Jul 15, 2018
Hypokalemiais a symptom that is manifested by low potassium content in tissues. The acceptable amount of potassium in the plasma is at least 3.5 mmol / l. The fall in concentration below this indicator indicates the occurrence of an electrolyte imbalance, which, under conditions of adequate care, often causes severe damage in the patient's body.
Exchange processes in tissues are impossible without the participation of potassium. In tandem with sodium, he creates a potassium-sodium balance, which is responsible for the osmotic processes through the cell membranes. This is necessary for the normal functioning of the nerve and muscle fibers. Do not do without potassium and acid-alkaline processes. In addition, he takes an active part in the work of enzymes, and also prevents water retention in the intercellular space.
With a significant imbalance of potassium, the normal functioning of the heart( arrhythmia), the nervous system( decreased reflexes, muscle weakness, decreased intestinal peristalsis, dynamic intestinal obstruction), respiratory organs are often disrupted. Serious consequences for a person's normal life require serious attitude and mandatory correction of hypokalemia.
Causes of hypokalemia
There are three main causes that can cause pathological changes associated with hypokalemia: inadequate intake of potassium in the body, excessive removal of it from the body and violation of the movement of potassium at the cellular level. The inadequate intake of potassium from food affects the fascination with strict diets and the exhaustion of oneself by hunger to achieve harmony or religious belief( ascetic way of life).
A rare cause of hypokalemia in our time is the eating of clay, which is called geophagia. Such a food predilection is found in the traditions of the Negro people living in South America. At the same time potassium forms inactive compounds with gland iron and can not participate in metabolic processes of the body.
Excessive excretion of potassium from the body is a fairly common problem. It includes many pathological conditions. Imbalance in the work of the stomach and intestines, which is manifested by frequent vomiting, profuse diarrhea. Intentional inducing of vomiting in people with mental illness( anorexia, etc.).
Uncontrolled intake of various medicines, such as laxatives, certain antibiotics( for example, Penicillin), diuretics, corticosteroids( Prednisilone), Insulin, often cause hypokalemia. Tumors of the adrenal glands, cirrhotic changes in the liver, primary and secondary kidney diseases can lead to a significant drop in potassium in the blood. Important is the sufficient intake of human and other trace elements into the body, for example, magnesium, the exchange of which in tissues is closely related to potassium.
There are also more rare causes that cause hypokalemia. For example, Bartter's syndrome, which manifests itself as signs of hypokalemia in young children. Finally, the reason for the incorrect redistribution of potassium ions at the cellular level, which leads to a delay in the potassium inside the cells. This process can be influenced by an incorrectly selected dose of insulin in the treatment of diabetes mellitus, treatment with excessive doses of vitamin B12 and folic acid in oncology, adrenaline overdose, alcohol poisoning. It should be noted that the identification of the true cause, which caused signs of hypokalemia, in each case, is of enormous importance for effective treatment and successful recovery.
Symptoms of hypokalemia
Symptoms of this disease are diverse and nonspecific, can occur and with a variety of other diseases. In the early stages, when the amount of potassium is reduced slightly, the patient begins to worry about unmotivated weakness and fatigue, even in the absence of significant physical activity and normal sleep. There are pains and weakness in the lower extremities, sometimes convulsions, which already at the initial stage leads to a significant decrease in efficiency. Unfortunately, during this period, patients rarely come to see a doctor, explaining their condition by various causes( stress, weather conditions, hypovitaminosis).In the absence of adequate care, the concentration of potassium in the plasma gradually decreases, which leads to aggravation of hypokalemia, which is manifested by a violation of the function of many organs.
Quite often, with hypokalemia, the nervous system suffers. There are paresthesia( a feeling of "crawling crawling," burning, tingling of the skin), numbness and weakness of the limbs, in severe cases, paralysis and paresis occur. Changing the psyche, which manifests as apathy, depression, a decrease in the emotional background. Sleep does not bring a feeling of vivacity, drowsiness increases until lethargy. Violated the function of the stomach and intestines by reducing peristalsis. This is manifested by nausea, eructation, vomiting, constipation, flatulence, decreased appetite, in neglected cases, paralysis of the intestine, which leads to dynamic intestinal obstruction.
Violations of hypokalemia also affect the basic functions of the heart - excitability and conduct of an electrical impulse. Against this background, there are significant changes in the ECG, in severe cases, extrasystoles and ventricular fibrillation, which often leads to death. Especially dangerous hypokalemia for patients with ischemic disorders that take glycosides. Such people, undoubtedly, are at risk and require special supervision. The tragedy can lead to the development of muscle paralysis, especially intercostal and respiratory, which often causes the need for resuscitation and transfer of the patient to artificial respiration.
Much professionalism requires the identification of symptoms of hypokalemia in young children. For obvious reasons, children can not express and correctly characterize their feelings. The main symptoms of hypokalemia in them are: polyuria( an increase in the amount of daily urine) and a decrease in blood pressure. A very important role in the formulation of a true diagnosis is played by comprehensive diagnosis.
Diagnosis of hypokalemia
Diagnosis of the disease involves the collection of a detailed anamnesis. After clarifying the complaints, it is necessary to understand the reasons for their occurrence. In this case, they learn about the possible presence of dysfunction in the patient's digestion: frequent vomiting, diarrhea, perhaps the patient himself causes a vomiting reflex.
