Hyperkalemia - causes and symptoms of the disease, diagnosis and methods of drug therapy. Hyperkalemia - symptoms, causes, treatment Hyperkalemia occurs when

In some cases, an increase in the amount of vitamins and minerals in the body causes severe malaise and even the development of various rather serious ailments. Such a violation of health can be provoked by many factors, they require close attention and adequate correction under the supervision of a doctor. A rather dangerous pathological condition of this kind is considered hyperkalemia. Let's talk on www.site how hyperkalemia is treated, what it is, what symptoms indicate it.

What is hyperkalemia?

Hyperkalemia disease is a pathological condition that is accompanied by an increase in the amount of potassium electrolytes in the blood, and at the same time poses a threat to human life. Patients with such an ailment require prompt and adequate medical care, as the disease can cause cardiac arrest due to untimely therapy.

It is known that the optimal level of potassium in the blood is 3.5-5 mmol/L. Approximately 98% of this substance is found in the cells, and the remaining two percent are present in the intracellular fluid (including blood).

Potassium is necessary for the accomplishment of a mass of physiological processes, and an increase in its concentration in the blood can be provoked by excessive consumption or inefficient excretion of this element.

About how hyperkalemia manifests itself (symptoms of the disease)

Mild hyperkalemia can practically not make itself felt. Most often, it is diagnosed after a routine blood test or in the presence of changes in the electrocardiogram. In certain cases, a mild form of hyperkalemia can be manifested by a violation of the rhythm of heart contractions, the patient feels them as a heartbeat.

More pronounced hyperkalemia usually causes more pronounced malaise. When conducting an ECG, high T-waves, increased ORS and P-R intervals become noticeable. In addition, the disease causes ventricular, severe muscle weakness. The doctor may note the appearance of cardiac arrhythmia, sharpening of the T wave on the electrocardiogram, as well as an increase in the amount of potassium up to 7 mmol / l or even more.

About how hyperkalemia is corrected (treatment of the disease)

The choice of therapy for this disorder depends solely on the causes of its development. In the event that the potassium level reaches 6.5 mmol / l or exceeds this figure, it is necessary to immediately take measures to reduce it to a normal level. A similar effect can be achieved by introducing calcium (in the form of calcium chloride or). Such a drug is able to quickly and effectively neutralize the toxic effects of hyperkalemia. An excellent effect is given by intravenous administration of a ten percent solution of calcium gluconate. Within one to five minutes, thirty to fifty milliliters of such a composition is injected.

It is worth noting that one ampoule of calcium chloride contains three times more calcium than calcium gluconate. Such a remedy begins to act in a few minutes (less than five), and the effect of its administration lasts about half an hour to an hour. The dosage is selected against the background of constant ECG monitoring during administration.

In addition, to treat hyperkalemia and reduce the likelihood of complications, various medical manipulations can be performed that can temporarily stop the aggressive effects of potassium before it is removed from the body. Some patients are given ten to fifteen units of insulin intravenously (combined with fifty milliliters of fifty percent dextrose). Such therapy leads to a displacement of potassium ions into the cells and its effectiveness remains stable for several hours. In parallel, other corrective measures are being taken.

So, bicarbonate can also be used to shift potassium into the cells. Patients are given one ampoule over five minutes.

A good effect is also given by the use of salbutamol (albuterol or ventolin), beta 2-selective catecholamines in the amount of ten to twenty milligrams.

If hyperkalemia is particularly severe, the patient needs hemodialysis or hemofiltration. Such measures help to quickly and effectively eliminate excess potassium from the body. They are used when the underlying causes of hyperkalemia cannot be corrected quickly.

In order to reduce potassium levels over several hours, the patient is shown oral or rectal use of sodium polystyrene sulfate. Furosemide also helps to speed up the excretion of potassium along with urine.

How to treat hyperkalemia if it is not severe?

Patients with mild hyperkalemia should limit the amount of potassium in the diet to forty to sixty mmol / day. They should stop taking drugs that can slow down the excretion of potassium from the body. Such drugs include potassium-sparing diuretics, NSAIDs, and ACE inhibitors.

