I-Hyperkalemia ifunyaniswa xa izinga lakho le-serum potassium lilinganisa 5.0 mEq / L okanye ngaphezulu. Ingabangelwa kukungenisa i-potassium eninzi, ingagcini i-potassium eyaneleyo, okanye i-potassium ephuma kwiiseli.
Ukuvavanya kunokunceda ukufumanisa ukuba zeziphi iindlela ezikhupha i-potassium yakho ephakamileyo. Kuphela xa uyazi ukuba kutheni u-hyperkalemia ungayiphatha ngokufanelekileyo kwaye unethemba lokuthintela ukuphindaphinda.
Uvavanyo lweGazi
Ngaphambi kokuhla kweendlela zokuvavanya ngokusemthethweni, ugqirha uya kufuna ukuqinisekisa ukuba unempilo ye-hyperkalemia. Amaxesha amaninzi, amazinga e-potassium aphakanyiswa ngamanga, imeko eyaziwa ngokuba yi-pseudohyperkalemia, ngenxa yegazi lakho .
I-tourniquet esetyenzisiweyo kakhulu okanye ide kakhulu ingabangela ukuba iiseli ezibomvu zegazi zibe ne-hemolyze okanye ziqhekeke, zenzeke i-potassium kwi-specimen. Ukuphindaphinda kwakhona kweengqindi ngexesha lokutshatyalaliswa kwamanzi kungenza ukuba i-potassium igule kwiiseli zakho, ukwandisa iziphumo zebhabhu zakho ngokubanzi ukuya kwi-1 ukuya kwi-2 mEq / L.
Umsebenzi wakho wokuqala ugqirha kukuphinda uhlaziye izinga lakho le potassium. Ukuba amazinga akho ahlala ephakamileyo, ugqirha wakho unokuyalela le mvavanyo elandelayo.
Uvavanyo lokuqala
Ukungaphumeleli kwe-Renal , nokuba kuyinto enzima okanye engapheliyo, yenye yezona zizathu eziqhelekileyo ze-hyperkalemia. Xa izintsi zihluleka, azikwazi ukukhupha i-potassium ngokufanelekileyo. Oku kunokukhokelela ekwakheni i-potassium egazini.
Igazi irea nitrogen (BUN) kunye ne-creinine ukulinganisa indlela iinjongo zakho ezisebenza ngayo kwaye zifakwe njengenxalenye yecandelo elisezantsi lokuxilonga. Ezinye iimvavanyo kwipaneli ziquka i-sodium, i-chloride, i-bicarbonate kunye ne-glucose. Ezi xabiso zetabha zisetyenziselwa ukubala i-anion gap, ukuba iphakanyisiwe, ibonisa i-acidosis ye-acidosis.
I-Acidosis inokubumba i-potassium ngaphandle kweeseli ize ibe negazi. Amanqanaba aphezulu e-glucose, njengoko anokubonakala kwi- diabetes engalawulwayo , unokukwenza okufanayo. Amanqanaba e-sodium ephantsi ekujongene namazinga aphezulu e-potassium angabonisa ukuba imeko ye-hormonal eyaziwa njenge-hypoaldosteronism.
Inani elipheleleyo legazi lingaba luncedo lokuvavanya. Inani elimhlophe legazi lingaba ngumqondiso wesifo okanye ukutshabalala emzimbeni. Iqondo eliphantsi le-hemoglobin kunye ne-hematocrit libonisa i-anemia. I-anemia ebangelwa ukuphuka kweeseli ezibomvu zeeseli, ezibizwa ngokuba yi- hemolytic anemia , zinokukhulula amanqanaba aphezulu e-potassium egazini.
- BUN
- Creatinine
- Iphaneli yamathambo
- Gcwalisa inani legazi
Iimvavanyo ezizodwa
Ngokuxhomekeke kwiimpawu zakho kunye nembali yezobugqirha, ugqirha wakho unokukhetha ukhetho olulandelayo.
- I-Aldosterone: I- Aldosterone yi-hormone eveliswa yi-adrenal gland elawula uxinzelelo lwegazi. Nangona amazinga e-potassium aphakamileyo kwaye amanqanaba e-sodium aphantsi, iqondo le-aldosterone liyadingeka ukuqinisekisa ukuxilongwa kwe-hypoaldosteronism. I-Hypotension ikwaqhelekile kwimeko.
- I-Creatinine phosphokinase (CPK): Amanqanaba aphakamileyo e-CPK akhombisa ukuba kukho ukulimala kwiimisipha. Akukona nje ukuba le ntsholongwane iphelelwe yimisipha kodwa inokukhukula iinjongo, ezikhokelela ekuphelelweni kwezintso kwizinto ezibizwa ngokuba yi- rhabdomyolysis . I-Potassium iphinda ivuke ngaphandle kweesisipha.
- Amazinga e-Digoxin: I- Digoxin yenye yeyeza ezininzi ezinokuthi zibe nefuthe elibi le-hyperkalemia. Ngokungafani ne-beta-blockers enokunyusa i-serum potassium, i-digoxin inokuhlolwa kwegazi ukujonga ukuba imithi ingakanani egazini lakho.
