instit.oncol.cluj-napoca- sectia hematologie - 2012
instit.oncol.cluj-napoca- sectia hematologie - 2012
instit.oncol.cluj-napoca- sectia hematologie - 2012
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- Catabolism exagerat<br />
- Necroze tisulare, rabdomioliza<br />
- Deficit de insulina<br />
- Deficit de mineralocorticoizi<br />
- Intoxicatie digitalica<br />
- Succinilcolina<br />
- Blocante beta-adrenergice<br />
- Deficit de catecolamine<br />
- Antagonisti de aldosteron<br />
21.2.3 CLINIC:<br />
1. Manifestari cardio-vasculare<br />
- Aritmii, Asistola ventriculara, Blocuri de conducere si conducere intarziata<br />
- EKG: unde T ascutite, unde P de amplitudine scazuta, interval PR prelungit, complexe<br />
QRS largi<br />
2. Manifestari neuro-musculare<br />
- Parestezii,Atonie musculara, insuficienta ventilatorie,Paralizie flasca, Confuzie mentala<br />
21.2.4 TRATAMENT:<br />
1. Masuri generale<br />
- Tratamentul cauzei<br />
- Restrictionarea aportului<br />
- Evitarea medicamentelor ce pot determina hiperpotasemie<br />
2. Hiperpotasemie moderata: K 7 mEq/l, manifestari cardiace<br />
- Inversarea efectului de membrane: 1 fiola Ca gluconic iv in 5 minute<br />
- Introducerea K in celula:<br />
o Glucoza 10% 250-500 ml cu 10-20 unit insulina<br />
o Bicarbonat Na 50-100 ml in 10 minute<br />
o Beta-agonisti<br />
- Eliminarea K: kayexalate 20-30 g oral in 50 ml sorbitol 7-% a 4 ore<br />
- Furosemid<br />
- Dializa: cand celelalte masuri nu au fost eficiente, in caz de insuficienta renala,<br />
distructii tisulare severe cu productie mare de K<br />
21.3. HIPONATREMIA<br />
21.3.1 DEFINITIE. Scaderea Na sub 136 mEq Na, fie prin pierdere de Na, fie prin exces de apa,<br />
fie prin aport insuficient. Na este principalul electrolit extracelular.<br />
- 1 g Na= 43 mEq Na<br />
- 1 g NaCl= 17 mEq Na<br />
21.3.2 CAUZE:
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