisinopril), nā ARB (e like me losartan), a i ʻole spironolactone ʻaʻole hiki ke hoʻomaʻemaʻe koke i ka pāpaʻa, e piʻi ai ke koko potassium i ke kiʻekiʻe o ka naʻau i loko o nā hola.

Pehea e ho'ōla ai ka calcium intravenous i ke ola o kekahi i ka wā o ka pilikia nui-potassium (hyperkalemic) inā ʻaʻole ia e hoʻohaʻahaʻa i ko lākou koko potassium?¶

Pepehi ke koko kiʻekiʻe i ka potassium ma ka depolarizing i ka hoʻomaha ʻana o ka uila o nā ʻiʻo ʻiʻo o ka naʻau, e laka ana i ko lākou mau ala sodium i pani ʻia no laila e ākea ka hōʻailona uila o ka naʻau i loko o kahi "sine wave" a hoʻōki i ka paʻi. ʻO ka hoʻokomo ʻana i ka calcium intravenous (calcium chloride a i ʻole calcium gluconate) ʻaʻole ia e hoʻololi i ka nui o ka potassium i loko o ke koko; akā, hoʻokiʻekiʻe koke ka calcium i ka hiki o ka paepae uila o ka puʻuwai, e hoʻihoʻi ana i ka ʻāpana uila maʻamau e pono ai ke ahi maʻamau i loko o 1 a 3 mau minuke. Hāʻawi ia i nā kauka he 30-a-60 mau minuke pale o ka pale uila ʻoiai ʻo ka insulin, albuterol, a me ka dialysis e hoʻoneʻe maoli i ka pālolo mai ke kahe koko.

No ke aha i ala aʻe ai kahi kanaka olakino olakino me ka lolo loa mai ka ʻāʻī a hiki i ke kakahiaka ma hope o ka ʻai ʻana i ka pāʻina pātaʻi nui a i ʻole ka ʻaina pizza?¶

Kapa ʻia kēia hōʻike maʻamau ʻo Hypokalemic Periodic Paralysis (a i ʻole Thyrotoxic Periodic Paralysis i ka wā e hoʻoulu ʻia e ka thyroid gland overactive, kahi mea maʻamau i nā kāne ʻōpio makua). ʻO ka ʻai ʻana i kahi pāʻina kiʻekiʻe-carbohydrate e hoʻoulu i ka hoʻokuʻu nui ʻana o ka insulin mai ka pancreas e hana i ke kō. I ka poʻe me ka genetic ion-channel mutation a i ʻole hyperthyroidism i ʻike ʻole ʻia, ʻo ka piʻi ʻana o ka insulin e hoʻoulu i ka pāpaʻi sodium-potassium ma luna o nā ʻiʻo iwi ʻoiai nā ala kīnā ʻole e pale ai i ka potassium mai ka haʻalele ʻana i nā pūnaewele, e hoʻomaʻemaʻe kokoke i nā pālolo āpau mai ke kahe koko (`K+ < 2.0 mEq/L`) a me ka waiho ʻana i nā wāwae a me nā lima i lolo no kekahi manawa a hiki i ka wā e hoʻihoʻi maikaʻi ʻia ka potassium a hāʻawi ʻia ka lāʻau thyroid/beta-blocker.

No ke aha e pono ʻole ai i nā kahu hānai pilikia e hui pū i ka potassium intravenous i loko o kahi wai kō (D5W dextrose) ʻeke IV i ka wā e mālama ai i ka potassium haʻahaʻa haʻahaʻa?¶

Ke loaʻa mua i ka mea maʻi ka haʻahaʻa o ke koko potassium (`< 2.5 mEq/L`) me ka ʻiʻo lolo a i ʻole ka puʻuwai arrhythmias, ʻo ka hoʻokomo ʻana i kahi ʻeke IV me ka dextrose (sugar) e hoʻoulu i ko lākou pancreas e hoʻokuʻu i kahi piʻi o ka insulin endogenous. Ma muli o ka hoʻokuke ʻana o ka insulin i ka potassium mai ke kahe koko i loko o nā pūnaewele, hāʻawi ka potassium i loko o kahi ʻeke wai kō i ka hāʻule ʻana o ke kiʻekiʻe o ka pāpaʻa koko o ka mea maʻi i ka mua, hiki ke hoʻopau koke i ko lākou mau ʻiʻo hanu a i ʻole ke hoʻomaka ʻana o Torsades de Pointes ventricular fibrillation. Pono e hui pū ʻia ka potassium intravenous no ka hypokalemia koʻikoʻi me ka paʻakai ʻole kō.

