Zusammenfassung
Die akute Hyperkaliämie ist eine gefährliche und sofort zu behandelnde Elektrolytstörung. Durch Veränderungen im Membranpotenzial kann sie zu Herzrhythmusstörungen und Tod führen. Die auftretenden EKG-Veränderungen sind vielfältig und sollten schnell erkannt werden. Die Therapie besteht aus verschiedenen Stufen. Neben einer allfällig notwendigen Membranstabilisierung gilt es, Kalium in den Intrazellulärraum zu verschieben und danach aus dem Körper zu eliminieren. Eine gängige Methode zur Verschiebung des Kaliums in den Intrazellulärraum besteht aus der durchaus komplikationsträchtigen Verabreichung von Insulin-Glucose-Gemischen. Hier kommen im klinischen Alltag vielfältige Rezeptvariationen zur Anwendung, die im Hinblick auf das jeweilige Nutzen-Risiko-Verhältnis nicht immer ideal zu sein scheinen. Ein praxistaugliches und gut memorierbares Insulin-Glucose-Gemisch weist ein Verhältnis von 1 IE Insulin zu 4 g Glucose (1:4) auf. Die therapeutische Elimination aus dem Körper geschieht über eine gesteigerte Diurese oder die Anwendung von Nierenersatzverfahren. Ein besonderes Augenmerkt muss der engmaschigen Kontrolle des Kaliums und des Blutzuckerspiegels zukommen. Nach Überwindung der Akutsituation muss das Augenmerk auf der Therapie der zugrunde liegenden Störung und ggf. auf der Neueinstellung der Dauermedikation des Patienten liegen.
Abstract
Acute hyperkalemia is a dangerous electrolyte disorder, which must be treated immediately. It can lead to cardiac arrhythmia and death due to alterations in cell membrane potentials. The resulting alterations in the electrocardiogram (ECG) are multifarious and need to be rapidly recognized. Treatment consists of various stages. In addition to membrane stabilization, which is always necessary, potassium must be displaced into the intracellular space and then eliminated from the body. A commonly applied method for displacement of potassium into the intracellular space involves the administration of insulin-glucose mixtures, which is associated with many complications. In the clinical routine many prescription variations are applied, which do not always appear to be ideal with respect to the individual risk-benefit ratio. A practically useful and easily memorized insulin-glucose mixture has a relationship of 1IU insulin to 4g glucose. The therapeutic elimination from the body is carried out using an enhanced diuresis or the utilization of renal replacement procedures. Special attention must be paid to the continous monitoring of potassium and blood sugar levels. After overcoming the acute situation, attention must be paid to treatment of the underlying disorder and if necessary to readjustment of the long-term medication of the patient.
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Groene, P., Hoffmann, G. Sichere Behandlung der akuten Hyperkaliämie. Anaesthesist 66, 426–430 (2017). https://doi.org/10.1007/s00101-017-0306-4
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DOI: https://doi.org/10.1007/s00101-017-0306-4