Sıvı Elektrolit Bozuklukları ve Tedavisi
Synopsis
Sıvı ve elektrolit dengesi ve tedavisi yeterince anlaşılmamaktadır. Bu nedenle verilen tedaviler morbidite ve mortalitenin artmasına neden olabilmektedir. Sıvı ve elektrolit konusu uzun, karışıktır. Bu bölümde size sıvı ve elektrolit bozuklukları olabildiğince açıklayıcı ve basit şekilde anlatılmaya çalışıldı.
Bütün sıvı ve elektrolit bozukluklarında ilk bilinmesi gereken hastayı değerlendirmektir. Unstabil hastalar hızlıca güvenlik çemberine alınmalı, çift damar yolu açılıp monitörize edilmelidir. Hastanın anamnezi, kullandığı ilaçlar, semptomları sorgulanmalıdır. Fizik muayenesi, ultrasonografi ve vital bulguları ile sıvı volümü değerlendirilmelidir. Unstabil hastalar için ideal sıvı mevcut değildir; ancak kristalloidler ilk tercih olarak kullanılmalıdır.
Elektrolit bozukluklarında yüksek olan değer düşürülmeli, düşük olan değer yükseltilmelidir. Basit mantık olarak doğru olmasına rağmen tedavi kriterleri, altta yatan nedenleri göz önünde bulundurulmalı ve hastalar sık kontrol edilmelidir.
References
Boddy K, King PC, Hume R, Weyers E. The relation of total body potassium to height, weight, and age in normal adults [Internet]. Vol. 25, J. clin. Path. 1972. Available from: http://jcp.bmj.com/
Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Vol. 26, Pediatric Nephrology. 2011. p. 377–84.
Hiperkalemi | Tedavi ve Yönetim | Bakım noktası [Internet]. [cited 2024 Feb 3]. Available from: https://www.statpearls.com/point-of-care/23182
Palmer BF, Clegg DJ. Staying Current Physiology and pathophysiology of potassium homeostasis. Adv Physiol Educ [Internet]. 2016;40:480–90. Available from: http://advan.physiology.org
Acker CG, Johnson JP, Palevsky PM, Greenberg A. Hyperkalemia in Hospitalized Patients Causes, Adequacy of Treatment, and Results of an Attempt to Improve Physician Compliance With Published Therapy Guidelines [Internet]. Available from: http://archinte.jamanetwork.com/
Dépret F, Peacock WF, Liu KD, Rafique Z, Rossignol P, Legrand M. Management of hyperkalemia in the acutely ill patient. Vol. 9, Annals of Intensive Care. Springer Verlag; 2019.
Mattu A, Brady WJ, Robinson DA. Electrocardiographic manifestations of hyperkalemia. American Journal of Emergency Medicine. 2000;18(6):721–9.
Durfey N, Lehnhof B, Bergeson A, Durfey SNM, Leytin V, McAteer K, et al. Severe hyperkalemia: Can the electrocardiogram risk stratify for short-term adverse events? Western Journal of Emergency Medicine. 2017 Aug 1;18(5):963–71.
Gupta AA, Self M, Mueller M, Wardi G, Tainter C. Dispelling myths and misconceptions about the treatment of acute hyperkalemia. Am J Emerg Med. 2022 Feb 1;52:85–91.
Shrager MW. Digitalis Intoxication A Review and Report of Forty Cases, with Emphasis on Etiology [Internet]. Available from: http://archinte.jamanetwork.com/
Ferrannini E, Taddei S, Santoro D, Natali A, Boni C, Del Chiaro D, et al. Independent stimulation of glucose metabolism and Na+-K+ exchange by insulin in the human forearm [Internet]. 1988. Available from: www.physiology.org/journal/ajpendo
ALLON M. albuterol and insulin for treatment of hyperkalemia in hemodialysis patients.
Moussavi K, Fitter S, Gabrielson SW, Koyfman A, Long B. Management of Hyperkalemia With Insulin and Glucose: Pearls for the Emergency Clinician. Journal of Emergency Medicine. 2019 Jul 1;57(1):36–42.
Blumberg A, Weidmann P, Ferrari P. Effect of prolonged bicarbonate administration on plasma potassium in terminal renal failure. Vol. 41, Kidney International. 1992.
Harel Z, Harel S, Shah PS, Wald R, Perl J, Bell CM. Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: A systematic review. American Journal of Medicine. 2013;126(3).
Udensi U, Tchounwou P. Potassium homeostasis, oxidative stress, and human disease. Int J Clin Exp Physiol. 2017;4(3):111.
