Hyperkalemie označuje stav, kdy je zvýšená hladina draslíku v krvi. Hyperkalemie je především nebezpečná životu potenciálním vyvoláním srdeční arytmie až náhlé smrti. Proto je velmi důležité dodržovat dietní opatření s omezením draslíku. Nutriční terapeut musí přistupovat k pacientům velmi individuálně a sestavit vhodný nutriční plán. Při jeho zpracovávání musí zohlednit laboratorní výsledky, stravovací zvyklosti pacienta a požadavky lékaře.
Hyperkalaemia refers to a condition in which there is an elevated potassium level in the blood. Hyperkalaemia is particularly life threatening by potentially causing cardiac arrhythmia or even sudden death. Therefore, it is essential to adhere to dietary measures with potassium restriction. A nutritional therapist must take a highly individual approach to the patients and develop an appropriate nutritional plan. When designing the plan, he or she must take into account the laboratory results, the patient's dietary habits, and the physician's requirements.
- MeSH
- Potassium MeSH
- Hyperkalemia * diet therapy MeSH
- Humans MeSH
- Nutrition Therapy * MeSH
- Fruit MeSH
- Food MeSH
- Vegetables MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
BACKGROUND: Hyperkalaemia is a life-threatening electrolyte disturbance and also a potential cause of cardiac arrest. The objective was to assess the effects of acute pharmacological interventions for the treatment of hyperkalaemia in patients with and without cardiac arrest. METHODS: The review was reported according to PRISMA guidelines and registered on PROSPERO (CRD42023440553). We searched OVID Medline, EMBASE, and CENTRAL on September 9, 2024 for randomized trials, non-randomized trials, observational studies, and experimental animal studies. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. Outcomes included potassium levels, ECG findings, and clinical outcomes. Certainty of evidence was evaluated using GRADE. RESULTS: A total of 101 studies were included, with two studies including patients with cardiac arrest. In meta-analyses including adult patients without cardiac arrest, treated with insulin in combination with glucose, inhaled salbutamol, intravenous salbutamol dissolved in glucose, or a combination, the average reduction in potassium was between 0.7 and 1.2 mmol/l (very low to low certainty of evidence). The use of bicarbonate had no effect on potassium levels (very low certainty of evidence). In neonatal and paediatric populations, inhaled salbutamol and intravenous salbutamol reduced the average potassium between 0.9 and 1.0 mmol/l (very low to low certainty of evidence). There was no evidence to support a clinical beneficial effect of calcium for treatment of hyperkalemia. CONCLUSIONS: Evidence supports treatment with insulin in combination with glucose, inhaled or intravenous sal-butamol, or the combination. No evidence supporting a clinical effect of calcium or bicarbonate for hyperkalaemia was identified.
- MeSH
- Albuterol * administration & dosage therapeutic use MeSH
- Administration, Inhalation MeSH
- Potassium blood MeSH
- Glucose administration & dosage MeSH
- Bicarbonates administration & dosage MeSH
- Hyperkalemia * drug therapy MeSH
- Insulin * administration & dosage therapeutic use MeSH
- Humans MeSH
- Heart Arrest drug therapy therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Review MeSH
- Systematic Review MeSH
Draslík (kálium) je hlavným intracelulárnym katiónom v organizme. Jeho distribúciu medzi intracelulárnym a extracelulárnym prostredím modulujú viaceré faktory, ako acidobáza, inzulín, glukagón, katecholamíny, aldosterón, osmolalita, fyzická aktivita. Bilancia je zabezpečovaná prevažne renálnou exkréciou a sčasti aj exkréciou gastrointestinálnym traktom. V článku sa rozoberajú najčastejšie príčiny hypo - a hyperkaliémie, ich diagnostika, diferenciálna diagnostika a liečba.
Potassium is the main intracellular cation in the human body. Its distribution between intracellular and extracellular envirobnment is modulated by various factors such as acid-base balance, insulin, glucagon, catecholamines, aldosterone, serum osmolality and, physical activity. Potassium homeostatsis is regulated by renal excretion, less important is gastrointestinal secretion. The most frequent causes of hypokalaemia and hyperkalaemia, including their diagnosis and treatment are discussed in the article.
U srdečního selhání je hyperkalemie problémem hned z několika důvodů, jimiž jsou například neurohumorální mechanismy v patofyziologii tohoto onemocnění, renální selhání, komorbidity a také léky, které přinášejí prognostický prospěch. Mezi takové léky patří inhibitory renin‑angiotenzin‑aldosteronového systému, které mohou zvyšovat hodnoty kalemie, zejména při kombinaci s jinými léčivy (např. s nesteroidními antirevmatiky). Pokud hyperkalemie není korigovaná, může mít závažné důsledky zejména pro srdce. Proto je velmi důležité respektovat některá pravidla ‒ uvážlivě předepisovat léky, které ovlivňují kalemii, brát v úvahu všechny faktory, které zvyšují riziko hyperkalemie, a pokud hyperkalemie vznikne, zahájit včas její léčbu. V tomto přehledu jsou shrnuty obvyklé postupy v léčbě hyperkalemie a rovněž diskutovány nové molekuly, jež mohou snížit riziko vzniku hyperkalemie (finerenon) nebo mohou účinně zmírňovat kalemii (chelační polymer patiromer či iontové síto zirkonium‑cyklosilikát sodný).
