The causes of hypokalemia can be due to various circumstances that briefly or permanently reduce the concentration of potassium in the cells and disrupt important vital processes.
- Low intake of potassium with food, which may be caused by a decrease or lack of appetite due to some pathology or a deliberate decrease in the transport of this element into the body. It should be noted that at first, in the absence of potassium in food (and the food itself), the body regulates the balance (excretes less with urine and through the digestive tract), but this cannot continue indefinitely, because there will come a time when there is simply nothing to compensate for.
- Increased need for potassium in certain conditions (surgery, pregnancy, the postpartum period).
- Geophagy (eating clay – eating disorders in young children and pregnant women, as well as a long-standing habit of South American blacks). Clay, binding potassium and iron ions, interferes with their absorption in the digestive tract.
- Enhanced excretion of K in urine with endocrine pathology (Itzingo-Cushing’s syndrome, primary aldosteronism, Conn’s syndrome) and its treatment with hormonal agents.
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- Some diseases of the excretory system, leading to impaired reverse absorption of potassium ions in the blood in the kidneys (more excreted in the urine), as well as Fanconi syndrome (impaired functioning of the proximal tubules), metabolic acidosis characteristic of diabetes mellitus, tubular acidosis resulting from the influence diuretics.
- Excretion of potassium with sweat during excessive physical exertion or in other circumstances conducive to increased sweating.
- Loss of potassium through the gastrointestinal tract (normally with feces removed approximately 7-8 mmol / day), usually due to diseases of the gastrointestinal tract (polyp, diarrhea, prolonged vomiting, fistulas of the stomach or intestines, VIPoma – pancreatic tumor) or uncontrolled use laxatives.
- Familial hypokalemic periodic paralysis (episodic attacks of muscle weakness amid falling potassium levels) – SPPP associated with a defect in certain genes.
- Various disturbances in the electrolyte balance due to the transport of potassium ions to cells from the extracellular fluid caused by pathological conditions and their treatment (administration of large doses of insulin in diabetic ketoacidosis, hyperglycemia).
- Adrenaline, mineralocorticoids (hormones of the adrenal cortex), adrenocorticotropic hormone (ACTH), testosterone, glucose, insulin and, of course, used to treat other diseases, as well as the introduction of large volumes of potassium-free infusion solutions.
- Improper use of diuretics, especially loop diuretics, most often causes symptoms of hypokalemia (cramps in the calf muscles, polyuria, muscle weakness, heart rhythm disturbance). It should be noted that diuretics help to eliminate not only potassium, but also magnesium with the development of a condition called hypomagnesemia.
Plasma magnesium deficiency can be caused by stresses, especially of a chronic nature, hard work, but also lack of exercise, high ambient temperatures, pregnancy, hormonal contraception, and unhealthy diet. As for loop diuretics, they not only remove potassium, but also other trace elements (sodium, calcium and magnesium, of course, too). Meanwhile,.
Perhaps a departure from the topic in order to describe the main symptoms of hypomagnesemia may be useful, since the reasons for the removal of this trace element are present very often (and diuretics contribute), and a decrease in magnesium levels affects the work of many body systems (not in vain constantly reminiscent of the media). Thus, hypomagnesemia can be suspected by some signs:
- The state, which people call the “chronic fatigue syndrome”, after a long rest does not leave a feeling of weakness, reduced ability to work.
- Reactions of the nervous system to the events: irritability, depression, headaches, dizziness, nervous tics, phobias appear, sleep is upset, memory suffers.
- Violations of contractility of the muscle apparatus, which lead to muscle pain and cramps in the muscles of the back, neck, upper and lower extremities.
- The cardiovascular system will respond to magnesium deficiency by the appearance of pain in the heart, irregular blood pressure in the direction of falling or rising, a violation of the lipid spectrum with the development of atherosclerosis, changes in the blood and a tendency to increased thrombosis.
- A change in the general condition when a person puzzles over the search for the causes of tooth decay, hair loss, and brittle nails. Everything starts to go wrong: body temperature decreases, limbs become cold, go numb, meteorological dependence, digestive upset (diarrhea and constipation), premenstrual syndrome (in women who were previously healthy) appear.
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What is hyperparathyroidism?
