Ivyihutirwa vy’ivy’ipotasiyumu: Guhagarika umutima n’ugusenyuka kw’ivy’ipotasiyumu¶

Potasiyumu (K+) ni co kintu nyamukuru kiri mu mubiri w’umuntu, kikaba gifise 98 kw’ijana vy’ivyo bita potassium vyose biri mu mubiri (3,500 to 4,000 mEq) ibitswe imbere mu mitsi y’amagufa n’ingingo z’umubiri kandi 2 kw’ijana gusa ni vyo bigendagenda mu maraso atari mu ngingo. Kubera ko ubushobozi bw’umuyagankuba bwo kuruhuka (-90 millivolts) be n’ugusubira gukora kw’ingingo yose y’imitsi y’umutima be n’imitsi y’amagufa bivana n’urugero rukomeye ruri hagati ya potasiyumu iri mu ngingo (140 to 150 mEq/L) be n’ivyo bita potasiyumu biri hanze y’ingingo ngenderwako (3.5 to 5.0 mEq/L), mbere n’uguhindura gatoyi potasiyumu mu maraso canke gusohoka muri yo, birashobora guhagarika umutima canke bikatuma umubiri urema mu minota mikeyi.

Ivyihutirwa vy’ivyo bita potassium bishobora gutera ubuzima ku bihe bibiri bitandukanye: Hyperkalemia ikaze (Serum K+ > 6.0 to 6.5 mEq/L), akenshi yitwa "umwicanyi w'umucerezi" kubera ko abarwayi bafise ubumuga bw'amafyigo, babuze amaraso, bakomerekejwe n'ugujanjagurwa, rhabdomyolyse, canke imigenderanire hagati y'imiti igabanya ACE / ARBs, spironolactone, trimethoprim-sulfamethoxazole (Bactrim), n'imiti igabanya umunyu ugutera kw’umutima kw’umuvuduko w’umutima canke uguhagarara kw’umutima kw’umuvuduko w’umutima ata n’imburi hafi iriho; na Ikibazo c’amaraso gikomeye (Serum K+ < 2.5 mEq/L), biterwa n’uguruka cane/gucika intege, imiti igabanya ububabare bw’umubiri canke thiazide, ubuvuzi bw’indwara y’igisukari yitwa ketoacidose, canke Ugusenyuka kw’ibihe bimwe bimwe (harimwo n’ugusenyuka kw’ibihe bimwe bimwe biterwa n’ugusenyuka kw’amaraso inyuma y’ifunguro ry’ibifungurwa vyinshi canke imyimenyerezo), ivyo bikaba bitera amaboko**, ukudakora neza kw’imitsi yo guhema, n’indwara y’umutima yica Torsades de Pointes. Niba wicura ko hariho ikibazo gikomeye c’ivy’ivyatsi bita potassium, hamagara inomero y’ivyihutirwa yo mu karere kawe (911 muri Leta Zunze Ubumwe za Amerika na Kanada, 112 mu bihugu vyose vy’Ubumwe bw’Uburayi, 999 mu Bwongereza) uciye kuri telefone yacu . inomero z'ivyihutirwa ububiko ubwo nyene, hanyuma ugasubiramwo gusubiza ubuzima mu mutima n'amahaha (CPR), Gukomeretswa n'indwara y'ibice, na gukomereka cane kw'amafyigo n'ugusenyuka kw'amafyigo.

Ivyo ubikore ubu¶

1. Hamagara 911 / 112 / 999 ubwo nyene: Hamagara abaganga b’ivyihutirwa ubwo nyene iyo umuntu arwaye indwara y’amafyigo, ariko arakora diyalize, canke ariko arafata umuvuduko w’amaraso / imiti yo gukura amazi mu mubiri, agira ubugoyagoye butunguranye mu maguru, adashobora guhaguruka avuye ku ntebe canke ku gitanda, agira ububabare canke ububabare bwo mu gikiriza, ububabare bwo mu gikiriza, ububabare bwo mu gikiriza, ububabare bwo mu gikiriza, ububabare bwo mu gikiriza. canke umutima udatera neza, canke guhema nabi.
2. HAGARIKA ubwo nyene ibintu vyose biva kuri potasiyumu n’imiti igumya potasiyumu: Niba hyperkalemia (potasiyumu nyinshi) ikeka, uce uhagarika ubwo nyene imiti yose y’inyongera y’ivyo bita potasiyumu (*K-Dur, Klor-Con, Slow-K"ts), *"umunyu muto, Nu-Salt, Umunyu Usubirira Umunyu wa Morton, LoSalt, zikozwe mu umunyu w’ipotasiyumu, Imiti igabanya ubukana bw’indwara (ibuprofen, naproxen), Imiti igabanya ACE / ARBs (lisinopleri, losartan), *imiti igabany amazi y’umubiri,a triamterene*), na **imiti y’ibitea indwara y’ibihh(Bactrim / Septra)**.
3. IBIMENYETSO VY’IBIMENYETSO VY’IBIMENYETSO: Ntukigere utanga ibinyobwa birimwo isukari, umutobe w’ivyamwa, canke ibifungurwa birimwo ibinure vyinshi: Iyo umuntu ariko aragira ubugoyagoye butunguranye bw’amaguru n’amaboko (hypocalemic paralysis), NTUMUHE ibinyobwa birimwo isukari, umutobe w’ibitoke vy’umukara, umutobe w’ibitoke vy’ibitoke vy’ibitoke vy’ibitoke vy’ibitoke vy’ibitoke vy’ibitoke. ivyo kunywa. Isukari ituma insuline endogène iva mu maraso ihita itera, iyo potassium isigaye ikava mu maraso ikaja mu ngingo z’umubiri kandi igashobora guca ituma imitsi yabo yo guhema irema canke igatuma umutima ugira ububabare bw’umutima.
4. Umuntu agume aryamye ahagaze, kandi usuzume ingene ahumeka: Urugamba urwo ari rwo rwose rwo ku mubiri rurarekura adrenaline canke rugatuma umutima ugira ububabare bwinshi. Umuntu agume aruhutse buhoro buhoro ku mugongo (canke amushigikire ku bushuhe bwa degre 45 nimba umurwayi w’idialyse afise amazi mu mahaha yiwe). Raba neza igifu kiduga: hypokalemie ikaze n’iyi hyperkalemie ikaze vyose birashobora gutuma umubiri urema.
5. Bwira abaganga nimba umurwayi afise fistule canke graft y’amaraso: Nimba umurwayi ari ku hemodialyse y’ugucungera, uce ubwira abaganga ubwo nyene ukuboko gufise AV fistule canke graft kugira ngo ntihagire amacuffs y’umuvuduko w’amaraso canke inshinge z’imitsi y’amaraso zishirwa mu gice c’amaraso co mu bitaro, kandi usabe intra-1. calcium, n’ugusukura amaraso vyihutirwa 24/7**.
6. Niwitegure gutangura CPR ubwo nyene iyo umurwayi atakaje ubwenge: Uguhagarara kw’umutima kw’i Hyperkalemic gushobora gutera bukwi na bukwi uko ECG igenda iragwira ikagira umuvuduko w’amaraso. Iyo uwo muntu ataco akora, agahagarika guhema nk’uko bisanzwe, uce utangura gufatanya igifu ku 100 gushika ku 120 ku munota, hanyuma ushireko igikoresho citwa Automated External Defibrillator (AED).

Igiti c'ingingo: Gutoranya vyihutirwa hyperkalemia n'hypokalemia¶

flowchart TD
    Start["Ivyiyumviro bikomeye vy’uko umuntu afise potassium (Ubugoyagoye bugenda buraduga, umutima utera, umutima udakora neza, canke ingorane zo gukoreshwa imiti)"] --> CallEMS["Hamagara 911 / 112 / 999 Ubwo nyene; Uronke STAT 12-Lead ECG n'Ikibanza co Kwitwararika Gazi y'Amaraso Potasiyumu (K+)"]

    CallEMS --> SplitDir{"Suzuma ECG y'amabara 12 n'uburongozi bwa potasiyumu yo mu maraso (K+)"}

    SplitDir -->|HYPERKALEMIA: Serum K+ > 5.5 to 6.5+ mEq/L OR Peaked T Waves / Flattened P / Widened QRS / Sine Wave| HyperPath["INTAMBWE YA 1 (Amasegonda - Guhagarika Uruzitiro rw'Umutima, NTIBIGABANYA K+):\nUshiremwo IV Calcium Ubwo nyene (10 mL 10% Calcium Chloride CANKE 30 mL 10% Calcium Gluconate mu minota 2-5; Subiramwo nimba QRS iguma ari yagutse)"]

    HyperPath --> HyperShift["INTAMBWE YA 2 (Iminota 15-30 - Shira K+ mu Nsoro):\n1. IV Insuline isanzwe (Ibice 10) + IV Dextrose (25-50 g D50W/D10W; Gukurikirana isukari mu masaha 4-6)\n2. Igitigiri kinini c'imiti y'umusonga (10 gushika kuri 20 mg = 4x-8x Igitigiri c'imiti y'umusonga)\n3. IV Bikarbonate ya Sodiyumu (Niba hariho Asidozi y'Imibiri)"]

    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["AMATEGEKO Y'IBIMENYETSO VY'IGIHUGU:\n1. NTUZOKWIGEZE UTERA K+ muri Dextrose (D5W Itera Insuline & Itera Indwara y'Igitera)\n2. IMANA YOSE Suzuma kandi Uzuze IV Sulfate ya Magnesium (2 g IV) Mbere/Igihe kimwe\n3. Gutandukanya umubiri wose K+ gutakaza n'ugusenyuka kw'ibihe (uguhinduka kw'ingingo)"]