To prevent severe hyperkalemia, it is also necessary to exclude the use of medications that can move potassium from the cells to the intracellular space. These drugs include primarily beta-blockers.

To accelerate the excretion of potassium from the body, loop and thiazide diuretics are used (in the absence of contraindications).

Hyperkalemia is a rather serious condition that requires immediate correction under the supervision of a doctor. Lack of adequate and timely therapy can pose a threat to the life and health of the patient.

Hyperkalemia is a condition that develops as a result of an increase in the content of potassium in the blood serum (while its level exceeds 5 mmol / l).

Hyperkalemia is diagnosed in approximately 1-10% of patients presenting to hospitals. However, its prevalence has increased in recent years. This is mainly due to an increase in the number of prescriptions to patients of drugs that can affect the RAAS (renin-angiotensin-aldosterone system), the main tasks of which are to maintain systemic arterial pressure and normal blood flow in vital organs (liver, heart, kidneys, brain).

Potassium and its role in the human body

Potassium is the main intracellular cation. Along with sodium, it maintains the balance of acids and alkalis in the body, normalizes the water-salt balance, has a decongestant effect, and activates many enzymes. In addition, it plays a key role in the conduction of nerve impulses and contraction of skeletal and cardiac muscles.

Potassium salts make up half of all salts contained in the body, and it is their presence that ensures the normal functioning of blood vessels, muscles, and endocrine glands. Potassium prevents the accumulation of excess sodium salts in the vessels and cells of the body and, thereby, has an anti-sclerotic effect. It helps prevent overwork, reduces the risk of chronic fatigue syndrome.

To ensure the optimal balance of potassium in the body, it is necessary that all its regulatory mechanisms function and interact as smoothly as possible. The role of the main mechanism-regulator of potassium is performed by the kidneys, and their activity, in turn, is stimulated and controlled by the hormone aldosterone secreted by the adrenal glands. Normally, even with an increased intake of potassium from food, this mechanism maintains its constant level in the blood serum. In cases where there is a violation of the regulation of potassium, and as a result of this, hyperkalemia develops, disturbances also occur in the activity of the nervous and cardiovascular systems.

The danger of hyperkalemia lies in the fact that it, causing disturbances in cardiac contractions, provokes a change in the course of electrical processes in it. The consequence of this is: intoxication of the body, arrhythmia and even cardiac arrest. Therefore, even with a mild form of hyperkalemia, treatment is required immediately, with the use of intensive care measures.

Causes of hyperkalemia

The main causes of hyperkalemia are a violation of the redistribution of potassium from the intracellular space to the extracellular space, as well as potassium retention in the body.

Hyperkalemia can develop as a result of a decrease in excretion (discharge) by the kidneys. This condition is caused by:

• Renal failure, when up to 1000 mEq of potassium is excreted by the kidneys during the day - a dose that significantly exceeds the amount of potassium that normally enters the body;
• Damage to the kidney tissue, as a result of which hyperkalemia develops even with a reduced (compared to the average indicator) potassium intake;
• Conditions in which the adrenal cortex secretes less aldosterone than is required for the normal functioning of the body (hypoaldosteronism). Such conditions are accompanied by adrenal insufficiency, as well as a decrease in the level of sensitivity of the epithelial tissue of the tubules to aldosterone, which is observed in patients with nephropathy, systemic lupus erythematosus, amyloidosis, with lesions of the renal interstitium, etc.

Hyperkalemia due to improper redistribution of intracellular potassium into the blood is provoked by:

• Various types of cell damage and their destruction, which can occur due to the destruction of blood cells (leukocytes, platelets, erythrocytes), with oxygen starvation, a decrease in blood supply to tissues, as well as their necrosis; with the development of a syndrome of prolonged tissue crushing, burns, an overdose of cocaine;
• Hypoglycemic disease due to increased breakdown of glycogen and enzymatic hydrolysis of proteins and peptides, as a result of which an excessive amount of potassium is released, leading to hyperkalemia;
• intracellular acidosis.

