kaliopenia - a pathological condition characterized by a decrease in the concentration of potassium ions in the blood plasma. Symptoms for the treatment of hypokalemia are discussed below.
GENERAL
Potassium is one of the most important minerals in the human body. By reducing its concentration violated processes neuromuscular and biological activity in the whole cell.
The basic amount is concentrated inside cells. Therefore, it can be a great loss of intracellular contents without the express deficiency in the blood plasma concentration.
Potassium Normal plasma (serum) in adult blood - 3.5-5.5 mmol / l. Accordingly, as evidenced by the potassium level hypokalemia 3.4 mmol / l or below.
The exchanging of potassium plays an important role the normal operation kidney - approximately 85% of consumed potassium output them. potassium metabolism is regulated renin-angiotensin-aldosterone system. That is why an imbalance in the system, as well as a serious renal disease, often leads to the expression of potassium deficiency in the body.
CAUSES
By the occurrence of hypokalemia can lead various pathological conditions and diseases. All the reasons that lead to the emergence of potassium deficiency in the blood can be divided into several groups, which differ in their mechanism of action.
State, causing the movement of potassium ions:
- Alkalosis - metabolic or respiratory.
- Increased insulin levels in the blood (hyperglycemia or excess exogenously administered).
- Excess agonists of alpha-2 adrenoceptor (stress, administering dopamineAdrenaline, noradrenaline and t. D.).
- Taking high doses of folic acid and vitamin B12 in the treatment of pernicious anemia.
- Hereditary and thyrotoxic periodic paralysis.
Factors that violate the hormonal regulation of water and electrolyte metabolism:
- Primary aldosteronism.
- Diseases accompanied by secondary hyperaldosteronism: nephrotic syndrome, heart failure, Renovascular hypertension, cirrhosis of the liver, Reninsekretiruyuschie tumor and m. P.
- The disease or Cushing's syndrome, congenital adrenal hyperplasia and the like. D.
Provoke renal tubular dysfunction:
- renal tubular acidosis.
- Some congenital and genetically caused condition - Bartter syndrome, Gitelman, Liddle.
- Reducing the concentration of magnesium ions in the plasma.
Other reasons leading to the development of hypokalemia:
- Insufficient potassium content in the received food.
- Excessive sodium intake in the diet, or by infusion administration.
- Elevated Potassium loss in diarrhea, vomiting, aspiration of gastric contents, the presence of gastrointestinal fistulas and m. P.
- Prolonged or uncontrolled use of laxatives and diuretics.
- The use of certain medication: carbenicillin, gentamicin, amphotericin B, theophylline, corticosteroids, etc...
- Diabetes insipidus.
- some forms leukemia and other malignancies.
CLASSIFICATION
Standard classification of hypokalemia not exist.
Symptoms of hypokalemia
The severity of the clinical manifestations of hypokalemia depends on the level of potassium in the blood and the rate of its decrease. Usually enough symptoms appear already expressed at lower levels of potassium to 3 mmol / l and below.
Symptoms of hypokalemia varied. The dominant features of potassium reduction in the blood plasma are the disruption of cardiac, skeletal and smooth muscle. Usually, when hypokalemia affects first the muscles of the lower extremities, and then - the trunk and respiratory muscles.
Main manifestations lowering the potassium concentration:
- Progressive muscle weakness, fatigue.
- Paresthesia, limb muscle cramps.
- At low values of critical potassium may develop paresis and paralysis of the limbs.
- Disordered breathing until it stops.
- Gastrointestinal disorders: nausea, vomiting, paralytic ileus (intestinal paresis).
- Disruption of the heart arrhythmias (beats, Supraventricular and ventricular tachycardia, ventricular fibrillation), atrioventricular block and the like. D.).
- Hypotension.
- Kidney involvement: polyuria, nocturia, primary polydipsia.
- Depression, anxiety and other symptoms psychasthenia.
- Impaired glucose tolerance.
- For persons taking cardiac glycosides, may contribute to hypokalemia glycoside intoxication, even when receiving conventional doses.
Unfortunately, there is no pathognomonic symptoms which could be immediately suspect hypokalemia.
Lack correction potassium deficiency leads to clinical manifestations of weighting and development of life-threatening conditions.
DIAGNOSTICS
The main method of diagnosis of hypokalemia is determining the level of potassium ions in serum. We investigate the venous blood. However, there are factors that may adversely affect the result of the analysis, which leads to diagnostic errors.