    HypoRules --> HypoReplace["IV igenzurwa + Igisubizo ca potasiyumu (KCl) co mu kanwa:\n- IV co ku ruhande Max: 10 mEq/isaha | ICU y’umurongo wo hagati: 20-40 mEq/isaha ku ECG ikomeza\n- Wongereko KCl yo mu kanwa (20-40 mEq) iyo Uvyuka; Ukwiyubara (Igitigiri gito + Propranolol) mu gusenyuka kw'imitsi y'umubiri kugira ngo umuntu ntasubire gutera"]

Igereranyo ry’uruhande n’uruhande: Hyperkalemia ikaze n’iyi Hypokalemia ikaze¶

Kubera ko vyompi bifise potasiyumu nyinshi cane biteye akaga be n’ivyo bita potasiyumu bike cane bishobora gutuma umuntu agira ugusenyuka kw’imitsi y’umubiri (kenshi bifatwa nk’indwara ya Guillain-Barre canke ugucika intege kw’umutsi w’umugongo) be n’indwara y’umutima ishobora gutuma umuntu apfa**, umuntu aca agira E**cardiogram (EC2-lect and **1) ivyo kwitaho amaraso yo mu mitsi y'umuyagankuba potassium ni ngombwa:

Igice ca 1: Hyperkalemia ikaze cane: Impamvu, ugutera imbere kwa ECG, n’umugwi w’ugukiza C-BIG-K-Drop¶

1. Igituma Hyperkalemia Ibaho: Gusohoka kw’amafyigo kudashoboka n’ugusohoka kw’utugingo ngengabuzima twinshi¶

1. Ugusohoka kwa potassium mu mafyigo nabi (Indwara y’amafyigo idakira, Igikomerekezo c’amafyigo gikomeye, n’imiti itatu yo kwa muganga):
2. Amafyigo afise amagara meza asohora 90 kw’ijana vy’ivyo kurya vy’umusi ku musi mu gice c’amafyigo co kure (nephron distal) agenzurwa na aldosterone.
3. Mu barwayi bafise Indwara y’amafyigo idakira (CKD Stages 4 gushika 5), Indwara y’amafyigo y’Iherezo (ESRD) bariko barasukura amaraso (na cane cane inyuma y’iminsi 3 y’impera y’umusi hagati y’imisi 3 yo gusukura amaraso ku wa gatanu n’uwa mbere canke inyuma yo kurya ivyokurya birimwo potassium nyinshi nk’ibitoke, ibitoke, ibitoke ivyamwa, amazi y’ikoko, canke ibintu bisubirira umunyu), canke Igikomerekezo c’amafyigo (AKI), potassium irarundanywa ningoga.
4. Imigenderanire y’imiti yica: Mbere no ku barwayi bafise ubumuga butoyi gusa bw’amafyigo, gufatanya ACE Inhibitor (lisinopril, ramipril) canke ARB (losartan, valsartan) n'umuti urwanya imitsi y'umubiri (spironolactone, eplerenone) hanyuma akandika umuti usanzwe wo mu nzira y’amasobe Trimethoprim-Sulfamethoxazole (Bactrim / Septra) (trimethoprim irazibira imihora y’amazi y’umubiri [ 1 ].ENaC] mu mfyigo bisa n’ivyo amiloride) canke NSAID (ibuprofen, naproxen) itera hyperkalemie ikomeye cane, ishobora gutuma umuntu apfa mu misi 3 canke 5.
5. Ihinduka ryinshi ry’ivya Potasiyumu (Indwara y’Ugusenyuka, Rhabdomyolyse, Guturika, n’Acidose):
6. Kubera ko imitsi y’amagufa irimwo . 140 mEq ya potasiyumu kuri litiro y’amazi ari mu turemangingo, ikintu cose gicapura utugingo ngengabuzima tw’imitsi canke utugingo ngengabuzima dutukura, gica gisuka potasiyumu nyinshi cane zitaziguye mu maraso:
   • Indwara y’ugujanjagurwa n’indwara y’ugusenyuka: Iyo umugozi uremereye, imodoka, canke ikintu gisenyutse gikuwe ku maguru y’umuntu yafashwe (reperfusion release), myoglobine, aside lactique, n’umupfunda wica wa potassium birasesagura umutima mu minota mikeyi (**"death smiling).
   • Indwara y’amaraso ikaze cane, indwara y’ibivyimba, n’indwara y’amaraso menshi.
   • Succinylcholine mu barwayi baturitse, bajanjaguritse, bakomeretse mu mugongo, canke mu mitsi y’umugongo: Guha umuti w’ubumuga succinylcholine umurwayi amasaha arenga 24 gushika kuri 48 inyuma y’uguturika cane, gukomeretswa n’ugujanjagurwa, gufatwa n’indwara y’umutima, canke gukomeretswa n’umutsi w’umugongo (canke mu Duchen dystrophyrme- n’imitsi yose, bigatuma potassium yo mu maraso itera 3 gushika kuri 5+ mEq/L mu masegonda 60, bigatuma umutima uhagarara ubwo nyene.
   • Acidose y'ibinyabuzima idasanzwe (irengeje urugero H+ ions zija mu ngingo mu guhindura K+ gusohoka mu ngirabuzimafatizo), Imiti igabanya ubukana bwa Beta, na Imiti igabanya ububabare yitwa Digoxin irenze urugero.

