The old iron who has been working in the clinic knows that insulin with glucose is used to treat hyperkalemia, and the principle is also clear to everyone, that is, the synthesis of glycogen is used to consume potassium ions, so that potassium ions enter the cells, reduce the concentration of peripheral blood potassium ions, and achieve the purpose of treating hyperkalemia.
(Sounds like a temporary solution to cover your ears, because this does not let the potassium ions excrete from the body, but temporarily changes the potassium ions to another place, so that it does not continue to increase in the peripheral blood, affecting the function of the heart)
<h1 class="pgc-h-arrow-right" > why does hyperkalemia affect the heart? </h1>
Before talking about potassium lowering ions, we must understand the impact of potassium ions on the heart.
As we all know, the resting potential of the heart's cardiomyocytes is caused by the outflow of potassium ions, that is to say, the outflow of potassium ions forms a potential difference between the inside and the outside, so that the ventricular muscle cells are in a polarized state and are not easily excited.
If the peripheral blood potassium ion concentration increases, the concentration of potassium ions outside the membrane of ventricular muscle cells increases, due to the difference in concentration and the action of the electric field force, potassium ion outflow is difficult, potassium ions can not flow out, the difference between the internal negative and external positive will be reduced, the potential difference between the two sides of the cell membrane will be smaller, the polarization state will be reduced, and the ventricular muscles will be more likely to be excited, and even self-excited.
This is why patients with hyperkalemia develop ventricular arrhythmias such as ventricular tachycardia, ventricular fibrillation, and even cardiac arrest.
Therefore, based on this, patients with hyperkalemia must be actively treated (generally blood potassium more than 5.5mmol/L is hyperkalemia, and patients with serum potassium above 6mmol/L have cardiac risk)
<h1 class="pgc-h-arrow-right" >why does sodium bicarbonate reduce potassium, and where is the principle? </h1>
Some time ago, a colleague asked me, patients with hyperkalemia, with insulin with glucose to treat hyperkalemia, the principle can be understood and accepted, but what is the principle of using sodium bicarbonate to fight hyperkalemia?
In the treatment of hyperkalemia, the effect of intravenous hypertonic alkaline solution (5% sodium bicarbonate) is to increase blood volume, K⁺ is diluted, so that K⁺ is moved into the cell or excreted by the urine, some people say, 5% glucose can also dilute the blood Why not use? In fact, it is not not used, sugar with insulin is not used, but the dilution effect is secondary, and we can not dilute vigorously, otherwise, it is not better to directly fill pure water?
More importantly, Na⁺ in sodium bicarbonate has the effect of opposing K⁺, which is mainly reflected in the sodium-potassium exchange of the renal tubules and the negative potential of the tubule fluid left when the distal tubules reabsorb sodium with the collecting duct can attract the leap cells to secrete potassium, so as to promote the excretion of potassium ions. Some people should ask, since sodium ions can fight potassium, why not directly use high-concentration sodium chloride injection, the effect is not better?
The answer is no, this is because the absorbed sodium and chlorine in sodium chloride are not 1:1 absorption, sodium ions absorb more, chloride ion absorption is less, so that there will be a large number of chloride ions left in the peripheral blood to cause hyperchloremia, aggravating the patient's acidosis (most patients with high potassium have acidosis, the specific principle we will talk about later).
<h1 class="pgc-h-arrow-right" >why is calcium gluconate used to treat hyperkalemia? </h1>
We have just said that the heart problem caused by hyperkalemia is because potassium ions affect the resting potential of ventricular muscle cells, thereby affecting the excitability of cardiomyocytes, and calcium ions can fight potassium ions, and by promoting the release of acetylcholine, improve the permeability of cells, reduce the excitability of cardiomyocytes, thereby alleviating cardiac toxicity caused by potassium ions.
That is to say, the purpose of using calcium gluconate is to fight potassium ions to avoid inducing arrhythmias, not to reduce potassium ion concentrations, which is an emergency strategy.
Therefore, on the whole, insulin with glucose and blood dilution are temporary palliative solutions, and it is the fundamental treatment that allows potassium ions to be discharged.
summary:
The treatment of hyperkalemia is mainly to prevent cardiac accidents, and if the drug does not work, dialysis must be rushed.
Again, in the face of absolute strength, all moves are flower fist embroidery legs. In the face of dialysis, all excretory drugs are also pale and weak.
Well, today I will share here, I am Dr. Qi pay attention to me, learn some useful medical knowledge.
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