Kalium: Was man über Kalium wissen sollte

Zusammenfassung

Kalium ist das wichtigste intrazelluläre Kation. Das Verhältnis zwischen intra- und extrazellulärer Kaliumkonzentration bestimmt das Ruhemembranpotenzial der Zelle, somit spielt Kalium eine essenzielle Rolle in der zellulären Erregbarkeit. Der Kaliumgradient zwischen Extra- und Intrazellulärraum wird durch die Aktivität der Na⁺/K⁺-ATPase aufrechterhalten. Die Niere nimmt eine zentrale Rolle im Kaliumhaushalt ein, da die renale Kaliumelimination den aktuellen Bedürfnissen angepasst werden kann. Klinische Zeichen von Störungen des Kaliumhaushaltes sind zwar eher unspezifisch, allerdings können sowohl eine Hypo- als auch eine Hyperkaliämie zu vital bedrohlichen Herzrhythmusstörungen führen. Störungen des Kaliumhaushaltes können einerseits durch eine positive oder negative Bilanz, andererseits aber auch durch Verteilungsstörungen zwischen Intra- und Extrazellulärraum bedingt sein. Die Therapie ist abhängig vom Schweregrad der Störung, wobei neben einer spezifischen Therapie auch die Ursache der Störung beseitigt werden muss.

Abstract

Potassium is the major intracellular cation. Potassium homeostasis is maintained by the activity of the Na⁺/K⁺-ATPase and by renal function. It is critical for many cellular functions, including the excitability of nerve and muscle cells. Therefore, changes of potassium balance may lead to life-threatening cardiac arrhythmias. The electrocardiogram is a fast and easy way to determine whether changes in plasma K⁺ levels influence the heart. In all cases of hyper- or hypokalemia renal dysfunction needs to be excluded, as the kidneys account for 90 % of the excretion of K⁺ intake. Disorders of potassium balance demand early recognition, etiologic discrimination and finally assessing the urgency and establishing the appropriate therapy.

