{"id":27704,"date":"2023-04-24T10:58:42","date_gmt":"2023-04-24T03:58:42","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27704"},"modified":"2023-04-24T10:58:42","modified_gmt":"2023-04-24T03:58:42","slug":"cac-nguyen-nhan-gay-tang-kali-mau-va-co-che","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/cac-nguyen-nhan-gay-tang-kali-mau-va-co-che\/","title":{"rendered":"C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y t\u0103ng Kali m\u00e1u v\u00e0 c\u01a1 ch\u1ebf"},"content":{"rendered":"

T\u0103ng kali m\u00e1u n\u1eb7ng l\u00e0 c\u1ea5p c\u1ee9u y\u00eau c\u1ea7u \u0111i\u1ec1u tr\u1ecb ngay l\u1eadp t\u1ee9c, t\u00f9y thu\u1ed9c v\u00e0o b\u1ea5t\u00a0 th\u01b0\u1eddng tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3.Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a t\u0103ng kali huy\u1ebft th\u01b0\u1eddng x\u1ea3y ra khi\u00a0 n\u1ed3ng \u0111\u1ed9 kali > 6,5 mEq \/ L, bao g\u1ed3m:\u00a0\u00a0<\/strong><\/p>\n

\u00a0+ Tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh c\u01a1 ( y\u1ebfu ,li\u1ec7t m\u1ec1m v\u00e0 suy h\u00f4 h\u1ea5p )\u00a0\u00a0<\/strong><\/p>\n

\u00a0+ ECG ti\u1ebfn tri\u1ec3n khi n\u1ed3ng \u0111\u1ed9 K m\u00e1u t\u0103ng ( s\u00f3ng T nh\u1ecdn, P d\u1eb9t , PR d\u00e0i , nh\u1ecbp th\u1ea5t\u00a0 t\u1ef1 ph\u00e1t, ph\u1ee9c h\u1ec7 QRS r\u1ed9ng, S s\u00e2u. Cu\u1ed1i c\u00f9ng, ECG c\u00f3 d\u1ea1ng \u201c s\u00f3ng sin \u201c sau \u0111\u00f3 l\u00e0\u00a0 rung th\u1ea5t.\u00a0\u00a0<\/strong><\/p>\n

T\u00e1c \u0111\u1ed9ng tr\u00ean tim c\u00f3 th\u1ec3 x\u1ea3y ra \u0111\u1ed9t ng\u1ed9t v\u00e0 kh\u00f4ng b\u00e1o tr\u01b0\u1edbc.\u00a0\u00a0<\/strong><\/p>\n

1. C\u01a1 ch\u1ebfchung c\u00e1c g\u00e2y t\u0103ng Kali m\u00e1u<\/h2>\n

* T\u0103ng Kali m\u00e1u gi\u1ea3 t\u1ea1o.<\/p>\n

-Trong t\u0103ng K m\u00e1u gi\u1ea3 t\u1ea1o<\/a>, n\u1ed3ng \u0111\u1ed9 K m\u00e1u t\u0103ng cao .(B\u1ea3ng 6.1) C\u00e1c nguy\u00ean nh\u00e2n\u00a0 g\u00e2y t\u0103ng K m\u00e1u gi\u1ea3 t\u1ea1o, do l\u1ed7i x\u00e9t nghi\u1ec7m bao g\u1ed3m : s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u t\u0103ng cao (\u00a0 \u0111\u1ebfm > 1.000.000) , b\u1ea1ch c\u1ea7u t\u0103ng ( >200.000 ) , t\u0103ng b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n, l\u1ea5y\u00a0 m\u00e1u trong c\u01a1n thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ho\u1eb7c trong l\u00fac huy\u1ebft t\u00e1n.Hi\u1ebfm g\u1eb7p t\u00ecnh tr\u1ea1ng\u00a0 t\u0103ng K m\u00e1u gi\u1ea3 t\u1ea1o c\u00f3 t\u00ednh ch\u1ea5t gia \u0111\u00ecnh, trong \u0111\u00f3 K \u201c r\u00f2 r\u1ec9\u201d t\u1eeb c\u00e1c h\u1ed3ng c\u1ea7u\u00a0 trong l\u00fac ch\u1edd \u0111\u1ec3 x\u00e9t nghi\u1ec7m.<\/p>\n

