Hyperkalemia imapezedwa pamene mlingo wanu wa potassiamu umayendera 5.0 mEq / L kapena kuposa. Zikhoza kuyambitsa kuyamwa potaziyamu wambiri, osati kutulutsa potaziyamu wokwanira, kapena potassium yotuluka m'maselo.
Kuyesera kungathandize kudziwa njira zomwe zimayambitsa potassium yanu. Pokhapokha mutadziwa chifukwa chake muli ndi hyperkalemia mungathe kuchiyendetsa bwino ndikuyembekeza kupewa kubwereza.
Mayesero a Magazi
Musanayambe njira yowunika, dokotala wanu akufuna kuonetsetsa kuti muli ndi hyperkalemia yeniyeni. Kaŵirikaŵiri, miyezo ya potaziyamu imakulira zabodza, zomwe zimadziwika kuti pseudohyperkalemia, chifukwa cha momwe magazi anu amakopera .
Chombo choyendetsa ntchito chomwe chimagwiritsidwa ntchito mwamphamvu kwambiri kapena kutalika kwambiri chingayambitse maselo ofiira a hemolyze kapena kupasuka, potassium yothamanga mu specimen. Kuwonjezeredwa kwa chifuwa panthawi ya mitsempha kungachititsenso kuti potaziyamu iwonongeke m'maselo anu, kuonjezera zotsatira za labu yanu pafupifupi 1 mpaka 2 mEq / L.
Ntchito yoyamba ya dokotala ndiyo kuyambiranso msinkhu wanu wa potaziyamu. Ngati zigawo zanu zikhalebe zapamwamba, dokotala wanu akhoza kulamula mayesero awa.
Mayesero oyambirira
Kulephera kuchepetsa mphamvu , kaya ndi kovuta kapena kosalekeza, ndi chimodzi mwa zifukwa zomwe zimayambitsa hyperkalemia. Impso zikalephera, zimatha kusokoneza potaziyamu moyenera. Izi zingachititse kumanga potaziyamu m'magazi.
Magazi a urea nitrogen (BUN) ndi creatinine muyeso momwe impso zanu zikugwiritsira ntchito bwino ndipo zikuphatikizidwa ngati gawo la mawonekedwe oyambirira. Mayesero ena m'gululi ali ndi sodium, kloride, bicarbonate, ndi shuga. Maphunziro awa amagwiritsidwa ntchito kuwerengera kusiyana kwa anion kuti, ngati yakwezedwa, imasonyeza kusakaniza kwa asidi.
Acidosis imatha kupanga potaziyamu kunja kwa maselo ndi m'magazi. Maseŵera amphamvu a shuga, monga momwe angaonekere mu matenda a shuga osatetezedwa , akhoza kuchita chimodzimodzi. Mavitamini otsika kwambiri omwe ali pamwamba pa potaziyamu amatha kutanthauza chikhalidwe cha mahomoni chotchedwa hypoaldosteronism.
Kuwerengera kwathunthu kwa magazi kungakhalenso kuyesa koyesa kothandiza. Kuyera kwa magazi kumakhala chizindikiro cha matenda kapena kutupa m'thupi. Mankhwala otchedwa hemoglobin ndi hematocrit amasonyeza kuperewera kwa magazi. Matenda a magazi omwe amayamba chifukwa cha kuwonongeka kwa maselo ofiira ofiira, omwe amadziwika kuti hemolytic anemia , akhoza kumasula potassium m'magazi.
- BUN
- Creatinine
- Pulogalamu yamagetsi
- Kuchuluka kwa magazi
Mayesero enieni
Malingana ndi zizindikiro zanu ndi mbiri yachipatala, dokotala wanu angasankhenso kuchita zina mwa mayesero otsatirawa.
- Aldosterone: Aldosterone ndi hormone yotulutsa adrenal gland yomwe imayambitsa kuthamanga kwa magazi. Ngakhale kuti potaziyamu ndipamwamba kwambiri ndipo ma sodium ali otsika, chiwerengero cha aldosterone n'chofunika kutsimikizira kuti matenda a hypoaldosteronism ndi otani. Kusagwirizana kumakhalanso kofala ndi chikhalidwe.
- Creatinine phosphokinase (CPK): Mipamwamba ya CPK imasonyeza kuti pakhala kuvulala kwa minofu. Sikuti kokha mavitaminiwa amachoka m'matumbo koma amatha kusefukira impso, zomwe zimapangitsa kuti impso zilephereke mu zomwe zimatchedwa rhabdomyolysis . Potaziyamu imatulukanso kunja kwa minofu ya minofu.
- Magulu a Digoxin: Digoxin ndi imodzi mwa mankhwala omwe angathe kukhala ndi zotsatira za hyperkalemia. Mosiyana ndi beta-blockers zomwe zingathenso kutulutsa seramu potassium, digoxin ali ndi mayeso a magazi kuti awone momwe mankhwala aliri m'magazi anu.