Dhondup T, Qian Q. Acid-Base and Electrolyte Disorders in Patients with and without Chronic Kidney Disease: An Update. Kidney Diseases. 2017;3(4):136–48.
Castro D, Sharma S. Hypokalemia. Urology at a Glance [Internet]. 2023 Mar 18 [cited 2024 Feb 4];89–91. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482465/
Kardalas E, Paschou SA, Anagnostis P, Muscogiuri G, Siasos G, Vryonidou A. Hypokalemia: A clinical update. Vol. 7, Endocrine Connections. BioScientifica Ltd.; 2018. p. R135–46.
Osadchii OE. Mechanisms of hypokalemia-induced ventricular arrhythmogenicity. Vol. 24, Fundamental and Clinical Pharmacology. 2010. p. 547–59.
Diercks DB, Shumaik GM, Harrigan RA, Brady WJ, Chan TC. Electrocardiographic manifestations: Electrolyte abnormalities. Journal of Emergency Medicine. 2004;27(2):153–60.
Mirijello A, Rinninella E, De Leva F, Tosoni A, Vassallo G, Antonelli M, et al. Hypokalemia-induced pseudoischemic electrocardiographic changes and quadriplegia. Am J Emerg Med. 2014;32(3).
Surawicz B. Electrolytes and the electrocardiogram. Postgrad Med. 1974;55(6):123–9.
Palmer BF. Regulation Of Potassium Homeostasis. Clinical Journal of the American Society of Nephrology. 2014;10(6):1050–60.
Catalano A, Chilà D, Bellone F, Nicocia G, Martino G, Loddo I, et al. Incidence of hypocalcemia and hypercalcemia in hospitalized patients: Is it changing? J Clin Transl Endocrinol. 2018 Sep 1;13:9–13.
Renaghan AD, Rosner MH. Hypercalcemia: Etiology and management. Nephrology Dialysis Transplantation. 2018 Apr 1;33(4):549–51.
Turner JJO. Hypercalcaemia – presentation and management. Vol. 17, CME ENDOCRINOLOGY Clinical Medicine. 2017.
Sadiq NM, Naganathan S, Badireddy M. Hypercalcemia. StatPearls [Internet]. 2023 Sep 4 [cited 2024 Feb 7]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK430714/
Cooper MS, Gittoes NJL. Diagnosis and management of hypocalcaemia. Vol. 336, BMJ. 2008. p. 1298–302.
Fong J, Khan A, Frcpc MD, Face F. Hypocalcemia: Updates in diagnosis and management for primary care. Canadian Family Physician [Internet]. 2012 Feb [cited 2024 Feb 7];58(2):158. Available from: /pmc/articles/PMC3279267/
Goyal A, Anastasopoulou C, Ngu M, Singh S. Hypocalcemia. Endocrinology and Diabetes: A Problem Oriented Approach: Second Edition [Internet]. 2023 Oct 15 [cited 2024 Feb 7];219–30. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430912/
Verbalis JG. Disorders of body water homeostasis. Best Pract Res Clin Endocrinol Metab. 2003;17(4):471–503.
Sonani B, Naganathan S, Al-Dhahir MA. Hypernatremia. StatPearls [Internet]. 2023 Aug 24 [cited 2024 Feb 6]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK441960/
EDELMAN IS, LEIBMAN J, O’MEARA MP, BIRKENFELD LW. Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. J Clin Invest. 1958;37(9):1236–56.
Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Vol. 29, Nephrology Dialysis Transplantation. Oxford University Press; 2014.
Nielsen S, Digiovannit SR, Christensen EI, Kneppertt MA, Harris HW. Cellular and subcellular immunolocalization of vasopressin-regulated water channel in rat kidney. Vol. 90, Physiology Communicated by Maurice B. 1993.
Muhsin SA, Mount DB. Diagnosis and treatment of hypernatremia. Vol. 30, Best Practice and Research: Clinical Endocrinology and Metabolism. Bailliere Tindall Ltd; 2016. p. 189–203.
Lindner G, Funk GC, Schwarz C, Kneidinger N, Kaider A, Schneeweiss B, et al. Hypernatremia in the Critically Ill Is an Independent Risk Factor for Mortality. American Journal of Kidney Diseases. 2007 Dec;50(6):952–7.
Oracio H, Drogué JA, Adias EM. H YPERNATREMIA. Vol. 342. 2000.
Guidelines for management of Hypernatremia. 2007.