* T\u0103ng Kali m\u00e1u do t\u00e1i ph\u00e2n b\u1ed1<\/p>\n

T\u0103ng kali m\u00e1u do t\u00e1i ph\u00e2n ph\u1ed1i l\u01b0\u1ee3ng kali th\u1eeba gi\u1eefa c\u00e1c t\u1ebf b\u00e0o trong th\u1eddi gian\u00a0 ng\u1eafn, t\u1eeb \u0111\u00f3 n\u00e2ng cao n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft thanh. T\u1ed5ng l\u01b0\u1ee3ng Kali m\u00e1u c\u01a1 th\u1ec3 kali\u00a0 kh\u00f4ng t\u0103ng do t\u00e1i ph\u00e2n ph\u1ed1i l\u1ea1i kali. Ch\u1ec9 c\u00f3 m\u1ed9t\u00a0\u00a0 l\u01b0\u1ee3ng nh\u1ecf kali n\u1eb1m \u1edf ngo\u1ea1i b\u00e0o (kho\u1ea3ng 56 mEq \u1edf m\u1ed9t ng\u01b0\u1eddi \u0111\u00e0n \u00f4ng 70 kg, so\u00a0 v\u1edbi t\u1ed5ng l\u01b0\u1ee3ng kali c\u01a1 th\u1ec3 kho\u1ea3ng 4200 mEq \/ L). Do \u0111\u00f3, m\u1ed9t s\u1ef1 thay \u0111\u1ed5i t\u01b0\u01a1ng\u00a0 \u0111\u1ed1i nh\u1ecf kali t\u1eeb n\u1ed9i b\u00e0o ra ngo\u1ea1i b\u00e0o s\u1ebd c\u00f3 th\u1ec3 g\u00e2y ra s\u1ef1 thay \u0111\u1ed5i l\u1edbn n\u1ed3ng \u0111\u1ed9\u00a0 kali huy\u1ebft t\u01b0\u01a1ng.<\/p>\n

1. T\u0103ng Kali m\u00e1u gi\u1ea3 t\u1ea1o\u00a0\u00a0<\/strong><\/h2>\n

– L\u1ea5y m\u00e1u trong khi b\u1ecb t\u00e1n huy\u1ebft<\/p>\n

– \u00a0Garo qu\u00e1 ch\u1eb7t trong khi l\u1ea5y m\u00e1u<\/p>\n

– \u00a0Ti\u1ec3u c\u1ea7u > 1.000.000<\/p>\n

– \u00a0B\u1ea1ch c\u1ea7u > 200.000<\/p>\n

– \u00a0T\u0103ng b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n<\/p>\n

– \u00a0T\u0103ng K m\u00e1u gi\u1ea3 t\u1ea1o gia \u0111\u00ecnh (K chui ra t\u1eeb c\u00e1c t\u1ebf b\u00e0o)<\/p>\n

2. Do t\u00e1i ph\u00e2n b\u1ed1 K ( K trao \u0111\u1ed5i gi\u1eefa c\u00e1c t\u1ebf b\u00e0o)\u00a0\u00a0<\/strong><\/h2>\n

– \u00a0Nhi\u1ec5m toan ( do chuy\u1ec3n h\u00f3a v\u00e0 h\u00f4 h\u1ea5p )<\/p>\n

– \u00a0T\u00ecnh tr\u1ea1ng \u01b0u tr\u01b0\u01a1ng<\/p>\n

– \u00a0Qu\u00e1 li\u1ec1u do d\u00f9ng l\u01b0\u1ee3ng l\u1edbn digitalis<\/p>\n

– \u00a0Li\u1ec7t c\u01a1 do h\u1ea1 K m\u00e1u chu k\u1ef3<\/p>\n

\"nn-t\u0103ng-kali-mau\"<\/p>\n

\u00a03.Thi\u1ebfu Aldosteron \/ \u0110\u00e1p \u1ee9ng k\u00e9m v\u1edbi aldosteron\u00a0\u00a0<\/strong><\/h2>\n