In heart failure, hyperkalaemia is a frequent problem because of several factors, such as neurohumoral mechanisms involved in pathophysiology of the disease, renal failure, comorbidities, and also drugs with prognostic benefit. Among such drugs are inhibitors of the renin‑angiotensin‑aldosterone system, which can increase potassium levels, especially when combined with other drugs, such as nonsteroidal antirheumatics and others. Hyperkalaemia can have severe consequences, if not corrected, mostly cardiac. Therefore, it is important to respect some rules, like prescribing drugs influencing potassium levels prudently, managing all factors increasing the risk of hyperkalaemia, and treating hyperkalaemia immediately if it develops. This overview summarizes all usual treatments of hyperkalaemia. New molecules are also discussed that can decrease the risk of developing hyperkalaemia, like finerenone, or decrease plasma potassium effectively, like chelating polymer patiromer or ion sieve sodium zirkonium cyclosilicate.
- MeSH
- Electrocardiography MeSH
- Hyperkalemia * etiology drug therapy complications MeSH
- Angiotensin-Converting Enzyme Inhibitors administration & dosage adverse effects therapeutic use MeSH
- Ions MeSH
- Investigational New Drug Application * methods MeSH
- Disease Attributes MeSH
- Humans MeSH
- Naphthyridines administration & dosage adverse effects therapeutic use MeSH
- Kidney Diseases complications MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- Polymers therapeutic use MeSH
- Randomized Controlled Trials as Topic MeSH
- Renin-Angiotensin System physiology drug effects MeSH
- Risk Factors MeSH
- Silicates MeSH
- Heart Failure * drug therapy complications prevention & control MeSH
- Statistics as Topic MeSH
- Age Factors MeSH
- Zirconium MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Potassium MeSH
- Hyperkalemia * epidemiology therapy MeSH
- Humans MeSH
- Emergency Service, Hospital MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Letter MeSH
- Comment MeSH
671etá žena byla přijata na interní jednotku intenzivní péče s poruchou vědomí při naměřené hodnotě sérové glukózy 83 mmoUl. Současně byla diagnostikována hyperkalémie 8,5 mmol/1, normochloremická metabolická acidóza a hyperosmolalita. K ovlivnění nepříznivých parametrů bylo zvažováno užití extrakorporální eliminační metody. Po zvážení rizika se však postupovalo konzervativně. Pacientka byla po šestnácti dnech propuštěna do domácí péče.
67-year-old woman was admitted to hospital for alteration of consciousness. Hyperglycaemia 83 mmoUl, hyperkalaemia 8.5 mmoUl, severe metabolic acidosis and hyperosmolality was recorded. We considered to use renal replacement therapy. Because the high risk of complications we decided to use conservative therapy. This metod was effective.
These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating room, cardiac surgery, catheter laboratory, dialysis unit, dental clinics, transportation (in-flight, cruise ships), sport, drowning, mass casualty incidents), and special patient groups (asthma and COPD, neurological disease, obesity, pregnancy).
- MeSH
- Hypothermia * MeSH
- Cardiac Surgical Procedures * MeSH
- Cardiopulmonary Resuscitation * MeSH
- Humans MeSH
- Resuscitation MeSH
- Heart Arrest * etiology therapy MeSH
- Pregnancy MeSH
- Water-Electrolyte Imbalance * MeSH
- Check Tag
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Akutní selhání ledvin je charakterizováno rychlým poklesem hodnoty glomerulární filtrace. Klinicky se nej-častěji manifestuje náhlým zvýšením a pokračujícím nárůstem hodnot sérového kreatininu a močoviny. Časná léčebná opatření zahrnují úpravu objemu tekutin, léčbu hyperkalemie a metabolické acidozy. Akutní selhání ledvin se vyskytuje relativně často, jeho léčba je nákladná a výsledky jsou zatíženy komplikující morbiditou a značnou mortalitou. Ve snaze snížit jeho výskyt je nutná prevence rizikových faktorů, identifikace rizikových nemocných a časné diagnostické vyšetření. Čím časnější je stanovení diagnózy, tím účinnější jsou léčebné postupy k zmírnění irrevezibilního poškození nefronů ledviny.
Acute renal failure is characterized by a rapid fall in the glomerular filtration rate. The most common clinical manifestation is an abrupt and sustained rise in creatinine and urea. Life threatening consequences include volume overload, hyperkalaemia and metabolic acidosis. Acute renal failure is both common and cost-ly and carries a high morbidity and mortality. As it is often preventable, identification of patients at risk and the institution of appropriate preventivě measures are critical. In incipient or established acute renal failure, rapid recognition and treatment may prevent irreversible loss of nephrons.
BACKGROUND: A 2-year-old intact female Irish Setter was presented with a 1-week history of anorexia, lethargy, vomiting and diarrhoea. Previous medical therapy included a 3-week treatment with phenobarbitone for suspected idiopathic epilepsy. In humans, phenobarbitone accelerates metabolism of both exogenous and endogenous steroids. CASE REPORT: Based on history, the physical examination showing abnormal mentation and laboratory abnormalities including azotaemia, hyponatraemia and hyperkalaemia, Addisonian crisis was suspected. An adrenocorticotropic hormone stimulation test was performed and confirmed the diagnosis. Treatment with intravenous fluid therapy, glucocorticoids and mineralocorticoids led to a resolution of clinical signs in 3 days. CONCLUSION: To the authors' current knowledge, this is the first reported case of Addisonian crisis in a dog most probably related to phenobarbitone administration. As Addisonian crisis can be life-threatening, clinicians should be aware of this adverse effect of phenobarbitone and use it cautiously in dogs with borderline hypoadrenocorticism.
- MeSH
- Addison Disease chemically induced veterinary MeSH
- Acute Disease MeSH
- Anticonvulsants adverse effects MeSH
- Epilepsy, Generalized drug therapy veterinary MeSH
- Phenobarbital adverse effects MeSH
- Dog Diseases chemically induced MeSH
- Dogs MeSH
- Animals MeSH
- Check Tag
- Dogs MeSH
- Female MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
