I-Hyperkalemia itholakala uma izinga lakho le-serum potassium lilinganisa u-5.0 mEq / L noma ngaphezulu. Kungabangelwa ukungenisa i-potassium kakhulu, ukungabi ne-potassium ngokwanele, noma i-potassium ephumayo yamaseli.
Ukuhlola kungasiza ekunqumeni ukuthi iyiphi yalezi zindlela ezibangela potassium yakho ephezulu. Kuphela uma wazi ukuthi kungani une-hyperkalemia ongayiphatha ngendlela efanele futhi ngethemba lokuthi ukuvimbela ukuphindaphinda.
Izivivinyo zegazi
Ngaphambi kokuhlahla indlela yokuhlolwa okuhlelekile, udokotela wakho uzofuna ukuqinisekisa ukuthi unempilo ehlanzekile ye-hyperkalemia. Ngokuvamile, amazinga e-potassium aphakanyiswa amanga, isimo esibizwa ngokuthi i-pseudohyperkalemia, ngenxa yokuthi igazi lakho lidonsa kanjani .
I-tourniquet esetshenziswa ngokuqinile kakhulu noma eside kakhulu ingabangela ukuthi amangqamuzana abomvu egazi asebenze noma aphumele, aphuze i-potassium ibe yi-specimen. Ukuphindaphinda kwesihluthulelo ngesikhathi sokugqekeza kungabangela i-potassium ukuphuma emangqamuzaneni akho, ukwandisa imiphumela yakho yebhu yakho cishe 1 kuya ku-2 mEq / L.
Umsebenzi wokuqala udokotela wakho ukuhlola kabusha izinga lakho le-potassium. Uma amazinga akho ehlala ephakeme, udokotela wakho angalawula ukuhlolwa okulandelayo.
Izivivinyo Zokuqala
Ukuhluleka kwe-Renal , kungakhathaliseki ukuthi kuyingozi noma okungapheliyo, kungenye yezimbangela ezivame kakhulu ze-hyperkalemia. Uma izinso zihluleka, azikwazi ukukhipha i-potassium ngendlela efanele. Lokhu kungaholela ekwakheni i-potassium egazini.
I-blood urea nitrogen (BUN) ne-creatinine ukukala ukuthi izinso zakho ziyasebenza kanjani futhi zifakwe njengengxenye yephaneli eliyisisekelo lomzimba. Okunye ukuhlolwa kwiphaneli kufaka i-sodium, i-chloride, i-bicarbonate, ne-glucose. Lezi zindinganiso zomthamo zisetshenziselwa ukubala i-anion gap ukuthi, uma iphakanyisiwe, ikhombisa i-metabolic acidosis.
I-Acidosis ingadonsela i-potassium ngaphandle kwamangqamuzana angene egazini. Amazinga aphezulu e-glucose, njengoba angabonakala ekushukela kwesifo sikashukela , angenza okufanayo. Amazinga aphansi e-sodium lapho ebhekene namazinga aphezulu e-potassium angasikisela isimo se-hormonal esibizwa ngokuthi i-hypoaldosteronism.
Ukubala okuphelele kwegazi kungabuye kube ukuhlolwa kokuhlola okuwusizo. Ukubala kwegazi elimhlophe kungaba isibonakaliso sokutheleleka noma ukuvuvukala emzimbeni. Amazinga aphansi e-hemoglobin ne-hematocrit abonisa ukuthi i-anemia. I-anemia ebangelwa ukwehlukana kwamaseli abomvu egazi, eyaziwa nangokuthi i- hemolytic anemia , ingakhulula amazinga aphezulu e-potassium egazini.
- BUN
- Creatinine
- Iphaneli yametabolic
- Gcwalisa inani legazi
Izivivinyo ezicacile
Kuye ngezibonakaliso zakho nomlando wezokwelapha, udokotela wakho angakhetha futhi ukuphishekela ezinye zezivivinyo ezilandelayo.
- I-Aldosterone: I- Aldosterone iyi-hormone ekhishwa yi-grenal adrenal elawula ukucindezeleka kwegazi. Ngisho noma amazinga e-potassium aphakeme futhi amazinga e-sodium aphansi, izinga le-aldosterone liyadingeka ukuze kuqinisekiswe ukuxilongwa kwe-hypoaldosteronism. I-hypotension ibuye ifane nesimo.
- I-Creatinine phosphokinase (CPK): Amazinga aphakeme we-CPK asikisela ukuthi kube khona ukulimala emisipha. Lokhu akukona nje ukuthi i-enzyme iphuma emisipha kodwa ingakhukhula izinso, okuholela ekuhlulekeni kwezinso kulokho okubizwa ngokuthi i- rhabdomyolysis . I-potassium iphinde ivuke emathisini omzimba.
- Amazinga e-Digoxin: I- Digoxin ingenye yemithi eminingi engaba nemiphumela emibi ye-hyperkalemia. Ngokungafani ne-beta-blockers engakwandisa i-serum potassium, i-digoxin inesifo se-blood ukuhlola ukuthi imithi ingakanani egazini lakho.