– \u00a0Suy thuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn nguy\u00ean ph\u00e1t <\/em>(t\u1ef1 mi\u1ec5n, lao, xu\u1ea5t huy\u1ebft, u th\u00e2m\u00a0 nhi\u1ec5m )<\/p>\n

– H\u1ed9i ch\u1ee9ng gi\u1ea3m renin v\u00e0 aldosteron ( SHH )\u00a0\u00a0<\/em><\/p>\n

4. C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c<\/strong><\/h2>\n

\u00a0\u00a0<\/strong>Suy th\u1eadn<\/strong><\/p>\n

– \u00a0GFR < 10-20% <\/strong>b\u00ecnh th\u01b0\u1eddng.<\/p>\n

– \u00a0K m\u00e1u c\u00f3 th\u1ec3 t\u0103ng nhanh \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn<\/p>\n

Thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y ra ho\u1eb7c l\u00e0m n\u1eb7ng th\u00eam t\u0103ng kali m\u00e1u (nhi\u1ec1u c\u01a1 ch\u1ebf)\u00a0 <\/strong><\/p>\n

Ngu\u1ed3n Kali\u00a0\u00a0<\/strong><\/p>\n

    \n
  • Truy\u1ec1n t\u0129nh m\u1ea1ch dung d\u1ecbch c\u00f3 kali<\/li>\n
  • Potassium citrate<\/li>\n
  • T\u00e1i ph\u00e2n b\u1ed1 g\u00e2y t\u0103ng kali m\u00e1u\u00a0<\/strong><\/li>\n
  • Arginine v\u00e0 lysine HCI (\u00edt khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng)<\/li>\n
  • Ch\u1eb9n Betaz-adrenergic<\/li>\n
  • Succinylcholine<\/li>\n
  • Digitalis (qu\u00e1 li\u1ec1u)<\/li>\n
  • Mannitol \u01b0u tr\u01b0\u01a1ng( g\u00e2y th\u1ea9m th\u1ea5u)<\/li>\n<\/ul>\n

    Thi\u1ebfu\/ \u0110\u00e1p \u1ee9ng k\u00e9m v\u1edbi Aldosterone\u00a0 : <\/strong>NSAIDs\u00a0\u00a0, Thu\u1ed1c \u1ee9c ch\u1ebf ACE\u00a0\u00a0, Thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 Angiotensin II , \u00a0Heparin\u00a0\u00a0, \u00a0Cyclosporine , FK 506 , Aminoglutethimide\u00a0\u00a0, L\u1ee3i ti\u1ec3u gi\u1eef K<\/p>\n

    C\u1ea3 toan chuy\u1ec3n h\u00f3a <\/strong>v\u00e0 toan h\u00f4 h\u1ea5p <\/strong>\u0111\u1ec1u \u0111\u01b0a kali ra kh\u1ecfi t\u1ebf b\u00e0o \u0111\u1ec3 trao \u0111\u1ed5i v\u1edbi ion hydro. R\u1ea5t\u00a0 kh\u00f3 kh\u0103n \u0111\u1ec3 \u01b0\u1edbc t\u00ednh s\u1ef1 thay \u0111\u1ed5i kali g\u00e2y ra do toan chuy\u1ec3n h\u00f3a.\u0110\u1ed1i v\u1edbi nhi\u1ec1u lo\u1ea1i toan chuy\u1ec3n\u00a0 h\u00f3a kali s\u1ebd t\u0103ng kho\u1ea3ng 0,7 mEq\/L khi gi\u1ea3m 0,1 \u0111\u1ed9 pH. \u0110\u1ed1i v\u1edbi nhi\u1ec5m toan h\u00f4 h\u1ea5p kali s\u1ebd t\u0103ng\u00a0 kho\u1ea3ng 0,3 mEq \/ L khi gi\u1ea3m 0,1 \u0111\u1ed9 pH. Nhi\u1ec5m toan g\u00e2y ra b\u1edfi axit h\u1eefu c\u01a1 nh\u01b0 ax\u00edt lactic v\u00e0 xe\u00a0 ton th\u01b0\u1eddng kh\u00f4ng g\u00e2y t\u0103ng kali m\u00e1u \u0111\u00e1ng k\u1ec3 v\u00ec l\u00fd do r\u1ea5t ph\u1ee9c t\u1ea1p.<\/p>\n