At the same time, excessive intake of potassium in the body with food or medications taken does not cause the development of persistent hyperkalemia.

Excessive consumption of potassium-containing products can cause hyperkalemia only in those cases when, in parallel, the level of potassium excreted with urine decreases in the body (in case of impaired renal function).

Symptoms of hyperkalemia

Regardless of the causes of hyperkalemia, the disease in the initial stages practically does not manifest itself. At this stage, it is often diagnosed absolutely by chance during tests or during the passage of an electrocardiogram. Prior to this, the only symptom of hyperkalemia may be only a slight disturbance of the normal heart rhythm, which, as a rule, goes unnoticed by patients.

As the pathological process progresses, the number of symptoms of hyperkalemia increases significantly. In this case, the disease is accompanied by:

• Spontaneous vomiting;
• stomach cramps;
• Arrhythmia;
• Reducing the number of urges to urinate, which is accompanied by a decrease in the amount of urine output;
• Increased fatigue;
• Frequent clouding of consciousness;
• General weakness;
• Convulsive twitching of muscles;
• Change in sensitivity and the appearance of a tingling sensation in the limbs (in the hands, feet) and in the lips;
• Progressive ascending paralysis affecting the respiratory system;
• ECG changes (the earliest symptom of hyperkalemia).

Treatment of hyperkalemia

The method of treating hyperkalemia directly depends on the nature of the course of the disease and the causes that provoked it.

With a critical increase in the level of potassium over 6 mmol / l, when the patient is threatened with cardiac arrest, it is required to take a set of emergency measures aimed at reducing it. So, intravenous administration of a solution of chloride or calcium gluconate should normally have a positive effect after 5 minutes. When this does not happen, the dose of the drug is administered again. The action of the solution continues for three hours, after which the procedure is repeated.

Subsequent therapy involves the appointment of drugs that inhibit the further development of hyperkalemia and the development of complications.

Hyperkalemia is a deviation of potassium levels in the human body upwards. It can be caused by both malfunctioning of the kidneys and an abnormal release of potassium from the cells.

Also common causes are a violation of the acid-base balance and progressive uncontrolled diabetes.

An excess of potassium is possible with dehydration and the use of foods with a saturated concentration of potassium, medicines containing potassium, and the inability of the kidneys to remove potassium concentrates in the urine.

Hyperkalemia is usually manifested by weakness in the muscles. For accurate diagnosis of elevated potassium levels, ECG (electrocardiography) is used, because the rise in the amount of potassium in the blood affects the performance of the myocardium.

ICD-10 code

Pathology according to the international classification of diseases is in the group "Disorders of water-salt metabolism", this also includes conditions in which alkaline-acid disorders occur, with a general coding E 87.5.

Causes of excess potassium in the blood

To fully understand where hyperkalemia comes from, one should understand where potassium comes from in the body, what functions it performs, and how it is excreted from the body.

The ingestion of potassium into the human body occurs with the consumption of food and liquids. Rarely, with a large intake of potassium-containing foods and liquids every day, the human body still maintains normal levels.

In order to remove such an electrolyte as potassium, the body connects the work of the kidneys, which are controlled by hormones.

They can both affect the speedy excretion of potassium, and its retention in the body.

Potassium is concentrated within cells and maintained at normal plasma levels.

This indicator does not depend on the body's water balance, because only two percent of potassium is outside the cells.

Most of it leaves the body in the urine (up to 80 percent), which is why the kidneys play an important role in maintaining normal levels of potassium in the body.

The main causes that provoke hyperkalemia are factors associated with the irrational distribution of potassium (in and out of cells), as well as its accumulation in the body.

With an excess of leukocytes, or increased deformation of platelets and erythrocytes, there is a loss of potassium by the cells. In such a situation, hyperkalemia is assigned the value of "false", since the concentration inside the cells of other tissues of the body does not change.