- Ukuhlolwa kwe-uric acid ne-phosphorus : Uma amaseli ephuka, akhipha i-uric acid ne-phosphorus ngaphezu kwe-potassium. Lokhu kungenzeka ku-anemia noma i-flame-ups yesifo se-sickle cell. Kungase futhi kwenzeke ku- tumor lysis syndrome uma kunqamuka okukhulu kwamangqamuzana ngemva kwe-chemotherapy.
Ukuhlolwa kwe-Urine
I- urinalysis elula ibheka igazi, i-glucose, amaprotheni, noma ukutheleleka emcinini.
Ukuthola okungavamile kungabonisa i-glomerulonephritis, ukuvuvukala kwezinso, noma i-glomerulonephrosis, isimo esingenalo ukuvuvukala lapho izinso zivuza amaprotheni. Kungabonisa futhi isifo sikashukela esingalawulwa.
Izivivinyo zomchamo eziqondile kakhulu zingase ziqhutshwe ukuze zihlole ukuthi izinso ziyasebenza kanjani. Uma ukuvinjwa komchamo we-potassium ne-sodium kungaphakathi kwemingcele okulindelekile, izinso akumele zibekwe icala. Isizathu esingezona-mkhuba kufanele siphenywe. Ukuhlolwa kwe-urine myoglobin kungaqinisekisa ukuxilongwa kwe-rhabdomyolysis.
- Okuyisisekelo sokuvuthwa
- I-urine potassium ne-sodium
- I-urine myoglobin
Uvivinyo lwezinhliziyo
I-Hyperkalemia ingabangela ama-arrhythmias asongela ukuphila uma amazinga akho e-potassium ephakeme kakhulu. I- electrocardiogram (ECG) iyithuluzi elibalulekile lokuxilonga, hhayi nje ukuthola amacala aphezulu kakhulu e-hyperkalemia kodwa nokukhomba ukuthi uhlobo luni lwe-arrhythmia lukhona.
I-ECG iyalinganisa ukuqhutshwa kagesi ngenhliziyo, ukusuka emagumbini aphezulu enhliziyo, i-atria, ekamelweni eliphezulu, ama-ventricles. Umugqa ngamunye ku-ECG kusuka ku-PQRST ubonisa ukusebenza noma ukutakula ikamelo elihlukile le-muscle yenhliziyo.
Njengoba i-serum potassium iyanda, izinguquko ze-ECG ziba nzima nakakhulu. Ukuqala emazingeni ama-5.5 meq / L nangaphezulu, ama-ventricles angase abe nobunzima bokuthola. Lokhu kungabonakala njengama-t-waves agxile kwi-ECG. Ukuqalisa ukusebenza kwe-Atrial kuthinteka ku-6.5 mEq / L ukuze ama-p-waves angabe esabonakala. Ku-7.0 mEq / L, amagagasi e-QRS avuliwe, afana nokusebenziselwa ukubambezeleka kwama-ventricles.
I-arrhythmias ye-cardiac ijwayele ukuthuthukisa ku-8.0 mEq / L. Lokhu kungafaka konke okuvela ku-sinus bradycardia kuya kwi- tricycardia ye-ventricular . Esimweni esibi kunazo zonke, i-asystole, ukulahlekelwa kwazo zonke izimo zombane, kungenzeka. Ngenkathi i-ECG ingatholi imbangela ye-hyperkalemia, ibonisa ubukhulu besimo. I-arrhythmias ye-cardiac idinga ukwelashwa okuphuthumayo.
Ukuhlonza okuhlukile
Abantu abane- cirrhosis, ukwehluleka kwe-heart congestive , nesifo sikashukela basengozini enkulu yokuthuthukisa i-hyperkalemia. Ezinye izimo ezingapheli ezingaba yisici sibandakanya i-amyloidosis ne- sickle cell isifo .
Uma ngabe imithi enqunywe njenge-ACE inhibitors, i-angiotensin-receptor blockers, i- beta-blockers , i-cyclosporine, i-digoxin, i-minoxidil, i-spironolactone, ne-tacrolimus, qaphela ukuthi amazinga akho e-potassium anganda. Udokotela wakho angase afune ezinye izimbangela ze-hyperkalemia, njengokuhluleka kwenqunu kanye ne-hypoaldosteronism, njengoba kuchaziwe ngenhla.
> Imithombo:
> Kehnhardt A, uKemper MJ. I-Pathogenesis, Ukuxilongwa Nokuphathwa Kwe-Hyperkalemia. I-Pediatr Nephrol. 2011 Mar; 26 (3): 377-384. i-doi: 10.1007 / s00467-010-1699-3.
> Levis JT. Ukuhlolwa kwe-ECG: Hyperkalemia. I-Perm J. 2013 Ebusika; 17 (1): 69.ngabe: 10.7812 / TPP / 12-088
> Lewis JL. Hyperkalemia. I-Merck Manual: I-Professional Version. Kubuyekezwe ngo-Ephreli 2016. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hyperkalemia.
> Mount DB. Izimbangela nokuhlolwa kwe-Hyperkalemia kubantu abadala. Ku: Forman JP (ed), UpToDate [Inthanethi] , Waltham, MA. Kubuyekezwe ngo-February 2018.
> Simon LV, Farrell MW. Hyperkalemia. Ku: StatPearls [Inthanethi]. I-Treasure Island (FL): I-StatPearls Publishing. 2018 Jan-.