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DOI: 10.1055/a-1202-9240
Kalium – was Intensivmediziner wissen sollten
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Kalium (K+; Molekulargewicht 39) ist das wichtigste intrazelluläre Kation und für die normale Zellfunktion unerlässlich. Veränderungen in der K+-Regulation können zu neuromuskulären, gastrointestinalen und kardialen Anomalien führen. Sowohl Hypo- als auch Hyperkaliämie sind dafür bekannt, dass sie potenziell tödliche Rhythmusstörungen, kardiale Funktionsstörungen sowie andere Komplikationen auslösen können [1]. Hypokaliämie, Hyperkaliämie und Kaliumvariabilität sind unabhängig voneinander mit einer erhöhten Mortalität assoziiert, ein Monitoring diesbezüglich ist unerlässlich [2].
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Dyskaliämien sind intensivmedizinisch sehr häufig und prognostisch relevant.
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Die klinische Ausprägung der Symptomatik ist wesentlich von der zeitlichen Dynamik abhängig.
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Begleitende Elektrolytstörungen sollten gleichzeitig korrigiert werden, da sie sich gegenseitig verstärken.
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Transzelluläre Kaliumshifts sind bedeutend und können sowohl für die Entstehung als auch bei der Therapie eine entscheidende Rolle spielen.
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Vulnerabel für Hyperkaliämien sind insbesondere Patienten mit Herzinsuffizienz, Nierenschädigung und Diabetiker.
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Diagnostisch sollte neben der Klinik und einer Blutgasanalyse immer auch ein EKG geschrieben werden.
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Vollelektrolytlösungen sind Infusionstherapie der Wahl bei Hyperkaliämie.
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Rhythmusprobleme stellen die klassische Indikation für eine Akuttherapie einer Hyperkaliämie dar.
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Therapiemaßnahmen beinhalten die kardiale Membranstabilisierung durch Kalziumgabe, Induktion einer intrazellulären Kaliumaufnahme („Kaliumshift“) und schließlich die Elimination von Kalium durch forcierte Diurese oder extrakorporale Verfahren (Dialyse).
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Bei guter Diurese ist meist keine Nierenersatztherapie notwendig.
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Bei Hypokaliämie findet sich meist die Trias Hypovolämie, Hypotonie, Hypokaliämie.
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Hypokaliämien imponieren klinisch durch körperliche Schlappheit und Arrhythmien.
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Therapeutisch braucht die Repletion des Gesamtkörperkaliumdefizits deutlich länger als die kurzfristige Korrektur des Serumkaliums.
Publication History
Article published online:
25 August 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
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