{"id":21577,"date":"2023-04-15T21:17:56","date_gmt":"2023-04-15T14:17:56","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21577"},"modified":"2023-04-17T14:50:42","modified_gmt":"2023-04-17T07:50:42","slug":"loi-tieu-giu-kali-va-cac-chi-dinh-tren-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/loi-tieu-giu-kali-va-cac-chi-dinh-tren-lam-sang\/","title":{"rendered":"L\u1ee3i ti\u1ec3u gi\u1eef kali v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh tr\u00ean l\u00e2m s\u00e0ng"},"content":{"rendered":"

L\u1ee3i ti\u1ec3u gi\u1eef kali c\u00f3 t\u00e1c d\u1ee5ng \u1edf \u1ed1ng l\u01b0\u1ee3n xa, \u1ee9c ch\u1ebf kh\u1ea3 n\u0103ng t\u00e1i h\u1ea5p thu natri b\u1eb1ng c\u00e1ch trao \u0111\u1ed5i v\u1edbi kali, tr\u1ef1c ti\u1ebfp l\u00ean c\u00e1c t\u1ebf b\u00e0o (triamteren, amilorid) ho\u1eb7c b\u1eb1ng c\u00e1ch \u0111\u1ed1i kh\u00e1ng v\u1edbi aldosteron.<\/strong><\/p>\n

1.Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h2>\n

1.1 T\u0103ng huy\u1ebft \u00e1p.<\/h3>\n

C\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali c\u00f3 t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u t\u01b0\u01a1ng \u0111\u1ed1i y\u1ebfu, ch\u00fang th\u01b0\u1eddng xuy\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u kh\u00e1c nh\u01b0 l\u1ee3i ti\u1ec3u quai, thiazide. Tr\u1eeb c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u00ecnh tr\u1ea1ng gi\u1eef mu\u1ed1i n\u01b0\u1edbc ho\u1eb7c m\u1ed9t s\u1ed1 \u0111i\u1ec1u ki\u1ec7n di truy\u1ec1n hi\u1ebfm g\u1eb7p, th\u00ec vai tr\u00f2 ch\u00ednh c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p th\u00f4ng th\u01b0\u1eddng l\u00e0 b\u00f9 \u0111\u1eafp l\u01b0\u1ee3ng kali v\u00e0 magie b\u1ecb m\u1ea5t g\u00e2y ra b\u1edfi thiazide ho\u1eb7c l\u1ee3i ti\u1ec3u quai.<\/p>\n

Eplerenone \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nh\u1eefng b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p k\u00e8m ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i, eplerenone hi\u1ec7u qu\u1ea3 nh\u01b0 enalapril (40 mg\/24h) trong vi\u1ec7c gi\u1ea3m ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i c\u0169ng nh\u01b0 h\u1ea1 huy\u1ebft \u00e1p. Tuy nhi\u00ean, c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u0103ng huy\u1ebft \u00e1p c\u00f3 t\u0103ng aldosterone nguy\u00ean ph\u00e1t th\u00ec eplerenone (100-300 mg\/24h) ch\u1ec9 c\u00f3 hi\u1ec7u qu\u1ea3 b\u1eb1ng m\u1ed9t n\u1eeda spironolactone (75-225 mg\/24h) trong vi\u1ec7c h\u1ea1 huy\u1ebft \u00e1p.<\/p>\n

Thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 aldosterone \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng th\u00eam v\u00e0o c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb, tuy kh\u00f4ng c\u00f3 qu\u00e1 nhi\u1ec1u nghi\u00ean c\u1ee9u l\u1edbn v\u1ec1 v\u1ea5n \u0111\u1ec1 n\u00e0y. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p c\u1ee7a n\u0103m th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean cho th\u1ea5y spironolactone < 50 mg gi\u1ea3m HA t\u00e2m thu\/t\u00e2m tr\u01b0\u01a1ng t\u01b0\u01a1ng \u1ee9ng l\u00e0 20\/7 mmHg v\u00e0 li\u1ec1u > 50 mg kh\u00f4ng l\u00e0m gi\u1ea3m th\u00eam HA. Hi\u1ec7n nay, c\u00e1c khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb THA c\u1ee7a M\u1ef9 v\u00e0 ch\u00e2u \u00c2u c\u0169ng nh\u01b0 c\u1ee7a H\u1ed9i Tim M\u1ea1ch Vi\u1ec7t Nam, thu\u1ed1c l\u1ee3i ti\u1ec3u kh\u00e1ng aldosterone \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p quy \u01b0\u1edbc trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb, kh\u00f3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p b\u1eb1ng c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng.<\/p>\n

