.
+
( 1X 106/L)
+ 6.7mEq/L, Na+ 140mEq/L, 0.8mg/dl. .
(1)(+ >5.3mEq/L)
1) +:
2) PLT
48 (50mg/)
. QRS . : 450mg/dl, 2.8mg/dl, 190mg/dl, + 8.3mEq/L, Na+ 136mEq/L, pH 7.07, HCO3- 14mEq/L
(2)
3) + :
- (
+
+-+ ATP
(3)
3) + :
- (
+
+
Posm H2O + +
(4)
3) + :
(+)
- (
+ PO43- o Ca2+
A tumor lysis-like syndrome during therapy of visceral leishmaniasis
3
9.8mg/dl ( 5.1mg/dl)
+ 5.9 mEq/L ( 4.1mEq/L)
PO43- 5.2mg/dl ( 3.1mg/dl)
E. Liberopoulos et al: Ann Clin Lab Sci 2002;32: 419-421
+
(5)
4) +
3Na+
2K+
Na+
K+
Aldo-RecALDO
- +
Cl-
( Addison)
( )
(50% )
63 , (Septrin forte 1X2 ). . : :160mg/dl, : 60mg/dl, : 1.6mg/dl, +: 7.2mmol/L,Cl-: 110mmol/L, Na+:134mmol/L, pH: 7.33, PCO2: 32mmHg HCO3-: 16mmol/L.
)
)
) K+
) K+
+
+ , :
)
)
)
)
Siamopoulos KC, Elisaf M, Katopodis K
Iatrogenic hyperkalemia - points to consider in diagnosis and management
Nephrol Dial Transplant 1997;13: 2402-2406
+
+ : - -:
+:
+
+ (0.4mmol/L)
, , o +
+
+ : - -:
+:
3Na+
2K+
Na+
K+
Aldo-RecALDO
- +
Cl-
3Na+Na+
K+
2K+
ALDO
: + V +
-
Aldo-Rec
, :
)
)
)
) -
Na+
K+ ALDO,-
Cl-
- +
Aldo-Rec
3Na+
2K+
: +
+ ( )
+ ()- + ( )
+ ( ) + ( )
: 2004;4: 167-176
: -
+
+
Hyperkalemia (K+>5.3mEq/L) in 9.3% of CHF patientsHJ Milionis et al: Eur J Heart Fail 2002;4: 167-173
:
: 1.5mg/dl, K+: 5.7mmol/L, Cl-: 109mmol/L, Na+: 134mmol/L pH: 7.34
9 ++
9 (0.2-1mg/)
-
(1)
9 Ca2+ (10ml 10% 2 3 )
(2)
+ :
) 1L + 15-20 + 0.5-1.5mEq/L, 1h
) NaHCO3 (44-50mEq)
) -
+ :
9 9 9
(3)
+
+
+
+
+-+ ATP
(1)
( +)
(/)
Cushing- ACTH
+ ( )
3Na+Na+
K+
Aldo-Rec
2K+
ALDO
- +
Cl-
+ + (, , , +)
(3)
: , , ,
+ (+ ): , ,
(n=76)
8
4
8
9
3
3
H Milionis et al: Southern Med J 2002;95: 1280-1287
( )
Milionis HJ, Bourantas KL, SiamopoulosKC, Elisaf MS
Acid-base and electrolyte abnormalities in patients with acute leukemia
Am J Hematol 1999;62: 201-207
63%
30.3%
31.8%
45.4%
9%
Am J Hematol, 1999;62:201-207
Alterations in electrolyte equilibrium in
patients with acute leukemiaFilippatos TD et al: Eur J Haematol 2005;75: 449-460
Na+
Cl-
-48mV
+-
Na+
-83mV
+-
V +
-
(4)
: , , ,
+ : .. ( )
52 . . : 82mg/dl, K+ : 2.5mmol/L, pH: 7.52, PCO2: 46mmHg HCO3-: 32mmol/L.
:
)
)
)
)
, :
) +
) Mg2+
)
) a+
+
Mg2+
+ :
/
(1)
+ :
(2)
(3)
+
Mg2+
+ ..
+ (25mmol/L)
M. Elisaf et al: Postgrad Med J 1995;71: 211-212
M Elisaf et al: Q J Med 2000;93: 318
(4)
+
Mg2+
( , cisplatin, ,
, )
+
(+ )
Elisaf M, Milionis H, Siamopoulos KC
Hypomagnesemic hypokalemia and hypocalcemia: Clinical and laboratory characteristics
Miner Electrolyte Metab 1997;23: 105-112
Elisaf M, Merkouropoulos M, TsianosEV, Siamopoulos KC
Acid-base and electrolyte abnormalities in alcoholic patients
Miner Electrolyte Metab 1994;20: 274-281
(n=127)
12.6%
29.9%
17.3%
29.1%
20.5%
M. Elisaf et al: Miner Electrolyte Metab 1994;20: 274-281
+ 55mmo/L Mg2+ 1mmol/L. 140/90mmHg
K+
Na+ (, .)