The most common pathologies in which potassium is released into the space outside the cell are:

The leading place among all the possible causes of hyperkalemia are problems with the functioning of the kidneys.

How does hyperkalemia work in the kidneys?

In order to understand what processes occur in the kidneys with hyperkalemia, It should be understood that the performance of the kidneys depends on the following factors:

• A quantitative indicator of healthy nephrons, which are the smallest elements of the structure of the kidneys, and consist of renal tubules and tubules;
• Normal content of aldosterone, which is a hormone secreted by the adrenal glands;
• It is also important to have a normal fluid intake and a satisfactory amount of arriving sodium in the blood.

The above components control the rate of CF (glomerular filtration rate). An excess of potassium is recorded when the GFR falls below 15 milliliters per minute, or when a person's urine output falls below one liter in 24 hours.

Normal glomerular filtration rate is 80-120 milliliters per minute.

Falling GFR is usually a sign of kidney failure, which in turn leads to hyperkalemia. Also, potassium can be retained with the help of the hormone renin. This happens because this hormone activates the work of aldosterone, and when it declines in the body, it leads to Addison's disease.

This can be provoked by certain medications (Captopril, Indomethacin). People suffering from diabetes and the elderly are predominantly affected.

A blow to the renin also occurs as a result of chronic nephritis, sickle cell anemia, direct kidney damage, and diabetes.

Violation of GFR accompanies kidney failure, in which tissue death occurs, leads to rapid progression of hyperkalemia.

Symptoms of hyperkalemia

The main symptom associated with hyperkalemia is general weakness in the muscles. But there are other symptoms that can be used to suspect the progression of the disease.

Among them:

In many cases, hyperkalemia occurs without symptoms, before the onset of cardiotoxicity and complications. So if you feel the first symptom - general fatigue, you should immediately go to the hospital for further examination.

Diagnostics

Diagnosis of this pathology occurs when the saturation of potassium in the plasma is more than 5.5 mmol / l. In extremely rare cases, symptoms may not appear. In childhood, more than 6 - 6.5 mmol / l is taken as an indicator of potassium above the norm.

With age, these figures decrease, and by one month they are set within 5.7-6 mmol / l. The causes that provoke the progression of hyperkalemia in children are no different from adults.

The excess of potassium in the blood is more than 8 mmol / l. may cause cardiac arrest.

Severe forms of hyperkalemia need prompt treatment. This should be borne in mind, first of all, by patients suffering from kidney failure, developing heart failure, using diuretics (diuretic drugs) and ACE inhibitors (prevention of heart and kidney failure), or patients with other kidney pathologies.

The diagnosis consists of: examination, study of the history and medications taken, determining the level of potassium in the blood and urine, conducting an ECG (electrocardiography), as well as with kidney damage - ultrasound (ultrasound).

Additional studies for hyperkalemia include:

• Clinical blood test;
• Biochemistry of blood. Allows you to get accurate data on the level of potassium concentration in the blood;
• Electrocardiogram (ECG). Allows you to determine the obvious deviations characteristic of hyperkalemia. In the results of the cardiogram, a T-wave indicator is noted, which indicates a problem in the heart muscle. With the progression of hyperkalemia, without proper treatment, the P waves disappear, which indicates ventricular tachycardia, or their fibrillation, and in extreme cases, asystole;
• Ultrasound examination of the kidneys (ultrasound). This study helps to determine the condition of the kidneys, and the presence of abnormalities in them.

What is the relationship between hyperkalemia and diabetes?

In patients with type 1 diabetes, insulin concentration is important to save life. With an increase in potassium in the blood, diabetic ketoacidosis (impaired carbohydrate metabolism) occurs, which is a painful complication of diabetes.

With an insufficient amount of insulin, the glucose level rises, reaching the upper critical levels. Its high level provokes alkaline-acid processes, which causes potassium to be released from the cells.

Diabetics have a low efficiency of the kidneys, to remove potassium from the body. Consequently, potassium levels rise and hyperkalemia progresses.

