Hyperkalemia

오늘은 hyperkalemia에 대하여 알아보겠습니다.   Hyperkalemia란 혈중 K수치가 5.5meq 이상인 경우를 의미하며심정지가 올 수 있는 요인이므로 긴급한 치료가 요구됩니다.   원인1) K이온의 extracellular shift : 조직손상, 근육압박, rhabdomyolysis, 외상, 화상, 출혈, acidosis, insulin deficiency2) 부적절한 K이온 배출 : ACEI, spironolactone, Beta blocker, NSAIDs 3) K흡수 초과4) artifactual pseudohyperkalemia -> Hemolysis     증상 – : cardiac arrhythmia, 말초혈관저항 감소되며 저혈압 유발, EKG상 tall T wave   치료1) 초기치료 (실제 체내에서 제거되는 K양은 없음) <table width="595" class="txc-table" style="border: medium; border-image: none; width: 595px; font-family: gulim; font-size: 13.33px; border-collapse: collapse;" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td style="border: 1px solid rgb(204, 204, 204); width: 135px; height: 24px;"> <span style="display: inline !important; float: none; background-color: rgb(239, 233, 245); color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">Calcium gluconate</td><td style="width: 208px; height: 24px; border-top-color: rgb(204, 204, 204); border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid;"> <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;"><span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">심장 전도이상 방지</td><td style="width: 250px; height: 24px; border-top-color: rgb(204, 204, 204); border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid;"> <span style="display: inline !important; float: none; background-color: rgb(239, 233, 245); color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">N/S 100ml + Ca 1A IV</td></tr><tr><td style="width: 135px; height: 24px; border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-left-color: rgb(204, 204, 204); border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-right-style: solid; border-bottom-style: solid; border-left-style: solid;"> <span style="display: inline !important; float: none; background-color: rgb(239, 233, 245); color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;"> Insuline + glucose</td><td style="width: 208px; height: 24px; border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"> <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">K <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">이온의 세포내로의 이동 촉진</td><td style="width: 250px; height: 24px; border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"> <span style="display: inline !important; float: none; background-color: rgb(239, 233, 245); color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">50DW 50ml + RI 10nuit IV</td></tr><tr><td style="width: 135px; height: 24px; border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-left-color: rgb(204, 204, 204); border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-right-style: solid; border-bottom-style: solid; border-left-style: solid;"> <span style="display: inline !important; float: none; background-color: rgb(239, 233, 245); color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">Bicarbonate</td><td style="width: 208px; height: 24px; border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"> <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">K <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">이온의 세포내로의 이동 촉진</td><td style="width: 250px; height: 24px; border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"> metabolic acidosis시 NaHco3 3A IV</td></tr><tr><td style="width: 135px; height: 25px; border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-left-color: rgb(204, 204, 204); border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-right-style: solid; border-bottom-style: solid; border-left-style: solid;"> <span style="display: inline !important; float: none; background-color: rgb(239, 233, 245); color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">Albuterol</td><td style="width: 208px; height: 25px; border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"> <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">K <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">이온의 세포내로의 이동 촉진</td><td style="width: 250px; height: 25px; border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"> 10~20mg nebulizer</td></tr></tbody></table>   2) 급성기 치료 (초치료만 하면 K이온 ECF로 재분포되므로 이하 치료병행) <strike></strike> <table width="700" class="txc-table" style="border:none;border-collapse:collapse;;font-family:gulim;font-size:13.33px" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td style="width:233px;height:24px;border-bottom:1px solid #ccc;border-right:1px solid #ccc;border-top:1px solid #ccc;border-left:1px solid #ccc;;"> <span style="display: inline !important; float: none; background-color: rgb(239, 233, 245); color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">Loop diuretics (신기능 정상시)</td><td style="width:233px;height:24px;border-bottom:1px solid #ccc;border-right:1px solid #ccc;border-top:1px solid #ccc;;"> <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;"><span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">신장에서 <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">K<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">이온 배출증가</td><td style="width:233px;height:24px;border-bottom:1px solid #ccc;border-right:1px solid #ccc;border-top:1px solid #ccc;;"> furosemide 40~160mg</td></tr><tr><td style="width:233px;height:24px;border-bottom:1px solid #ccc;border-right:1px solid #ccc;border-left:1px solid #ccc;;"> <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">cation-exchange resin <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">  : sodium polystyrene sulfonate<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">  (<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">칼리메이트<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">, <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">카로스<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">)</td><td style="width:233px;height:24px;border-bottom:1px solid #ccc;border-right:1px solid #ccc;;"> <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;"> colon<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">에서 <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">K<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">이온 배출증가</td><td style="width:233px;height:24px;border-bottom:1px solid #ccc;border-right:1px solid #ccc;;"> oral : 15~30g  rectal : 50g in DW (enema)</td></tr><tr><td style="width:233px;height:24px;border-bottom:1px solid #ccc;border-right:1px solid #ccc;border-left:1px solid #ccc;;"> <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">HD, CRRT (<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">가장 빠르고 효과적<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">)</td><td style="width:233px;height:24px;border-bottom:1px solid #ccc;border-right:1px solid #ccc;;"> <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;"> Extracorporeal K<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">이온 배출</td><td style="width:233px;height:24px;border-bottom:1px solid #ccc;border-right:1px solid #ccc;;"> BF 200~300ml/min, dialysate fluid : K free</td></tr><tr><td style="width:233px;height:24px;border-bottom:1px solid #ccc;border-right:1px solid #ccc;border-left:1px solid #ccc;;"> <span style="display: inline !important; float: none; background-color: rgb(239, 233, 245); color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">peritoneal dialysate</td><td style="width:233px;height:24px;border-bottom:1px solid #ccc;border-right:1px solid #ccc;;"> <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;"> peritoneal K <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">이온 배출 <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">  (HD<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">보다 <span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">K<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">이온 제거속도 매우느림<span style="color: rgb(68, 68, 68); font-family: Gulim,굴림,AppleGothic,sans-serif; font-size: 13.33px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: 0pt; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">)</td><td style="width:233px;height:24px;border-bottom:1px solid #ccc;border-right:1px solid #ccc;;"> Fast exchange, 3~4L/hr</td></tr></tbody></table>