重症基础高钾血症的处理

希望本文对你有用~

作者

做柠要厚道

来源

重症山水

此篇涉及的是如何让你在老大查房时

把处理HyperK的方法流畅的背出来........

记好，这就是

C(See)BIGKDrop！

处理高钾血症没那么复杂

（最后一张图）

简单介绍了处理HyperK的机制

分了三类

1.稳定细胞电活动

2.转运K

3.排K

并且给出了effectonset和duration

这样能正确的理解

处理高钾血症需要遵循的处理顺序

虽然很多的处理方法目前有些争议

比如高渗盐水，扩容，碳酸氢钠应用时机，降钾树脂有效与否

此篇小文都不涉及

希望对你有用！

高钾血症的ECG表现

[记忆法]

高钾血症的处理方法

CBIGKDrop

CBIGKDrop

(ManagementofHyperkalemiawithECGchanges)

-CCa剂

-Bβ受体激动剂(沙丁胺醇)/碳酸氢钠

-I胰岛素

-G葡萄糖

-K降K树脂(聚苯乙烯磺酸钠)

-D袢利尿剂(有尿)/透析(无尿)

Thegoaloftreatmentistopreventcardiacarrhythmia,thenlowerserumpotassium.Themanagementofhyperkalemiacanbesummarizedbythemnemonic

C(See)BIGKDrop详解

Mnemonic

Whatitmeans

C"See"

Calcium:Calciumgluconate(10%)10mLIVover10min.

Calciumisacardiacstabilizer.

B

Betaagonists:Salbutamol10-20mgin4mLnormalsalinenebulizedover10minORBicarbonate:sodiumbicarbonate8.4%(50mEq)1ampouleIVover5minutes(Contentious[3])

Bothoftheseagentscausetemporaryintracellularshift.

I

Insulin:Shortactinginsulin10unitsIVpushfollowedby...(seenextbox!)

G

Glucose:D50W1ampouleIVover5minutegivenwithinsulin.

Insulincausestemporaryintracellularshiftandglucoseisgiventomaintainbloodglucoselevels.

K

Kayexalate:Sodiumpolystyrenesulfonate15-30gin15-30mL(70%sorbitol)PO.(Contentious-[3].)Kayexalatemayfacilitategastrointestinalremoval.

EDITORSNOTE:

ThisismainlyforCHRONICrenalfailure.NotforuseintheACUTEphase.

D

Diuretics:Furosemide40-80mgIVpush.

Thisfacilitatesrenalremoval.

Dialysisachievesextracorporealremoval.

ACochranereviewconcludedthat,whenECGchangesduetohyperkalemiaarepresent,IVcalciumiseffectiveinpreventingdeterioration[2].Thereafter,emergenttherapiesforloweringpotassiumlevelsarenebulizedorinhaledsalbutamoland/orIVinsulin-and-glucose[2].

Thereisnoevidencesupportingtheuseofbicarbonateasmonotherapy[2].Existingevidencedoesnotsupporttheuseofbicarbonateforinducingintracellularshiftintreatingacutehyperkalemia[3].

Kayexalateisanexchangeresinusedtobindpotassiumintheintestinewhengivenorally.ThetwoconcernswithKayexalateareitsineffectivenessinloweringserumpotassiumanditspotentialtoxicity.Thishasbeenthesubjectofausefulreview[3].

Dialysisisefficient,butusuallytakesabout2hourstogetstartedinapatientwithnodialysisaccess.

References:

[1]MosesS.().HyperkalemiaManagement.FamilyPracticeNotebook.

[2]MahoneyBA,SmithWAD,LoD,TsoiK,TonelliMClaseC.().Emergencyinterventionsforhyperkalaemia(Review).TheCochraneCollaboration.3:1-66

[3]KamelSKWeiC.().Controversialissuesinthetreatmentofhyperkalaemia.Nephrol.Dial.Transplant.18:-.

ReviewingwiththeStaff(Dr.A.R.Morton)

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