How is hyperkalemia treated?

Therapy, in the treatment of this pathology, is aimed at restoring the normal level of potassium in the blood, eliminating the complications and symptoms caused by hyperkalemia. Treatment for different degrees of severity of hyperkalemia is different.

Mild degrees of severity include a concentration of not more than 6 mmol / l, with normal ECG values.

In this case, therapy is limited to:

• The introduction of a diet low in potassium;
• Eliminate the influence of medications that change the level of potassium in the blood;
• Introduce a diuretic (at the doctor's choice) with a loop effect, in order to increase the excretion of potassium from the body.

Predominantly recommended Polystyrene, which is dissolved in sorbitol. This drug glues excess potassium and removes it through the intestinal mucus. A side effect is an increase in the concentration of sodium in the blood, as potassium is converted to sodium.

The following foods can be included in the diet that reduce potassium levels in the blood:

• Fresh vegetables. From vegetables, carrots and cabbage are perfect for eliminating hyperkalemia;
• Products from the category of greens. It would be appropriate to use onions, asparagus, celery and parsley;
• Among the berries that lower potassium are: cranberries, blackberries, blueberries and strawberries;
• Fresh fruits such as plums, peaches, pineapples, grapes have a positive effect on potassium;
• Citrus fruits: lemons, tangerines, oranges.
• Pasta;
• alfalfa sprouts;

In addition to the introduction of foods that lower potassium, those foods that contribute to its growth should be excluded from the diet.

Among them:

• Watermelons;
• Any kind of chocolate;
• Nuts, pistachios, seeds of any kind, raisins;
• Wheat;
• Salmon and tuna;
• Milk products;
• Tomatoes (tomato paste), beets;
• soy products;
• Dates.

In the case of a mild form of hyperkalemia in infants, proper nutrition is necessary for both the mother who is breastfeeding and the child.

Cooking quick meals, such as mivina, cereals and soups in bags, etc., is not recommended.

Therapy for moderate and severe degrees implies more potent and urgent measures to normalize the level of potassium in the blood.

With the accumulation of potassium in the blood more than 6 mmol / l, and the accompanying deviations in the indicators of the cardiogram (ECG), urgent therapy is needed, aimed at moving potassium away from the body.

First of all, you need to do the following:

1. Introduce calcium gluconate (10%), in a volume of ten to twenty milliliters. This will prevent the effects of the increase in potassium on the myocardium. Calcium gluconate should be administered only as prescribed by a doctor, and strictly under his supervision. Since if you introduce calcium gluconate, with the use of glycosides (Digoxin), arrhythmia may begin to progress, caused by a lack of potassium in the body. In case of deviations on the cardiogram, in the form of a wave, or the cessation of the activity of the heart, the intake of the drug can be increased to the level of 10 milliliters in two minutes.
   Relief will come after a couple of minutes, but will not last long. After 30 minutes everything will resume, so the effect is only temporary;
2. The use of insulin in the dimension of 5-10 units per vein, with the immediate next injection of a 50% glucose solution, in the amount of 50 milliliters, as well as dextrose, will help lower the potassium level after an hour, and will last as long as possible. The duration of action reaches several hours. The peak effect is noted after an hour and a half, after injection;
3. The use of inhalations with the drug Albuterol, lowers blood saturation with potassium, for up to one and a half hours. It is necessary to breathe 10 milliliters of the solution;
4. In order to quickly remove excess potassium in the body with hyperkalemia, apply Polystyrene sulfonate. All of the above measures are not able to treat kidney failure, it should be carried out when connected to an artificial kidney machine (hemodialysis).
5. A controversial option is the introduction of NaHCO (sodium bicarbonate). Its introduction into the body briefly reduces the levels of potassium in the body. In the presence of kidney pathologies, the effectiveness of treatment in this way decreases.

Hyperkalemia, clearly progressive and displayed in the cardiogram, puts the patient's life at risk. With such deviations, it is urgent to apply treatment to normalize potassium in the blood.