1.2 Suy tim<\/h3>\n

C\u00e1c thu\u1ed1c \u0111\u1ed1i kh\u00e1ng aldosterone \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 t\u00e1c d\u1ee5ng b\u1ea3o v\u1ec7 tim m\u1ea1ch tr\u00ean b\u1ec7nh nh\u00e2n suy tim c\u00f3 ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i gi\u1ea3m. Nghi\u00ean c\u1ee9u RALES l\u00e0 m\u1ed9t nghi\u00ean c\u1ee9u l\u1edbn th\u1ef1c hi\u1ec7n tr\u00ean 1.663 b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i gi\u1ea3m (EF <35%) k\u00e8m ph\u00e2n \u0111\u1ed9 NYHA III- IV. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c chia ng\u1eabu nhi\u00ean ra hai nh\u00f3m, nh\u00f3m placebo v\u00e0 nh\u00f3m \u0111i\u1ec1u tr\u1ecb th\u00eam spironolactone 25-50 mg\/24h so v\u1edbi \u0111i\u1ec1u tr\u1ecb quy \u01b0\u1edbc. Nh\u00f3m s\u1eed d\u1ee5ng spironolactone gi\u1ea3m 30% t\u1ef7 l\u1ec7 t\u1eed vong, gi\u1ea3m 35% t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n do suy tim trong v\u00f2ng 2 n\u0103m \u0111i\u1ec1u tr\u1ecb.<\/p>\n

Nghi\u00ean c\u1ee9u EMPHASIS-HF th\u1ef1c hi\u1ec7n tr\u00ean b\u1ec7nh nh\u00e2n suy tim t\u00e2m thu c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng nh\u1eb9, \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng eplerenone v\u1edbi li\u1ec1u t\u0103ng t\u1edbi 50 mg\/24h, gi\u00fap gi\u1ea3m 27% t\u1eed vong tim m\u1ea1ch v\u00e0 nh\u1eadp vi\u1ec7n do suy tim gi\u1ea3m 42%. K\u1ebft qu\u1ea3 \u0111\u1ea1t \u0111\u01b0\u1ee3c trung b\u00ecnh sau 21 th\u00e1ng \u0111i\u1ec1u tr\u1ecb.<\/p>\n

Thu\u1ed1c kh\u00e1ng aldosterone \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o t\u1ea5t c\u1ea3 c\u00e1c khuy\u1ebfn c\u00e1o c\u1ee7a H\u1ed9i Tim M\u1ea1ch ch\u00e2u \u00c2u 2016, H\u1ed9i Tim M\u1ea1ch M\u1ef9 2017 v\u00e0 H\u1ed9i Tim M\u1ea1ch Vi\u1ec7t Nam<\/a> hi\u1ec7n nay trong \u0111i\u1ec1u tr\u1ecb suy tim c\u00f3 ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i gi\u1ea3m EF 35% (khuy\u1ebfn c\u00e1o I-A). Tuy nhi\u00ean, nh\u1eefng l\u1ee3i \u00edch n\u00e0y h\u1ea7u nh\u01b0 kh\u00f4ng xu\u1ea5t hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n suy tim v\u1edbi ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n.<\/p>\n