Hyperparathyroidism is a disease in kittens and adults, arising from metabolic dysfunction and causing leaching of bone calcium. As you know, only 1% of calcium in the body of cats occurs in the blood system. Accordingly, 99% of this trace element is contained in the teeth and bones of the skeleton. The trace element balance is provided by two hormones:
Thus, it becomes clear that in case of insufficient production of one of the hormones, an imbalance occurs and, as a rule, towards a decrease in the amount of calcium. Veterinarians determine two forms of the disease: primary and secondary. For each of the varieties, a special treatment option is used.
With prolonged hypokalemia, the bones of the animal become very fragile, the physical development of kittens slows down. If you do not start timely treatment, a fatal outcome is possible.
With hypokalemia, the diet should consist of products containing potassium or helping its absorption. Consult a physician to compile it. In this case, you can not deal with self-assignments, because an excess of potassium in the blood is even more dangerous than its lack.
Recall some products that can be included with hypokalemia in the diet.
Bee honey, apple cider vinegar, wheat bran, and yeast will help increase the potassium content. But these products can be consumed in moderation, because due to their saturation, all of them can cause damage to their health in excess.
Fish, liver, cottage cheese are useful for hypokalemia. Carrots, pumpkins, radishes, tomatoes, cucumbers, zucchini, lingonberries, and currants cope well with increasing potassium levels in the body. A lot of potassium in pine nuts, peanuts, almonds. Bananas, prunes, dried apricots, figs and raisins, watermelons, melons also increase the level of potassium. Watermelons and melons should be consumed sparingly.
It is necessary to exclude the use of so popular coffee today, because it contributes to increased urination and, consequently, loss of potassium.
Try to cook food steamed or baked, as fried or boiled foods during the cooking process lose a lot of nutritional and beneficial properties.
How to treat hypokalemia?
If symptoms of hypokalemia are found, which are confirmed by the results of studies, it is important that doctors conduct an electrolyte level correction. A reduced amount of such a trace element as potassium in the blood serum must be increased by any means.
There are various oral preparations designed to increase a trace element that causes hypokalemia, such as potassium. But, some of them can cause irritation in the digestive tract, as well as periodic bleeding. These drugs should be prescribed exclusively by a doctor.
The doctor prescribes a drug
For example, KCI in the liquid state, when used orally during low potassium levels in the body, is able to increase the level of the trace element in question quickly, in just 2-3 hours.
But, if the dosage is exceeded, then there is a risk of damage to the surface of the stomach during treatment. Basically, drugs for the treatment of hypokalemia have a special shell for ease of use. They are used at a dosage of no more than 25-50 meq.
If you follow the recommendations of specialists, then bleeding of the stomach will occur less frequently. If the patient has a severe form of hypokalemia, and it cannot be treated with simple oral methods, then potassium levels should be reimbursed parenterally.
The solution of this microcomponent can irritate the inner part of the peripheral veins, for this reason the concentration in no case should exceed 40 meq / l. As for the speed of increasing the level of potassium in the patient’s body, it all depends on its movement inside the cells.
It is not recommended to use a glucose solution with the introduction, which can increase the level of insulin in the blood. This will lead to transient worsening of the symptoms of the underlying disease.
If patients take diuretics, then they do not need to constantly consume potassium, but its level is recommended to be controlled without errors:
- when previously patients had problems with the left ventricle;
- while taking Digoxin, with diabetes;
- people with asthma;
- patients who receive beta agonists.
Triamteren is used to increase potassium levels. Its dose should be about 100 mg (orally once a day). When using Spironolactone, it is recommended to be taken orally (25 mg throughout the day).
If hypokalemia is pronounced, especially in adults, and can not be adjusted, then a large dose of a drug such as potassium chloride is administered. It can be used together with diuretic potassium-sparing agents (Triamteren, Amiloride or Spironolactone).
The most formidable complication of this electrolyte disorder is considered to be heart rhythm disturbances – ventricular tachycardia, ventricular fibrillation, which, without emergency treatment, very often lead to death. Hypokalemia also increases sensitivity to cardiac glycosides, which increases the risk of glycosidic (digitalis) intoxication.
Some patients develop respiratory failure due to severe weakness of the diaphragm and intercostal muscles. Dynamic intestinal obstruction is possible. A very rare complication of severe hypokalemia is rhabdomyolysis (destruction of muscle tissue). Prolonged depletion of potassium ions can lead to the appearance of cysts in the kidneys, chronic renal failure.