In kidney failure, patients are connected to a hemodialysis machine to remove large amounts of potassium in the blood.

Hemodialysis machine

Effective treatment will be prescribed only by a qualified doctor, since individual indicators and concomitant diseases are different for everyone.

But in most cases, an intensive course of treatment is the use of all of the above methods.

To prevent relapse, you must carefully monitor your diet and medication intake. For all questions, it is better to consult a qualified doctor.

How to prevent the occurrence of hyperkalemia?

In order to prevent the occurrence of this pathology, it is necessary to adhere to a certain diet, with approximately equal saturation with useful substances.

Adjustment of the diet for the prevention of high potassium is as follows:

Herbal preparations will also help maintain the normal state of the body. They can be infused and consumed as a tea.

These herbs include:

• nettle;
• Medicinal dandelion;
• Horsetail leaves;
• Alfalfa.

Expert forecast

A fatal outcome is possible only with the rapid progression of hyperkalemia and the complete inactivity of the patient. If symptoms are detected, and the earliest treatment to the hospital, treatment is started within an hour after diagnosing the pathology.

In the case of mild forms of the disease, correction of the diet mainly helps to resolve the issue and the outcome is favorable. But you should continue to see a doctor.

In the case of severe stages, everything depends on how quickly and effectively the treatment is prescribed and applied. In such situations, the presence of kidney pathologies and other diseases play an important role.

When remission is achieved, nutrition should be normalized, and the course of treatment prescribed by the doctor should be followed, as well as being examined regularly.

Do not self-medicate and be vigilant!

Hyperkalemia is an increase in the content of potassium in the blood above 5 mmol / l. It appears when there is an increased exit of ions from cells or a violation of their excretion by the kidneys. An excess of this electrolyte leads to a violation of the conduction of the myocardium, and with a sharp increase in the level, cardiac arrest is possible. Learn more about the causes of hyperkalemia, its symptoms and treatment methods in this article.

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Potassium in the body regulates all the functions of the myocardium: excitability, automatism, conduction of impulses and contraction of muscle fibers. Normally, even with increased intravenous administration of potassium salts, they are quickly excreted by the kidneys without causing significant changes in the electrolyte composition of the blood.

In diseases of the kidneys, and especially with low filtration capacity, a number of medications can cause hyperkalemia. These include:

• potassium preparations in tablets (Kalipos prolongatum, Caldium);
• infusion solutions;
• (Triampur, Veroshpiron);
• (Enap, Kapoten);
• angiotensin receptor blockers (Valsakor, Candesar);
• non-steroidal anti-inflammatory drugs (Ibuprom, Naproxen, Rancelex);
• cytostatics (Cyclosporin).

Hyperkalemia can be caused by:

• with autoimmune diseases, infections, transfusion of incompatible blood, poisoning with hemolytic poisons;
• tissue breakdown due to a malignant tumor;
• damage to muscle fibers in trauma, dermatomyositis;
• extensive burns;
• increased acidity of the blood (acidosis);
• insulin deficiency in diabetes mellitus;
• the use of beta-blockers, muscle relaxants, against the background of metabolic disorders or potassium excretion;
• congenital disorder of the structure of sodium channels (hyperkalemic paralysis), characterized by a sharp weakening of the limbs during physical activity;
• heatstroke;
• dehydration;
• diseases of the endocrine system: Addison's disease, pseudohypoaldosteronism;
• sickle cell anemia;
• medicinal and autoimmune nephritis;
• urolithiasis, prostate hypertrophy, obstructing the outflow of urine.

A stable chronic increase in potassium in the blood in almost all cases is caused by a decrease in its excretion by the kidneys. In acute renal failure, there is an increased release of it from the cells due to the active breakdown of proteins and acidification of the blood, and in the chronic form of the pathology, hyperkalemia is explained by the weak filtering ability of nephrons.

