Kalium in der Intensivmedizin

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].

Abstract

Potassium is the major intracellular cation and is essential for normal cellular function. Alterations in K+ regulation can lead to neuromuscular, gastrointestinal, and cardiac abnormalities. Both hypo- and hyperkalemia are known to cause potentially fatal arrhythmias, cardiac dysfunction, as well as other complications. Hypokalemia, hyperkalemia, and potassium variability are independently associated with increased mortality, and monitoring in this regard is essential.

Kernaussagen

• Dyskaliämien sind intensivmedizinisch sehr häufig und prognostisch relevant.

• Die klinische Ausprägung der Symptomatik ist wesentlich von der zeitlichen Dynamik abhängig.

• Begleitende Elektrolytstörungen sollten gleichzeitig korrigiert werden, da sie sich gegenseitig verstärken.

• Transzelluläre Kaliumshifts sind bedeutend und können sowohl für die Entstehung als auch bei der Therapie eine entscheidende Rolle spielen.

• Vulnerabel für Hyperkaliämien sind insbesondere Patienten mit Herzinsuffizienz, Nierenschädigung und Diabetiker.

• Diagnostisch sollte neben der Klinik und einer Blutgasanalyse immer auch ein EKG geschrieben werden.

• Vollelektrolytlösungen sind Infusionstherapie der Wahl bei Hyperkaliämie.

• Rhythmusprobleme stellen die klassische Indikation für eine Akuttherapie einer Hyperkaliämie dar.

• 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).

• Bei guter Diurese ist meist keine Nierenersatztherapie notwendig.

• Bei Hypokaliämie findet sich meist die Trias Hypovolämie, Hypotonie, Hypokaliämie.

• Hypokaliämien imponieren klinisch durch körperliche Schlappheit und Arrhythmien.

• Therapeutisch braucht die Repletion des Gesamtkörperkaliumdefizits deutlich länger als die kurzfristige Korrektur des Serumkaliums.

Schlüsselwörter

Kalium - Intensivmedizin - Hypokaliämie - Hyperkaliämie - Arrhythmien - kardiale Dysfunktion

Keywords

potassium - intensive care - hypokalemia - hyperkalemia - arrhythmias - cardiac dysfunction

Publication History

Article published online:
10 February 2022

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