{"id":33769,"date":"2022-08-27T19:35:35","date_gmt":"2022-08-27T12:35:35","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=33769"},"modified":"2022-08-27T19:37:07","modified_gmt":"2022-08-27T12:37:07","slug":"tang-kali-mau-trong-y-hoc","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/tang-kali-mau-trong-y-hoc\/","title":{"rendered":"T\u0103ng kali m\u00e1u trong y h\u1ecdc"},"content":{"rendered":"

vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft T\u0103ng kali m\u00e1u trong y h\u1ecdc<\/strong><\/a>, xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y<\/a>.<\/p>\n

T\u00e1c gi\u1ea3: B\u00e1c s\u0129 Ph\u1ea1m Ho\u00e0ng Thi\u00ean<\/em><\/p>\n

ICU Protocols: A stepwise approach Group \u201cC\u1eadp nh\u1eadt ki\u1ebfn th\u1ee9c y khoa\u201d<\/em><\/p>\n

M\u1ed9t b\u1ec7nh nh\u00e2n nam 60 tu\u1ed5i, m\u1eafc b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng, t\u0103ng huy\u1ebft \u00e1p v\u00e0 c\u00f3 d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ACEi), nh\u1eadp vi\u1ec7n v\u00ec nh\u1eefng c\u01a1n ch\u00f3ng m\u1eb7t. Khi nh\u1eadp vi\u1ec7n, m\u1ea1ch 60 \/ ph\u00fat, HA 110\/70 mmHg v\u00e0 nh\u1eadn th\u1ee9c b\u00ecnh th\u01b0\u1eddng. Sinh h\u00f3a m\u00e1u c\u1ee7a \u00f4ng cho th\u1ea5y ur\u00ea 90 mg \/ dL, creatinine 2,0 mg \/ dL, Na 130 mEq
\n\/ L v\u00e0 K 6,5 mEq \/ L.<\/p>\n

Table 57.3 Nh\u1eefng thay \u0111\u1ed5i c\u1ee7a ECG trong t\u0103ng kali m\u00e1u<\/p>\n\n\n\n\n\n\n\n
T cao, c\u00f3 \u0111\u1ec9nh (peak) v\u1edbi kho\u1ea3ng QT ng\u1eafn<\/td>\n<\/tr>\n
\u0110o\u1ea1n PR v\u00e0 th\u1eddi gian QRS k\u00e9o d\u00e0i<\/td>\n<\/tr>\n
M\u1ea5t s\u00f3ng P<\/td>\n<\/tr>\n
QRS d\u00e3n r\u1ed9ng v\u00e0 c\u00f3 d\u1ea1ng h\u00ecnh sin<\/td>\n<\/tr>\n
V\u00f4 t\u00e2m thu v\u00e0 ECG ph\u1eb3ng (flat ECG)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
$\"Fig.$
Fig. 57.2 Hyperkalemia<\/figcaption><\/figure>\n
Step 1: H\u1ed3i s\u1ee9c ban \u0111\u1ea7u<\/h2>\n
B\u1ec7nh nh\u00e2n b\u1ecb t\u0103ng kali m\u00e1u n\u1eb7ng c\u1ea7n \u0111\u01b0\u1ee3c l\u1eadp m\u1ed9t \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch kh\u1ea9n c\u1ea5p v\u00e0 theo d\u00f5i ECG li\u00ean t\u1ee5c.<\/p>\n
H\u1ecd c\u00f3 th\u1ec3 b\u1ecb ng\u1eebng nh\u1ecbp tim \u0111\u1ed9t ng\u1ed9t. N\u00ean l\u00e0m theo ACLS protocol trong nh\u1eefng t\u00ecnh hu\u1ed1ng n\u00e0y (xem Chap. 19).<\/p>\n
Step 2: \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a t\u0103ng kali m\u00e1u v\u00e0 s\u1ef1 kh\u1ea9n c\u1ea5p c\u1ee7a \u0111i\u1ec1u tr\u1ecb<\/h2>\n