2. Intambwe zine z’ugupima umutima (ECG) zituma umutima uhagarara¶

Naho amahinduka ya ECG afitaniye isano cane n’urugero rwa potassium mu maraso, abarwayi bafise indwara y’amafyigo idakira barashobora kugira ECG isa n’iyisanzwe ku rugero rwa potassium rwa 100.000. 7.0 mEq/L hanyuma ugaca ugira fibrillate bukwi na bukwi, mu gihe abarwayi bafise igisebe gikomeye (ugukomeretswa n’ugujanjagurwa) bashobora gufatwa ku . 6.0 mEq/L. Raba izi ntambwe zine za kera za ECG:

1. Intambwe ya 1 (K+ 5.5 to 6.5 mEq/L): Muremure, Muto, Mu buryo Buhuye "Isonga" T Imiraba:
2. Ikimenyetso ca mbere c’uko umuntu afise hyperkalemia: Imiraba ya T iraba ndende, igira umutwe mutoyi, kandi ikaba isongoye cane (“nk’ibarabara ry’ishengero” canke “ihema”), cane cane mu nzira z’imbere y’umutima . V2 to V4, biherekejwe n’igihe ca QTc kigabanutse.
3. Intambwe ya 2 (K+ 6.5 to 7.5 mEq/L): Ubumuga bwo mu mutwe (Ugukura kwa PR no gutakaza imipfunda ya P):
4. Imitsi y’umutima irashobora gushikirwa n’indwara y’amaraso menshi kuruta imitsi y’umutima. Igihe ca PR kirareha, umuvuduko wa P urasa n’uwugutse, hanyuma umuvuduko wa P ukazimangana burundu ("sinoventricular rhythm", aho umutsi w’ibihaha uguma utera umuriro mu gacerere ku bihimba vy’umutima ataco utanga umupfunda wa P uboneka kuri ECG).
5. Intambwe ya 3 (K+ 7.5 to 8.5 mEq/L): Ivyagutse, Ivyiza Bitangaje QRS n'Ibice vy'Ivyuma:
6. Kudakora kw’imirongo y’ivyuma vyihuta vy’umutima bituma ivyiyumviro bigenda buhoro biva ku ngingo ngenderwako bishika mu yindi ngingo ngenderwako. Igitero ca QRS kiragenda kiragwira (> 120 to 200+ ms), kwigana ubuzibuzi bw’ishami ry’umutsi w’ibubamfu canke iburyo, ubuzibuzi bw’imitsi, canke ubumuga bwa Brugada, akenshi bujana n’ubuzibuzi bw’umutima bukomeye canke ubuzibuzi bw’umutima bw’agaciro kanini.
7. Intambwe ya 4 (K+ > 8.5 to 9.0+ mEq/L): Imbere y'Iherezo "Imuvumba wa Sine" Igishushanyo:
8. Igihimba ca QRS cagutse gikomeza gufatanya n’umuvuduko muremure w’isonga T, kigahingura umuvuduko w’umutima Sine Wave uryoshe kandi uzunguruka. Mu masegonda canke iminota, umuvuduko w’umuvuduko w’amaraso urasenyuka ukagira ugutera kw’imitsi y’umutima (VF), ugutera kw’umuyagankuba utagira umutima (PEA), canke Asystole.

3. Intambwe 3 z'Itegeko ryo Gutabara mu Bitaro ku ndwara y'amaraso ikaze cane¶

Igihe cose umurwayi afise impinduka iyo ari yo yose y’umuvuduko w’amaraso (irenze y’isonga ry’umuvuduko w’amaraso) CANKE potassium yo mu maraso >= 6.5 mEq/L, imigwi y’ivyihutirwa ikora intambwe zitatu icarimwe:

Intambwe ya 1: Ushobora guca urwanya ubumara bwo mu mutima (NTIBUGABANYA Potassium mu maraso)¶