    Thu\u1ed1c ch\u1eb9n Beta-adrenergic <\/strong>g\u00e2y t\u0103ng K kh\u00f4ng \u0111\u00e1ng k\u1ec3 (0,1-0,2 mEq \/ L),th\u1ee9 ph\u00e1t do t\u00e1i ph\u00e2n\u00a0 b\u1ed1.<\/p>\n

    T\u00ecnh tr\u1ea1ng \u01b0u tr\u01b0\u01a1ng <\/strong>c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi t\u0103ng kali m\u00e1u. Khi gi\u1ea3i quy\u1ebft t\u00ecnh tr\u1ea1ng \u01b0u tr\u01b0\u01a1ng, n\u1ed3ng\u00a0 \u0111\u1ed9 kali c\u00f3 th\u1ec3 gi\u1ea3m nhanh ch\u00f3ng.N\u1ed3ng \u0111\u1ed9 Kali huy\u1ebft thanh b\u00ecnh th\u01b0\u1eddng khi t\u0103ng \u00e1p l\u1ef1c th\u1ea9m\u00a0 th\u1ea5u m\u00e1u \u0111\u1ed3ng ngh\u0129a kali \u0111ang c\u1ea1n ki\u1ec7t.<\/p>\n

    D\u00f9ng qu\u00e1 li\u1ec1u digitalis <\/strong>s\u1ebd g\u00e2y t\u0103ng kali m\u00e1u th\u1ee9 ph\u00e1t do \u1ee9c ch\u1ebf k\u00eanh Na-K- ATPase m\u00e0ng\u00a0 t\u1ebf b\u00e0o.<\/p>\n

    Succinylcholine l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf th\u1ea7n kinh c\u01a1 l\u00e0m t\u0103ng t\u00ednh th\u1ea5m kali c\u1ee7a t\u1ebf b\u00e0o c\u01a1 v\u00e0 c\u00f3\u00a0 th\u1ec3 t\u0103ng nh\u1eb9 kali trong kho\u1ea3ng 0,5 mEq\/ L \u1edf ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng. T\u0103ng kali m\u00e1u n\u1eb7ng h\u01a1n\u00a0 c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh b\u1ecfng v\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh th\u1ea7n kinh c\u01a1 m\u00e3n t\u00ednh.<\/p>\n

    Li\u1ec7t c\u01a1 do h\u1ea1 K m\u00e1u chu k\u1ef3 c\u00f3 t\u00ednh gia \u0111\u00ecnh <\/strong>l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn g\u00e2y t\u0103ng kali m\u00e1u. Nguy\u00ean\u00a0 nh\u00e2n do r\u1ed1i lo\u1ea1n NST th\u01b0\u1eddng gen tr\u1ed9i k\u1ebft h\u1ee3p li\u1ec7t m\u1ec1m v\u1edbi t\u0103ng kali m\u00e1u c\u00f3 t\u00ednh chu k\u1ef3 . Kali\u00a0 huy\u1ebft thanh th\u01b0\u1eddng kho\u1ea3ng 6,0-8,0 mEq \/ L. Th\u01b0\u1eddng di\u1ec5n ra sau khi d\u00f9ng ch\u1ebf \u0111\u1ed9 \u0103n nhi\u1ec1u kali\u00a0 ho\u1eb7c ti\u1ebfp x\u00fac v\u1edbi l\u1ea1nh, c\u00f3 th\u1ec3 k\u00e9o d\u00e0i t\u1eeb v\u00e0i ph\u00fat \u0111\u1ebfn v\u00e0i gi\u1edd.<\/p>\n