T\u0103ng kali m\u00e1u n\u00ean \u0111\u01b0\u1ee3c x\u1eed tr\u00ed kh\u1ea9n c\u1ea5p trong nh\u1eefng t\u00ecnh hu\u1ed1ng sau:<\/p>\n
Thay \u0111\u1ed5i \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 (xem B\u1ea3ng 57.3 v\u00e0 H\u00ecnh 57.2)<\/p>\n
Y\u1ebfu ho\u1eb7c li\u1ec7t c\u01a1<\/p>\n
Ti\u00eau c\u01a1 v\u00e2n<\/p>\n
Ch\u1ea5n th\u01b0\u01a1ng nghi\u1ec1n n\u00e1t\/\u0111\u00e8 \u00e9p (crush injury)<\/p>\n
H\u1ed9i ch\u1ee9ng ly gi\u1ea3i kh\u1ed1i u<\/p>\n
Kali huy\u1ebft thanh h\u01a1n 7,0 mEq \/ L<\/p>\n
Kali t\u0103ng l\u00ean tr\u00ean 5 mEq\/L m\u1ed9t c\u00e1ch nhanh ch\u00f3ng<\/p>\n
Step 3: \u0110i\u1ec1u ch\u1ec9nh nhanh ch\u00f3ng t\u00ecnh tr\u1ea1ng t\u0103ng kali m\u00e1u n\u1eb7ng<\/h2>\n
\n
Calcium \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch\n
\n
Cho calcium gluconate ho\u1eb7c calcium chloride<\/li>\n
10 mL of 10% trong 2 ph\u00fat d\u01b0\u1edbi s\u1ef1 theo d\u00f5i li\u00ean t\u1ee5c ECG tr\u00ean monitoring.<\/li>\n
Canxi truy\u1ec1n t\u0129nh m\u1ea1ch ho\u1ea1t \u0111\u1ed9ng trong v\u00f2ng v\u00e0i ph\u00fat, nh\u01b0ng hi\u1ec7u qu\u1ea3 k\u00e9o d\u00e0i 30 – 60 ph\u00fat.<\/li>\n
Canxi ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch \u0111\u1ed1i kh\u00e1ng tr\u1ef1c ti\u1ebfp tr\u00ean ho\u1ea1t \u0111\u1ed9ng m\u00e0ng t\u1ebf b\u00e0o c\u1ee7a c\u01a1 tim khi t\u0103ng kali m\u00e1u v\u00e0 kh\u00f4ng g\u00e2y h\u1ea1 kali m\u00e1u.<\/li>\n
Canxi clorua ch\u1ee9a l\u01b0\u1ee3ng canxi cao g\u1ea5p 3 l\u1ea7n so v\u1edbi canxi gluconate (13,6 so v\u1edbi 4,6 mEq trong 10 ml dung d\u1ecbch 10%) v\u00e0 l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c \u01b0u ti\u00ean.<\/li>\n
Canxi ti\u00eam t\u0129nh m\u1ea1ch c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1eb7p l\u1ea1i sau 5 ph\u00fat, n\u1ebfu b\u1ea5t th\u01b0\u1eddng ECG v\u1eabn c\u00f2n.<\/li>\n
Dung d\u1ecbch canxi \u0111\u1eadm \u0111\u1eb7c l\u00e0 ch\u1ea5t k\u00edch th\u00edch m\u00f4 v\u00e0 n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng theo \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch ngo\u1ea1i bi\u00ean l\u1edbn ho\u1eb7c t\u0129nh m\u1ea1ch trung t\u00e2m.<\/li>\n
Kh\u00f4ng n\u00ean cho canxi v\u00e0o dung d\u1ecbch ch\u1ee9a bicarbonate \u0111\u1ec3 tr\u00e1nh k\u1ebft t\u1ee7a canxi cacbonat.<\/li>\n
Canxi n\u00ean \u0111\u01b0\u1ee3c th\u1eadn tr\u1ecdng nh\u01b0 truy\u1ec1n ch\u1eadm \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng digitalis.<\/li>\n<\/ul>\n<\/li>\n