• Calcium iterwa mu mutsi (Ikora mu minota 1 gushika kuri 3; Imara iminota 30 gushika kuri 60):
• Calcium irasubizaho ata guca ku ruhande ikinogo c’umuyagankuba kiri hagati y’ubushobozi bw’uruzitiro rwo kuruhuka n’ubushobozi bwo ku ruhande (V_t), gugabanya igice ca QRS cagutse no gukiza umutima w’umuvuduko w’amaraso mu masegonda 60 gushika ku 180, naho nyene potassium yo mu maraso itarahinduka na gato.
• 10% ya Calcium Gluconate (Itekanye ku mirongo ya IV y’inyuma): Gutanga 30 mL (3 grammes = 3 vials ya 10 mL) y’10% ya Calcium Gluconate IV mu minota 2 gushika ku 5 (amabwirizwa ya kera yakoreshwa sin 10 mL mbere, na **10 m2 y’ishobora kuba mbere, m2 isukari ya kalisiyumu irimwo gusa 4.65 mEq y’ivyuma vy’umubiri bita calcium ugereranyije n’ 13.6 mEq mu mL 10 za calcium chloride, ugusubiramwo mL 10 gushika kuri 30 buri minota 5 biratangwa iyo ukwaguka kwa QRS kw’ibara ry’agahama (hyperkalemic QRS) gukomeza ku gicapo).
• 10% ya Calcium Chloride (Ikunda cane iyo umutima uhagaze canke biciye ku murongo w’imitsi yo hagati): Uhe 10 mL (gram 1) ya 10% ya Calcium Chloride IV mu minota 2 gushika kuri 5 (irimwo incuro zitatu calcium y’intango ya gluconate).
• Ikidasanzwe ca Digoxin: Nimba uburwayi bwa hyperkalemie buterwa n’ubumara bwa digoxin / ubumara bwa glycoside bwo mu mutima, uhagarike gufata calcium IV isanzwe maze ushiremwo Digoxin Immune Fab (DigiFab) ubwo nyene iruhande y’insuline/dextrose.

Intambwe ya 2: Gukura Potassium mu maraso ukayishira mu ngingo (Ikora mu minota 15 gushika kuri 30; Imara amasaha 2 gushika kuri 6)¶

Kubera ko IV calcium ihera mu minota 30 gushika kuri 60, utegerezwa guca uyijana potassium iri hanze y’ingingo z’umubiri isubira mu ngingo z’imitsi y’amagufa mu gutuma Na+/K+-ATPase pompe: 1. Insuline isanzwe + Dextrose (Igabanya amaraso K+ na 0.6 to 1.2 mEq/L mu minota 15 gushika kuri 30): - Gutanga Ibice 10 vy’Insuline IV y’Umuntu Isanzwe (canke Ibice 5 ku barwayi bafise ubumuga bukomeye bw’amafyigo / ESRD kugira ngo ugabanye ingorane zo gutakaza isukari mu mubiri mu gihe c’ijoro), bibanza canke biherekejwe n’ibice 25 gushika ku bice 50 vy’Insuline Intravenous Dextrose** (50 to 100 mL of D50W, canke 250 to 500 mL of D10W n’iminota 30 canke 60) kiretse iyo isukari yo mu maraso y’intango imaze gushika . > 250 mg/dL (13.9 mmol/L). - Itegeko ryo gukurikirana isukari mu masaha 4 gushika ku 6: Kubera ko amafyigo yononekaye akuraho insuline buhoro cane, ugucerezwa kw’isukari nyinshi cane kenshi gutera amasaha 2 gushika ku 5 inyuma y’ugusunika insuline. Suzuma isukari mu maraso y’urutoke inyuma y’iminota 30 gushika kuri 60 mu masaha 6. 2. Imiti igabanya ubukana bw'indwara ya Beta-2 (Albuterol / Salbutamol) (Igabanya amaraso K+ n'Iyongera 0.5 to 1.0 mEq/L: - Gutanga 10 mg gushika kuri 20 mg y’imiti y’ibitoke (Salbutamol) ubudasiba mu minota 10 gushika kuri 15. - Iciyumviro c'imiti: Ivyo ni incuro 4 gushika kuri 8 kurusha imiti isanzwe 2.5 mg ubuvuzi bw’indwara y’umusonga. Kubera ko abarwayi ba dialyse bagera kuri 20% gushika kuri 40% badashobora gufata umuti witwa albuterol gusa, ntiwigere ukoresha umuti witwa albuterol nk’umuti umwe ata insuline yo mu maraso. 3. Bicarbonate ya sodium iterwa mu mutsi (Ku ndwara y’acidose canke umutima uhagaze): - Gutanga 50 gushika kuri 150 mEq ya Bikarbonate ya Sodiyumu (vyiza ni nk’umuti w’isotonic w’ 150 mEq in 1 L of D5W canke 1.26% / 1.4% Sodium Bicarbonate mu barwayi bafise asidi igabanutse, canke . 1 to 2 ampules [50 to 100 mL] of 8.4% NaHCO3 mu asidoze ikaze / QRS yagutse / umutima uhagaze).