    T\u0103ng Kali th\u1ee9 ph\u00e1t do kh\u1ea3 n\u0103ng b\u00e0i ti\u1ebft Kali gi\u1ea3m\u00a0\u00a0<\/strong><\/p>\n

    \u0110a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u0103ng kali huy\u1ebft th\u1ee9 ph\u00e1t v\u01b0\u1ee3t qu\u00e1 t\u1ed5ng l\u01b0\u1ee3ng kali c\u01a1 th\u1ec3 l\u00e0 do ch\u1ee9c n\u0103ng\u00a0 b\u00e0i ti\u1ebft kali c\u1ee7a th\u1eadn . Th\u1eadn gi\u1ea3m b\u00e0i ti\u1ebft K do m\u1ed9t ho\u1eb7c hai l\u00ed do:<\/p>\n

      \n
    • Thi\u1ebfu ho\u1eb7c c\u00e1c t\u1ebf b\u00e0o \u1ed1ng th\u1eadn \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi Aldosterone<\/li>\n
    • Suy th\u1eadn ( Gi\u1ea3m GFR )<\/li>\n<\/ul>\n

      T\u00f3m l\u1ea1i : t\u0103ng kali huy\u1ebft do c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1edbi aldosterone ho\u1eb7c GFR.<\/p>\n

      Thi\u1ebfu ho\u1eb7c \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi Aldosterone ( type IV RTA )\u00a0\u00a0<\/strong><\/p>\n

      T\u0103ng K th\u1eadt s\u1ef1 (t\u0103ng t\u1ed5ng l\u01b0\u1ee3ng kali c\u01a1 th\u1ec3) do th\u1eadn gi\u1eef kali s\u1ebd n\u1eb7ng l\u00ean n\u1ebfu thi\u1ebfu aldosterone,\u00a0 ho\u1eb7c t\u1ebf b\u00e0o \u1ed1ng th\u1eadn k\u00e9m \u0111\u00e1p \u1ee9ng v\u1edbi aldosterone. C\u00e1c h\u1ed9i ch\u1ee9ng g\u00e2y t\u0103ng kali m\u00e1u th\u1ee9 ph\u00e1t\u00a0 do c\u00e1c r\u1ed1i lo\u1ea1n g\u00e2y thi\u1ebfu ho\u1eb7c \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi Aldosterone g\u1ecdi l\u00e0 RTA type IV.<\/p>\n

      Suy tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn nguy\u00ean ph\u00e1t <\/strong>th\u1ee9 ph\u00e1t do lao, t\u1ef1 mi\u1ec5n,\u00a0 kh\u1ed1i u th\u00e2m nhi\u1ec5m, ho\u1eb7c xu\u1ea5t huy\u1ebft s\u1ebd d\u1eabn \u0111\u1ebfn thi\u1ebfu h\u1ee5t c\u1ea3 cortisol v\u00e0 aldosterone. M\u1eb7t kh\u00e1c,\u00a0 suy tuy\u1ebfn y\u00ean s\u1ebd \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn cortisol nh\u01b0ng kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn aldosterone,v\u00ec v\u1eady suy\u00a0 tuy\u1ebfn y\u00ean kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n quan tr\u1ecdng c\u1ee7a t\u0103ng kali m\u00e1u.<\/p>\n

      H\u1ed9i ch\u1ee9ng gi\u1ea3m renin v\u00e0 aldossterone (SHH) <\/strong>l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn g\u00e2y t\u0103ng kali m\u00e1u. N\u00f3\u00a0 \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi renin huy\u1ebft t\u01b0\u01a1ng th\u1ea5p,aldosterone huy\u1ebft t\u01b0\u01a1ng th\u1ea5p, v\u00e0 t\u0103ng kali m\u00e1u. C\u00f3\u00a0 th\u1ec3 k\u1ebft h\u1ee3p toan chuy\u1ec3n h\u00f3a nh\u1eb9. Suy th\u1eadn nh\u1eb9 \u0111\u1ebfn v\u1eeba ph\u1ea3i, nh\u01b0ng GFR th\u01b0\u1eddng> 20% m\u1ee9c\u00a0 b\u00ecnh th\u01b0\u1eddng. H\u1ed9i ch\u1ee9ng n\u00e0y g\u1eb7p trong m\u1ed9t lo\u1ea1t c\u00e1c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn, nh\u01b0ng nguy\u00ean nh\u00e2n\u00a0 ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb l\u00e0 d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u quai ho\u1eb7c thu\u1ed1c l\u1ee3i ti\u1ec3u\u00a0 quai c\u1ed9ng v\u1edbi corticoid.<\/p>\n