No ke aha ʻaʻole e ʻoi aku ka maikaʻi o ka potassium haʻahaʻa (hypokalemia) a hāʻawi pū ke kauka i ka magnesium intravenous?¶

I loko o nā puʻupuʻu distal o ka puʻupaʻa, hana ʻia nā ion magnesium intracellular e like me kahi plug i loko o nā kahawai potassium microscopic (i kapa ʻia ʻo ROMK channels) e hoʻōki i ka nui o ka pāpaʻa mai ka lele ʻana i waho i ka mimi. Ke loaʻa ka magnesium haʻahaʻa a me ka potassium haʻahaʻa i ka mea maʻi, i loaʻa pinepine mai ka diuretics, ka maʻi paʻi, a i ʻole ka luaʻi ʻana, e hamama ākea kēlā mau awāwa puʻupaʻa. ʻAʻole pili i ka nui o ka potassium a ka haukapila e hoʻokomo ai i loko o nā aʻa o ka mea maʻi, e ninini pololei ia i loko o ka mimi a hiki i ka hāʻawi ʻia ʻana o ka magnesium sulfate e hoʻopaʻa i ka leak a hoʻōla i nā pamu sodium-potassium cell.

Nā alakaʻi pili¶

• ʻO ka make ʻana o Digoxin, ka ʻawaʻawa foxglove, a me ka hoʻāʻo hyperkalemia
• ʻO ka ʻeha ʻeha a me ka compartment syndrome ke kōkua mua
• ʻO ka ʻeha ʻeha ʻeha, rhabdomyolysis, a me ka hoʻāʻo ʻana i ka mimi ʻeleʻele
• ʻO ka ʻona wai, ka hyponatremia pili i ka hoʻoikaika kino, a me ka pehu o ka lolo
• ʻO ka hoʻōla ʻana o ka puʻuwai puʻuwai (CPR) a me ke alakaʻi AED

Nā kumu a me ke alakaʻi kūhelu¶

• ʻAhahui Puʻuwai ʻAmelika (AHA): *Nā alakaʻi no ka mālama ʻana i ka maʻi maʻi puʻuwai a me ka mālama ʻana i ka maʻi maʻi maʻi: Mahele 10: Nā Kūlana Kūikawā o ka Hoʻōla hou ʻana (Hypokalemia a me Hypokalemia) *.
• 'Aha Ho'ōla 'Eulopa (ERC): Nā kuhikuhi no ka ho'ōla hou 'ana: Ho'opa'a 'ia ka na'au ma nā Kūlana Kūikawā: Nā 'A'ole Electrolyte (Potassium Disorders).
• UK Kidney Association (UKKA) & Resuscitation Council UK: Nā Kūlana Hoʻomaʻamaʻa Kauka: Hoʻomaʻamaʻa ʻana i ka Hyperkalemia Acute i nā mākua ma ka Halemai a me ke Kaiāulu (2020/2023 Update).
• ʻO ka maʻi maʻi: ka hoʻomaikaʻi ʻana i nā hopena honua (KDIGO): Controversies Conference on Potassium Management in Acute and Chronic Kidney Disease.
• ANZCOR (Komike o Australian and New Zealand on Resuscitation): Alakaʻi 11.5: Nā lāʻau lapaʻau a me ka Electrolyte Management in Adult Advanced Life Support.

• ʻO kēia alakaʻi no ka ʻike ʻike a ʻaʻole ia e pani i ka loiloi olakino ʻoihana a i ʻole ka mālama koʻikoʻi o ka haukapila pilikia. Ma muli o ka hiki ʻana mai o ka pilikia pāpaʻa koʻikoʻi ke hoʻopaʻa koke ʻia i ka naʻau a i ʻole ka maʻi ʻōpū o ka hanu me ka ʻole o ka ʻōlelo aʻo ʻana, makemake nui mākou e lawe i kahi kōkua mua a me ka papa CPR i kākoʻo ʻia ma o ka International Federation of Red Cross and Red Crescent Societies (IFRC), kou lāhui Red Cross Society, St John Ambulance, a i ʻole kahi mea lawelawe kūloko i hōʻoia ʻia.*