Subscribe to RSS
DOI: 10.1055/s-2002-20010
Klinische Aspekte der Hyperkaliämie
Clinical Aspects of Hyperkalaemia Manuskript nach einem Vortrag bei der 15. Irseer Fortbildungsveranstaltung der DGEM, 27. 10. 2001Publication History
Publication Date:
11 February 2002 (online)

Zusammenfassung
Hyperkaliämie ist eine häufige und weiter zunehmende Erkrankung. Die Genese ist meist durch das Zusammentreffen mehrerer Faktoren bedingt. Diese sind nicht selten iatrogen verursacht. Zunehmendes Alter des Patienten, Diabetes mellitus, Störungen des Renin-Angiotensin-Aldosteron-Systems, antibiotische Hochdosistherapie und Immunsuppressiva sind Ursachen der Hyperkaliämie. Pathophysiologisch stehen vier Mechanismen im Vordergrund: Nierenfunktionsstörung, hyporeninämischer Hypoaldosteronismus, tubuläre Störungen, zelluläre Störungen.
Abstract
Hyperkalaemia is a frequent disorder. Usually the combined action of several causative factors is required to bring about a hyperkalaemia. They are often iatrogenic. Increasing age, diabetes mellitus, disorders of the renin-angiotensin-aldosterone system, high-dose antibiotics and immunosuppressive treatment may result in hyperkalaemia. The most important pathogenetic mechanisms are renal insufficiency, hypoaldosteronism, tubular disorders and cellular disorders.
Literatur
- 1 Paice B, Gray J MB, McBride D, Donnelly T, Lawson D H. Hyperkalemia in patients in hospital. BMJ. 1983; 285 1189-1192
- 2 Moore M L, Bailey R R. Hyperkalemia in patients in hospital. N Z Med J. 1989; 102 557-558
- 3 Shemer J, Modan M, Ezra D, Cabili S. Incidence of hyperkalemia in hospitalized patients. Isr J Med Sci. 1983; 19 659-661
- 4 Dreifus L S, Pick A. A clinical correlative study of the electrocardiogram in electrolyte imbalance. Circulation. 1956; 14 815-825
- 5 Hrnciar J. Diabetic nephropathie and isolated hyporenin hypoaldosteronism. VNITR LEK. 1996; 42 (6) 394-399
- 6 The CONSENSUS Trial Study Group . Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study. N Engl J Med. 1987; 316 1429-1436
- 7 Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an Angiotensin-Converting-Enzyme Inhibitor, Ramipril, on Cardiovascular Events in High-Risk Patients. N Engl J Med. 2000; 342 145-153
- 8 Pitt B, Zannad F, Remme W J, Cody R, Castaigne A, Perez A, Palensky J, Wittes J. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999; 341 709-717
- 9 Lewis E J, Hunsicker L G, Bain R P, Rohde R D. The Collaborative Study Group . The Effect of Angiotensin-Converting-Enzyme Inhibition on Diabetic Nephropathy. N Engl J Med. 1993; 329 1456-1462
- 10 Effectiveness of spironolacton added to an angiotensin-converting enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure. Am J Cardiol 1996 78 (8): 902-907
- 11 Wen S F. Nephrotoxicities of nonsteroidal anti-inflammatory drugs. J Formos Med Assoc. 1997; 96 (3) 157-171
- 12 Oster J R, Singer I, Fishman L M. Heparin-induced aldosterone suppression and hyperkalemia. Am J Med. 1995; 98 (6) 575-586
- 13 Schepkens H, Vanholder R, Billiouw J M, Lamaire N. Life-threatening Hyperkalemia during Combined Therapy with Angiotensin-converting Enzyme Inhibitors and Spironolactone: An Analysis of 25 Cases. Am J Med. 2001; 110 438-441
- 14 Singhvi S M, Duchin K L, Morrison R A, Willard D A, Everett D W, Frantz M. Disposition of fosinopril sodium in healthy subjects. Br J Clin Pharmacol. 1988; 25 9-15
