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Distribúciu draslíka v tele a udrţovanie gradientu K + medzi extracelulárnou tekutinou a bun-kami<br />
však ovplyvňujú aj ďalšie činitele.<br />
<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><br />
Hodnoty draslíka v plazme (P), resp. sére (S), erytrocytoch (Erc), leukocytoch (Lkc)<br />
a trombocytoch (Tr)<br />
<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><br />
mmol/l<br />
mg/l<br />
Skupina <strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><br />
x±s Rozpätie x±s Rozpätie<br />
<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><br />
Novorodenci, 2-d P 4,6±0,6 (3,4 <strong>–</strong> 5,7) 178±22 130 <strong>–</strong> 220<br />
Deti, 1 <strong>–</strong> 35-mes. P 4,6±0,5 3,6 <strong>–</strong> 5,6 180±20 140 <strong>–</strong> 220<br />
Dospelí P 4,0 3,5 <strong>–</strong> 4,6 158 140 <strong>–</strong> 180<br />
Novorodenci, 1-d P 4,7±0,1 <strong>–</strong> 182±5,1 <strong>–</strong><br />
Dospelí S 4,1±0,3 3,5 <strong>–</strong> 4,7 160±11 140 <strong>–</strong> 180<br />
Muţi S <strong>–</strong> 3,6 <strong>–</strong> 4,8 <strong>–</strong> 140 <strong>–</strong> 190<br />
Ţeny S <strong>–</strong> 3,6 <strong>–</strong> 4,6 <strong>–</strong> 140 <strong>–</strong> 180<br />
Dospelí S 4,1±0,3 3,4 <strong>–</strong> 4,7 158±13 132 <strong>–</strong> 184<br />
Erc 99±5 89 <strong>–</strong> 110 3,9±0,2 3,5 <strong>–</strong> 4,3<br />
<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong>-<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><br />
mmol/kg<br />
g/kg<br />
<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><br />
Novorodenci, 1-d Erc 97±2 <strong>–</strong> 3,8±0,1 <strong>–</strong><br />
Deti, 4 <strong>–</strong> 36-mes. Erc 92±3 86<strong>–</strong>98 3,4±0,1 3,3 <strong>–</strong> 3,9<br />
Rôzni Tr 120±30 (62<strong>–</strong>71) 4,4±1,1 (2,4 <strong>–</strong> 5,9)<br />
na sušinu Lkc 380±20 <strong>–</strong> 14,8±0,8 <strong>–</strong><br />
<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><br />
Kaliémia sa v praxi hodnotí vţdy vo vzťahu k pH, pretoţe pri acidóze sa K + uvoľňuje z väzby na<br />
intracelulárne fosfáty, ako aj pri rozpade tkanivových bielkovín, na kt. je organicky viazaný. Pri<br />
alkalémii sa naopak K + viaţe v bunkách na fosfáty a zvýšene sa stráca močom, pretoţe Na + , kt. sa<br />
pre ne<strong>do</strong>statok Cl <strong>–</strong> vstrebal v proximálnom tubule len obmedzene, sa v distálnom tubule vymieňa za<br />
H + a K + . Tieto deje sa vystupňujú pri dehydratáci. Pri dehydratácii vystupuje K + po osmotickom<br />
spáde z buniek a po rehydratácii sa vracia opäť <strong>do</strong> buniek. Pri ne<strong>do</strong>statku K + , zvyšuje sa výmena<br />
Na + za H + a vzniká para<strong>do</strong>xná acidúria. Pritom sa môţe uplatniť aj hypoperfúzia obličiek a<br />
intracelulárna acidóza obličkového tkaniva.<br />
Výrazný vplyv na tok K + <strong>do</strong> buniek majú niekt. hormóny. Inzulín napomáha vstup glukózy <strong>do</strong> buniek,<br />
najmä pri súčasnom podávaní glukózy s následnou tvorbou glykogénu; časť účinku je podmienená<br />
aj mechanizmom nezávislým od transportu glukózy. Pri deficite inzulínu (inzulíndependentný<br />
diabetes mellitus) nastáva deplécia K + , kt. môţe <strong>do</strong>sahovať aţ 500 aţ 1000 mmol. Al<strong>do</strong>sterón<br />
pôsobí nielen na bunky distálneho tubulu, ale aj na bunky iných tkanív zvyšujúc vtok Na + du buniek<br />
a výtok K + z buniek. Adrenalín a agonisty -adrenergických receptorov zvyšujú koncentráciu K + v<br />
bunkách; antagonisty -adrenergických receptorov zniţujú koncentráciu K + v bunkách a gradient K + .<br />
Poruchy hospodárenia organizmu s draslíkom<br />
Prebytok draslíka v tele<br />
Stavy so zvýšenými zásobami K + v tele sú zriedkavé. Prebytok K + vyvolávajú zmeny bilancie K + ,<br />
alkalóza, pozit. energetická bilancia, malnutrícia a i.<br />
Hyperkaliémia <strong>–</strong> sérová koncentrácia K + > 5,5 mmol/l) môţe byť následkom ne<strong>do</strong>statočného<br />
vylučovania K + obličkami al. jeho zvýšeného výtoku z buniek, príp. ide o násle<strong>do</strong>k zvýšeného<br />
prívodu K + . Skutočný nadbytok K + v tele je však zriedkavou príčinou hyperkaliémie. Hyperkaliémia<br />
sa zisťuje pri týchto stavoch:
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