1.3 H\u1ed9i ch\u1ee9ng Liddle<\/h3>\n

\u0110\u00e2y l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd r\u1ed1i lo\u1ea1n hi\u1ebfm g\u1eb7p, di truy\u1ec1n gen tr\u1ed9i nhi\u1ec5m s\u1eafc th\u1ec3 th\u01b0\u1eddng, b\u1ec7nh g\u00e2y ra t\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u00e1c k\u00eanh natri \u1edf \u1ed1ng g\u00f3p, do \u0111\u00f3 d\u1eabn \u0111\u1ebfn hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng h\u1ea5p thu natri v\u00e0 t\u0103ng \u0111\u00e0o th\u1ea3i kali. Tr\u00ean l\u00e2m s\u00e0ng, b\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u0103ng huy\u1ebft \u00e1p n\u1eb7ng, h\u1ea1 kali m\u00e1u, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, \u0111i\u1ec1u tr\u1ecb \u0111\u00e1p \u1ee9ng t\u1ed1t b\u1eb1ng amiloride ho\u1eb7c triamterene. S\u1eed d\u1ee5ng thu\u1ed1c \u0111\u1ed1i kh\u00e1ng hormone chuy\u1ec3n ho\u00e1 mu\u1ed1i n\u01b0\u1edbc (spironolactone, eplerenone) trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0 kh\u00f4ng hi\u1ec7u qu\u1ea3. Amiloride c\u0169ng ch\u1ee9ng t\u1ecf c\u00f3 l\u1ee3i \u00edch trong nghi\u00ean c\u1ee9u tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o nh\u1ea1t do lithium.<\/p>\n

1.4 C\u01b0\u1eddng aldosterone<\/h3>\n

Thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali r\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p th\u1eeba mu\u1ed1i n\u01b0\u1edbc ho\u1eb7c c\u01b0\u1eddng aldosterone ti\u00ean ph\u00e1t do t\u0103ng ti\u1ebft aldosterone ( h\u1ed9i ch\u1ee9ng Conn, tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn l\u1ea1c ch\u1ed7).<\/p>\n

C\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u01b0\u1eddng aldosterone th\u1ee9 ph\u00e1t g\u00e2y ra do suy tim, x\u01a1 gan, b\u1ec7nh th\u1eadn c\u0169ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u00e1p \u1ee9ng t\u1ed1t b\u1eb1ng c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u kh\u00e1ng aldosterone. Ngo\u00e0i ra, vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u quai ho\u1eb7c thiazide c\u00f3 th\u1ec3 g\u00e2y ra ho\u1eb7c l\u00e0m t\u0103ng n\u1eb7ng l\u00ean t\u00ecnh tr\u1ea1ng m\u1ea5t d\u1ecbch v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra c\u01b0\u1eddng aldosterone th\u1ee9 ph\u00e1t \u1edf m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p. Hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng ti\u1ebft hormone mu\u1ed1i n\u01b0\u1edbc v\u00e0 t\u0103ng th\u1ea3i natri \u1edf \u1ed1ng l\u01b0\u1ee3n xa c\u1ee7a th\u1eadn c\u0169ng \u0111\u1ed3ng ngh\u0129a v\u1edbi vi\u1ec7c t\u0103ng \u0111\u00e0o th\u1ea3i kali. V\u00ec v\u1eady, s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0 r\u1ea5t c\u00f3 \u00fd ngh\u0129a. Tuy nhi\u00ean, s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c n\u00e0y \u1edf c\u00e1c b\u1ec7nh nh\u00e2n suy tim, suy th\u1eadn th\u01b0\u1eddng d\u00f9ng li\u1ec1u th\u1ea5p v\u00e0 \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd, c\u00f2n tr\u01b0\u1eddng h\u1ee3p x\u01a1 gan th\u01b0\u1eddng d\u00f9ng li\u1ec1u cao (> 50 mg\/24h).<\/p>\n

2.Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h2>\n

Thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali c\u00f3 th\u1ec3 l\u00e0m cho t\u00ecnh tr\u1ea1ng t\u0103ng kali m\u00e1u n\u1eb7ng, th\u1eadm ch\u00ed d\u1eabn \u0111\u1ebfn t\u1eed vong \u1edf nh\u1eefng nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng nh\u1ea1y c\u1ea3m. Nh\u00f3m b\u1ec7nh nh\u00e2n b\u1ecb suy th\u1eadn m\u1ea1n t\u00ednh th\u01b0\u1eddng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng v\u00e0 th\u01b0\u1eddng kh\u00f4ng d\u00f9ng thu\u1ed1c n\u00e0y do c\u00f3 nguy c\u01a1 g\u00e2y t\u0103ng kali m\u00e1u n\u1eb7ng.<\/p>\n

