Cudurka Hyperkalemia waxaa lagu ogaadaa marka heerkaaga potassium-ka uu cabbiro 5.0 mEq / L ama in ka badan. Waxaa sababi kara in la gooyo potassium-ka aad u badan, oo aan ka dhalaalin potassium ku filan, ama potassium salka dareenka unugyada.
Tijaabadu waxay kaa caawin kartaa in la go'aamiyo kuwaas oo ka mid ah farsamooyinkaasi ay ku kicinayaan potassium-kaaga sare. Kaliya markaad ogtahay sababta aad u haysatid hyperkalemia waad u daaweyn kartaa si habboon waxaana rajeyneynaa inaad ka hortagto soo noqoshada.
Baaritaanka Dhiiga
Ka hor intaadan tagin waddada qiimeynta rasmiga ah, dhakhtarkaagu wuxuu doonayaa inuu hubiyo inaad qabto hyperkalemia runta ah. Marar dhif ah, heerarka potassium ayaa si khalad ah u kordhay, xaalad loo yaqaanno pseudohyperkalemia, sababta oo ah sida dhiigaaga loo qaado .
Gundhiga oo loo isticmaalo si aad u adag ama aad u dheer wuxuu unugyada dhiiga gaduudan u keeni karaa hemolyze ama qarxa, potassium ku daato maadada. Xidmidda dhuunta xayawaanka ee lagu daaweeyo venipuncture waxay sidoo kale keeni kartaa potassium in ay ka soo baxdo unugyadaada, sii kordhiso natiijooyinka shaybaarkaaga illaa 1 illaa 2 mEq / L.
Dhaqtarkaaga ugu horreeya ee dhakhtarku waa inuu dib u eego heerkulkaaga potassium. Haddii heerarkaagu sarreeyo, dhakhtarkaagu wuxuu dalban karaa tijaabooyinka soo socda.
Imtixaanada hore
Dib u dhac ku yimaada isbeddelka , haddii uu yahay mid daran ama mid joogto ah, waa mid ka mid ah sababaha ugu badan ee keena hyperkalemia. Marka kelyuhu ay ku fashilmaan, ma awoodaan in ay si sax ah u quutaan potassium. Tani waxay keeni kartaa in la dhiso kaniiniga potassium ee dhiiga.
Nitrogen (BUN) iyo kreatinine ayaa qiyaasta sida kelyahaagu u shaqeynayo oo ay ku jiraan qayb ka mid ah guddiga qaab-dhismeedka aasaasiga ah. Baaritaannada kale ee guddiga waxaa ka mid ah sodium, chloride, bicarbonate, iyo glucose. Qiimaha shaybaarkan waxaa loo isticmaalaa in lagu xisaabiyo farqiga anion ee, haddii uu kor u kacay, tilmaanta metabolic acidosis.
Acidosis waxay ka qaadi kartaa potassium unugyada iyo dhiigga. Heerarka gulukooska ee sarreeya, sida lagu arki karo sonkorowga aan kontoroolin , ayaa sameeya isla sidaas. Heerarka soodhiyood ee hoose ee wejiga heerarka sare ee potassium ayaa soo jeedin kara xaalad hormoon la yiraahdo hypoaldosteronism.
Tirada dhiigga oo dhameystiran ayaa sidoo kale noqon karta tijaabo baaritaan lagu caawiyo. Tirada dhiigga caddaanku wuxuu noqon karaa calaamad muujinaysa caabuq ama infakshan jirka ku jira. Heerka dhiigga ee hooseeya iyo heerarka hematocrit ayaa muujiya dhiig-yaraanta. Dhiig-baxa oo sababay burburka unugyada dhiigga cas, oo loo yaqaanno dhiig-yaraanta dhiig-yarida , ayaa sii deyn kara heerarka sare ee potassium.
- BUN
- Creatinine
- Metabolic panel
- Tirada dhiigga oo buuxa
Baaritaano gaar ah
Iyada oo ku xiran calaamadahaaga iyo taariikhda caafimaadka, dhakhtarkaagu wuxuu sidoo kale dooran karaa inuu raaco qaar ka mid ah tijaabooyinka soo socda.
- Aldosterone: Aldosterone waa hormoon soo saaro qanjirrada adrenal ee xukuma cadaadiska dhiigga. Xitaa haddii heerka potassium uu sarreeyo oo heerka soodhiyana uu hooseeyo, heerka aaladda qaadashada ayaa loo baahan yahay si loo xaqiijiyo ogaanshaha cudurka hypoaldosteronism. Bini'aadanku sidoo kale waa mid caan ku ah xaaladda.
- Creatinine phosphokinase (CPK): Heerarka sare ee CPK waxay soo jeedinayaan in uu jiro dhaawac murqaha ah. Ma aha oo keliya in enzyme ka daadato muruqyada laakiin waxay daadin kartaa kelyaha, taas oo horseedaysa kalyaha oo ku fashilantay waxa loo yaqaan ' rhabdomyolysis' . Potassium ayaa sidoo kale ka soo baxaysa unugyada muruqyada.
- Qiyaaso Digoxin: Digoxin waa mid ka mid ah daawooyin badan oo ku yeelan kara saameyn daawada hyperkalemia. Si ka duwan beta-blockers kuwaas oo sidoo kale kordhin kara potassium serum, digoxin waxay leedahay baaritaan dhiig si loo hubiyo inta daawo ee ku jirta dhiiggaaga.
