Treatment of hyperkalaemia and bradycardia
Author Ольга Кияница
Hyperkalaemia and bradycardia are a fairly frequent combination, especially in the treatment of heart disease with potassium-containing drugs. This microelement is very important for normal cardiac activity, but as its deficiency, and excess leads to pathological conditions.
The diagnosis of hyperkalaemia is the case when the blood plasma determines the concentration of potassium more than 5 mmol / l. At 8 mmol / l or more, the cardiac activity ceases.
In many cases, moderate hypercalemia is determined by random examination. In over 80% of patients in the ECG study, there are signs of a transient atrioventricular blockade. Such conditions may not endanger the health and life of a person only when the correct treatment is prescribed.
Video Hyperkalemia. Symptoms, signs and methods of treatment
Correct treatment of hyperkalaemia, which caused bradycardia, is based on determining the causes of the pathological condition. The following predisposing factors can play a leading role in this:
- Incorrectly adjusted dosage of cardiac glycosides, which in excess of increase the level of potassium in the blood by suppressing the production of Na +, K + -ATPase.
- Increased physical activity becomes a cause of transient hyperkalemia, which after a while is replaced by hypokalemia.
- In diseases of the kidneys, especially chronic renal failure, hyperkalaemia is most often observed, as this pathology disturbs the normal removal of the trace element from the body.
- Urinary tract obstruction, which rarely occurs, but nevertheless in some undiagnosed cases can lead to increased potassium in plasma.
- Metabolic disorders (acidosis) and the massive loss of blood cells are often an indirect cause of hyperkalaemia.
In addition to cardiac glycosides, beta-blockers, pentamidine, trimethoprim can cause hyperkalaemia. Sometimes incorrect use of depolarizing muscle relaxants (suxamethonium chloride) can cause hyperkalaemia and, as a consequence, a slowed heartbeat. Therefore, any medicines, and not just those listed, should be taken only after medical appointment.
Medicinal treatment of hyperkalaemia and bradycardia
After normalizing the level of potassium in the blood plasma, cardiac activity is restored. Therefore, to eliminate bradycardia, the potassium concentration must be reduced first.
The tactics of eliminating hyperkalaemia are selected taking into account the level of elevated potassium in the blood, the severity of the clinic (weakness of the muscles), changes in the electrocardiogram. If hyperkalemia presents a life-threatening condition, then strong muscle weakness is determined, the teeth P are not visible on electrocardiography, the ventricular complexes expand, other signs of arrhythmias appear.
Severe hyperkalaemia is a direct indication of urgent care:
- Depending on the cause of hyperkalaemia, stop using medications that disturb excretion of potassium or increase its amount in the body.
- Calcium gluconate is injected intravenously in the form of 10% solution in a quantity of 10 ml. Time of introduction - 2-3 minutes. The medicine helps to reduce myocardial excitability, which prevents the development of ventricular fibrillation. After 2-3 minutes, as a rule, the first signs of action of the drug appear. If no such thing happens, then it is re-entered in the same amount.
- Use short-acting insulin (about 10-20 units) together with glucose up to 50 g. This helps stimulate the transfer of potassium from the intercellular fluid to the cells. If there is a high probability of developing hyperglycemia, then glucose is not given.
- Severe hyperkalemia, which is accompanied by metabolic acidosis, is treated with sodium bicarbonate. The drug is administered together with glucose, but its use is contraindicated in chronic renal failure, as there is a high risk of over-saturation of the body with sodium.
- Beta2-adrenostimulants - are administered by inhalation or parenteral route. Activate the process of transfer of potassium into cells. Rather soon begin to act, about 30 minutes after administration.
Reducing the potassium concentration in blood plasma is facilitated by the use of diuretics. Thiazide and loop diuretics are most commonly used. Cation exchange resins help to keep potassium in the digestive tract, in particular 1 g of the drug binds 1 mmol of potassium. For greater efficacy, it can be administered together with sorbitol, but not during the rehabilitation period after kidney transplantation, since sorbitol can cause colon necrosis.
In a clinically serious hyperkaliemia, hemodialysis is performed (mainly in acute and chronic renal failure). Today it is considered the most effective and fast way of reducing the concentration of potassium in the blood plasma. Peritoneal dialysis can be performed, but its effectiveness is not as pronounced as in hemodialysis.
Ancillary treatment of hyperkalaemia and bradycardia is important. It includes the following components:
- Dietary nutrition.
- Elimination of metabolic acidosis.
- Increase the volume of fluid outside the cells.
- Application of mineralocorticoids.
Anesthetist often cares for the treatment of patients with hyperkalemia, but with a pronounced bradycardia, given the high content of potassium, consultation of the cardiologist may be necessary. During therapy, patients with hyperkalaemia are in the intensive care unit.
Operative treatment of bradycardia with hyperkalemia
In some cases, a slow heartbeat could be observed even before the development of hyperkalaemia, whereas this pathology only contributed to the deterioration of the course of rhythm disturbance. Therefore, before treating bradycardia radically with surgical methods, the potassium content in blood plasma should be corrected. For this purpose, the above-mentioned methods of medical treatment are used.
Video Installing Pacemaker
After reaching the taxable level of potassium, a complete examination of the patient is carried out and surgical intervention is performed. Most often a patient with bradycardia is implanted with an electrical pacemaker. With its help, the heart rate is kept within the limits set by the program. At the same time, depending on the patient's condition, cardiological preparations may continue to be used. Thus, with a competently performed minor invasive operation, the emergence of asystole can be prevented.