MORRIS-JONES MB Lond PH, HOUSTON Manc IB, Evans Mb RC, Senior Registrar P DI. PROGNOSIS OF THE NEUROLOGICAL COMPLICATIONS OF ACUTE HYPERNATRÆMIA. Vol. 69, Mod. Concepts cardiovasc. Dis. 1967.
Chawla R, Todi S, Agarwal DK. Hyponatremia. ICU Protocols: A Stepwise Approach [Internet]. 2023 Jun 14 [cited 2024 Feb 7];433–40. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470386/
Lindner G, Pfortmüller CA, Leichtle AB, Fiedler GM, Exadaktylos AK. Age-Related Variety in Electrolyte Levels and Prevalence of Dysnatremias and Dyskalemias in Patients Presenting to the Emergency Department. Gerontology. 2014;60(5):420–3.
Sahay M, Sahay R. Hyponatremia: A practical approach. Vol. 18, Indian Journal of Endocrinology and Metabolism. Medknow Publications; 2014. p. 760–71.
Hussain I, Ahmad Z, Garg A. Extreme hypercholesterolemia presenting with pseudohyponatremia - A case report and review of the literature. J Clin Lipidol. 2015 Mar 1;9(2):260–4.
Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: Evaluating the Correction Factor for Hyperglycemia.
Darwish OM, Lutnick E, Dalimov Z, Waisanen KM, Wang D, Houjaij A, et al. Neuraxial vs General Anesthesia: 30-Day Mortality Outcomes Following Transurethral Resection of Prostate. Urology. 2021 Nov 1;157:274–9.
Lindner G, Schwarz C, Haidinger M, Ravioli S. Hyponatremia in the emergency department. Vol. 60, American Journal of Emergency Medicine. W.B. Saunders; 2022. p. 1–8.
Hsu YJ, Chiu JS, Lu KC, Chau T, Lin SH. Biochemical and etiological characteristics of acute hyponatremia in the emergency department. Journal of Emergency Medicine. 2005 Nov;29(4):369–74.
Gankam Kengne F, Decaux G. Hyponatremia and the Brain. Vol. 3, Kidney International Reports. Elsevier Inc; 2018. p. 24–35.
Chifu I, Gerstl A, Lengenfelder B, Schmitt D, Nagler N, Fassnacht M, et al. Treatment of symptomatic hyponatremia with hypertonic saline: A real-life observational study. Eur J Endocrinol. 2021 May 1;184(5):647–55.
Thomas DR, Cote TR, Lawhorne L, Levenson SA, Rubenstein LZ, Smith DA, et al. Understanding Clinical Dehydration and Its Treatment. Vol. 9, Journal of the American Medical Directors Association. Elsevier Inc.; 2008. p. 292–301.
Does the patient have signs of shock? Algorithms for IV fluid therapy in adults. 2013.
Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Vol. 26, Pediatric Nephrology. 2011. p. 377–84.
Hiperkalemi | Tedavi ve Yönetim | Bakım noktası [Internet]. [cited 2024 Feb 3]. Available from: https://www.statpearls.com/point-of-care/23182
Palmer BF, Clegg DJ. Staying Current Physiology and pathophysiology of potassium homeostasis. Adv Physiol Educ [Internet]. 2016;40:480–90. Available from: http://advan.physiology.org
Acker CG, Johnson JP, Palevsky PM, Greenberg A. Hyperkalemia in Hospitalized Patients Causes, Adequacy of Treatment, and Results of an Attempt to Improve Physician Compliance With Published Therapy Guidelines [Internet]. Available from: http://archinte.jamanetwork.com/
Dépret F, Peacock WF, Liu KD, Rafique Z, Rossignol P, Legrand M. Management of hyperkalemia in the acutely ill patient. Vol. 9, Annals of Intensive Care. Springer Verlag; 2019.
Mattu A, Brady WJ, Robinson DA. Electrocardiographic manifestations of hyperkalemia. American Journal of Emergency Medicine. 2000;18(6):721–9.
Durfey N, Lehnhof B, Bergeson A, Durfey SNM, Leytin V, McAteer K, et al. Severe hyperkalemia: Can the electrocardiogram risk stratify for short-term adverse events? Western Journal of Emergency Medicine. 2017 Aug 1;18(5):963–71.
Gupta AA, Self M, Mueller M, Wardi G, Tainter C. Dispelling myths and misconceptions about the treatment of acute hyperkalemia. Am J Emerg Med. 2022 Feb 1;52:85–91.