Insulin v\u1edbi glucose\n
\n
Cho 10 \u0111\u01a1n v\u1ecb insulin truy\u1ec1n t\u0129nh m\u1ea1ch c\u00f9ng v\u1edbi 50 ml dextrose 50%.<\/li>\n
Theo d\u00f5i \u0111\u01b0\u1eddng huy\u1ebft m\u1ed7i 30 ph\u00fat.<\/li>\n
\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft tr\u00ean 250 mg \/ dL, c\u00f3 th\u1ec3 ch\u1ec9 cho insulin.<\/li>\n
T\u00e1c d\u1ee5ng c\u1ee7a insulin b\u1eaft \u0111\u1ea7u trong v\u00f2ng 10 ph\u00fat v\u00e0 k\u00e9o d\u00e0i 4-6 gi\u1edd.<\/li>\n
Insulin v\u00e0 glucose l\u00e0m gi\u1ea3m kali m\u00e1u b\u1eb1ng c\u00e1ch chuy\u1ec3n kali v\u00e0o b\u00ean trong c\u00e1c t\u1ebf b\u00e0o.<\/li>\n
N\u00f3 l\u00e0m gi\u1ea3m kali m\u00e1u 0,5-1,2 mEq \/ L.<\/li>\n
C\u1ea3nh gi\u00e1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn.<\/li>\n<\/ul>\n<\/li>\n
Salbutamol (albuterol) phun kh\u00ed dung\n
\n
10 mg trong 4 ml dung d\u1ecbch mu\u1ed1i \u0111\u01b0\u1ee3c phun kh\u00ed dung trong 10 ph\u00fat (g\u1ea5p b\u1ed1n l\u1ea7n li\u1ec1u thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n th\u00f4ng th\u01b0\u1eddng).<\/li>\n
Hi\u1ec7u qu\u1ea3 trong v\u00f2ng 90 ph\u00fat k\u1ec3 t\u1eeb khi phun kh\u00ed dung.<\/li>\n
Kali m\u00e1u th\u01b0\u1eddng gi\u1ea3m 0,5-1,2 mEq \/ L.<\/li>\n
N\u00f3 ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch chuy\u1ec3n kali v\u00e0o b\u00ean trong t\u1ebf b\u00e0o.<\/li>\n<\/ul>\n<\/li>\n
Sodium bicarbonate\n
\n
C\u1ea7n ch\u1ec9 \u0111\u1ecbnh th\u1eadn tr\u1ecdng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ecdn l\u1ecdc: t\u0103ng kali m\u00e1u li\u00ean quan \u0111\u1ebfn nhi\u1ec5m toan chuy\u1ec3n h\u00f3a n\u1eb7ng.<\/li>\n
Li\u1ec1u th\u00f4ng th\u01b0\u1eddng l\u00e0 25 mEq (25 ml 8.4%) truy\u1ec1n trong 5 ph\u00fat.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
Step 4: \u0110\u00e1nh gi\u00e1 nguy\u00ean nh\u00e2n g\u00e2y t\u0103ng kali m\u00e1u<\/h2>\n
L\u1ea5y chi ti\u1ebft b\u1ec7nh s\u1eed v\u00e0 th\u0103m kh\u00e1m n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 t\u00ecm ki\u1ebfm c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a c\u00e1c b\u1ec7nh li\u00ean quan \u0111\u1ebfn t\u0103ng kali m\u00e1u nh\u01b0 suy th\u1eadn v\u00e0 b\u1ec7nh tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn..<\/p>\n
C\u1ea7n t\u00ecm ki\u1ebfm ti\u1ec1n s\u1eed b\u1ec7nh th\u1eadn ho\u1eb7c n\u1ed3ng \u0111\u1ed9 kali \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 suy gi\u1ea3m \u0111\u1ed9t ng\u1ed9t c\u1ee7a ch\u1ee9c n\u0103ng th\u1eadn.