Intambwe ya 3: Kura Potassium mu mubiri ubuziraherezo¶

Guhindura potassium mu ngingo bigura amasaha makeyi gusa; iyo potassium irengeje urugero itegerezwa gukurwa mu mubiri biciye mu amafyigo, inzira y’amara, canke hemodialyse: 1. Ivyo gusohoka mu mafyigo ("Kaluresis" mu barwayi bakikora amasobe): - Nimba umurwayi atari umugera wa dialyse, ushiremwo isotonique crystalloïdes (0.9% Normal Saline canke Lactated Ringer's / Isotonic Bicarbonate) kugira ngo umuntu asubire gutera amaraso mu mfyigo hamwe n’Imiti itera amaraso mu mutsi (Furosemide 40 to 80 mg IV canke Bumetanide 1 to 2 mg IV) kugira ngo ushiremwo potasiyumu mu nkari. 2. Ivyuma vy'ubu bifatanya potassium mu kanwa / mu nda: - Igikoko c'umunyu (SZC / Lokelma, 10 g orally): Itoranya imitego y’iyon za potassium mu nzira y’amaraso kugira ngo ihindure sodium na hydrogène; itangura kugabanya potassium mu maraso mu masaha 1 gushika kuri 2. - Ikinyabuzima (Veltassa): Igitera ivyuma bifatanya ivyuma (bitangura buhoro, 4 to 7 hours). - Irinde imiti ya Sodium Polystyrene Sulfonate (Kayexalate) iri kumwe na Sorbitol: Imiti ya Kayexalate y’agaciro itangura buhoro cane, idashobora kumenyekana kandi ifise imburi ya FDA ku gupfa kw’amaraso n’ugutoboka kw’amara (na cane cane inyuma yo kubagwa canke iyo umuntu afise indwara y’umusonga). 3. Ivyihutirwa vy'ugukura amaraso mu bihe bimwe bimwe (Ikigereranyo c'inzahabu gitomoye): - Igihe kimwe c’amasaha 3 gushika kuri 4 c’ugukora Hemodialyse intermittent gikura 50 gushika kuri 120+ mEq ya potassium mu mubiri, kigatuma potassium yo mu maraso igabanywa ku 100.000. 1.0 to 1.5 mEq/L mw’isaha ya mbere gusa. Hemodialyse ni ngombwa ku murwayi wese afise indwara y’amafyigo y’amafyigo, dialyse yabuze, idahera K+ > 6.5 mEq/L naho nyene umuntu yoba avuwe n’abaganga, canke ugusenyuka kw’ingingo ngenderwako nyinshi (indwara y’ugusenyuka, rhabdomyolyse, canke ugusenyuka kw’ibivyimba).

Igice ca 2: Hypokalemie ikaze: Ubumuga buduga, Ubumuga bugenda buraduga, n’amategeko yo gusubirira¶

1. Ingene Hypokalemie Ikomeye (Serum K+ < 2.5 mEq/L) Bitera Ubumuga n'Umutima Ugahagarara .¶

Iyo potasiyumu iri mu maraso y’umubiri igabanutse munsi ya 2,5 mEq/L: - Igihimba c'imitsi y'amagufa: Ubushobozi bwo kuruhuka bw'imitsi y'amagufa buva ku -90 mV gushika kuri -100 to -110 mV (hyperpolarization) hanyuma mu buryo buteye ubwoba igaca ihinduka, igatuma ubugoyagoye bukomeye bw’imitsi buringaniye butangura mu bice vyo hasi (amatako n’ibibero), bugaduga bukaja ku umubiri, amaboko, n’izosi, maze amaherezo imitsi y’imbere y’umubiri, g n’imitsi y’inyuma** m mu gihe umuntu azigama imitsi y’amaso n’ivyo yumva. - Hypokalemic Rhabdomyolysis: Ivyo bita potassium biva mu mitsi ikora mu bisanzwe bituma imitsi y’aho hantu igwiza mu gihe umuntu ariko arakora imyimenyerezo. Igihe potasiyumu yo mu maraso ari < 2.0 to 2.5 mEq/L, amaraso yo mu mitsi arabura mu gihe umuntu ariko arakora cane, ivyo bikaba bituma imitsi ipfa (rhabdomyolyse). - Uguteba kw’ugusubira gukora kw’umutima n’ugutera kw’imitsi y’umutima: Mu mitsi y’umutima, hypokalemia ibuza imihora ya potassium ikosora hanze (I_Kr kandi I_K1), bikaba bituma habaho imipfunda ya U igaragara cane, bikaba bituma Ikiringo ca QU kiramba, kandi bikaba bituma habaho ugusubira inyuma kw’imitsi hakiri kare bigahinduka ugutera kw’umutima kw’imiterere myinshi (Torsade de Pointes) n’ugutera kw’imipfunda y’umutima.