Shrager MW. Digitalis Intoxication A Review and Report of Forty Cases, with Emphasis on Etiology [Internet]. Available from: http://archinte.jamanetwork.com/
Ferrannini E, Taddei S, Santoro D, Natali A, Boni C, Del Chiaro D, et al. Independent stimulation of glucose metabolism and Na+-K+ exchange by insulin in the human forearm [Internet]. 1988. Available from: www.physiology.org/journal/ajpendo
ALLON M. albuterol and insulin for treatment of hyperkalemia in hemodialysis patients.
Moussavi K, Fitter S, Gabrielson SW, Koyfman A, Long B. Management of Hyperkalemia With Insulin and Glucose: Pearls for the Emergency Clinician. Journal of Emergency Medicine. 2019 Jul 1;57(1):36–42.
Blumberg A, Weidmann P, Ferrari P. Effect of prolonged bicarbonate administration on plasma potassium in terminal renal failure. Vol. 41, Kidney International. 1992.
Harel Z, Harel S, Shah PS, Wald R, Perl J, Bell CM. Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: A systematic review. American Journal of Medicine. 2013;126(3).
Udensi U, Tchounwou P. Potassium homeostasis, oxidative stress, and human disease. Int J Clin Exp Physiol. 2017;4(3):111.
Dhondup T, Qian Q. Acid-Base and Electrolyte Disorders in Patients with and without Chronic Kidney Disease: An Update. Kidney Diseases. 2017;3(4):136–48.
Castro D, Sharma S. Hypokalemia. Urology at a Glance [Internet]. 2023 Mar 18 [cited 2024 Feb 4];89–91. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482465/
Kardalas E, Paschou SA, Anagnostis P, Muscogiuri G, Siasos G, Vryonidou A. Hypokalemia: A clinical update. Vol. 7, Endocrine Connections. BioScientifica Ltd.; 2018. p. R135–46.
Osadchii OE. Mechanisms of hypokalemia-induced ventricular arrhythmogenicity. Vol. 24, Fundamental and Clinical Pharmacology. 2010. p. 547–59.
Diercks DB, Shumaik GM, Harrigan RA, Brady WJ, Chan TC. Electrocardiographic manifestations: Electrolyte abnormalities. Journal of Emergency Medicine. 2004;27(2):153–60.
Mirijello A, Rinninella E, De Leva F, Tosoni A, Vassallo G, Antonelli M, et al. Hypokalemia-induced pseudoischemic electrocardiographic changes and quadriplegia. Am J Emerg Med. 2014;32(3).
Surawicz B. Electrolytes and the electrocardiogram. Postgrad Med. 1974;55(6):123–9.
Palmer BF. Regulation Of Potassium Homeostasis. Clinical Journal of the American Society of Nephrology. 2014;10(6):1050–60.
Catalano A, Chilà D, Bellone F, Nicocia G, Martino G, Loddo I, et al. Incidence of hypocalcemia and hypercalcemia in hospitalized patients: Is it changing? J Clin Transl Endocrinol. 2018 Sep 1;13:9–13.
Renaghan AD, Rosner MH. Hypercalcemia: Etiology and management. Nephrology Dialysis Transplantation. 2018 Apr 1;33(4):549–51.
Turner JJO. Hypercalcaemia – presentation and management. Vol. 17, CME ENDOCRINOLOGY Clinical Medicine. 2017.
Sadiq NM, Naganathan S, Badireddy M. Hypercalcemia. StatPearls [Internet]. 2023 Sep 4 [cited 2024 Feb 7]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK430714/
Cooper MS, Gittoes NJL. Diagnosis and management of hypocalcaemia. Vol. 336, BMJ. 2008. p. 1298–302.
Fong J, Khan A, Frcpc MD, Face F. Hypocalcemia: Updates in diagnosis and management for primary care. Canadian Family Physician [Internet]. 2012 Feb [cited 2024 Feb 7];58(2):158. Available from: /pmc/articles/PMC3279267/
Goyal A, Anastasopoulou C, Ngu M, Singh S. Hypocalcemia. Endocrinology and Diabetes: A Problem Oriented Approach: Second Edition [Internet]. 2023 Oct 15 [cited 2024 Feb 7];219–30. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430912/
Verbalis JG. Disorders of body water homeostasis. Best Pract Res Clin Endocrinol Metab. 2003;17(4):471–503.