\nC\u1ea7n khai th\u00e1c ti\u1ec1n s\u1eed s\u1eed d\u1ee5ng thu\u1ed1c \u0111\u1ec3 lo\u1ea1i tr\u1eeb c\u00e1c thu\u1ed1c nh\u01b0 \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin, \u1ee9c ch\u1ebf men chuy\u1ec3n, thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid, thu\u1ed1c \u0111\u1ed1i kh\u00e1ng aldosterone v\u00e0 xi-r\u00f4 c\u00f3 ch\u1ee9a kali c\u00f3 th\u1ec3 g\u00e2y t\u0103ng kali m\u00e1u \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn.<\/p>\n
Step 5: X\u00e9t nghi\u1ec7m<\/h2>\n
N\u00ean theo d\u00f5i kali m\u00e1u th\u01b0\u1eddng xuy\u00ean.<\/p>\n
\n
Ur\u00ea, creatinin m\u00e1u.<\/li>\n
Natri, canxi, magi\u00ea, ph\u1ed1t ph\u00e1t.<\/li>\n
Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch.<\/li>\n
C\u00f4ng th\u1ee9c m\u00e1u to\u00e0n ph\u1ea7n.<\/li>\n
\u0110\u01b0\u1eddng huy\u1ebft.<\/li>\n
CPK.<\/li>\n
Lactate dehydrogenase..<\/li>\n<\/ul>\n
Step 6: Ng\u1eebng nh\u1eadp v\u00e0o kali<\/h2>\n
\n
B\u1eaft \u0111\u1ea7u ch\u1ebf \u0111\u1ed9 \u0103n kh\u00f4ng c\u00f3 kali.<\/li>\n
Tr\u00e1nh s\u1eed d\u1ee5ng thu\u1ed1c c\u00f3 ch\u1ee9a kali.<\/li>\n
Tr\u00e1nh c\u00e1c thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y t\u0103ng kali m\u00e1u.<\/li>\n<\/ul>\n
Step 7: Lo\u1ea1i b\u1ecf kali<\/h2>\n
\n
Thu\u1ed1c l\u1ee3i ti\u1ec3u: c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c l\u1ee3i ti\u1ec3u quai \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn b\u1ea3o t\u1ed3n v\u00e0 c\u00f3 qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch.<\/li>\n
Nh\u1ef1a resin trao \u0111\u1ed5i cation: Natri polystyren sulfonate.\n
\n
Trong ru\u1ed9t, natri polystyrene sulfonate chi\u1ebfm kali (v\u00e0 canxi v\u00e0 magi\u00ea \u1edf m\u1ee9c \u0111\u1ed9 th\u1ea5p h\u01a1n) v\u00e0 gi\u1ea3i ph\u00f3ng natri (1 gm li\u00ean k\u1ebft v\u1edbi 1 meq kali).<\/li>\n
N\u00f3 th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng ba l\u1ea7n m\u1ed7i ng\u00e0y nh\u01b0ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c cho b\u1eb1ng \u0111\u01b0\u1eddng tr\u1ef1c tr\u00e0ng.<\/li>\n
Li\u1ec1u u\u1ed1ng th\u01b0\u1eddng d\u00f9ng l\u00e0 20g u\u1ed1ng c\u00f9ng 100 ml dung d\u1ecbch sorbitol 20% \u0111\u1ec3 ng\u0103n ng\u1eeba t\u00e1o b\u00f3n.<\/li>\n
M\u1ed1i lo ng\u1ea1i ch\u00ednh v\u1edbi natri polystyrene sulfonate trong sorbitol l\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ho\u1ea1i t\u1eed ru\u1ed9t, th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn \u0111\u1ea1i tr\u00e0ng v\u00e0 h\u1ed3i tr\u00e0ng.<\/li>\n
Kali huy\u1ebft thanh gi\u1ea3m \u00edt nh\u1ea5t 0,4 mEq \/ L trong 24 gi\u1edd \u0111\u1ea7u ti\u00ean.<\/li>\n<\/ul>\n<\/li>\n
L\u1ecdc m\u00e1u\n
\n
