低カリウム血症
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English Journal
- Efficacy and safety of long-term antibiotics (macrolides) for the treatment of chronic rhinosinusitis.
- Cervin A, Wallwork B.Author information Royal Brisbane & Women's Hospital, School of Medicine, University of Queensland, Level 9, Room 915, UQ Health Science Building, Herston, QLD, 4029, Australia, a.cervin@uq.edu.au.AbstractLong-term treatment of airway inflammation/infection with macrolide antibiotics has now been in use for almost 30 years. Whereas the beneficial clinical effect in cystic fibrosis and COPD have been backed up by randomized controlled trials, the evidence from the upper airways is not as strong. We have identified 22 open studies in chronic rhinosinusitis, with and without polyps, but only 2 randomized controlled trials. Of the controlled trials, the one including CRS patients just without polyps, showed a significant effect in sino-nasal outcome test, saccharine transit time, nasal endoscopy, and IL-8 levels in lavage fluid after 12 weeks of roxithromycin, whereas, in the other RCT with a mixed study group of CRS patients with and without polyps, 12 weeks of azithromycin showed no effect compared to placebo. Concerns regarding the risk of macrolides to induce arrhythmia have been raised. Recent FDA guidelines changes has recommended caution in patients with risk factors such as long QT syndrome, bradycardia, hypokalemia, or hypomagnesemia. Ototoxicity is another concern. Long-term macrolide antibiotics in the treatment of CRS patients is still a viable option in a select group of patients.
- Current allergy and asthma reports.Curr Allergy Asthma Rep.2014 Mar;14(3):416. doi: 10.1007/s11882-013-0416-2.
- Long-term treatment of airway inflammation/infection with macrolide antibiotics has now been in use for almost 30 years. Whereas the beneficial clinical effect in cystic fibrosis and COPD have been backed up by randomized controlled trials, the evidence from the upper airways is not as strong. We ha
- PMID 24429901
- Cardiovascular morbidity associated with gonadotropin releasing hormone agonists and an antagonist.
- Albertsen PC1, Klotz L2, Tombal B3, Grady J4, Olesen TK5, Nilsson J6.Author information 1University of Connecticut Health Center, Farmington, CT, USA. Electronic address: Albertsen@nso.uchc.edu.2Division of Urology, University of Toronto, ON, Canada.3University Clinics Saint Luc/Catholic University of Louvain, Brussels, Belgium.4University of Connecticut Health Center, Farmington, CT, USA.5Ferring Pharmaceuticals, Copenhagen, Denmark.6Department of Clinical Sciences, Lund University, Sweden.AbstractBACKGROUND: Androgen deprivation therapy (ADT) is associated with increased cardiovascular morbidity.
- European urology.Eur Urol.2014 Mar;65(3):565-73. doi: 10.1016/j.eururo.2013.10.032. Epub 2013 Nov 1.
- BACKGROUND: Androgen deprivation therapy (ADT) is associated with increased cardiovascular morbidity.OBJECTIVE: To determine whether cardiovascular morbidity differs following initiation of gonadotropin-releasing hormone (GnRH) agonists compared with an antagonist.DESIGN, SETTING, AND PARTICIPANTS:
- PMID 24210090
- A retrospective study of laparoscopic unilateral adrenalectomy for primary hyperaldosteronism caused by unilateral adrenal hyperplasia.
- Jiang SB, Guo XD, Wang HB, Gong RZ, Xiong H, Wang Z, Zhang HY, Jin XB.Author information Minimally Invasive Urology Center, East District of Provincial Hospital Affiliated to Shandong University, 9th Floor, Block C, No. 9677, East Jingshi Road, Jinan, 250014, People's Republic of China.AbstractOBJECTIVE: To evaluated the long-term outcomes of laparoscopic unilateral adrenalectomy for primary aldosteronism (PA) caused by unilateral adrenal hyperplasia (UAH).
- International urology and nephrology.Int Urol Nephrol.2014 Feb 2. [Epub ahead of print]
- OBJECTIVE: To evaluated the long-term outcomes of laparoscopic unilateral adrenalectomy for primary aldosteronism (PA) caused by unilateral adrenal hyperplasia (UAH).METHODS: One hundred and sixty-four patients who underwent laparoscopic unilateral adrenalectomy for UAH from January 2004 to December
- PMID 24488149
Japanese Journal
- 子牛下痢症に生じた絶対的なカリウム欠乏症についての検討
- Two Elderly Patients with Mineralocorticoid Excess Due to 11β-Hydroxysteroid Dehydrogenase Type 2 (11β-HSD2) Impairment
- Inada Mitsuo,Iwasaki Keiko,Imai Chihiro,Hashimoto Satoshi
- Internal Medicine 47(7), 631-636, 2008
- A 75-year-old woman had a low circulating level of aldosterone, despite the mineralocorticoid excess state. These abnormalities were improved by spironolactone administration. The distinct elevation o …
- NAID 130000080065
Related Links
- hypopotassemia /hy·po·po·tas·se·mia/ (-po″tah-se´me-ah) hypokalemia. hy·po·po·tas·se·mi·a (h p-p-t-s m-) n. See hypokalemia. hypopotassemia [-pot′əsē′mē·ə] Etymology: Gk, hypo + D, potasch, potash; Gk, haima, blood a ...