Sonani B, Naganathan S, Al-Dhahir MA. Hypernatremia. StatPearls [Internet]. 2023 Aug 24 [cited 2024 Feb 6]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK441960/
EDELMAN IS, LEIBMAN J, O’MEARA MP, BIRKENFELD LW. Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. J Clin Invest. 1958;37(9):1236–56.
Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Vol. 29, Nephrology Dialysis Transplantation. Oxford University Press; 2014.
Nielsen S, Digiovannit SR, Christensen EI, Kneppertt MA, Harris HW. Cellular and subcellular immunolocalization of vasopressin-regulated water channel in rat kidney. Vol. 90, Physiology Communicated by Maurice B. 1993.
Muhsin SA, Mount DB. Diagnosis and treatment of hypernatremia. Vol. 30, Best Practice and Research: Clinical Endocrinology and Metabolism. Bailliere Tindall Ltd; 2016. p. 189–203.
Lindner G, Funk GC, Schwarz C, Kneidinger N, Kaider A, Schneeweiss B, et al. Hypernatremia in the Critically Ill Is an Independent Risk Factor for Mortality. American Journal of Kidney Diseases. 2007 Dec;50(6):952–7.
Oracio H, Drogué JA, Adias EM. H YPERNATREMIA. Vol. 342. 2000.
Guidelines for management of Hypernatremia. 2007.
MORRIS-JONES MB Lond PH, HOUSTON Manc IB, Evans Mb RC, Senior Registrar P DI. PROGNOSIS OF THE NEUROLOGICAL COMPLICATIONS OF ACUTE HYPERNATRÆMIA. Vol. 69, Mod. Concepts cardiovasc. Dis. 1967.
Chawla R, Todi S, Agarwal DK. Hyponatremia. ICU Protocols: A Stepwise Approach [Internet]. 2023 Jun 14 [cited 2024 Feb 7];433–40. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470386/
Lindner G, Pfortmüller CA, Leichtle AB, Fiedler GM, Exadaktylos AK. Age-Related Variety in Electrolyte Levels and Prevalence of Dysnatremias and Dyskalemias in Patients Presenting to the Emergency Department. Gerontology. 2014;60(5):420–3.
Sahay M, Sahay R. Hyponatremia: A practical approach. Vol. 18, Indian Journal of Endocrinology and Metabolism. Medknow Publications; 2014. p. 760–71.
Hussain I, Ahmad Z, Garg A. Extreme hypercholesterolemia presenting with pseudohyponatremia - A case report and review of the literature. J Clin Lipidol. 2015 Mar 1;9(2):260–4.
Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: Evaluating the Correction Factor for Hyperglycemia.
Darwish OM, Lutnick E, Dalimov Z, Waisanen KM, Wang D, Houjaij A, et al. Neuraxial vs General Anesthesia: 30-Day Mortality Outcomes Following Transurethral Resection of Prostate. Urology. 2021 Nov 1;157:274–9.
Lindner G, Schwarz C, Haidinger M, Ravioli S. Hyponatremia in the emergency department. Vol. 60, American Journal of Emergency Medicine. W.B. Saunders; 2022. p. 1–8.
Hsu YJ, Chiu JS, Lu KC, Chau T, Lin SH. Biochemical and etiological characteristics of acute hyponatremia in the emergency department. Journal of Emergency Medicine. 2005 Nov;29(4):369–74.
Gankam Kengne F, Decaux G. Hyponatremia and the Brain. Vol. 3, Kidney International Reports. Elsevier Inc; 2018. p. 24–35.
Chifu I, Gerstl A, Lengenfelder B, Schmitt D, Nagler N, Fassnacht M, et al. Treatment of symptomatic hyponatremia with hypertonic saline: A real-life observational study. Eur J Endocrinol. 2021 May 1;184(5):647–55.
Thomas DR, Cote TR, Lawhorne L, Levenson SA, Rubenstein LZ, Smith DA, et al. Understanding Clinical Dehydration and Its Treatment. Vol. 9, Journal of the American Medical Directors Association. Elsevier Inc.; 2008. p. 292–301.
Does the patient have signs of shock? Algorithms for IV fluid therapy in adults. 2013.
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249-284
Published
May 3, 2024
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Çelebi M. Sıvı Elektrolit Bozuklukları ve Tedavisi. In: Akman C, Karcıoğlu Ö, editors. Dahili Aciller [Internet]. Türkiye: Academician Publishing Book DOI Portal; 2024 [cited 2026 Jul. 13]. pp. 249-84. Available from: https://omp35.books.akademisyen.net/index.php/akya/catalog/book/3074/chapter/13178
