disorders of potassium metabolism
DESCRIPTION
Disorders of Potassium metabolism. Dr. Hammed Al shakhatreh Consultant Nephrologist . Total body K is about 3500 m moll 2 % extracellular 98% intracellular S.K 3.5- 5.3 m mol/ litter normally regulation of S.K is by kidney and GI firstly, secondly by shifting. Renal regulation - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/1.jpg)
Disorders of Potassium metabolism
Dr. Hammed Al shakhatrehConsultant Nephrologist
![Page 2: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/2.jpg)
• Total body K is about 3500 m moll 2 % extracellular 98% intracellular
• S.K 3.5- 5.3 m mol/ litter normally regulation of S.K is by kidney and GI firstly, secondly by shifting.
![Page 3: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/3.jpg)
Renal regulation
• Aldosterone• High distal Na delivery • High urine flow rate• High K in tubular cells• Metabolic alkalosis
![Page 4: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/4.jpg)
Others Route of excretion is GI system by diarrhea and vomiting. The last system to regulate of S.K is by shifting from cells outside by acidosis and into cells by alkalosis also by Insulin and epinephrine
Hypo kalmia S.K < 3.5 mmol/L
1- Low intake 2- Losses 3- Shifting
![Page 5: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/5.jpg)
To differentiate between renal and extrarenal causes in Hypokalemic patients urine K > 20 mmol/L suggests a renal etiology where's urine K < 20 mmol/L suggests an extrarenal etiology.
![Page 6: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/6.jpg)
Causes of Hypokalemia
• Inadequate potassium intake (severe malnutrition)• Extrarenal potassium losses Vomiting Diarrhea
• Hypokalemia due to urinary potassium losses Diuretics (loop, thiazides, acetazolamide) Osmotic dieresis (hyperglycemia)
![Page 7: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/7.jpg)
Hypokalemia with hypertension
• Primary aldosteronism• Glucocorticoid remediable hypertension • Malignant hypertension• Renovascular hypertension• Rennin-secreting tumor• Essential hypertension with excessive diuretics
![Page 8: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/8.jpg)
• Liddle's syndrome• 11 β -hydroxysteroid dehydrogenase deficiency Genetic• Drug-induced (chewing tobacco, licorice, some
French wines)• Congenital adrenal hyperplasia
![Page 9: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/9.jpg)
Hypokalemia with a normal blood pressure
• Distal RTA (type 1)• Proximal RTA (type 2)• Bartter's syndrome• Gitelman's syndrome• Hypomagnesaemia (cisplatinum, alcoholism,
diuretics)
![Page 10: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/10.jpg)
Hypokalemia due to potassium shifts
• Insulin administration• Catecholamine excess (acute stress)• Familial periodic hypokalemic paralysis• Thyrotoxic hypokalemic paralysis
![Page 11: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/11.jpg)
clinical manifestation of Hypokalmia
1. Muscle weakness 2. Constipation, distended abdomen 3. Polyuria 4. Arrhythmia specially in patient taking dioxin. 5. ECG- U wave, ST depression
![Page 12: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/12.jpg)
Treatment of Hypokalmia
Potassium Chloride I.V allowed 200mmol/day and urgently 60 m mol/hour in central line under monitoring
![Page 13: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/13.jpg)
Hyperkalemia
• Serum potassium > 5.3 m mol/L• Pseudohyerkalemia seen in blood haemolysis after
drawing from the patient Pseudohyperkalemia
• Hemolysis • Thrombocytosis• Severe leukocytosis• Fist clenching
![Page 14: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/14.jpg)
True Hyperkalemia• Acute or chronic renal failure• Aldosterone deficiency (type 4 renal tubular
acidosis) Frequently associated with diabetic nephropathy,
chronic interstitial nephritis, or obstructive nephropathy.
• Adrenal insufficiency (Addison's disease)• Drugs that inhibit potassium excretion• Kidney diseases that impair distal tubule function
![Page 15: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/15.jpg)
• Sickle cell anemia• Systemic lupus erythematosus• Abnormal potassium distribution • Insulin deficiency • β -blockers • Metabolic or respiratory acidosis• Familial hyperkalemic periodic paralysis• Abnormal potassium release from cells• Rhabdomyolysis• Tumor lysis syndrome
![Page 16: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/16.jpg)
Clinical manifestation • muscle weakness• Paralysis
ECG manifestation • Peak T wave • Wide QRS• Prolonged PR up to absent P wave• Sine wave • Ventricular Fibrillation
![Page 17: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/17.jpg)
Treatment of Hyperkalmia
- S.K 5.5-6.5 without ECG manifestations don’t treat. - S.K 5.5-6.5 with ECG manifestations treat . - S.K > 6.5 treat 1. I.V calcium2. Give insulin with GW3. Beta agonist4. Kayexalate GIVE 50 g in 30 ml Orbital by mouth or 50 g in a
retention enema. 5.Haemodialysis.
![Page 18: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/18.jpg)
What is the diagnosis?
1. Digoxin poisoning2. Hyperkalemia3. Intra-aortic balloon pump4. Pericardial effusion5. Right fascicular block
![Page 19: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/19.jpg)
Image Challenge
Q. What is the diagnosis? Answer:
2. Hyperkalemia
The electrocardiogram shows a regular rhythm, with a widened QRS complex in a sine-wave configuration, and there no discernible P waves. The T waves were fused with the widened QRS complexes to form the sine-wave pattern (sinoventricular rhythm). The patients serum �potassium level was 9.1 mmol per liter. His condition stabilized after the administration of calcium chloride, bicarbonate, glucose, and insulin therapy, which was followed by hemodialysis
![Page 20: Disorders of Potassium metabolism](https://reader036.vdocuments.us/reader036/viewer/2022062323/56816330550346895dd3af4c/html5/thumbnails/20.jpg)
Thank You