\u1ede b\u1ec7nh nh\u00e2n c\u00f3 d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c l\u00e0m \u1ea3nh h\u01b0\u1edfng ho\u1eb7c \u1ee9c ch\u1ebf h\u1ec7 renin angiotensin nh\u01b0 thu\u1ed1c ch\u1eb9n \u03b2, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 b\u1ecb kali m\u00e1u cao, c\u1ea7n th\u1eadn tr\u1ecdng khi d\u00f9ng v\u00e0 theo d\u00f5i s\u00e1t \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3.<\/p>\n

B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh gan th\u01b0\u1eddng suy gi\u1ea3m qu\u00e1 tr\u00ecnh chuy\u1ec3n ho\u00e1 t\u1ea1i gan khi d\u00f9ng spironolactone v\u00e0 triamterene, do \u0111\u00f3 ch\u00fa \u00fd t\u0103ng li\u1ec1u cho ph\u00f9 h\u1ee3p.<\/p>\n

C\u00e1c thu\u1ed1c ho\u1eb7c c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf m\u1ea1nh CYP3A4 nh\u01b0 erythromycin, \u0080uconazole, diltiazem, n\u01b0\u1edbc nho \u00e9p c\u00f3 th\u1ec3 l\u00e0m gia t\u0103ng \u0111\u00e1ng k\u1ec3 n\u1ed3ng \u0111\u1ed9 eplerenone trong m\u00e1u, do \u0111\u00f3 c\u1ea7n gi\u1ea3m li\u1ec1u v\u00e0 th\u1eadn tr\u1ecdng khi ph\u1ed1i h\u1ee3p c\u00e1c thu\u1ed1c n\u00e0y. Tuy nhi\u00ean, c\u00e1c thu\u1ed1c n\u00e0y kh\u00f4ng \u1ea3nh h\u01b0\u1edfng t\u1edbi chuy\u1ec3n ho\u00e1 spironolactone.<\/p>\n

D\u00f9ng c\u00f9ng thu\u1ed1c ch\u1ed1ng vi\u00eam gi\u1ea3m \u0111au kh\u00f4ng steroid c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali.<\/p>\n

3.Li\u1ec1u d\u00f9ng<\/strong><\/h2>\n

C\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a c\u1ee7a spironolactone c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i \u0111\u1ee7 d\u00e0i \u2013 \u0111\u1ee7 \u0111\u1ec3 cho ph\u00e9p d\u00f9ng spironolactone m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y. Do c\u1ea7n c\u00f3 th\u1eddi gian ph\u1ea3i t\u00edch l\u0169y c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a \u1edf d\u1ea1ng ho\u1ea1t \u0111\u1ed9ng n\u00ean spironolactone th\u01b0\u1eddng kh\u1edfi ph\u00e1t ch\u1eadm, m\u1ea5t t\u1edbi 48h tr\u01b0\u1edbc khi \u0111\u1ea1t hi\u1ec7u qu\u1ea3 t\u1ed1i \u0111a. Li\u1ec1u d\u00f9ng th\u00f4ng th\u01b0\u1eddng l\u00e0 b\u1eaft \u0111\u1ea7u v\u1edbi 12,5 mg\/24h, t\u0103ng \u0111\u1ebfn li\u1ec1u 50 mg\/24h. C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n nh\u01b0 ph\u00ec \u0111\u1ea1i tuy\u1ebfn v\u00fa v\u00e0 t\u0103ng kali m\u00e1u li\u00ean quan \u0111\u1ebfn li\u1ec1u d\u00f9ng v\u00e0 th\u01b0\u1eddng \u1edf li\u1ec1u tr\u00ean 50 mg\/24h, li\u1ec1u n\u00e0y hay \u0111\u01b0\u1ee3c d\u00f9ng cho b\u1ec7nh nh\u00e2n x\u01a1 gan c\u00f3 c\u1ed5 tr\u01b0\u1edbng.<\/p>\n

