低钾血症医学知识培训课件.ppt

1、低钾血症医学知识低钾血症医学知识Key Hormones Involved in Normal Potassium Homeostasis.Insulin and b-adrenergic catecholamines promote the entry of potassium into muscle cells by stimulating NA+/K+ATPase.Aldosterone promotes potassium excretion through its effects on NA+/K+ATPase and epithelial sodium and potassium

2、channels in collecting-duct cells.Angiotensin II has a synergistic effect on the stimulation of aldosterone production induced by hyperkalemia.Plus signs denote stimulation,and minus signs inhibition.Modified from GennariThyroid hormone2低钾血症医学知识血钾稳态的维持K e y H o r mo n e s I n v o l v e d i3低钾血症医学知识

3、低钾血症对神经肌肉、心肌的影响膜电位3 低钾血症医学知识The Effects of Serum K+Concentration on Neuromuscular IrritabilityState Em Et (Em-Et)Neuromuscular Irritability Normal -90 -65 25 NormalHypokalemia (more negative)-65 (Hyperpolarization)Hyperkalemia (less negative)-65 (partial depolarization)4低钾血症医学知识T h e E f f e c t s o

4、 f S e r u m K+C o n c e n5低钾血症医学知识 低钾血症对神经肌肉、心肌的影响5 低钾血症医学知识6低钾血症医学知识 低钾血症对神经肌肉、心肌的影响1 对神经-肌肉兴奋性的影响7低钾血症医学知识低钾血症对神经肌肉、心肌的影响2 对心脏的影响（E f f e c t8低钾血症医学知识低钾血症对神经肌肉、心肌的影响 传导性（C o n d u c t i o9低钾血症医学知识（2）心电图（E l e c t r o c a r d i o g r a m,E C G10低钾血症医学知识低钾血症时心律失常的表现低钾血症对神经肌肉、心肌的影响1 011低钾血症医学知识低钾血症对

5、机体的其它影响对酸硷平衡的影响对血管的影响1 1肌肉血钾减少，进入细胞内减少，细胞能量代谢减少，肌肉坏死12低钾血症医学知识对洋地黄类强心药物毒性的敏感性增高低钾血症对机体的其它影响13低钾血症医学知识低血钾心电图实例1 3 低钾血症医学知识14低钾血症医学知识正常成年人血清钾的正常值为3.5 5.0 mmo l/L。Mineralocorticoid excessPrimary hyperaldosteronismAdrenal adenomaAdrenal carcinomaBilateral adrenal hyperplasiaCongenital adrenal hyperplasi

6、a*11b-hydroxylase deficiency17a-hydroxylase deficiencyRenin-secreting tumorsEctopic corticotropin syndromeCushings syndromeGlucocorticoid-responsive aldosteronism*Renovascular hypertensionMalignant hypertensionVasculitisApparent mineralocorticoid excessLiddles syndrome*11b-hydroxysteroid dehydrogena

7、se deficiencyImpaired chloride-associated sodium transportBartters syndrome*Gitelmans syndrome*15低钾血症医学知识M i n e r a l o c o r t i c o i d e x c e s s 低钾血症低钾血症医学知识培训课件甲状腺机能亢进促进钠/钾ATP酶的合成血钾进入细胞增多17低钾血症医学知识低钾血症体钾分布异常是指K+进入细胞内过多，机体并不缺钾嗜铬细胞瘤b受体激动可导致钠/钾ATP酶活性增高钾离子分布异常18低钾血症医学知识低钾血症体钾分布异常低钾性周期性麻痹嗜铬细胞瘤1 8

8、低钾血TABLE1.DRUG-INDUCEDHYPOKALEMIA.HYPOKALEMIA DUE TO TRANSCELLULAR POTASSIUM SHIFTHYPOKALEMIA DUE TO INCREASEDRENAL POTASSIUMLOSSHYPOKALEMIA DUE TO EXCESS POTASSIUM LOSS IN STOOLb2-Adrenergic agonist Epinephrine Decongestants Pseudoephedrine,Phenylpropanolamine Bronchodilators Albuterol Terbutaline

9、Pirbuterol Isoetharine Fenoterol Ephedrine Isoproterenol MetaproterenolTocolytic agents Ritodrine NylidrinTheophylline Caffeine Verapamil intoxication Chloroquine intoxicationInsulin overdose Barium poisoningDiuretics Acetazolamide Thiazides Chlorthalidone Indapamide Metolazone Quinethazone Bumetani

10、de Ethacrynic acid Furosemide Torsemide Mineralocorticoids Fludrocortisone Substances with mineralocorticoid Effects Licorice、Carbenoxolone、GossypolHigh-dose glucocorticoidsHigh-dose antibiotics Penicillin Nafcillin Ampicillin Carbenicillin Drugs associated with magnesium depletion Aminoglycosides C

11、isplatin Foscarnet Amphotericin BPhenolphthalein Sodium polystyrene sulfonate 19低钾血症医学知识药物对低血钾的影响T A B L E 1.D R U G-I N D U C E D H Y原醛肾素瘤动脉狭窄库欣CAH11脱氢酶缺乏Liddle低血钾（血钾3.5mmol/L）重复检测，确认致低血钾药物使用、肠道失钾，病史尿路失钾RASS肾小管病变嗜铬细胞瘤甲状腺机能亢进低血钾性周期性麻痹钾离子分布障碍巴特氏综合征范可尼综合征肾小管酸中毒容量（血压）无有20低钾血症医学知识低血钾的观察与诊疗原醛低血钾（血钾3.5 mm

12、o l/L）重复21低钾血症医学知识库欣综合征临床表现高血压发生机制2 1 低钾血症医学知识22低钾血症医学知识理盐激素过多（醛固酮）-原发性临床表现高血压发生机制2 223低钾血症医学知识理盐激素过多（醛固酮）-继发性 1 血管性高血压发生机制2 324低钾血症医学知识理盐激素过多（醛固酮）-继发性 2 肾素瘤高血压发生机制2 425低钾血症医学知识理盐激素过多（D O C）-先天性肾上腺皮质增生症临床表现高血26低钾血症医学知识理盐激素过多（D O C）-分泌D O C 的肿瘤临床表现高血压发生27低钾血症医学知识原发性糖皮质激素抵抗临床表现高血压发生机制2 7 低钾血症医学知28低钾血症医学知识原发性糖皮质激素抵抗临床表现高血压发生机制2 8 低钾血症医学知29低钾血症医学知识表观盐皮质激素过多临床表现高血压发生机制2 9 低钾血症医学知识30低钾血症医学知识谢谢3 0 低钾血症医学知识