\u0110\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh n\u1ebfu t\u0103ng kali m\u00e1u v\u1eabn t\u1ed3n t\u1ea1i m\u1eb7c d\u00f9 \u0111\u00e3 d\u00f9ng c\u00e1c bi\u1ec7n ph\u00e1p tr\u00ean ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ea5t k\u1ef3 ch\u1ec9 \u0111\u1ecbnh l\u1ecdc m\u00e1u n\u00e0o kh\u00e1c. Th\u1ea9m t\u00e1ch m\u00e1u (hemodialysis) c\u00f3 th\u1ec3 lo\u1ea1i b\u1ecf 25-50 mEq kali m\u1ed7i gi\u1edd, v\u1edbi s\u1ef1 thay \u0111\u1ed5i d\u1ef1a tr\u00ean n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft thanh ban \u0111\u1ea7u, lo\u1ea1i m\u00e1y v\u00e0 di\u1ec7n t\u00edch b\u1ec1 m\u1eb7t c\u1ee7a m\u00e1y th\u1ea9m t\u00e1ch \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, t\u1ed1c \u0111\u1ed9 d\u00f2ng m\u00e1u, t\u1ed1c \u0111\u1ed9 d\u00f2ng ch\u1ea3y c\u1ee7a th\u1ea9m t\u00e1ch, th\u1eddi gian l\u1ecdc m\u00e1u v\u00e0 n\u1ed3ng \u0111\u1ed9 kali c\u1ee7a ch\u1ea5t th\u1ea9m t\u00e1ch.<\/li>\n
C\u1ea3nh gi\u00e1c t\u0103ng kali m\u00e1u d\u1ed9i l\u1ea1i (rebound hyperkalemia) sau l\u1ecdc m\u00e1u.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
Step 8: X\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n g\u00e2y t\u0103ng kali m\u00e1u v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u (xem Table 57.4)<\/h2>\n
Table 57.4 C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y t\u0103ng kali m\u00e1u<\/p>\n\n\n\n\n
T\u0103ng kali m\u00e1u do gi\u1ea3i ph\u00f3ng t\u1eeb t\u1ebf b\u00e0o<\/em><\/p>\n
Gi\u1ea3 t\u0103ng kali m\u00e1u (v\u00ed d\u1ee5: tan m\u00e1u, t\u0103ng b\u1ea1ch c\u1ea7u r\u00f5 r\u1ec7t, t\u0103ng ti\u1ec3u c\u1ea7u, si\u1ebft ch\u1eb7t n\u1eafm \u0111\u1ea5m qu\u00e1 m\u1ea1nh trong khi l\u1ea5y m\u00e1u)<\/p>\n
Nhi\u1ec5m toan chuy\u1ec3n h\u00f3a<\/p>\n
Thi\u1ebfu h\u1ee5t insulin, T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, v\u00e0 t\u0103ng th\u1ea9m th\u1ea5u (DKA, HHS, truy\u1ec1n octreotide)<\/p>\n
T\u0103ng d\u1ecb h\u00f3a m\u00f4 (increased tissue catabolism) Thu\u1ed1c ch\u1eb9n b-adrenergic<\/p>\n
Ti\u00eau c\u01a1 v\u00e2n<\/p>\n
Qu\u00e1 li\u1ec1u digitalis<\/p>\n
T\u0103ng kali m\u00e1u do li\u1ec7t chu k\u1ef3 (Hyperkalemic periodic paralysis) Succinylcholine<\/p>\n
H\u1ed9i ch\u1ee9ng ly gi\u1ea3i kh\u1ed1i u T\u1eadp th\u1ec3 d\u1ee5c qu\u00e1 m\u1ee9c<\/td>\n<\/tr>\n
Gi\u1ea3m b\u00e0i ti\u1ebft kali qua n\u01b0\u1edbc ti\u1ec3u<\/em><\/p>\n
Suy th\u1eadn<\/p>\n
Gi\u1ea3m aldosterone (do thu\u1ed1c, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, suy th\u01b0\u1ee3ng th\u1eadn) T\u0103ng kali m\u00e1u do toan h\u00f3a \u1ed1ng th\u1eadn type 4 Ureterojejunostomy<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Suggested Reading<\/h2>\n
\n
McGowan CE, Saha S, Chu G, et al. Intestinal necrosis due to sodium polystyrene sulfonate (Kayexalate) in sorbitol. South Med J. 2009;102:493.<\/li>\n
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