- Uric acid iyo fosfooraska baarista: Marka unugyada jabaan, waxay sii daayaan uric acid iyo fosfooraska marka lagu daro potassium. Tani waxay ku dhici kartaa dhiig-yaraanta dhiig-yaraanta ama faleebada cudurka sickle cell. Waxay sidoo kale ku dhici kartaa cilladda lysis syndrome-ka marka ay jirto ba'an weyn oo ah unugyada ka dib daweynta kiimiko.
Tijaabada Cudurka
Kaadi- yare oo fudud waxay u eegtaa dhiigga, sonkorta, borotiinka, ama caabuqa kaadida.
Natiijooyinka aan caadiga ahayn waxay muujin karaan glomerulonephritis, bararka kalyaha, ama glomerulonephrosis, xaalad aan xannibneyn oo kelyaha ka soo baxa protein. Waxay kaloo muujin kartaa sokorowga aan la xakameynin.
Baaritaano dheeraad ah oo kaadida ah ayaa laga yaabaa in la dabagalo si loo hubiyo sida fiican ee kelyuhu u shaqeynayaan. Haddii dheecaanka kaadida ee potassium iyo sodium ay ku jiraan xaddiga la filayo, kelyuhu maaha inay eedeeyaan. Sababta aan caanaha ahayn waa in la baaraa. Baaritaanka myoglobin kaadida ayaa xaqiijin karta baaritaanka cudurka rhabdomyolysis.
- Kaadi urin aasaasi ah
- Kiniinka kaadida iyo soodhiyamka
- Mininoglobin kine
Baaritaanka wadnaha
Cudurka Hyperkalemia wuxuu kicin karaa arrin dareen-celin ah haddii heerarka potassium uu aad u sarreeyo. Cudurka elektrokardiogram-ka (ECG) waa qalab muhiim ah oo lagu ogaanayo, maaha oo keliya in la ogaado xaalado daran oo ah hyperkalemia laakiin sidoo kale lagu aqoonsado nooca arrin xasaasiyadeed.
ECG waxay cabirtaa qalabka korontada ee wadnaha, laga bilaabo qolalka sare ee wadnaha, atria, qolladaha hoose, saliidaha. Khad kasta oo ECG ka soo jeeda PQRST waxay u taagan tahay waxqabasho ama soo kabashada qol kale oo ka mid ah muruqyada wadnaha.
Sida kiniiniga potassium-ku kordhiyo, isbedelka ECG wuxuu noqdaa mid aad u daran. Laga bilaabo heerarka 5.5 meq / L iyo wixii ka sareeya, neefta ayaa laga yaabaa inay ku adkaato soo kabashada. Tan waxaa laga yaabaa in loo arko inay tahay hirar mawjado badan oo ku yaal ECG. Dhaqaajinta qatarta ah waxay saameyneysaa 6.5 mEq / L sidaa daraadeed lakabka p-yada lama arki karo. At 7.0 mEq / L, mawjadaha QRS waa la ballaadhiyay, oo ku habboon dib-u-socodka hawo-mareenada.
Qalalaas wadnaha ayaa u muuqda mid horumar ah 8.0 mEq / L. Tani waxay ku jiri kartaa wax kasta oo ka yimaada bradycardia sinusta ilaa taakawidhiyada lagu xakameynayo . Xaaladda ugu xumayd, asystole, luminta dhammaan tamarta korontada, way dhici kartaa. Iyadoo ECG aysan sheegin sababta keenta hyperkalemia, waxay ka tarjumaysaa heerka darnaanta xaaladda. Arrhythmias waa mid u baahan daaweyn degdeg ah.
Tijaabooyin kala duwan
Dadka qaba cirrhosis, wadnaha oo xirma wadnaha , iyo sonkorowgu waxay halis ugu jiraan in uu ku dhaco hyperkalemia. Xaalado kale oo dabadheeraad ah oo noqon kara arrin waxaa ka mid ah amyloidosis iyo cudurka sickle cell .
Haddii laguu qoro daawooyinka sida celiyeyaasha ACE, xannibeeyeyaasha angiotensin-receptor, beta-blockers , cyclosporine, digoxin, minoxidil, spironolactone, iyo takrolimus, ogsoonow in heerarkaaga potassium uu kordhi karo. Dhakhtarkaagu waxaa laga yaabaa inuu raadsado waxyaabo kale oo keena hyperkalemia, sida jilicsanaan la'aanta iyo hypoaldosteronism, sida kor ku xusan.
> Ilo:
> Kehnhardt A, Kemper MJ. Pathogenesis, Diagnosis and Management of Hyperkalemia. Pediatr Nephrol. 2011 Mar; 26 (3): 377-384. doi: 10.1007 / s00467-010-1699-3.
> Levis JT. ECG Baaritaanka: Hyperkalemia. Perm J. 2013 Qaboobaha; 17 (1): 69.doi: 10.7812 / TPP / 12-088
> Lewis JL. Hyperkalemia. Manhajka Merck: Heerka Xirfadaha. Dib u cusbooneysiiyay Abriil 2016. https://www.merckmanuals.com/professional/endocrine-and-matabolic-disorders/electrolyte-disorders/hyperkalemia.
> Buugga DB. Sababaha iyo Qiimeynta Hyperkalemia ee Dadka Qaangaarka ah. Gudaha: Forman JP (ed), UpToDate [Internet] , Waltham, MA. Dib loo cusbooneysiiyay February 2018.
> Simon LV, Farrell MW. Hyperkalemia. In: StatPearls [Internet]. Jasiiradda Treasure (FL): Daabacaadda StatPearls. 2018 Jan-.