      T\u1ebf b\u00e0o \u1ed1ng th\u1eadn \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi aldosterone <\/strong>x\u1ea3y ra v\u1edbi m\u1ed9t s\u1ed1 r\u1ed1i lo\u1ea1n th\u1eadn m\u00e3n t\u00ednh. H\u1ed9i\u00a0 ch\u1ee9ng n\u00e0y kh\u00e1 gi\u1ed1ng v\u1edbi h\u1ea1 aldosterone , nh\u01b0ng ho\u1ea1t \u0111\u1ed9ng renin v\u00e0 aldosterone trong huy\u1ebft\u00a0 t\u01b0\u01a1ng kh\u00f4ng th\u1ea5p. C\u00f3 th\u1ec3 c\u00f3 suy th\u1eadn nh\u1eb9, nh\u01b0ng th\u01b0\u1eddng GFR\u00a0 \u00a0kh\u00f4ng th\u1ea5p \u0111\u1ebfn m\u1ee9c c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch s\u1ef1 t\u0103ng kali huy\u1ebft tr\u00ean c\u01a1 s\u1edf m\u1ed9t m\u00ecnh suy th\u1eadn\u00a0 (GFR th\u01b0\u1eddng > 20% c\u1ee7a m\u1ee9c b\u00ecnh th\u01b0\u1eddng). Nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi\u00a0 corticoid.<\/p>\n

      M\u1ed9t s\u1ed1 thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y t\u0103ng kali m\u00e1u b\u1eb1ng c\u00e1ch can thi\u1ec7p v\u00e0o vi\u1ec7c s\u1ea3n xu\u1ea5t aldosterone ho\u1eb7c\u00a0 b\u1eb1ng c\u00e1ch ng\u0103n ch\u1eb7n nh\u1eefng t\u00e1c \u0111\u1ed9ng th\u1ea3i kali c\u1ee7a aldosterone. C\u00e1c lo\u1ea1i thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y t\u0103ng kali\u00a0 m\u00e1u do c\u00e1c c\u01a1 ch\u1ebf n\u00e0y bao g\u1ed3m :Amiloride, spironolactone, triamteren, trimethoprim, heparin,\u00a0 NSAIDs, v\u00e0 \u1ee9c ch\u1ebf ACE.<\/p>\n

      Suy th\u1eadn\u00a0\u00a0<\/strong><\/p>\n

      Th\u1eadn b\u00ecnh th\u01b0\u1eddng \u0111i\u1ec1u ch\u1ec9nh s\u1ef1 b\u00e0i ti\u1ebft kali khi xu\u1ea5t hi\u1ec7n kali th\u1eeba, duy tr\u00ec t\u1ed5ng l\u01b0\u1ee3ng kali c\u01a1 th\u1ec3\u00a0 v\u00e0<\/p>\n