- Hypopotassemia definition, hypokalemia. See more. Thesaurus Translator Reference Word of the Day Blog Slideshows Apps by Dictionary My Account Log Out Log In follow Dictionary.com Dictionary Thesaurus Translator More...
Related Pictures
★リンクテーブル★
[★]
- 英
- hypokalemia, hypopotassemia
- 同
- 低K血症
- 関
- カリウム。高カリウム血症。電解質異常
定義
- 血清カリウム <3.5mEq/l ⇔ 基準範囲:3.4-4.5 mEq/l (臨床検査法提要第32版)
原因
- 周期性四肢麻痺発作時、インスリン・グルコースの投与(細胞のNa-K ATPaseを活性化するため)
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病因
- ぽけめ
- アルカレミア、インスリン使用、カテコラミン使用、低下リウム性周期性四肢麻痺、急激な造血(VB12で治療中の巨赤芽球性貧血、AMLの急性転化)、低体温
- 消化管からのK喪失:(Uk<25mEq/日または15mEq/L、またはTTKG<3)
- 消化管からの喪失+代謝性アシドーシス:下痢、緩下薬乱用、絨毛腺腫
- 嘔吐とNGTドレナージによるカリウム喪失
- 腎性K喪失:(Uk>30mEq/日または15mEq/L、またはTTKG>7)
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- アシドーシス:DKA、RTA(近位RTA(2型)と多くの遠位RTA(1型))
- アルカローシス
- 利尿薬、嘔吐、NGTドレナージ(続発性高アルドステロン症)
- Bartter症候群(HHenleのループ機能異常:フロセミド様効果)
- Gitelmann症候群(遠位曲尿細管の機能異常:サイアザイド様効果)
- Mg欠乏:遠位でのK分泌亢進が原因の可能性
- 原発性高アルドステロン症:Conn症候群など
- 続発性高アルドステロン症:腎血管性疾患、レニン分泌性腫瘍
- 非アルドステロン性ミネラルコルチコイド(Cushing症候群、Liddle症候群、外因性ミネラルコルチコイド、肝臓)
病態生理
検査
鑑別診断のために
- 検査としては尿検査(Uk,UCl,Uosm),血液検査(Bosm,Mg,K),血ガス
心電図
- ECGの変化は心室の再分極が遅延し、心筋細胞内のK+濃度をうまく補正できないことによる。
- QT延長:細胞外K濃度が低い→静止膜電位が低下→再分極に時間がかかる?
- QRS幅延長
- T波の平低化、U波出現
- ST低下
- 期外収縮
- (最初に)T平坦,U出現,ST低下,QT延長 → (重度になれば)PR延長, QRS減高, QRS幅拡大 → VFリスク↑
症状
- <3mEq/Lでなければ症状が出現することはほとんどない。(HIM.282)
- 神経系:感覚鈍麻、傾眠傾向、無関心
- 心血管系:心筋壊死、心筋線維症、、末梢血管収縮
- 消化器:食欲不振、悪心・嘔吐、イレウス
- 筋骨格:筋力低下、呼吸筋麻痺
- impaired muscle metabolism and the blunted hyperemic response to exercise associated with profound K+ depletion increase the risk of rhabdomyolysis.(HIM.282)
- 泌尿器:多尿、腎濃縮力低下、糸球体濾過量・腎血漿流量低下、尿細管間質性腎炎、慢性腎盂腎炎
- 内分泌:糖忍容力低下(インスリンと共にカリウムが細胞に入っていかない、インスリン分泌能↓+インスリン抵抗性↑(HIM.282))、その他の代謝異常(負の窒素バランス、代謝性アルカローシス)
低カリウム血症による腎機能不全
- uptodateより
- 尿濃縮能の低下:impaired urinary concentrating ability:≦3.0mEq/Lの低カリウム血症が慢性的に持続すると中等度の腎機能低下が起こる。集合管におけるADHに対する反応性低下と関連づけられている(The concentrating defect is associated with decreased collecting tubule responsiveness to antidiuretic hormone)が、完全によく分かっていない。2つのことは少なくとも寄与している;アクアポリン2の発現の減少、Na-K-2Cl共輸送対の活性の低下。
- increased ammonia production
- increased bicarbonate reabsorption
- altered sodium reabsorption
- hypokalemic nephropathy
合併症
治療
国試