Hi\u1ec7n nay, t\u1ea1i Vi\u1ec7t Nam, c\u00e1c thu\u1ed1c kh\u00e1ng aldosterone c\u00f3 bi\u1ec7t d\u01b0\u1ee3c l\u00e0 Aldactone, Verospirone \u0111\u01b0\u1eddng u\u1ed1ng li\u1ec1u 25-50 mg. Thu\u1ed1c c\u00f3 d\u1ea1ng ph\u1ed1i h\u1ee3p v\u1edbi furosemide v\u00e0 spironolactone l\u00e0 Spiromide 20\/50 (20 mg furosemide, 50 mg spironolactone) v\u00e0 Spiromide 40\/50 (40 mg furosemide, 50 mg spironolactone)\u2026<\/p>\n

Eplerenone c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i m\u1ed9t c\u00e1ch t\u1ef1 nhi\u00ean v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y, li\u1ec1u th\u01b0\u1eddng l\u00e0 25-100 mg.<\/p>\n

Triamterene n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng nhi\u1ec1u l\u1ea7n m\u1ed7i ng\u00e0y l\u00e0 t\u1ed1t nh\u1ea5t, nh\u01b0ng v\u00ec n\u00f3 hi\u1ebfm khi \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u01a1n \u0111\u1ed9c (hay \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi hydrochlorothiazide d\u1ea1ng vi\u00ean ph\u1ed1i h\u1ee3p li\u1ec1u c\u1ed1 \u0111\u1ecbnh), th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y. Vi\u1ec7c s\u1eed d\u1ee5ng li\u1ec1u thiazide th\u1ea5p h\u01a1n l\u00e0m cho nguy c\u01a1 r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i \u00edt h\u01a1n, d\u1eabn \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng triamterene v\u1edbi li\u1ec1u t\u1ed5ng g\u1ed9p th\u1ea5p h\u01a1n.<\/p>\n

Amiloride c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng m\u1ed9t l\u1ea7n ho\u1eb7c hai l\u1ea7n m\u1ed7i ng\u00e0y do th\u1eddi gian b\u00e1n h\u1ee7y d\u00e0i. Amiloride c\u0169ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi hydrochlorothiazide \u1edf li\u1ec1u c\u1ed1 \u0111\u1ecbnh.<\/p>\n

4.T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong><\/h2>\n

4.1 T\u0103ng kali m\u00e1u:<\/h3>\n

M\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n \u0111\u00e3 \u0111\u01b0\u1ee3c bi\u1ebft khi d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u trong \u0111\u00f3 c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i l\u00e0 t\u0103ng kali m\u00e1u. T\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i n\u00e0y c\u00f3 th\u1ec3 gi\u1ea3m b\u1edbt \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3 v\u00e0 \u0111\u1ea3m b\u1ea3o theo d\u00f5i b\u1ec7nh nh\u00e2n th\u01b0\u1eddng xuy\u00ean. C\u1ea7n ch\u00fa tr\u1ecdng h\u01a1n \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i trong khi \u0111i\u1ec1u tr\u1ecb \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3, ho\u1eb7c \u1edf ng\u01b0\u1eddi \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u00e1c thu\u1ed1c g\u00e2y \u0111\u1ed9c th\u1eadn.<\/p>\n

4.2 T\u0103ng chuy\u1ec3n ho\u00e1 acid:<\/h3>\n

Do c\u01a1 ch\u1ebf c\u1ee7a c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali \u1ee9c ch\u1ebf song song vi\u1ec7c b\u00e0i ti\u1ebft K+ v\u00e0 H+ n\u00ean c\u00f3 th\u1ec3 g\u00e2y ra t\u00ecnh tr\u1ea1ng nhi\u1ec5m toan t\u1ea1i \u1ed1ng th\u1eadn.<\/p>\n