      n\u1ed3ng \u0111\u1ed9 kali ECF kh\u00f4ng \u0111\u1ed5i. \u0110\u00e0o th\u1ea3i t\u1eeb th\u1ea5p nh\u1ea5t l\u00e0 10 mEq\/24h \u0111\u1ebfn cao nh\u01b0 10 mEq \/ kg \/\u00a0 24 gi\u1edd. Gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a b\u00e0i ti\u1ebft kali t\u1ef7 l\u1ec7 thu\u1eadn v\u1edbi GFR. N\u1ebfu GFR l\u00e0 100% l\u00fac b\u00ecnh th\u01b0\u1eddng,\u00a0 L\u01b0\u1ee3ng kali t\u1ed1i \u0111a c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft trong m\u1ed9t ng\u00e0y kho\u1ea3ng 10 mEq \/ kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3. 70\u00a0 X 10 = 700 mEq \u1edf m\u1ed9t ng\u01b0\u1eddi 70 kg. N\u1ebfu GFR gi\u1ea3m \u0111\u1ebfn 50% ,l\u01b0\u1ee3ng kali t\u1ed1i \u0111a c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft\u00a0 trong m\u1ed9t ng\u00e0y kho\u1ea3ng 50% . 700 = 350 mEq. \u0110\u00e2y l\u00e0 \u01b0\u1edbc t\u00ednh s\u01a1 b\u1ed9 s\u1ef1 b\u00e0i ti\u1ebft kali t\u1ed1i \u0111a v\u00ec c\u01a1\u00a0 ch\u1ebf \u0111\u1ec1n b\u00f9 do th\u1eadn th\u1ea3i kali s\u1ebd t\u0103ng b\u00e0i ti\u1ebft kali, v\u00e0 b\u00e0i ti\u1ebft kali c\u0169ng t\u0103ng l\u00ean khi c\u01a1 th\u1ec3 t\u1ef1 b\u1ea3o v\u1ec7 ch\u1ed1ng l\u1ea1i t\u0103ng kali m\u00e1u. N\u1ebfu GFR ti\u1ebfp t\u1ee5c gi\u1ea3m t\u1edbi 20% c\u1ee7a m\u1ee9c b\u00ecnh th\u01b0\u1eddng, s\u1ef1 b\u00e0i ti\u1ebft kali\u00a0 s\u1ebd gi\u1ea3m t\u1ed1i \u0111a<\/p>\n

      \u0111\u1ebfn ph\u1ea1m vi kho\u1ea3ng 140 mEq\/24h (20% . 700 mEq\/ 24h).<\/p>\n

      C\u00e1c ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng trung b\u00ecnh c\u00f3 kho\u1ea3ng 1 mEq kali m\u1ed7i kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3,\u00a0 Kho\u1ea3ng 70 mEq\/24h \u1edf m\u1ed9t ng\u01b0\u1eddi 70 kg. \u0110\u1ed1i v\u1edbi m\u1ed9t ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng c\u00f3 ch\u1ee9a<\/p>\n

      T\u00e0i li\u1ec7u tham kh\u1ea3o: \u201cACID-BASE, FLUIDS, AND ELECTROLYTES MADE RIDICULOUSLY SIMPLE\u201d T\u00e1c gi\u1ea3 Richard A. Preston, M.D. M.B.A.<\/p>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

      T\u0103ng kali m\u00e1u n\u1eb7ng l\u00e0 c\u1ea5p c\u1ee9u y\u00eau c\u1ea7u \u0111i\u1ec1u tr\u1ecb ngay l\u1eadp t\u1ee9c, t\u00f9y thu\u1ed9c v\u00e0o b\u1ea5t\u00a0 th\u01b0\u1eddng tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3.Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a t\u0103ng kali huy\u1ebft th\u01b0\u1eddng x\u1ea3y ra khi\u00a0 n\u1ed3ng \u0111\u1ed9 kali > 6,5 mEq \/ L, bao g\u1ed3m:\u00a0\u00a0 \u00a0+ Tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh c\u01a1 ( y\u1ebfu ,li\u1ec7t m\u1ec1m v\u00e0 […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[23,33],"tags":[],"yoast_head":"\nC\u00e1c nguy\u00ean nh\u00e2n g\u00e2y t\u0103ng Kali m\u00e1u v\u00e0 c\u01a1 ch\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"T\u0103ng kali m\u00e1u n\u1eb7ng l\u00e0 c\u1ea5p c\u1ee9u y\u00eau c\u1ea7u \u0111i\u1ec1u tr\u1ecb ngay l\u1eadp t\u1ee9c, t\u00f9y thu\u1ed9c v\u00e0o l\u00e2m s\u00e0ng v\u00e0 b\u1ea5t\u00a0th\u01b0\u1eddng tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y t\u0103ng Kali m\u00e1u v\u00e0 c\u01a1 ch\u1ebf - 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