Recommendations before blood sampling for analysis:
- Blood for the studies taken in the morning on an empty stomach, preferably - before getting up. Avoid physical exertion and prolonged tourniquet on the limb.
- The blood must be centrifuged immediately after collection to avoid hemolysis or potassium diffusion from RBCs.
- No less than three weeks prior to the study to cancel diuretics, laxatives and antihypertensive drugs.
- At least three or four days before the examination the patient should be advised to use salt in the range of average values - 5-6 grams per day.
- A blood test to determine the level of potassium is recommended multiple times, since a change of its level may be episodic.
In addition to determining the level of potassium in the blood plasma must identify etiopathogenic causes hypokalemia and assess the severity of its symptoms.
Methods of diagnosis hypokalemia manifestations:
- Medical history and evaluation of the patient's complaints.
- measurement of blood pressure, auscultation of the heart and lungs, and other methods of physical examination.
- Elektrokadiografiya (ECG). There flattening or T wave inversion, increase in amplitude of the wave U, ST segment depression below isolines and lengthening the interval QT-U.
- Determination of blood pH. Hypokalemia often accompanied alkalosis (increasing pH). Thus alkalosis may be a cause of lowering the potassium level in the blood. However, in certain diseases (diabetic or tubular acidosis) Reduced blood pH.
- Determination of renal secretion potassium daily. The level of potassium in the urine above 15 mmol / L indicates a renal pathology.
- A study of chlorides in the urine.
- Determining the level of renin and aldosterone in the blood plasma.
- Investigation levels of insulin and epinephrine.
- Functional tests: reninstimuliruyuschy, suppression of aldosterone and some others.
According to the testimony and conduct other tests (ultrasound, CT, MRI, and so on. D.).
TREATMENT
The grounds for choosing a method of treatment of hypokalemia are level lowering the potassium concentration in blood and the severity of the clinical manifestations.
The basis of therapy is exogenous administration of potassiumWhich can be a special diet and / or potassium-containing drugs.
A diet rich in potassium, assigned when unexpressed hypokalemia (potassium levels in plasma - 3-3.5 mmol / l) and loss excluding microelement through the gastrointestinal tract.
Foods rich in potassium include:
- Dried fruits: dried apricots, prunes, raisins.
- Legumes: beans, peas, lentils.
- Seaweed.
- Nuts: almonds, hazelnuts, peanuts, cashews, etc...
- Honey and pollen.
- Vegetables: potatoes, carrots, pumpkin.
- Rye bread.
- Fruits and berries: watermelon, cantaloupe, bananas.
Normally, the adult organism with food must come 2-4 g potassium per day. With intense physical stress the need for this trace increases and should be 4-6 g per day.
Principles of drug correction of hypokalaemia:
- Preference is given to oral administration of potassium in the form of its salts.
- When choosing a product to be considered the blood pH. Thus, in preferred alkalosis potassium chloride. And when acidosis assigned bicarbonate or potassium citrate.
- In severe hypokalemia and severe lesions of the digestive system of potassium is administered parenterally.
- Solutions of potassium-irritating to peripheral veins, so infusion is conducted slowly (10-20 mmol / hour). potassium concentration in the solution must not exceed 40 mmol / l.
- To obtain the desired concentration using 0.9% sodium chloride solution. glucose solutions are not applicable, since reactance increase insulin thus may exacerbate hypokalemia.
- During the treatment it is necessary to regularly monitor the level of potassium in the blood (for parenteral administration - every few hours), and monitor the patient's condition and ECG. This is due to the fact that the level of potassium in the blood does not always reflect the true deficiency of this trace element. And against the background of the treatment can easily be overdosed potassium and hyperkalemia development.
Along with the completion of potassium deficiency is essential that a correction of pathological conditionsWhich are the cause of hypokalemia.
COMPLICATIONS
Hypokalemia - a laboratory term, which reflects the change (decrease) in the concentration of this important trace element in blood plasma. Therefore, the clinical manifestations of the condition and its complications are.
The most dangerous complication of hypokalemia:
- Paresis and paralysis of the lower limbs.
- Deep breathing problems until it stops.
- The defeat of the cardiovascular system, until the development of atrial fibrillation and flutter.
- kidney failure.
PREVENTION
Prevention of hypokalemia consists primarily in a balanced diet, which includes foods rich in potassium.
Also need timely diagnosis and treatment of diseases in which may be reduced urovenb potassium in the blood.
FORECAST FOR RECOVERY
By eliminating the cause of the decrease in blood potassium level, and adequate correction deficiency of this micronutrient favorable prognosis.
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