2. Ugutakaza potassium vy’ukuri n’ugusenyuka kw’ibihe bitandukanye (uguhinduka kw’ibihimba vy’umubiri)¶

Abaganga b’ibihe vyihutirwa bategerezwa guca batandukanya imvo zibiri zitandukanye rwose z’ugusenyuka kw’amaraso, kuko kuvura cane ica kabiri bitera ubumuga bw’amaraso butera urupfu:

3. Amategeko ane y’inzahabu yerekeye gusubirira potassium mu bitaro¶

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

Ibibazo bikunda kubazwa¶

Ni kuki "ibisubirira umunyu" vyo mu maduka y'ibifungurwa (nka NoSalt, Nu-Salt, canke Morton Salt Substitute) biteye akaga ku bantu barwaye indwara y'amafyigo canke bari ku bipimo vy'umuvuduko w'amaraso?¶

Kugira ngo ikintu kiryoshe umunyu ata gukoresha umuti witwa sodium, abawuhingura bakoresha hafi 100 kw’ijana w’umunyu witwa chlorure de potassium (KCl). Akayiko kamwe k’icayi k’ikintu gisubirira umunyu wa potasiyumu kirimwo potasiyumu itagira agasembwa ingana n’imigera 2.500 gushika ku 2.800 (65 gushika ku 70 mEq), iyo na yo ikaba ari nyinshi kuruta potasiyumu iri mu bitoke bininibinini bitandatu. Naho amafyigo afise amagara meza ashobora gucungera iyo potasiyumu y’inyongera, umuntu wese afise indwara y’amafyigo idakira, umutima udakora neza, canke umuntu wese afata imiti igabanya ACE (nka lisinopril), ARBs (nk’iyo losartan), canke spironolactone ntashobora gukuraho iyo potasiyumu ningoga, ivyo bikaba bituma urugero rwa potasiyumu rwo mu maraso rwongerekana.

Ni gute calcium iterwa mu mutsi ikiza ubuzima bw’umuntu mu gihe c’ivyago vy’ivyihutirwa bifise potassium nyinshi (hyperkalemic) nimba mu vy’ukuri itagabanya potassium mu maraso yiwe?¶

Potassium nyinshi mu maraso yica mu gukuraho umuyagankuba uriko uraruhuka w'ingingo z'imitsi y'umutima, ivyo bikaba bifunga imihora yazo ya sodium kugira ngo ikimenyetso c'umuyagankuba w'umutima kiguke kibe "umuvuduko wa sine" maze kigahagarika gutera. Gutera umuti witwa calcium mu mutsi (chlorure de calcium canke gluconate de calcium) ntibihindura na gato urugero rwa potassium mu maraso; ahubwo, calcium ica ubwo nyene ivyura ubushobozi bw’umuyagankuba bw’ingingo z’umutima, igasubizaho ikibanza gisanzwe c’umuyagankuba gikenewe kugira ngo ingingo z’umutima zishobore gutera umuriro mu buryo busanzwe mu minota 1 canke 3. Ivyo bituma abaganga bashobora kwikingira umuyagankuba mu minota 30 gushika kuri 60 mu gihe insuline, albuterol be n’imiti yo gukura amaraso mu maraso mu vy’ukuri bikuramwo iyo potasiyumu.

Ni kubera iki umuntu akiri muto afise amagara meza yavyuka amugaye rwose kuva mw’izosi gushika mu gitondo amaze kurya inyama nyinshi z’umuceri canke z’umuceri w’umuceri?¶

Ivyo bimenyetso vya kera vyitwa Hypokalemic Periodic Paralysis (canke ubumuga bw’ibihe bitera umubiri iyo buvyurwa n’igihimba c’umubiri gikora cane, kikaba ari ikintu gisanzwe cane cane ku bagabo bakiri bato bakuze). Kurya ifunguro ryinshi ririmwo ibinure vyinshi bituma insuline nyinshi cane iva mu mara kugira ngo ikoreshe iyo sukari. Mu bantu bafise ihinduka ry’imitsi y’iyon canke indwara y’umubiri idasanzwe, iyo insuline itera cane amapompa ya sodium-potassium ku mitsi y’amagufa mu gihe imitsi idakora neza ibuza potassium kuva mu ngingo ngenderwako, igakura hafi potassium yose mu maraso (`K+ < 2.0 mEq/L`) no gusiga amaguru n’amaboko bimugaye mu gihe gito gushika potassium igarutse neza, bagaca bafata umuti wo gukingira thyroïde/beta-blocker.