Features of treatment
Treatment of hyperkalemia should be aimed at normalizing the level of potassium in the blood and eliminating the symptoms caused by hyperkalemia.
With a slight increase in potassium levels, up to 6 mmol / l, it will be sufficient to cancel drugs that increase potassium levels (for example, beta-blockers, potassium-sparing diuretics, ACE inhibitors and others).
Also effective in this case will be a diet for hyperkalemia, which includes limiting foods high in potassium compounds.
The use of laxatives and various enemas is also effective to accelerate the excretion of potassium with feces through the gastrointestinal tract. In this situation, it is appropriate to choose Sorbitol (polystyrene sulfonate) as the drug of choice. With the help of it, the so-called cation-exchange therapy is carried out, which, unfortunately, is not so effective, regarding the decrease in the concentration of potassium ions in the plasma, with advanced cascades of pathogenetic processes, in more severe cases.
It is also appropriate to add a loop diuretic to the patient, provided that the renal function is not critically impaired, and thereby increase the excretion of potassium through the kidneys.
If hyperkalemia is more pronounced, and the level of potassium exceeds 6 mmol / l, then decisive action and a set of measures are required for this case, aimed at reducing the intake of potassium in the body and its urgent removal from blood plasma.
In order to effectively reduce the level of potassium in the plasma, you need to act in two directions – to facilitate its movement into the cells and its removal out of the body.
When cardiac arrhythmias occur, apply a 10% solution of calcium gluconate, inject it intravenously 10-20 ml for 15-20 minutes. It should be used with caution if the patient has recently taken cardiac glycosides (digitalis preparations). Calcium gluconate improves the performance of the electrocardiogram, but does not reduce the concentration of potassium in the blood, respectively, does not act etiotropically.
In the case of acidosis, under the control of blood pH, sodium bicarbonate (sodium bicarbonate) is administered intravenously at a dose of 44 mEq. Calcium Chloride is sometimes administered for the same purpose, if a central venous catheter is installed, since Calcium Chloride has a strong irritating effect and can cause inflammation of the walls of blood vessels (phlebitis), and surrounding tissues.
Directly to reduce the concentration of potassium in the plasma, by moving it inside the cells, intravenous drip of glucose is used – a solution of 40%, 200-300 ml, and insulin, based on every 3 g of glucose in 1 unit, for 30 minutes. If there is an urgent need, then insulin is additionally injected intravenously – 15 units, in place with a 40% glucose solution, 10 ml.
The use of potassium-excreting diuretics, such as Bumetanide, Furosemide, is appropriate exclusively in patients with preserved renal excretory function. In case of aldosterone deficiency, the introduction of its synthetic precursors, Fluorohydrocortisone or Deoxycorticosterone Acetate, is appropriate.
According to some reports, the level of potassium in the plasma may also decrease due to the introduction of beta-agonists, for example, Albuterol. It should be inhaled using an inhaler for 10 minutes, while the dose is 5 mg / ml.
Incomparable, especially in the case of severe renal failure, are extracorporeal cleaning methods. The greatest effectiveness in hyperkalemia is demonstrated by hemodialysis. With its help, it is possible, in one four-hour session, to reduce the level of potassium in the plasma by 40-50%. It is possible to use other extracorporeal methods, for example, peritoneal dialysis, but its effectiveness is much lower.
After the patient’s condition is stabilized and the emergency measures are completed, you can proceed to further maintain homeostasis and prevent the re-development of hyperkalemia.
For further maintenance therapy, it is appropriate to use any of the following therapeutic measures. It is recommended to take drugs that are synthetic analogues of Aldosterone. Also, potassium-excreting diuretics – Bumetamide, Furosemide help prevent further development of hyperkalemia. In addition, cation-exchange resins are used for maintenance therapy, which help to bind potassium in the gastrointestinal tract.
Therapy of hyperkalemia should begin immediately in patients with kidney disease when the concentration of potassium in the blood reaches 5,5 mmol / L, and in people with normal kidney function – 6,0 mmol / L.
Excess potassium can be removed not only through the kidneys, but also through the gastrointestinal tract, and also by dialysis.
First of all, laxative preparations are prescribed to the patient and special preparations are given that are capable of absorbing potassium well. These drugs are not absorbed from the intestinal lumen and the associated potassium is excreted quickly enough along with feces.
With preserved renal function, a diuretic is indicated that can remove potassium from the body.
In severe cases, a solution containing insulin, glucose and calcium chloride is administered intravenously to patients. Calcium ions are antagonists of potassium ions and thereby protect the muscle cells of the heart from damage. Unfortunately, this protection is very short-lived. Insulin in combination with glucose ensures the movement of potassium from the extracellular space into the cells, which ultimately reduces the concentration of the element in the blood serum.
If all of the above measures do not lead to the desired positive result, direct indications arise for a hemodialysis session, that is, connecting the patient to the “artificial kidney” apparatus.
The department in which patients are treated is determined by the pathology that caused the decrease in K (nephrology, gastroenterology, etc.). Patients in serious condition must be transferred to the intensive care unit. For starters, all medications that can lead to hypokalemia are canceled. The main and primary task is to normalize the concentration of K, stopping life-threatening rhythm disturbances.
- Correction of potassium deficiency. With a mild and stable condition of the patient, oral forms of the potassium preparation (KCl) are prescribed as treatment. In severe hypokalemia, intravenous administration is preferred. When combined with metabolic acidosis, hydrocarbonate, citrate salts are used. In order to avoid hyperkalemia, the infusion rate should not exceed 10 meq / h. In order to reduce the renal excretion of potassium ions, potassium-sparing diuretics (spironolactone) are added to the treatment.
- The fight against arrhythmias. In the vast majority of cases, K deficiency replenishment is sufficient to achieve sinus rhythm. In some situations, it is necessary to use antiarrhythmic drugs (amiodarone, propafenone, flecainide). With the development of ventricular fibrillation, the only treatment is defibrillation.
Correction of hypokalemia is prescribed depending on its cause. With a low intake of potassium in the human body, it is recommended to establish a normal diet – the food should be healthy, wholesome, balanced in nutrients and trace elements. It is very important to abandon hunger and strict diets. With excessive excretion of potassium from the tissues and a violation of its cellular metabolism, it is necessary to eliminate all available risk factors.
The use of antibiotics should be justified, prescribed exclusively by a doctor in adequate doses and terms.
Reception of corticosteroids for adrenal adenomas should take place under the close supervision of a 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 disease.
Doses of folic acid and vitamin B12 in the treatment of megaloblastic anemia should be adequate and individual, prescribed courses with sufficient interruptions in treatment.
Laxatives should be used to treat constipation, strictly on the recommendation of a doctor, after a thorough examination. It is strictly forbidden to use these funds for weight loss and the so-called “cleansing the body of toxins.”
Vomiting people who suffer from anorexia are strongly advised by the help of a psychotherapist.
It is also important to fight chronic alcoholism, to identify diseases, the long course of which, without the necessary treatment, leads to hypokalemia (cirrhosis of the liver, progressive tumors, kidney diseases). The elimination of all factors causing a lack of potassium in the blood plasma is an important step in the treatment of hypokalemia.
In some cases, replacement therapy is also required, that is, compensation for the missing trace element in organs and tissues. Potassium can be given in tablets (Panangin, Asparkam), administered intravenously and intravenously (by infusion is indicated for severe illness and as an emergency therapy). Doses of potassium should be correctly selected in accordance with the results of blood tests, urine tests, the condition of the patient and his resistance to treatment.
In case of hypokalemia associated with impaired cell metabolism, the administration of potassium preparations is intravenously prohibited, as this causes the occurrence of resistant hyperglycemia. Potassium salts such as chloride, bicarbonate, citrate, phosphate are used. With parenteral administration, the potassium salts are diluted with isotonic sodium chloride solution.
If an emergency requires rapid flooding of the body with potassium salts, then such therapy for hypokalemia is carried out under the watchful eye of the patient: ECG monitoring, checking of motor functions, respiration, determination of potassium 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 caution, they prescribe therapy to the elderly, especially with severe diabetes and kidney failure, as well as to patients taking potassium-sparing diuretics (for example, Spironolactone, Veroshpiron). Such people have a rather high risk of overdose. In contrast, patients with coronary heart disease, regularly taking cardiac glycosides, as well as patients taking insulin for diabetic ketoacidosis, the dosage of potassium should be higher.
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