What To Do If Dialysis Patients Experience Sudden Acute Hyperkalemia? Conduct Six-step Drills To Strengthen Medical And Nursing Response Capabilities
May 15, 2024
acute hyperkalemia
Hemodialysis is one of the commonly used treatments for patients with renal failure, but various complications may occur during dialysis, among which acute hyperkalemia is a serious complication that requires timely treatment. In order to improve the emergency response capabilities of medical staff for acute hyperkalemia and ensure the safety of patients, this emergency drill script is specially formulated.
Click to Cistanche for kidney disease
management practices
Patients with acute hyperkalemia are often in critical condition. Based on the abnormality of the patient's electrocardiogram, blood potassium level, and severity of clinical symptoms, they should be treated in accordance with the acute hyperkalemia treatment process of the "Expert Consensus on the Practice of Serum Potassium Management in Chinese Patients with Chronic Kidney Disease".
[Clinical manifestations]
The clinical symptoms caused by hyperkalemia are mainly related to the reduced excitability of myocardium and neuromuscular. Its severity depends on the degree and speed of increase in serum potassium, as well as whether it is combined with other electrolyte and water metabolism disorders and the patient's underlying disease state. Mild hyperkalemia usually has no clinical symptoms. Some patients with acute mild hyperkalemia may experience mild muscle tremors and abnormal sensation in the hands and feet. As blood potassium levels increase, acute severe hyperkalemia can cause serious consequences such as flaccid paralysis, fatal arrhythmias, and even cardiac arrest. The clinical manifestations of chronic hyperkalemia are nonspecific and are often masked by the underlying disease.
【Clinical Classification】
Mild: serum potassium >5.0~5.9 mmol/L, no characteristic changes of hyperkalemia in electrocardiogram;
Moderate: Mild increase in serum potassium combined with characteristic changes in electrocardiogram, or serum potassium 6.0 to 6.4 mmol/L without characteristic changes in electrocardiogram;
Severe: Moderate elevation of serum potassium combined with characteristic changes in electrocardiogram, or serum potassium ≥6.5 mmol/L.
【Management Standards】
1. For patients with serum potassium >6.5 mmol/L, even if there are no characteristic changes in the electrocardiogram, they should be actively treated, monitored by electrocardiogram, and emergency dialysis treatment should be performed immediately.
2. For patients with characteristic changes in electrocardiogram, intravenous calcium therapy should be initiated to antagonize myocardial toxicity. Under ECG monitoring, 10 ml of 10% calcium gluconate is injected intravenously. If no effect is observed within 5 to 10 minutes, another dose of calcium gluconate can be given. Calcium ions can stabilize myocardial cell membrane potential and restore myocardial cell excitability to normal. If there are no characteristic changes in the electrocardiogram, other emergency potassium-lowering treatments can be selected.
3. Intravenous injection of glucose⁃insulin solution and aerosol inhalation of albuterol can take effect within 30 minutes. It is recommended to use 500 ml of 10% glucose solution plus 10 IU of ordinary insulin for intravenous infusion for more than 1 hour; 50% can also be used in clinical practice Intravenous injection of glucose requires special attention. It is not recommended to use high-concentration glucose intravenous injection unless necessary for patients with diabetes. When albuterol is combined with insulin, the drop in blood potassium is greater. Patients with severe hyperkalemia are not suitable for taking the drug alone. Studies have shown that albuterol can increase the patient's heart rate. Patients with chronic HF and coronary heart disease who have cardiac dysfunction or arrhythmia need to be careful when using it. Patients need to be assessed for contraindications before treatment.
4. Short-term treatment with sodium bicarbonate can inhibit the increase in serum potassium caused by metabolic acidosis.
The above acute potassium-lowering drugs have the best effect within 2 hours, but the effect may disappear within 4 hours, so serum potassium needs to be monitored again in 2 to 4 hours.
Such drugs can help stabilize heart function in the short term, but if the patient has abnormal potassium excretion function, excess potassium in the body cannot be eliminated in the short term. Therefore, oral potassium ion binders can be combined with oral potassium ion binders to reduce blood potassium levels in the acute phase.
Dialysis can increase potassium clearance and can be used as an auxiliary treatment for acute hyperkalemia after using other methods. Patients with severe hyperkalemia and vascular access can directly undergo emergency dialysis treatment.
Some emergency patients with hyperkalemia may have an acute episode of chronic hyperkalemia rather than a transient increase in serum potassium. Even if the patient's first diagnosis is not hyperkalemia, if the patient has serum potassium >5.0 mmol/L ≥2 times during hospitalization, especially if there are multiple comorbidities, advanced age and other risk factors, a nephrologist needs to be promptly arranged to participate in multi-department collaborative diagnosis and treatment.
Patients who are discharged from the emergency department and are at risk of recurrence of hyperkalemia should be followed up regularly by the nephrology department and their electrolytes should be closely monitored.
How Does Cistanche Treat Kidney Disease?
Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.
Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.
Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.
Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.
Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.
Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.
Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.
In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.
In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.
