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1、兒童高鉀及低鉀血癥的危重處置要點(diǎn)公慈2017/7/9NationalCenterforChildren’sHealth,BeijingChildren1’s勤和Hospital概述???–骨骼肌內(nèi)濃度可140～150mEq/L?公慈2017/7/92017/7/9NationalCenterforChildrenNationalCenterforChildren’’sHealth,BeijingChildrensHealth,BeijingChildren22’’ss勤和HospitalHospital
2、鉀平衡?–鉀的需求量與熱卡比值：2mEq/100kcal???公慈2017/7/92017/7/9NationalCenterforChildrenNationalCenterforChildren’’sHealth,BeijingChildrensHealth,BeijingChildren33’’ss勤和HospitalHospital鉀平衡??如果機(jī)體突然攝入大量鉀，組織細(xì)胞–近曲小管和Henle袢將使80%進(jìn)入血中的鉀進(jìn)入細(xì)胞內(nèi)?–遠(yuǎn)曲小管和集合管主動(dòng)排泌–排泌量與攝入量、遠(yuǎn)曲小管和集合管細(xì)胞中
3、氫離子濃度、鈉離子重吸收等相關(guān)–腎臟不能在未攝入鉀的情況下停止機(jī)體對(duì)鉀的消耗公慈2017/7/92017/7/9NationalCenterforChildrenNationalCenterforChildren’’sHealth,BeijingChildrensHealth,BeijingChildren44’’ss勤和HospitalHospital鉀平衡?–2個(gè)鉀離子泵入細(xì)胞內(nèi)，3個(gè)鈉離子泵到細(xì)胞外，使細(xì)胞膜上產(chǎn)生電化學(xué)梯度–多因素可以影響該泵的活性，如胰島素、胰高血糖素、兒茶酚胺、醛固酮、酸堿平
4、衡狀態(tài)、血漿滲透壓、細(xì)胞內(nèi)鉀離子濃度等公慈2017/7/92017/7/9NationalCenterforChildrenNationalCenterforChildren’’sHealth,BeijingChildrensHealth,BeijingChildren55’’ss勤和HospitalHospital鉀平衡的調(diào)節(jié)公慈2017/7/92017/7/9NationalCenterforChildrenNationalCenterforChildren’’sHealth,BeijingChil
5、drensHealth,BeijingChildren66’’ss勤和HospitalHospital鉀離子的生理功能?–每合成1g糖原約需0.15mmol鉀，合成1g蛋白質(zhì)需0.45mmol鉀?–細(xì)胞膜內(nèi)外鉀離子濃度決定神經(jīng)肌肉細(xì)胞的靜息電位–血清鉀濃度很低，如細(xì)胞內(nèi)僅1%的鉀進(jìn)入細(xì)胞外液，尤其是心肌細(xì)胞，即可發(fā)生傳導(dǎo)異常甚至致死性心律失常?公慈2017/7/92017/7/9NationalCenterforChildrenNationalCenterforChildren’’sHealth,Bei
6、jingChildrensHealth,BeijingChildren77’’ss勤和HospitalHospital高鉀血癥（HYPERKALEMIA）公慈2017/7/9NationalCenterforChildren’sHealth,BeijingChildren8’s勤和Hospital高鉀血癥定義????公慈2017/7/92017/7/9NationalCenterforChildrenNationalCenterforChildren’’sHealth,BeijingChildrensH
7、ealth,BeijingChildren99’’ss勤和HospitalHospital高鉀血癥病因?–鉀的攝入和排泄失衡–鉀在細(xì)胞內(nèi)外分布異常??–ICU患者高鉀血癥常見原因?????公慈2017/7/92017/7/9NationalCenterforChildrenNationalCenterforChildren’’sHealth,BeijingChildrensHealth,BeijingChildren1010’’ss勤和HospitalHospital高鉀血癥病因靜脈或口服補(bǔ)鉀輸血（隨血
8、細(xì)胞貯存時(shí)間延長其風(fēng)險(xiǎn)增加）急慢性腎功能不全：GFR下降（尤其是＜15ml/min/1.73m2時(shí)）原發(fā)（如Addison?。┗蚶^發(fā)性低醛固酮癥（如慢性腎功能衰竭）腎素分泌減少先天性腎上腺皮質(zhì)增生癥假性低醛固酮癥充血性心力衰竭IV型腎小管性酸中毒酸中毒引起鉀離子再分布高鉀性家族性周期性麻痹糖尿病急性組織細(xì)胞破壞（燒燙傷、中暑、創(chuàng)傷、擠壓傷、橫紋肌溶解、腫瘤溶解綜合征、溶血、大量輸血、溶血尿毒綜合征、組織壞死等）采血時(shí)使用止血帶或取血困難致標(biāo)