Recently, hypokalemia is common in young women with anorexia. Find out whether a person adheres to strict diets or fasting. Be sure to find out what medications the patient is taking. Some groups of penicillin antibiotics, diuretics, vitamins( Folic acid, vitamin B12), Insulin, hormones( Prednisolone) can, with improper, uncontrolled application, significantly reduce the potassium content. Clarify the presence of chronic kidney disease, adrenal gland, liver, oncology, alcohol abuse. It is important to observe the rules for storing blood after a fence. Prolonged exposure to the tubes at room temperature leads to false hypokalemia and makes it difficult to properly diagnose.
After a visit to the therapist, the patient often needs consultations of related specialists: neurologist, cardiologist, endocrinologist. An important laboratory method of investigation is the determination of the concentration of potassium in the blood serum, the express method of which is photometry. The analysis of urine on the content of electrolytes can also help in the diagnosis of hypokalemia. It shows a decrease in the secretion of potassium by the kidneys to 15 mmol / l, which confirms the loss of potassium in the disease of the stomach and intestines. Conversely, an increase in its amount in the urine with a violation of the reverse absorption of renal tubules in the case of renal pathology.
Repeated biochemical blood tests, functional kidney studies( Reberg's test - determination of creatinine in the urine and blood serum), and examination of the abdominal cavity with ultrasound are carried out to accurately diagnose a decrease in the potassium content of the whole organism. For the examination of the functions of the heart, auscultation is prescribed for listening to tones( shortening of 2 tones), measuring blood pressure( hypotension), ECG( elongation of electric systole, shortening of mechanical systole, appearance of U-tooth).All methods of diagnostics should be carried out in a complex, consistently and qualitatively to reveal the complete picture of this pathology.
Treatment of hypokalemia
Correction of hypokalemia is assigned depending on its cause. With a low intake of potassium in the human body, it is recommended to establish a normal diet - food should be healthy, full, balanced in nutrients and trace elements. It is very important to give up hunger and hard diets. With excessive excretion of potassium from tissues and disturbance of its cellular metabolism, all available risk factors must be eliminated.
Reception of antibiotics should be justified, appointed exclusively by the doctor in adequate doses and terms.
Admission of corticosteroids with adrenal adrenal glands should be under close supervision of the doctor and monitoring of all functions and systems of the body. Treatment of type 2 diabetes( insulin-dependent) should be with a strictly selected dose in each case, with constant correction at different stages of the course of the disease.
Doses of folic acid and vitamin B12 in the treatment of megaloblastic anemia should be adequate and individual, appointed courses with sufficient interruptions in treatment.
Laxatives should be used to treat constipation, strictly following a doctor's recommendation, after a thorough examination. It is strictly forbidden to use these funds for weight loss and the so-called "cleansing the body of toxins."
People who cause vomiting, who suffer from anorexia, are strongly recommended the help of a therapist.
It is important to fight chronic alcoholism, to identify diseases, a long course of which without the necessary treatment leads to hypokalemia( cirrhosis, progressive tumors, kidney disease).Elimination of all factors that cause potassium deficiency in blood plasma is an important stage in the treatment of hypokalemia.
In some cases, replacement therapy, i.e., replacing the missing trace element in organs and tissues, is also required. Potassium can be given in tablets( Panangin, Asparcum), injected intravenously and intravenously( infusions are indicated in case of severe disease and as an emergency therapy).Doses of potassium should be properly selected in accordance with the results of blood tests, urine tests, the patient's condition and his resistance to treatment.
With hypokalemia associated with impaired cellular metabolism, the administration of potassium drugs is intravenously prohibited, as this causes the symptoms of resistant hyperglycemia. Potassium salts such as chloride, bicarbonate, citrate, phosphate are used. For parenteral administration, potassium salts are diluted with an isotonic solution of sodium chloride. Dilution of potassium glucose solution is not used, because in this case insulin enhances the redistribution of potassium inside cells and aggravates the phenomenon of potassium deficiency in the body.
If the urgent situation requires a rapid flood of the body with potassium salts, then this therapy for hypokalemia is carried out under the watchful monitoring of the patient: ECG monitoring, checking of motor functions, breathing, determination of the potassium content in the blood every four hours. This prevents the development of severe complications from the cardiovascular and nervous system and the risk of hyperglycemia. With great care, elderly people are prescribed therapy, especially with severe diabetes and kidney failure, as well as patients taking potassium-sparing diuretics( for example, Spironolactone, Veroshpiron).Such people have a rather high risk of overdose. In contrast, patients with ischemic heart disease, who regularly take cardiac glycosides, as well as patients taking insulin with diabetic ketoacidosis, should be given a higher dosage of potassium.
The effectiveness of treatment of hypokalemia and the timing of restoration of normal electrolyte blood composition directly depend on the timely treatment of the patient to the doctor, proper history, complete and comprehensive diagnosis, adequate treatment, individually selected in each case.
Do not forget about the prevention of hypokalemia. Daily intake of the necessary amount of fruits and vegetables will restore the necessary supply of potassium. To products containing a large amount of potassium, include: potatoes, cabbage, lettuce, spinach, bananas, dried apricots, raisins, nuts( walnuts, cedar, almonds).
It must be remembered that a drop in potassium in the blood can lead to severe consequences only in the absence of treatment. A healthy lifestyle, nutrition, consultation of a qualified specialist will protect against the development of hypokalemia and maintain health.