Schlüsselwörter

Kaliumhaushalt - transtubulärer Kaliumgradient - Hyperkaliämie - Hypokaliämie

Key words

potassium balance - transtubular potassium gradient - hyperkalemia - hypokalemia

Literatur

• 1 Rose B D, Post T W. Clinical Physiology of Acid-Base and Electrolyte Disorders, 5th ed. New York; McGraw-Hill 2001: pp. 836-856
• 2 Khuri R N, Strieder W N, Giebisch G. Effects of flow rate and potassium intake on distal tubular potassium transfer.  Am J Physiol. 1975;  228 1249-1261
• 3 West M L, Marsden P A, Richardson R M, Zettle R M, Halperin M L. New clinical approach to evaluate disorders of potassium excretion.  Mineral Electrolyt Metab. 1986;  12 234-238
• 4 Ethier J H, Kamel K S, Magner P O, Lemann Jr J, Halperin M L. The transtubular potassium concentration in patients with hypokalemia and hyperkalemia.  Am J Kidney Dis. 1990;  15 309-315
• 5 Denborough M. Malignant hyperthermia.  Lancet. 1998;  352 1131-1136
• 6 Knoll G A, Sahgal A, Nair R C, Graham J, van Walraven C, Burns K D. Renin-angiotensin system blockade and the risk of hyperkalemia in chronic hemodialysis patients.  Am J Med. 2002;  112 110-114
• 7 Schwartz A B. Potassium-related cardiac arrhythmias and their treatment.  Angiology. 1978;  29 194-205
• 8 Ferrannini E, Taddei S, Santoro D, Natali A, Boni C, Del Chiaro D, Buzzigoli G. Independent stimulation of glucose metabolism and Na⁺-K⁺ exchange by insulin in the human forearm.  Am J Physiol. 1988;  255 E953-958
• 9 Clausen T, Everts M E. Regulation of the Na, K-pump in skeletal muscle.  Kidney Int. 1989;  35 1-13
• 10 Sowinski K M, Cronin D, Mueller B A, Kraus M A. Subcutaneous terbutaline use in CKD to reduce potassium concentrations.  Am J Kidney Dis. 2005;  45 1040-1045
• 11 Allon M, Dunlay R, Copekney C. Nebulized albuterol for acute hyperkalemia in patients on hemodialysis.  Ann Intern Med. 1989;  110 426-429
• 12 Allon M, Shanklin N. Effect of bicarbonate administration on plasma potassium in dialysis patients: interactions with insulin and albuterol.  Am J Kidney Dis. 1996;  28 508-514
• 13 Kim H J. Combined effect of bicarbonbate administration on plasma potassium in dialysis patients: Interactions with insulin and albuterol.  Nephron. 1996;  72 476-482
• 14 Gerstman B, Kirkman R, Platt R. Intestinal necrosis associated with postoperative orally administered sodium polystyrene sulfonate in sorbitol.  Am J Kidney Dis. 1992;  20 159-161
• 15 Blumberg A, Weidmann P, Shaw S, Gnadinger M. Effect of various therapeutic approaches on plasma potassium and major regulating factors in terminal renal failure.  Am J Med. 1988;  85 507-512
• 16 Ahmed J, Weisberg L S. Hyperkalemia in dialysis patients.  Semin Dial. 2001;  14 348-356
• 17 Hou S, McElroy P A, Nootens J, Beach M. Safety and efficacy of low-potassium dialysate.  Am J Kidney Dis. 1989;  13 137-143
• 18 Blumberg A, Roser H W, Zehnder C, Müller-Brand J. Plasma potassium in patients with terminal renal failure during and after haemodialysis; relationship with dialytic potassium removal and total body potassium.  Nephrol Dial Transpl. 1997;  12 1629-1634
• 19 Allon M, Shanklin N. Effect of albuterol treatment on subsequent dialytic potassium removal.  Am J Kidney Dis. 1995;  26 607-613
• 20 Krause T, Gebershagen M U, Fiege M, Weisshorn R, Wappler F. Dantrolene - a review of its pharmacology, therapeutic use, and new developments.  Anaesthesia. 2004;  59 364-373
• 21 Naparstek Y, Gutman A. Case report: spurious hypokalemia in myeloproliferative disorders.  Am J Med Sci. 1984;  288 175-177
• 22 Ukaonu C, Hill D A, Christensen F. Hypokalemic myopathy in pregnancy caused by clay ingestion.  Obstet Gynecol. 2003;  102 1169-1171
• 23 Agarwal R, Afzalpurkar R, Fordtran J S. Pathophysiology of potassium absorption and secretion by the human intestine.  Gastroenterology. 1994;  107 548-571
• 24 Older J, Older P, Colker J, Brown R. Secretory villous adenomas that cause depletion syndrome.  Arch Intern Med. 1999;  159 879-880
• 25 Hariprasad M K, Eisinger R P, Nadler I M, Padmanabhan C S, Nidus B D. Hyponatremia in psychogenic polydipsia.  Arch Intern Med. 1980;  140 1639-1642
• 26 Douglas J B, Healy J K. Nephrotoxic effects of amphotericin B, including renal tubular acidosis.  Am J Med. 1969;  46 154-162
• 27 Wazny L D, Brophy D F. Amiloride for the prevention of amphotericin B-induced hypokalemia and hypomagnesemia.  Ann Pharmacother. 2000;  34 94-97
• 28 Milionis H J, Bourantas C L, Siamopoulos K C, Elisaf M S. Acid-base and electrolyte abnormalities in patients with acute leukemia.  Am J Hematol. 1999;  62 201-207
• 29 Jones D P, Chesney R W. Renal toxicity of cancer chemotherapeutic agents in children: ifosfamide and cisplatin.  Curr Opin Pediatr. 1995;  7 208-213
• 30 Groth C G, Backman L, Morales J M, Calne R, Kreis H, Lang P, Touraine J L, Claesson K, Campistol J M, Durand D, Wramner L, Brattstrom C, Charpentier B. Sirolimus (rapamycin)-based therapy in human renal transplantation: similar efficacy and different toxicity compared with cyclosporine. Sirolimus European Renal Transplant Study Group.  Transplantation. 1999;  67 1036-1042
• 31 Singhal P C, Abramovici M, Venkatesan J, Mattana J. Hypokalemia and rhabdomyolysis.  Miner Electrolyte Metab. 1991;  17 335-339
• 32 Shintani S, Shiigai T, Tsukagoshi H. Marked hypokalemic rhabdomyolysis with myoglobinuria due to diuretic treatment.  Eur Neurol. 1991;  31 396-398
• 33 Gabuzda G J. Ammonium metabolism and hepatic coma.  Gastroenterology. 1967;  53 806-810
• 34 Franse L V, Pahor M, Di Bari M, Somes G W, Cushman W C, Applegate W B. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program.  Hypertension. 2000;  35 1025-1030
• 35 Surawicz B. Relationship between electrocardiogram and electrolytes.  Am Heart J. 1967;  73 814-834
• 36 Sterns R H, Cox M, Feig P U, Singer I. Internal potassium balance and the control of the plasma potassium concentration.  Medicine (Baltimore). 1981;  60 339-354
• 37 Kruse J A, Carlson R W. Rapid correction of hypokalemia using concentrated intravenous potassium chloride infusions.  Arch Intern Med. 1990;  150 613-617
• 38 Hamill R J, Robinson L M, Wexler H R, Moote C. Efficacy and safety of potassium infusion therapy in hypokalemic critically ill patients.  Crit Care Med. 1991;  19 694-699
• 39 Whang R, Whang D D, Ryan M P. Refractory potassium repletion. A consequence of magnesium deficiency.  Arch Intern Med. 1992;  152 40-45
• 40 Shils M E. Experimental production of magnesium deficiency in man.  Ann N Y Acad Sci. 1969;  162 847-855