Symptoms in adults and children

For a long time, hyperkalemia does not manifest itself clinically, and then, when a level of 6-8 mmol / l is reached, patients experience:

• sharp muscle weakness up to paralysis of the limbs (often ascending, sluggish);
• violations of the clarity of speech;
• apathy, drowsiness;
• dizziness;
• shortness of breath, with an increase in the concentration of ions, respiratory failure appears;
• feeling of interruptions in the work of the heart;
• nausea;
• increased sweating;
• decrease in urine output;
• pain in the chest, abdomen;
• , turning into bradycardia or;
• inhibition of intestinal peristalsis.

In newborns, hyperkalemia is associated with functional immaturity of the renal tubules, late cord ligation, severe acidosis, or hemolysis of the blood.

A feature of the course of pathology in young children is the appearance of the first signs when the concentration of potassium exceeds 7 mmol / l. Frequent regurgitation, vomiting, adynamia, lethargy are noted, the rhythm of heart contractions, reflexes and intestinal motility are disturbed.

Watch the video about the importance of potassium in the human body:

ECG indications

The most severe manifestations of hyperkalemia are associated with impaired conduction in the myocardium. The following typical signs appear on the ECG:

• high and sharp T, shortening of ST;
• PQ extension;
• expansion of the ventricular complex and subsequent fusion with T;
• decrease in atrioventricular conduction;
• gradual disappearance of the atrial wave.

With the progression of electrolyte disturbances, sinusoidal waves are recorded instead of the typical form of P and QRS. If no help is provided at this stage, then a complete blockade of impulses or ventricular fibrillation develops, followed by asystole (cardiac arrest).

It should be noted that rhythm disturbances do not have a direct dependence on the content of potassium in the blood, and their severity depends on the initial electrical stability of the myocardium. In patients with angina pectoris, cardiosclerosis or myocarditis, excess potassium has a more pronounced cardiotoxic effect.

ECG with an increase in potassium in the blood

Other diagnostic methods

First of all, when examining blood, it is necessary to exclude a false increase in potassium. It is associated with its release from the cells during sampling. This situation can occur with prolonged or intense squeezing of the hand with a tourniquet, hemolysis or a high concentration of leukocytes, platelets. When blood coagulates, potassium also passes into the extracellular space, which leads to an increase in its level.

In order to correctly diagnose, you need:

• measure plasma concentration, not serum;
• explore others;
• take into account diuresis, renal filtration rate;
• exclude the influence of medicines and food;
• analyze the gas and acid-base composition of the blood;
• determine the activity of renin and aldosterone in the blood.

Treatment of hyperkalemia

A slight increase (up to 5.5 mmol / l) with preserved kidney function does not require special treatment. If signs of arrhythmia appear, or the patient has renal insufficiency, then therapy begins from the first minutes of diagnosis. The purpose of therapeutic measures is to transfer potassium into the cells and accelerate its removal from the body, restoring a normal ECG.

Correction in children

If potassium is in the range up to 7 mmol/l, then the introduction of a cation exchange resin (sodium polystyrene sulfonate with sorbitol) is usually sufficient.

At higher values ​​and changes in the electrocardiogram, calcium gluconate and sodium bicarbonate are administered. If this was not enough, then a dropper with glucose and short-acting insulin is connected. All this time, it is necessary to monitor the electrolyte composition of the blood and ECG. In severe condition, hemodialysis is performed.

Adult drugs

The main medicines can be used the same as for children, but in appropriate dosages. If necessary, beta-agonists are added to therapy, which reduce the level of potassium (Ventolin, Salbutamol) and diuretics (Lasix, Hypothiazide), which accelerate its excretion in the urine.

With a deficiency of aldosterone, it is required to provide its injection (Desoxycorticosterone acetate).