- Kuyeza kwa Uric acid ndi phosphorous: Pamene maselo akutha, amasula uric acid ndi phosphorous kuwonjezera potaziyamu. Izi zikhoza kuchitika m'magazi a hemolytic kapena flare-ups a sickle cell disease. Zitha kuchitanso ndi vuto lopweteka kwambiri la matendawa pamene maselo amatha kusokonezeka.
Mayesero a Mtsinje
Minofu yosavuta imayang'ana magazi, shuga, mapuloteni, kapena matenda mu mkodzo.
Zomwe sizinachitike bwino zingathe kuwonetsa glomerulonephritis, kutupa kwa impso, kapena glomerulonephrosis, zomwe sizili zotupa pomwe impso ikutha kuteteza mapuloteni. Ikhozanso kusonyeza shuga yomwe ili yosayendetsedwa.
Zowonjezerapo mayesero a mkodzo angayambe kufufuza kuti impso zikuchita bwino. Ngati mpweya wa potassium ndi sodium uli m'mitsempha yoyembekezeka, impso siziyenera kuimbidwa mlandu. Chifukwa chosakhala chachibwana chiyenera kufufuzidwa. Kuyezetsa mkodzo myoglobin kungatsimikizire kuti ali ndi rhabdomyolysis.
- Zomwe zimayendera urinalysis
- Potaziyamu ya umchere ndi sodium
- Myoglobin wamakina
Mayesero a Mtima
Hyperkalemia ingayambitse ziwalo zoopsa zowonjezera moyo wanu ngati mazamu anu a potaziyamu akukwera kwambiri. Chombo cha electrocardiogram (ECG) ndi chofunika chodziwiratu, osati kungozindikira milandu yambiri ya hyperkalemia koma kuti mudziwe mtundu wa arrhythmia.
Mgwirizano wa ECG umayendetsa magetsi pamtima, kuchokera pamwamba pa zipinda za mtima, pa atria, mpaka m'chipinda chapansi, m'makontomba. Mzere uliwonse pa ECG kuchokera pa PQRST umaimira kuchitidwa kapena kubwezeretsa chipinda china cha minofu ya mtima.
Monga seramu potaziyamu ikuwonjezeka, ECG isintha kwambiri. Kuyambira pazigawo 5.5 meq / L ndi pamwamba, zinyama zingakhale zovuta kubwezeretsa. Izi zingawoneke ngati mawonekedwe a ECG. Kuwombera kunthaka kumakhudza pa 6.5 mEq / L kuti mafunde a p asakhalenso awoneke. Pa 7.0 mEq / L, mafunde a QRS akufutukuka, okhudzana ndi kuyambitsidwa kwazomwe mazembera.
Arrhythmias a mtima amayamba kukula pa 8.0 mEq / L. Izi zikhoza kuphatikizapo chirichonse kuchokera ku sinus bradycardia kupita ku ventricular tachycardia . Pa zochitika zovuta kwambiri, asystole, kutayika kwa magetsi onse, akhoza kuchitika. Ngakhale kuti ECG sichidziŵa chifukwa cha hyperkalemia, imasonyeza kuopsa kwa chikhalidwecho. Cardiac arrhythmias amafunika kuchipatala.
Kusiyanitsa kusiyana
Anthu omwe ali ndi matenda a chiwindi, matenda osokonezeka mtima , ndi shuga amakhala pachiopsezo chachikulu chotengera hyperkalemia. Matenda ena omwe angakhale chinthu chophatikizapo amyloidosis ndi matenda a chikwangwani .
Ngati mwauzidwa mankhwala monga ACE inhibitors, angiotensin-receptor blockers, beta-blockers , cyclosporine, digoxin, minoxidil, spironolactone, ndi tacrolimus, dziwani kuti potaziyamu yanu ingapitirire. Dokotala wanu angayang'ane zifukwa zina za hyperkalemia, monga kulephera kwa mphuno ndi hypoaldosteronism, monga tafotokozera pamwambapa.
> Zotsatira:
> Kehnhardt A, Kemper MJ. Pathogenesis, Kuzindikira ndi Kulamulira kwa Hyperkalemia. Mwana wamwamuna Nephrol. 2011 Mar; 26 (3): 377-384. lembani: 10.1007 / s00467-010-1699-3.
> Levis JT. Kuzindikira kwa ECG: Hyperkalemia. Lus J. 2013 Zima; 17 (1): 69.iyi: 10.7812 / TPP / 12-088
> Lewis JL. Hyperkalemia. Merck Manual: Professional Version. Idasinthidwa April 2016. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hyperkalemia.
> Phiri la DB. Zimayambitsa ndi Kufufuza kwa Hyperkalemia mwa Achikulire. Mu: Forman JP (ed), UpToDate [Internet] , Waltham, MA. Idasinthidwa February 2018.
> Simon LV, Farrell MW. Hyperkalemia. Mu: StatPearls [Internet]. Chilumba cha Treasure (FL): StatPearls Publishing. 2018 Jan-.