--

. .

--

3.53.5--5 5 mEqmEq/L (/L (mmolmmol/L)/L)

++ < 3.5 < 3.5 mEqmEq/L /L

++ > 5 > 5 mEqmEq/L /L

--

TMP: TMP: // [[KK++]] :: 3838//11 -- KK++: ~: ~--67mV, Na67mV, Na++/K/K++ ATPaseATPase --3mV, 3mV, ((. . Ca)Ca)

2

--

++//++ ATPaseATPase

--

--

::

[[KK++]] [[KK++]] --

//

RelationRelation betweenbetween serumserum KK++ andand thethe magnitudemagnitude ofofKK++ depletiondepletion

--

100 mEq [K+]

65 mEq

90-95 mEq 5-10 mEq

~250

~2500

~250

~300

[[++] ] (( ))

(( //))

// [[ pHpH ] ] [[HH++]] , [, [KK++]]

-- ((, , ) )

(( ++//++ATPaseATPase ) )

(( 12 12 ))

(( ))

(( ))

(( / /

) )

(( ))

(( :: 5% 5% ) ) [[KK++]] ((22 ))

BartterBartterss GitelmanGitelmanss (( HenleHenle / / . . ))

(( 1111-- , , LiddleLiddless))

((--, , ) )

-- (( ) )

(( B, B, ))

(( ..))

HCO3-15 mmol/l

15 %

60 %

HCO3-18 mmol/l

pH 6.5

HCO3-26 mmol/l

pH 7.8pH 5.5

H+

H2O

3HCO3- CO2 + OH-CA

Na+

3Na+Na+-K

ATPase2K+

H+ATPase

HCO3- + H+

H2CO3

Na+

H+

H2O

HCO3-

OH- + CO2

CA

Cl-

CO2 + H2O

CA

-- (( ,, ))-- -- :: < 3< 3mEqmEq/L/L(( , , UU, , QTQT))

-- (( , , , , ) )

-- ,,, , -- (( ) )

-- , ,

(())-- RBFRBF GFR GFR (( ))-- ((, , ) ) -- ADHADH--

((), ), , , -- (( , , ++ATPaseATPase) )

-- (( ))-- (( ) )

-- (( GH receptors, IGFGH receptors, IGF--11) )

2424

++ < 20< 20mEq(mmolmEq(mmol)/day:)/day: ,,

:: (())

pHpH:: , ,

:: (())

++ > 20> 20mEq(mmolmEq(mmol)/day: )/day:

:: (10mEq/dmEq/d):): ((. . Cushing, Cushing, . . LiddleLiddle) ) ((

)) ((, , , , . . BartterBartter, , GitelmanGitelman))

::

HypokalemiaHypokalemia and Hypertension and Hypertension

Urine KUrine K++ excretionexcretion

< 25 < 25 mEq/dmEq/d

Plasma Plasma reninrenin activityactivity

> 30mEq/d> 30mEq/d

High or normalHigh or normal

Continued diuretic useContinued diuretic useRenovascularRenovascular HTNHTNMalignant HTNMalignant HTNReninRenin--secreting tumorsecreting tumorCushingCushings Syndromes Syndrome

LowLow

Plasma Plasma aldosteronealdosterone

LowLowHighHigh

Primary Primary HyperaldosteronismHyperaldosteronism LicoriceLicoriceLiddleLiddlessSAMESAMEOther Other MineraloMineralo--

corticoidcorticoid

Adrenal vein Adrenal vein aldoaldo +/+/-- CTCT

Adenoma:Adenoma:Do surgeryDo surgery

Hyperplasia:Hyperplasia:KK++ sparing diureticsparing diuretic

GI losses GI losses Prior diuretic RxPrior diuretic Rx

TranstubularTranstubular potassium potassium grandientgrandient (TTKG)(TTKG)

< 2 = < 2 = (( ) ) > 4 = > 4 =

((, , , , , , ) ) :: (( 1010mEqmEq/hr /hr 40 40 mEqmEq/L/L))

1 1 amp KCL amp KCL 13mEq13mEq

(( , , ))::

((, , )):: NaClNaCl

((, , ))

(( ))

[[++] ] -- (( ))

[[++] ] (( ))

: : 1.31.3--10%10% (33(33--83% 83% )) (35(35--75%)75%)

--

(( [[KK++]] ))

, , (( > 50000 > 50000 mmmm33) ) (( >750000>750000 mmmm33))

(() )

--

-- ++ -- (( ) )

, ,

(( GFR < 25 ml/minGFR < 25 ml/min))

[[KK++] ] , , , ,

(( V)V)

(( 5050--75% 75% ))

((CrClCrCl 2020--75 ml/min75 ml/min))

50% 50% (( ))

((--, , NSAIDsNSAIDs,, ,,TacrolimusTacrolimus))

, ,

2020--40mg 40mg

TTKG (TTKG ( >7 >7 ,

--

++ , , , ,

--..

:: ++ < 10 < 10 mEqmEq/L /L ++ < 40 < 40 mEqmEq/L /L

(( ))-- -- , , --

-- , , QRSQRS--

(( ))::-- -- -- --

-- -- --

, , --

11-- ((. . ) )

--

(( )) (monitoring)(monitoring)

IVIV ((1010--30 30 .. 10%)10%)(( , , 3030--60 60 ))

[[KK++] ] -- --

(50 (50 grgr 10 10 ++ 0.60.6--1 1 mEqmEq/L/L, , 30 30 ))

-- / / NaHCO3NaHCO3 (50(50--150 150 mEqmEq, 1, 1--3 3 FlaconFlacon))

-- 22-- (( 90 90 , , 0.50.5--1 1 mEqmEq/L)/L)

(( ))

[[KK++] ] ((

1.3 1.3 mEqmEq/L /L 1 1 )) [K[K++]] -- KayexalateKayexalate (1(1grgr 0.60.6--1 1 mEqmEq KK++ ))(( 11--22hh , max 4, max 4--66 hh,, ++ 11mEqmEq/L /L 2424hh ))

++ > 6 > 6 mEqmEq/L /L

2 g/day2 g/day

((NSAIDsNSAIDs, , --))

, , , , kayexalatekayexalate

- - - - Relation between serum K+ and the magnitude of K+ depletion - Hypokalemia and Hypertension Transtubular potassium grandient (TTKG) - - ( V)