Kalium – was Intensivmediziner wissen sollten

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].

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 - Hyperkaliämie - Hypokaliämie - Dialyse - Notfalltherapie

Publication History

Article published online:
25 August 2021

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