Tulburarile concentratiei de potasiu

Question 1

Intrarea K in celula e stimulata de ?

Answer 1

Insulina
Stimulare beta adrenergica
Teofilina

Question 2

Intrarea K in celula e diminuata de….

Answer 2

Stimularea alfa adrenergica
Acidoza metabolica
Lezarea/ moartea celulelor

Question 3

Rinichiul si echilibrul K. Locuri de reabsortie si secretie in rinichi

Answer 3

Reabsortie -90% in TCP si ansa Henle
Secretie(excretie) - celulele principale in tubii colectori ( dependent de ALDO)

Question 3

Rinichiul si echilibrul K. Locuri de reabsortie si secretie in rinichi

Answer 3

Reabsortie -90% in TCP si ansa Henle
Secretie(excretie) - celulele principale in tubii colectori ( dependent de ALDO)

Question 4

Efectul acidozei si alcalozei asupra K

Answer 4

Acidoza va reduce secretia de K
Alcaloza va creste secretia de K

Question 5

Cauze hipokaliemie??

Answer 5

Excretie renala crescuta ( K urinar >20mmol/zi)
-Diuretice ( tiazidice, de ansa)
Secretia crescuta de aldosteron (ALDO)
-insuficenta hepatica, insuficenta cardiaca, sdr nefrotic
-sdr Cushing, sdr Conn
-tumori generatoare de ACTH
Mineralocorticoizi exogeni ( corticosteroizi, liquorita)
Boli renale
-Acidoza tubulara renala 1 si 2, leziuni tubulare renale
-sdr Bartter, Gitelman si Liddle
-Leucemia acuta
-Nefrotoxicitate (Aminoglicozide , Amfortericina B)
-Leucemie acuta
Aport redus de K
Redistribuire la nivel celular
-Stimulare beta-adrenergica
-beta-agonisti
-insulina
-alcaloza
-IMA
Piergedi la nivel gasastrointestinal (K urinar <20mmoli/zi)- varsaturi,diaree, purgative, adenom vilos, fistule, ileostomie, ocluzie

Question 6

Caracteristici clinice sdr Bartter si Gittelman

Answer 6

Hipo K
Alcaloza metabolica
Hipercalciurie
Hipomagnezemie
TA N
Renina si Aldosteron crescute
* la sdr gitelman avem hipercalcemie ,nu hipercalciurie

Question 7

Tratament sdr Bartter si Gitelman

Answer 7

Suplimente de K
Amilorid
rar indometacin

Question 8

Caracteristice clinice Sdr Liddle?

Answer 8

Alcaloza
Hipokaliemie
dar TA crescuta si productie N de renina si aldosteron.

Question 9

Tratament hipokaliemie

Answer 9

Aport deficitar- creste aport sau suplimente orale de potasiu
Hiperadosteronism ( ciroza, tizidice) -spironolactona, eplerenona
*adaugati 20mmol de K/L cu verificare cel putin zilnic

Question 10

Cauze hiperkaliemie

Answer 10

Reducerea excretiei
-Injurie renala acuta ( frecvent)
-Medicamente( frecvent): diuretice economisitoare de potasiu( amilorid, trianterem, spironolactona, eplerenona) IECA, ( scad ALDO), AINS ( cresc prostaglandinele), ciclosporina, heparina,
-Deficit de aldosteron- hipoaldosteronism hiporeninemic( Acidoza tubulara renal tip 4), Boala Addison
-Acidoza
-Sdr Gordon
Cresterea eliberarii din celule)
Acidoza, cetoacidoza diabetica
Leziuni tisulare/reabdomioliza
Intoxicatie cu digoxin
Efort fizic marcat
Cresterea aportului exogen -transfuii sange conservat

Question 11

Caracterizeaza pseudohipoaldosteronismul de tip 1
A carui sdr e imagine in oglinda?

Answer 11

Rezistenta la actiunea aldosteronulu
Se careacterizeaza prin : hiperkaliemie, hiponatremie
E imaginea in oglinda a Sdr Liddle

Question 12

Sdr Godron ( pseudohipoaldosteronismul de tip 2)
Caracteristici
AL carui sdr e imagine in oglinda

Answer 12

Caracteristici: Retentie de Na si HTA
scaderea reninei si aldosteronului
Hiperkaliemie
Acidoza
Imagine in oglina a sindromuli Gitelman

Question 13

Modificari ECG la potasiu peste 7 mmoli/L
Simptome cardiace

Answer 13

Unda T in cort
Unda P diminuata
Model de unda sinusoida ( pre-oprire cardiaca)

Simptome cardace> hTA, bradicardie, asistolie

Question 14

Optiuni terapeutice in hiperkaliemie

Answer 14

Gluconat de Ca (porotectie cardiaca) 10 ml 10% i.v in 5 ml
Insulina suprafiziologica 10 U +50 ml glucoza
Salbutamol 0,5 mg
Noi chelatori de potasiu- Pantomer sau ciclosalicilat de zincroniu