(.. )
/
ACTH
Konstantinidis A, Elisaf M, Panteli K, Constantopoulos S
Severe muscle weakness due to hypokalemia as a manifestation of small-cell carcinoma
Respiration 1999;66: 269-272
76
. .: 2004; 21: 51-62
:-
--
(+ )
(+
KCl Per os
KCl
+: 60mEq/L ( 4amp) K+: 40mEq/L ( 3amp) K+: 10-20mEq/h
+(, )
KCl vs KHCO3
+
50-65 mEq K+/teaspoon Cl-
/
H2O:
&
Posm=2 X Na+ (mg/dl) (mg/dl)(mosmol/kg) (mmol/L)
18 6+ +
Posm=2 X Na+ + /18 + /6
Posm +
+ 2
Posm 2
:
Posm 2O
+ =+e + K+e
H2O
Na+e + K+e : + +
+ =+e + Ke+
H2O
+ ( +) > 2[]
H2O
H2O
Posm
ADH
H2O
2 ()
2
ADH
SIADH
( )
( , )
H2O
H2O
ADH +
+
+
+
H2O
33.7%(+
ADH
ADH
H2O Na+
+
+ 2
( ) ADH ( /)
:
SSRIs . a+
: 110mmol/L, 0.6mg/dl, + 4mmol/L,
, :
) Posm
) ,
) Uosm
) ADH
Milionis HJ, Liamis GL, Elisaf MS
The hyponatremic patient:
A systematic approach to laboratory diagnosis
CMAJ 2002;166: 1056-1062
-
Posm: /
Posm: ,
Posm ,
Na+
Posm H2O +
2 ( Na+)
H2O
H2O
(2)
( ):
Uosm
, , 1006
) Na+
) +
) Mg2+
) Ca++
(3)
Na+ (40mmol/L):
ADH
+ (25/1)
(>5mg/dl)
a+
56mmol/L
ADH, :
)
)
) PO43-
) pH
ADH
(+ FE )
(
:
+ 110mmol/L
Na+ 56mmol/L
2.3mg/dl (FE 20%)
PO43- 2.1mg/dl
21mg/dl (FE 64%)
SIADH
Multiple metabolic abnormalities in a
patient with SIADHE. Rizos et al: Nephron 2002;91: 339-340
ADH
( )
, , , .)
NaCl H2O
SIADH
9 +
+ +
SIADH
(.. )
H2O
NaCl
:
(, , , , )
+
80kg + 110mmol/L
: + 130mmol/L
+: 20mmol/L
40h
+ (mmol) 20mmol/L: 0.6 X 80 X 20=960mmol
NaCl (3%) : 960/514=1.8L
NaCl 3% 1.8L/40h=45ml/h + (0.5-1mg/kg)
ADH H2O
H2O
+ = +e + +e
H2O
: 2 > + + + =
+ ()
: , ,
ADH ADH
85 (=80 kg) . NaCl0.9% (1L /). 380C. 3 + : 164mmol/L, : 170mg/dl, + : 3.4mmol/L, : 90mg/dl, : 1.9mg/d,
, :
) H2O
)
)
)
)
H2O ( +)
( + ?)
+
+
H2O
[ H2O Na+]
)
)
)
)
Na+
) 40mmol/L
+
+ (
H2O a+
1L NaCl 0.9%
: / Na+
vs
: ( Na+ )
: 2 +
HYPERNATREMIA DURING CORRECTION OF HYPERCALCEMIA
2.5LNaCl 0.9% +2amp KCl/L
[osmolality 360mosmol/kg] 2.2mg/dl 1.4mg/dlCa2+ 167mg/dl 13.1mg/dl+ 143mmol/L 157mmol/L
G. Liamis et al: Nephron 2000;86: 358
;
) +
) +
) Uosm ( )
) pH
Uosm
>800mosmol/kg +
H2O
Uosm 440mosmol/Kg
,
) ( 1mmol/L/h)
)
) H2O
:
) 5% (+ KCl)
) NaCl 0.45% (+Cl)
) NaCl 0.9% (+KCl)
) NaCl 3% (+Cl)
( NaCl 0.9%)
Na+
-
H2O :
) 2L
) 5L
) 8L
) 10L
(1)
H2O:
0.5 (0.4) -1Na+
140
)
) NaCl 0.9%
) NaCl (N/4) + KCl (3amp/L)
) NaCl (N/2) + KCl (3amp/L)
(2)
.. /4: 1L N/4 +3 Cl 140mosmol 0.5 L H2O
60kg, + : 170mmol/L
: + 140mmol/L ( 30mmol/L)
: 60h
H2O = 0.5 X -1 = 6L
140
6L 2/60h=100ml/h 30-50ml/h( )
H2O 140ml/h /4 750ml2 180ml/h
/4 3KCL 500ml H2O 280ml/h