داخلی جنرال- علوم پزشکی تهران- بیمارستان امام

2.Calcium
✔️ Calcium directly antagonizes the membrane actions of hyperkalemia , while hypocalcemia increases the cardiotoxicity of hyperkalemia


✔️The effect of intravenous calcium administration begins within minutes but is relatively short lived (30 to 60 minutes). As a result, calcium should not be administered as monotherapy for hyperkalemia but should rather be combined with therapies that drive extracellular potassium into cells.

✔️Administration of calcium can be repeated every 30 to 60 minutes if the hyperkalemic emergency persists and the serum calcium does not become elevated.

✔️Calcium can be given as either calcium gluconate or calcium chloride. Calcium chloride contains three times the concentration of elemental calcium compared with calcium gluconate . However, calcium gluconate is generally preferred because calcium chloride may cause local irritation at the injection site .

✔️✔️The usual dose of calcium gluconate is 1000 mg (10 mL of a 10 percent solution) infused over two to three minutes, with constant cardiac monitoring.

 1. Insulin administration lowers the serum potassium concentration by driving potassium into the cells, primarily by enhancing the activity of the Na-K-ATPase pump in skeletal muscle .
✔️ Glucose is usually given with insulin to prevent the development of hypoglycemia. However, insulin should be given alone if the serum glucose is ≥250 mg/dL .
✔️ The serum glucose should be measured every hour for five to six hours after the administration of insulin, given the risk of hypoglycemia.

✔️The potassium-lowering effect of insulin is greatest at the high insulin levels achieved by a bolus injection. Administration of 10 units of regular insulin, followed immediately by 50 mL of 50 percent dextrose (25 g of glucose) leads to a relatively rapid reduction in serum potassium by approximately 1 mEq/L. T
✔️when glucose is given as a single bolus, hypoglycemia often develops an hour or more after the start of therapy for two reasons:

●The amount of glucose in a single bolus is insufficient to replace the glucose utilized in response to exogenous insulin.

●Insulin's prolonged half-life in patients with kidney disease leads to insulin levels high enough to promote glucose utilization for more than an hour.

The incidence of hypoglycemia depends more upon the dose of glucose than upon the dose of insulin. To avoid hypoglycemia, we recommend infusion of 10 percent dextrose at 50 to 75 mL/hour after the initial 25 g bolus and close monitoring of blood glucose levels every hour for five to six hours.

✔️The administration of glucose without insulin is not recommended, since the release of endogenous insulin can be variable and the attained insulin levels are generally lower with a glucose infusion alone .

✔️The effect of insulin begins in 10 to 20 minutes, peaks at 30 to 60 minutes, and lasts for four to six hours .

✅ درمان های فوری توصیه شده در هیپرکالمی با هدف کاهش موقت غلظت پتاسیم و کاهش خطرات قلبی تا زمانیکه درمانهای اصلی با هدف افزایش دفع پتاسیم از بدن تاثیر کنند
۱. انسولین
۲. کلسیم

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آقایی ۷۰ ساله مبتلا به سیروز با تابلوی انسفالوپاتی کبدی مراجعه کرده است در ازمایشات اولیه
Cr=2.3
K=6.8
BS glucomethry =300
دارند و ECG به صورت زیر است:

نکته مهم:
از تشخیصهای افتراقی درد RUQ پنومونی لوب تحتانی ریه راست است که باید در بررسی علت درد مدنظر باشد

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بیمارستان امام خمینی | تامز جی سی(مراقبت سلامت): آموزش تزریق صحیح انسولین
https://ikhc.tums.ac.ir/video/%D8%AA%D8%A7%D9%85%D8%B2-%D8%AC%DB%8C-%D8%B3%DB%8C(%D9%85%D8%B1%D8%A7%D9%82%D8%A8%D8%AA-%D8%B3%D9%84%D8%A7%D9%85%D8%AA):-%D8%A2%D9%85%D9%88%D8%B2%D8%B4-%D8%AA%D8%B2%D8%B1%DB%8C%D9%82-%D8%B5%D8%AD%DB%8C%D8%AD-%D8%A7%D9%86%D8%B3%D9%88%D9%84%DB%8C%D9%86-/277352

Therapeutics Dyspepsia -1401.pdf

نکته مهم:
در دردهای ناحیه اپیگاستر رد درد با منشا قلبی را اولویت اول قرار دهید به خصوص اگر درد اخیرا ایجاد شده.
در صورت رد آنژین قلبی ، دیس پپسی در یک فرد ۵۰ ساله اندیکاسیون اندوسکوپی خواهد داشت.