Dtsch Med Wochenschr 2016; 141(21): 1531-1536
DOI: 10.1055/s-0042-109043
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© Georg Thieme Verlag KG Stuttgart · New York

Hyper- und Hypokaliämien – „the silent killer“

„The silent killer: hyper- and hypokalaemia“
Mark Dominik Alscher
1   Robert-Bosch-Krankenhaus, Zentrum für Innere Medizin, Abteilung für Allgemeine Innere Medizin und Nephrologie
› Author Affiliations
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Publication History

Publication Date:
17 October 2016 (online)

Zusammenfassung

Die Bestimmung der Kaliumkonzentration im Serum ist die Grundlage für die Diagnose von Störungen im Kaliumhaushalt. Die Konzentration resultiert aus dem Zusammenspiel von Kaliumaufnahme, -ausscheidung und interner Verteilung zwischen zellulären und extrazellulären Räumen. Störungen des Kaliumhaushaltes sind häufig. Dies ist Folge einer zunehmend älter werdenden Bevölkerung mit Erkrankungen, die einerseits häufig zu einer Diuretika-Therapie anderseits zu einer Nierenschädigung führen. Im ersten Fall finden sich überwiegend Hypokaliämien, im Letzteren nicht selten Hyperkaliämien. Beide führen zu einer erhöhten Mortalität, häufig ohne dass die Ursache dafür erkannt wird. Häufig firmieren die Todesfälle aufgrund der Herzrhythmusstörungen, welche zu einem Herzstillstand führen können (Kammerflimmern und Hypo-Asystolie) als „plötzlicher Herztod“. Ein pathophysiologisches Verständnis für das mögliche Auftreten und die rechtzeitige Entdeckung durch eine Kontrolle des Kaliums sind entscheidend, um die Mortalität zu senken.

Abstract

The estimation of potassium in the serum is basis for the diagnosis of potassium disturbances. The value is a result of intake, excretion and internal distribution of potassium between intra- and extracellular compartments of the body. Clinically, we often see disturbances of potassium. The causes are explained by an aging population with morbidities that warrant diuretic treatment on the one side, and chronic kidney diseases on the other. In the first cases, we see hypokalaemia, in the latter hyperkalaemia. Both can lead to increased mortalities which are often labelled as “sudden heart death” without finding the underlying mechanism to be potassium driven. This is due to the fact that cardiac arrhythmias (ventricular fibrillation, heart block) lead to cardiac arrest. The pathophysiological understanding of the principles is the key for the guidance of diagnosis and therapy of the disturbances of potassium metabolism. Only by that, a decrease in mortality can be accomplished.

 
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