高鉀血癥課件

Hyperkalemia

高鉀血癥皖南醫(yī)學(xué)院王方5·12汶川地震

學(xué)習(xí)目標(biāo)：3.Graspthemanagementofhyperkalemia.掌握高鉀血癥的處理原則。2.Familiarwiththeetiologyandclinicalmanifestationsofhyperkalemia;熟悉高鉀血癥的病因、臨床表現(xiàn)；1.Understandthesignificanceofpotassium;了解鉀的生理功能；Significanceofpotassium【鉀的生理功能】8%2%Internalpotassiumdistribution90%ICF（140－160mmol／L）ECF(3.5~5.5mmol/L)BoneK+Significanceofpotassium【鉀的生理功能】

Promotingthecellmetabolism參與和維持細(xì)胞的代謝

Regulatingtheosmoticpressureandacid-basebalance維持細(xì)胞內(nèi)滲透壓、酸堿平衡

Maintaintheexcitabilityofneuromusculartissue維持神經(jīng)肌肉組織的興奮性

Maintenanceofmyocardialphysiologicalfunctions維持心肌的生理功能Hypokalemia:

Classification鉀代謝異常種類低鉀血癥：Hyperkalemia:

高鉀血癥：serumpotassiumlevellessthan3.5mmol/L血鉀濃度低于3.5mmol/L.serumpotassiumlevelexceeds5.5mmol/L血鉀濃度高于5.5mmol/L.Etiology病因1.Excessivepotassiumintake鉀攝入過多2.Decreasedpotassiumexcretion腎排泄功能減退3.Movementofpotassiumfromtheintracellularfluidtotheextracellularfluid細(xì)胞內(nèi)鉀外逸Etiology病因1.Excessivepotassiumintake鉀攝入過多Overingestionofpotassium-containingfoodsormedications食入過多含鉀食物或藥物b.Rapidinfusionofpotassium-containingIVsolutions靜脈補(bǔ)鉀過量或過速Etiology病因2.Decreasedpotassiumexcretion腎排泄功能減退Renalfailure腎衰b.potassium-conservingdiuretics保鉀利尿劑

Spironolactone螺內(nèi)酯（安體舒通）

Triamterene氨苯蝶啶Etiology病因3.Movementofpotassiumfromtheintracellularfluidtotheextracellularfluid細(xì)胞內(nèi)鉀外逸Hypercatabolism:Crushinginjury、burns

分解代謝過度：擠壓傷綜合征、燒傷b.Age(stored)blood庫(kù)血c.Metabolicacidosis代酸clinicalmanifestations臨床表現(xiàn)1.Nuromuscular神經(jīng)、肌肉應(yīng)激性改變

興奮抑制：vaguemind、paresthesias、

profoundweakness、ascendingflaccidparalysisinthearmsandlegs2.Gastrointestinal消化道功能障礙

nausea、abdominaldistention、diarrheaclinicalmanifestation臨床表現(xiàn)

3.Cardiovascular心臟

bradycardia心動(dòng)過緩、dysrhythmias心律不齊、

cardiacarrest心跳驟停

4.Microcirculationdisturbance微循環(huán)障礙

Pale、cool,clammyskin、hypotension

ECGChangesTallpeakedTwavesT波高尖WidenedQRScomplexQRS波增寬ProlongedPRintervalPR間期延長(zhǎng)FlatPwaves、absentPWavesP波低平、無(wú)P波Management處理原則

Verifyresults假如你是值班人員你應(yīng)該怎么處理？Management處理原則禁鉀、抗鉀、轉(zhuǎn)鉀、排鉀Restrict、Anti、Transfer、RemoveManagement處理原則1.禁鉀Restrict

DiscontinueIVpotassium,andholdoralpotassiumsupplements.立即停止輸注或口服含鉀藥物。

Initiateapotassium-restricteddiet.

避免進(jìn)食含鉀高的食物。Management處理原則2.抗鉀Anti

AdministerIVcalciumgluconate.葡萄糖酸鈣

Objection:calciumantagonizestheactionofhyperkalemiaontheheart目的:Ga2+對(duì)抗K+對(duì)心肌的毒性作用Management處理原則3.轉(zhuǎn)鉀Transfer

IVadministrationofsodiumbicarbonate

5%NaHCO3

IVadministrationofregularinsulinandahypertonicdextrosesolutionGS+RI

Objection:causeatemporaryshiftofpotassiumintothecells目的:促使K+轉(zhuǎn)移入細(xì)胞內(nèi),暫時(shí)降低血鉀濃度HK+Management處理原則4.排鉀Remove

Cationexchangeresins陽(yáng)離子交換樹脂

Peritonealdialysis腹膜透析

Hemodialysis血液透析ReflectionQuestions

1.Anursereviewstheelectrolyteresultsofanassignedclientandnotesthatthepotassiumlevelis6.4mmol/L.WhichofthefollowingwouldthenurseexpecttonoteontheECGasaresultofthelaboratoryvalue?A.TallpeakedTwavesB.ProminentUwaveC.STdepressionD.InvertedTwave2.Female,28y,sufferingfromcrashinjuryonbothlowerextremities.Laboratorytest: