高血鉀症(hyperkalemia).pptVIP

Hyperkalemia Hyperkalemia Symptoms Generalized fatigue Weakness Paresthesias Paralysis Palpitations Hyperkalemia Etiology Acute or chronic renal failure Crush injuries (rhabdomyolysis), burns Foods (eg, bananas, oranges, high-protein diets, tomatoes, salt substitutes) Redistribution: Acidosis, insulin deficiency, beta-blocker, acute digoxin overdose, succinylcholine, periodic paralysis (PP) Drugs – slow-K, spirinolactone diuretics, NSAIDs Hyperkalemia Mild: 5.5-6.5 mEq/L peaked T waves Moderate: 6.5-7.5 mEq/L prolonged PR interval decreased P wave ST depression or elevation slight widening of the QRS Hyperkalemia (cont.) Severe: 7.5-8.5 mEq/L wide QRS flat and wide P waves VPCs Life-threatening: 8.5 mEq/L loss of P AV blocks VT / VF sinusoid patern Hyperkalemia Specific management: See BIG Potassium Drop Calcium Bicarbonate Insulin and Glucose Kayexalate Dialysis Hyperkalemia General management: Continuous ECG monitoring DC K-sparing drugs (ACEI, spirinolactone) DC high-K foods Calcium Stabilize cell membrane Calcium gluconate 10%, 10 ml over 2-5 min 2nd dose after 5 min if no response Effect occurs in minutes and lasts for 1 hour Further calcium ineffective unless hypocalcemia exists Digoxin Toxicity ? contraindication ! Bicarbonate Shift K+ to intracellular 3 amp Jusomine IV over 5 min May repeat q10-15 min Onset in 30 min; duration: 1-2 hours Avoid bicarbonate if: Hypocalcemia Severe lung edema Glucose and Insulin Redistribution RI 10U + D50GW 50cc over 5 min Consider Albuterol Neb as adjunct Onset 50-60 min; duration: several hours Follow F/S Potassium Removal Cation-Exchange resin (Kayexalate) 15-30 gm PO q3-4 hrs or 50 gm in 200 ml retention enema for 30-60 min q4hr Dialysis: May experience significant hyperkalemia on rebound Summary Hyperkalemia Symptoms? Diagnosis? EKG? Etiology? Treatment? 謝謝聆聽 * 急診護理個案討論 新光醫院 急診科 張志華 醫師 2005 / 09 / 15 常考！ Nonspecific！ 考題！ 考題！ 余謹以至誠 於上帝及會眾面前宣， 終身純潔，忠貞職守 盡力提高護理專業標準， 勿為有損之事， 勿取服或故用有害之藥， 慎守病人及家務之秘密， 竭誠協助