- 15 Greenbaum R, Zucchelli P, Caspi A, Nouriel H, Paz R, Sclarovsky S, O'Grady P, Yee K F, Liao W C, Mangold B. Comparison of the pharmacokinetics of fosinoprilat with enalaprilat and lisinopril in patients with congestivee heart failure and chronic renal insufficiency. Br J Clin Pharmacol. 2000; 49 23-31
- 16 Mousa D, Rassoul Z, Popovich W, Hassan A, Margate V, Hawas F, Suleiman M, Khader A A. A New Treatment for Interdialytic Hyperkalemia - The Use of Fosinopril Sodium. Am J Nephrol. 1999; 19 395-399
- 17 Don B R, Schambelan M. Hyperkalemia in acute glomeulonephritis due to transient hyporeninemic hypoaldosteronism. Kidney Inst. 1990; 38 (6) 1159-1163
- 18 Deppe C E, Heering P J, Tinel H, Kinne-Saffran E, Grabensee B, Kinne R K. Effect of cyclosporin A on Na+/K+-ATPase in MDCK cells and two subtypes, C7 and C11. Exp Nephrol. 1997; 5 (6) 471-480
- 19 Kamel K S, Ethier J, Quaggin S, Levin A, Albert S, Carlisle E J, Halperin M L. Studies to determine the basis for hyperkalemia in recipients of a renal transplant who are treated with cyclosporin. J Am Soc Nephrol. 1992; 2 (8) 1279-1284
- 20 Perazella M A. Hyperkalemia in the elderly. A group at high risk. Conn Med. 1996; 60 (4) 195-198
- 21 Noto H, Kaneko Y, Takano T, Kurokawa K. Severe hyponatriemia and hyperkalemia induced by trimethoprom-sulfamethoxazol in patients with Pneumocystis carinii pneumonia. Intern Med. 1995; 34 (2) 96-99
- 22 Briceland L L, Bailie G R. Pentamidine-associated nephrotoxicity and hyperkalemia in patients with AIDS. DAPHE. 1991; 25 (11) 1171-1174
- 23 Clausen T. Adrenergic control of Na/K-homeostase. Acta Med Scand Suppl. 1983; 672 111-115
- 24 Smith T W. Digitalis. Mechanism of action and clinical use. N Engl J Med. 1988; 318 358-365
- 25 Salem M M, Rosa R M, Batlle D C. Extrarenal potassium tolerance in chronic renal failure. Implications of the treatment of acute hyperkalemia. Am J Kidney Dis. 1991; 18 (4) 421-440
- 26 Mimura M, Makino H, Knatsuka A, Yoshida S. Reduction of erythrocyte (Na+-K+)ATPase activities in non-insulin-depent diabetic patients with hyperkalemia. Metab Clin Exp. 1992; 41 (4) 426-430
- 27 Hughes M, Grant I S, Biccard B, Nimmo G. Suxamethonium and Critical Illness Polyneuropathy. Anaesth Intensive Care. 1999; 27 636-638
- 28 Mandelberg A, Krupnik Z, Houri S, Smetana S, Gilad E, Matas Z, Priel I E. Salbutamol Metered-Dose Inhaler With Spacer for Hyperkalemia. Chest. 1999; 115 617-622
- 29 Blumberg A, Weidmann P, Ferrari P. Effect of prolonged bicarbonate administration on plasma potassium in terminal renal failure. Kidney Int. 1992; 41 369-374
- 30 Gerstmann B 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
- 31 DeFronzo R A, Felig P, Ferrannini E, Wahren J. Effect of graded doses of insulin on splanchnic and peripheral potassium metabolism in man. Am J Physiol. 1980; 238 E421-E427
- 32 Gruy-Kapral C, Emmett M, Santa Ana C A, Porter J I, Fordtran J S, Fine K. Effect of single dose resin-carthartic therapy on serum potassium concentration in patients with end-stage renal disease. J Am Soc Nephrol. 1998; 10 1924-1930
- 33 Gordon R D. Syndrome of hypertension and hyperkalemia with normal glomerular filtration rate. Hypertension. 1986; 8 (2) 93-102
Dr. Thorsten Franz
Prof. Dr. Peter Gross
Universitätsklinikum Carl Gustav Carus Dresden · Medizinische Klinik III
Fetscherstraße 74
01307 Dresden