Ni kuki abaforomo b’ibihe vyihutirwa BATAKWIGEZE bavanga potassium mu mutsi mu mazi y’isukari (D5W dextrose) IV bag igihe uvura potasiyumu nke cane iteye akaga?¶

Igihe umurwayi asanzwe afise potassium nke cane mu maraso (`< 2.5 mEq/L`) bafise ubumuga bw’imitsi canke umutima udatera neza, gutera umufuko wo mu maraso urimwo dextrose (isukari) bituma amafyigo yabo arekura insuline nyinshi cane. Kubera ko insuline ikura potasiyumu mu maraso ikayijana mu ngingo ngenderwako, gutanga potasiyumu mu gafuko k’amazi y’isukari mu vy’ukuri bituma potasiyumu iri mu maraso y’umurwayi igabanuka mbere n’iyigabanuka mu ntango, ivyo bikaba bishobora gutuma imitsi yabo yo guhema irema bukwi na bukwi canke igatuma umuntu agira ubumuga bwo mu mutwe bushobora gutuma apfa. Potassium iterwa mu mitsi iyo umuntu afise hypokalemie ikaze cane, itegerezwa kwama ivangwa n’umunyu udafise isukari.

Ni kuki iyo umuntu afise potassium nke (hypokalemie) adashobora gukira gushika umuganga na we nyene atanga magnésium mu mutsi?¶

Imbere mu nzira z’amafyigo ziri kure, iyoni za magnésium ziri mu turemangingo zikora nk’igipfukisho kiri mu mirongo y’amazi y’amafyigo (yitwa imihora ya ROMK) kugira ngo potassium nyinshi cane ntizisohoke zije mu mafyigo. Iyo umurwayi afise magnesium nke na potassium nke, ivyo bikaba bishika kenshi cane kubera imiti igabanya amazi, gucibwamwo canke gukorora, iyo mihora y’amafyigo iguma yuguruye cane. Naho ibitaro vyoshiramwo potasiyumu ingana gute mu mitsi y’umurwayi, irasuka igororotse mu mavyi gushika umuntu ashize magnésium sulfate mu mutsi kugira ngo apfuke aho hantu hasohotse maze akoreshe amapompa y’ivyuma bita sodium-potassium y’ingingo ngenderwako.

Inyobora zifitaniye isano¶

• Ubumara bwa Digoxin, ubumara bwa foxglove, n'ugutoranya hyperkalemia
• Igikomerekezo co gujanjagurwa n'indwara y'ubutabazi bwambere
• Igikomerekezo gikomeye c'amafyigo, rhabdomyolyse, n'ugutoranya amasobe y'umwirabura
• Uguborerwa n’amazi, hyponatremie ijana n’imyimenyerezo, n’ukuvyimba kw’ubwonko
• Gusubiza ubuzima mu mutima n'amahaha (CPR) n'ubuyobozi bwa AED

Amasoko n'ubuyobozi buzwi¶

• Ishirahamwe ry’umutima ryo muri Amerika (AHA): Ingingo ngenderwako zo gusubiza ubuzima mu mutima n’amahaha no kwitwararika vyihutirwa umutima n’imitsi: Igice ca 10: Ibintu bidasanzwe vyo gusubiza ubuzima mu mutima (Hyperkalemia na Hypokalemia bishobora gutuma umuntu apfa).
• Inama y’Uburaya y’Ugusubiza Ubuzima (ERC): Ingingo ngenderwako zo Gusubiza Ubuzima: Guhagarara kw’Umutima mu Bihe Bidasanzwe: Ubumuga bw’Imitsi (Indwara za Potassium).
• Ishirahamwe ry'amafyigo ryo mu Bwongereza (UKKA) & Inama y'ugusubiza ubuzima mu buzima UK: Ingingo ngenderwako z'ubuvuzi: Ubuvuzi bw'indwara y'amafyigo y'abantu bakuze mu bitaro no mu kibano (2020/2023 Update).
• Indwara y'amafyigo: Guteza imbere ingaruka z'isi yose (KDIGO): Inama y'impaka ku bijanye no gucungera potassium mu ndwara y'amafyigo ikomeye n'iyidakira.
• ANZCOR (Komite ya Australiya na Nouvelle-Zélande ijejwe gusubiza ubuzima mu buzima): Ingingo ngenderwako 11.5: Imiti n’ugucungera amazi mu gufasha abantu bakuze mu buzima buteye imbere.

*Iyi nkuru ni iyo gutanga amakuru kandi ntisubirira isuzuma ry’ubuvuzi ry’abahinga canke ubuvuzi bw’ibitaro vyihutirwa. Kubera ko ivyihutirwa bikomeye vy’ipotasiyumu bishobora gutuma umutima uhagarara bukwi na bukwi canke imitsi y’uguhema ikabura ata n’umwe abimenyeshejwe, turagusavye cane gufata inyigisho yemewe y’ubutabazi bwa mbere n’ubutabazi bw’umutima biciye ku Ishirahamwe Mpuzamakungu ry’Umusaraba Mutukura n’Ishirahamwe ry’Ukwezi Gutukura (IFRC), ishirahamwe ryawe ry’igihugu ry’Umusaraba Mutukura ry’aho uba, St John a Ambulant.