Hyperkalemia
Introduction
Introduction Serum potassium ion >5mEq/L is called hyperkalemia, 6-7mEq/L is moderate hyperkalemia, and greater than 7mEq/L is severe hyperkalemia. The most common cause of hyperkalemia is renal failure, which is mainly characterized by fatigue and arrhythmia.
Cause
Cause
1, common diseases due to renal failure, excessive intake such as the input of potassium-containing solution too fast, too much, input storage for too long blood or a large amount of penicillin potassium salt, etc., can cause hyperkalemia.
2, renal potassium reduction is seen in renal failure, oliguria and anuria, adrenal insufficiency and so on.
3. Intracellular potassium migration is seen in severe hemolysis, hypoxia, acidosis, and crush syndrome caused by trauma caused by incompatible blood or other causes.
4. The decrease in extracellular fluid volume is seen in blood concentration due to dehydration, blood loss or shock.
Examine
an examination
Related inspection
Analysis of serum potassium and urine routine blood urinary potassium arterial blood gas
First, physical examination
Taking a medical history gives us a first impression and revelation, and also guides us to a concept of the nature of the disease.
Second, laboratory inspection
Laboratory examinations must be summarized and analyzed based on objective data learned from medical history and physical examination, from which several diagnostic possibilities may be proposed, and further consideration should be given to those examinations to confirm the diagnosis. Such as: blood potassium examination, electrocardiogram examination, etc.
Diagnosis
Differential diagnosis
Differential diagnosis of hyperkalemia:
(A) acute renal failure oliguria
Hyperkalemia is one of the common causes of death in oliguria. The disease should be differentiated from pre-renal oliguria. The latter is less severe due to insufficient renal blood perfusion and slow renal function damage. A ratio of pressure to blood osmotic pressure greater than 2 is helpful for differential diagnosis.
(two) chronic renal insufficiency
In the late stage of chronic renal insufficiency, the blood potassium level is increased, the urine relative density is low, and the fixed urine has protein-type red blood cells and white blood cells. The plasma urea nitrogen and muscle complexes are often significantly increased. The carbon dioxide binding force is often lowered according to the history symptoms and laboratory tests. Diagnosis is generally not difficult. Many factors such as infection with acidosis, large doses of potassium-sparing diuretics, and blood in the stock can cause a sharp or significant increase in serum potassium.
(three) low renin low aldosteronism
This disease is due to the reduction of aldosterone formation caused by renin deficiency. The main clinical manifestations are hyperkalemia and metabolic acidosis. This disease should be differentiated from Addison disease. Both have aldosterone reduction and hyperkalemia but low renin low aldosterone. Symptoms of plasma renin activity reduce plasma cortisol and ACTH values are normal and there are no clinical features of Addison disease such as hyperpigmentation weakness and loss of water.
(4) a1-hydroxylase deficiency
Patients with complete a-hydroxylase deficiency may have significant dehydration, hyperkalemia, hyponatremia and metabolic acidosis due to insufficient secretion of cortisol and aldosterone. As the secretion of ACTH stimulates the secretion of androgen from the adrenal cortex, female patients become masculine and male patients have precocious puberty.
(5) Hyperkalemia periodic paralysis