- Uric acid kunye neemvavanyo ze-phosphorus: Xa amaseli ehla, akhulula i-uric acid kunye ne-phosphorus ngaphezu kwe-potassium. Oku kunokwenzeka kwi-hemolytic anemia okanye i-flare-ups yesifo segleyile yesifo. Kungenzeka kwakhona kwi- tumor lysis syndrome xa kukho ukuphazamiseka okukhulu kweeseli emva kwe-chemotherapy.
Uvavanyo lweeUni
Uluhlu olulula olujongene negazi lubheka igazi, i-glucose, iprotheni, okanye usulelo kumchamo.
Iziphumo ezingavumelekanga zingabonisa i-glomerulonephritis, ukuvuvukala kweentso, okanye i-glomerulonephrosis, imeko engeyiyo yokuvuvukala apho iipilitheni zivuleka khona. Ingabonisa kwakhona isifo sikashukela esingalawulwayo.
Uvavanyo oluninzi lomchamo lunokuthi luqhutyelwe ukujonga ukuba iinjongo ziqhuba njani. Ukuba ukucinywa komchamo we potassium kunye ne-sodium kungaphakathi kwemida elindelekileyo, iintso aziyikusola. Isizathu esingafanelekiyo sifanele siphando. Ukuvavanya i-uryo myoglobin kunokuqinisekisa ukuxilongwa kwe-rhabdomyolysis.
- Uluhlu olusisiseko
- I-urine potassium kunye ne-sodium
- Urine myoglobin
Uvavanyo lweCardia
I-Hyperkalemia ingabangela i-arrhythmias yokusongela ubomi ukuba amazinga akho e-potassium aphakame kakhulu. I- electrocardiogram (ECG) ibaluleke kakhulu kwisixhobo sokuxilonga, kungekhona nje ukufumanisa imeko ezinzima ze-hyperkalemia kodwa ukuchonga ukuba luhlobo luni lwe-arthmia.
I-ECG imilinganiselo yokuqhuba umbane ngeentliziyo, ukusuka kumagumbi aphezulu entliziyweni, i-atria, kumagumbi angaphantsi, ii-ventricles. Umgca ngamnye kwi-ECG esuka kwi-PQRST ibonisa ukusetyenziswa okanye ukubuyisela ikamelo elithile le-muscle yenhliziyo.
Njengoko i-serum potassium iyanda, utshintsho lwe-ECG luba nzima kakhulu. Ukuqala kumanqanaba ama-5.5 meq / L nangaphezulu, ii-ventricles zinokuba nzima ukubuyisela. Oku kungabonwa njengama-t-waves ama-ECG. Ukusebenza kwe-Atrial kuthintela kwi-6.5 mEq / L ukuze ama-p-waves angabonakali. Kwi-7.0 mEq / L, amaza e-QRS awandisiwe, ahambelana nokusebenziselwa ukulibazisa kwee ventricle.
I-cardiac arrhythmias inokukhula kwi-8.0 mEq / L. Oku kungaquka yonke into esuka kwi-sinus bradycardia ukuya kwi- tachycardia ye-ventricular . Kwiimeko ezinzima kakhulu, i-asystole, ukulahleka kwayo yonke imiphumo yombane, inokwenzeka. Nangona i-ECG ingayifumani i-hyperkalemia, ibonakalisa ubunzima bemeko. Iinqununu zemizimba zifuna unyango olusandula.
Ukuxilongwa ngokungafani
Abantu abane- cirrhosis, ukungaphumeleli kwentliziyo yesifo , nesifo sikashukela basengozini enkulu yokuphuhlisa i-hyperkalemia. Ezinye izimo ezingapheliyo ezinokuba yinto ebandakanya i-amyloidosis kunye nesifo segciwane lesangqa .
Ukuba unikwe imithi efana ne-ACE inhibitors, i-angiotensin-receptor blockers, i- beta-blockers , i-cyclosporine, i-digoxin, i-minoxidil, i-spironolactone, kunye ne-tacrolimus, qaphela ukuba amazinga e-potassium akho anganda. Ugqirha wakho unokujonga ezinye izimbangela ze-hyperkalemia, njengokungaphumeleli kwindlala kunye ne-hypoaldosteronism, njengoko kuchazwe ngasentla.
> Imithombo:
> Kehnhardt A, uKemper MJ. I-Pathogenesis, i-Diagnosis kunye noLawulo lwe-Hyperkalemia. Pediatr Nephrol. 2011 uMar; 26 (3): 377-384. i-doi: 10.1007 / s00467-010-1699-3.
> Levis JT. I-ECG Ukuxilongwa: Hyperkalemia. I-J. J. Ebusika; 17 (1): 69.ngaba: 10.7812 / TPP / 12-088
> Lewis JL. Hyperkalemia. I-Merck Manual: I-Professional Version. Ukuhlaziywa ngo-Apreli 2016. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hyperkalemia.
> INtaba iDB. Izizathu kunye nokuVavanywa kwe-Hyperkalemia kuBantu abadala. Ku: Ifom JP (ed), UpToDate [Intanethi] , Waltham, MA. Ukuhlaziywa ngoFebruwari 2018.
> Simon LV, Farrell MW. Hyperkalemia. Kwi: StatPearls [Intanethi]. Isiqithi se-Treasure (FL): i-StatPearls Publishing. 2018 uJan-.