4.3 T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean nam gi\u1edbi:<\/h3>\n

Ph\u00ec \u0111\u1ea1i tuy\u1ebfn v\u00fa, gi\u1ea3m ham mu\u1ed1n t\u00ecnh d\u1ee5c. C\u00e1c steroid t\u1ed5ng h\u1ee3p c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c b\u1ea5t th\u01b0\u1eddng n\u1ed9i ti\u1ebft do t\u00e1c \u0111\u1ed9ng l\u00ean c\u00e1c th\u1ee5 th\u1ec3 nh\u1ea1y c\u1ea3m v\u1edbi steroid. Ch\u1ee9ng v\u00fa to do ph\u00ec \u0111\u1ea1i tuy\u1ebfn v\u00fa, gi\u1ea3m ham mu\u1ed1n t\u00ecnh d\u1ee5c v\u00e0 hi\u1ebfm g\u1eb7p h\u01a1n l\u00e0 ph\u00ec \u0111\u1ea1i l\u00e0nh t\u00ednh tuy\u1ebfn ti\u1ec1n li\u1ec7t \u0111\u1ec1u \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o khi s\u1eed d\u1ee5ng spironolactone. C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n n\u00e0y \u00edt g\u1eb7p h\u01a1n \u1edf eplerenone, c\u01a1 ch\u1ebf l\u00e0 do thu\u1ed1c t\u00e1c \u0111\u1ed9ng ch\u1ecdn l\u1ecdc l\u00ean c\u00e1c th\u1ee5 th\u1ec3 chuy\u1ec3n ho\u00e1 mu\u1ed1i n\u01b0\u1edbc v\u00e0 \u00edt t\u00e1c \u0111\u1ed9ng h\u01a1n l\u00ean c\u00e1c th\u1ee5 th\u1ec3 androgen v\u00e0 progesterone.<\/p>\n

4.4 Suy th\u1eadn c\u1ea5p:<\/h3>\n

D\u00f9ng triamterene c\u00f9ng thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid l\u00e0 indomethacin c\u00f3 th\u1ec3 g\u00e2y n\u00ean t\u00ecnh tr\u1ea1ng suy th\u1eadn c\u1ea5p. Tuy nhi\u00ean, kh\u00f4ng ghi nh\u1eadn t\u00ecnh tr\u1ea1ng n\u00e0y tr\u00ean c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali kh\u00e1c.<\/p>\n

4.5 S\u1ecfi th\u1eadn:<\/h3>\n

Triamterene c\u00f3 th\u1ec3 g\u00e2y l\u1eafng \u0111\u1ecdng canxi v\u00e0 g\u00e2y ra s\u1ecfi th\u1eadn<\/p>\n","protected":false},"excerpt":{"rendered":"

L\u1ee3i ti\u1ec3u gi\u1eef kali c\u00f3 t\u00e1c d\u1ee5ng \u1edf \u1ed1ng l\u01b0\u1ee3n xa, \u1ee9c ch\u1ebf kh\u1ea3 n\u0103ng t\u00e1i h\u1ea5p thu natri b\u1eb1ng c\u00e1ch trao \u0111\u1ed5i v\u1edbi kali, tr\u1ef1c ti\u1ebfp l\u00ean c\u00e1c t\u1ebf b\u00e0o (triamteren, amilorid) ho\u1eb7c b\u1eb1ng c\u00e1ch \u0111\u1ed1i kh\u00e1ng v\u1edbi aldosteron. 1.Ch\u1ec9 \u0111\u1ecbnh 1.1 T\u0103ng huy\u1ebft \u00e1p. C\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali c\u00f3 t\u00e1c d\u1ee5ng […]<\/p>\n","protected":false},"author":7,"featured_media":21566,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"\nL\u1ee3i ti\u1ec3u gi\u1eef kali v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh tr\u00ean l\u00e2m s\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"L\u1ee3i ti\u1ec3u gi\u1eef kali v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh tr\u00ean l\u00e2m s\u00e0ng l\u00e0 \u0111i\u1ec1u \u0111\u01b0\u1ee3c quan t\u00e2m khi s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y. 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