Diet for acute hyperkalemia

Foods rich in potassium are completely excluded from the diet. To do this, you need to follow these recommendations:

• vegetables - all fresh are prohibited, only boiled, greens, avocados, lentils, beans, green peas, potatoes are not recommended;
• fruits - a lot of potassium in bananas, melons, watermelon, citrus fruits, plums, apricots, grapes, cherries, pineapple, any dried fruits, so they are not allowed to patients;
• you can not eat meat, fish, you can not exceed 100 g of boiled chicken liver or shrimp per day;
• rye and bran bread, buckwheat, soy, chocolate, cocoa, molasses, nuts (especially peanuts) are removed from the menu.

Foods Not Allowed for Hyperkalemia

Prevention measures

It is possible to prevent hyperkalemia when conducting blood tests for electrolytes when taking potassium-sparing diuretics, beta-blockers, ACE inhibitors, and when using them, avoid adverse combinations - potassium preparations in tablets, vitamin complexes, dietary supplements or table salt substitutes.

If long-term therapy with drugs that affect the concentration of potassium is planned, then a prerequisite is to monitor the filtration capacity of the kidneys and adjust the dose when it is reduced. It is also important to monitor the main functions of the myocardium using an ECG.

Hyperkalemia occurs when potassium is retained in the body due to impaired kidney function or massive cell destruction. It is characterized by muscle weakness, heart rhythm disturbance. In severe cases, ascending paralysis and cardiac arrest are possible.

For diagnosis, a blood test is performed and typical changes in the ECG are detected. A slight deviation can be corrected by diet, and if clinical or ECG signs appear, urgent therapy is necessary. With the ineffectiveness of medications, hemodialysis is prescribed.

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Hyperkalemia associated with a characteristic sequence of ECG changes. The earliest manifestation is a narrowing and sharpening in the form of a hut at the top of the T wave.
The QT interval at this stage is shortened, corresponding to a decrease in the duration of AP. Developing extracellular hyperkalemia reduces the resting membrane potential of the atria and ventricles, thereby inactivating sodium channels, which reduce Vmax and conduction velocity. The QRS complex begins to expand, and the amplitude of the P wave decreases. Prolongation of the PR interval may occur, sometimes followed by second- or third-degree AV block.

Complete disappearance of P waves may be associated with a nodal replacement rhythm or with the so-called sinoventricular conduction (with sinoventricular conduction, there is no excitability of the atrial myocardium with an intact conduction system.

In this case, the impulse from the sinus node is conducted to the ventricles through the AV connection with the formation of a pseudoventricular - without a P wave on the ECG - rhythm with narrow ventricular complexes.
This is a “latent sinus rhythm” that increases with exercise.)

ECG for hyperkalemia

In a later period development of hyperkalemia, the sinus impulse is conducted from the SA node to the AV node, but a clear P wave is not formed.
Moderate to severe hyperkalemia sometimes presents as ST elevation in the right precordial leads (V1 and V2) and mimics the ischemic injury current or pattern seen in Brugada syndrome. However, even severe hyperkalemia can have atypical or undiagnosed ECG changes.

Very pronounced hyperkalemia in the presence of some additional conditions leads to asystole, sometimes preceded by slow undulating (sinusoidal) ventricular flutter.

Triad, consisting of tall, pointed T waves (as a result of hyperkalemia), elongated (as a result of hypocalcemia), and LVH (as a result of arterial hypertension), is a highly probable sign of chronic renal failure.

As a result of electrophysiological changes associated with hypokalemia, on the contrary, hyperpolarization of CMC membranes occurs and the duration of AP increases. The main ECG sign of this abnormality is ST depression with flattened T-waves and enlarged U-waves. The U-waves may exceed the amplitude of the T-waves.

Clinical T wave separation and U wave on surface ECGs may be difficult or even impossible. The visible U-wave in hypokalemia and other pathological conditions may indeed be part of the T-wave, the shape of which changes under the influence of a voltage gradient between M-cells, or mid-myocardial cells, and adjacent myocardial layers.

Prolongation of repolarization in hypokalemia as part of the acquired long QT(U) syndrome predisposes to torsades de pointes tachycardia. Hypokalemia when taking digitalis also increases the likelihood of tachyarrhythmias.

Educational video deciphering the ECG for electrolyte disorders

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