Amilorid as trimetren causes:
a- CNS disturbances.
b- Hyperkalamia***
c- Hypokalamia.
d- Not affect K [Potassium].
Hyperkalaemia is a water-electrolyte disorder defined by an excess of potassium in the blood plasma: its positive diagnosis is confirmed by the ionogram when the serum potassium is greater than 5 mmol / L. The severity is divided into: slight (5.5-5.9 mmol / L), moderate (6.0-6.4 mmol / L), and severe (> 6.5 mmol / L) 1. When it is severe and especially rapidly formed (acute), hyperkalemia can be life-threatening because it is a source of arrhythmias and conductive disorders that can lead - in the most serious cases and in the absence of urgent treatment - at a cardio-circulatory stop.
Physiological reminders:
Potassium is a predominantly intracellular ion. Its contribution is food - dried fruits, bananas, chocolate, green vegetables, etc. - in normal situations. The long-term regulation of the potassium stock and the maintenance of a normal plasma level (potassium) are ensured by a variable renal excretion subjected to a hormonal regulation: the action of the aldosterone (hormone effector of the SRAA) on the distal nephron increases the tubular secretion of potassium and therefore its urinary elimination. In the shorter term, serum potassium is also influenced by two other factors:
- On the one hand, the activity of Na / K-ATPase which goes in the direction of a lowering of the potassium by increasing the intracellular entries of potassium: the operation of this ion pump is itself favored by various stimuli physiological and especially hormonal, such as the action of insulin and catecholamines;
- On the other hand, the passive ion exchange between H + and K +, the intracellular passage of an ion promoting the output of the other to maintain the electroneutrality of the intracellular medium: that is why potassium and pH vary in the opposite direction.
Potassium ion is involved in several cellular physiological processes regarding membrane (electrical) stability and action potentials. He intervenes in particular in the muscular contraction of the striated myocytes, at the same time of the common skeletal striated myocytes and the cardiomyocytes, explaining the observable clinical signs in the hyperkalemia.
causes:
Hyperkalaemia is a fairly common anomaly since in hospital, it can affect up to one in ten hospitalized patients2.
The etiological diagnosis can often be deduced from the clinical context if one has the notion of a pathology or a treatment at risk of hyperkalemia in the patient. When the diagnosis is not obvious, measurement of kaliuresis may provide etiological guidance.
Differential diagnosis:
False hyperkalaemias are due to potassium transfer from the intracellular medium to the plasma that occurs during or after sampling, leading to an overestimate of the patient's actual serum potassium. They mainly occur:
- In the case of laborious, prolonged sampling, with a tight tourniquet: the cell lysis is accompanied by a release of intracellular potassium in the venous blood taken downstream of the withers; in case of doubt or technical difficulties, the sample may be taken without tourniquet or even by arterial means;
- when the time between sampling and centrifugation is prolonged, for example if the blood is taken at home;
- during massive leukocytosis and thrombocytosis, particularly in a context of haematological disease in which the compromised blood cells are more likely to undergo spontaneous lysis (acute leukemias and myeloproliferative syndromes in particular).
a- CNS disturbances.
b- Hyperkalamia***
c- Hypokalamia.
d- Not affect K [Potassium].
Hyperkalaemia is a water-electrolyte disorder defined by an excess of potassium in the blood plasma: its positive diagnosis is confirmed by the ionogram when the serum potassium is greater than 5 mmol / L. The severity is divided into: slight (5.5-5.9 mmol / L), moderate (6.0-6.4 mmol / L), and severe (> 6.5 mmol / L) 1. When it is severe and especially rapidly formed (acute), hyperkalemia can be life-threatening because it is a source of arrhythmias and conductive disorders that can lead - in the most serious cases and in the absence of urgent treatment - at a cardio-circulatory stop.
Physiological reminders:
Potassium is a predominantly intracellular ion. Its contribution is food - dried fruits, bananas, chocolate, green vegetables, etc. - in normal situations. The long-term regulation of the potassium stock and the maintenance of a normal plasma level (potassium) are ensured by a variable renal excretion subjected to a hormonal regulation: the action of the aldosterone (hormone effector of the SRAA) on the distal nephron increases the tubular secretion of potassium and therefore its urinary elimination. In the shorter term, serum potassium is also influenced by two other factors:
- On the one hand, the activity of Na / K-ATPase which goes in the direction of a lowering of the potassium by increasing the intracellular entries of potassium: the operation of this ion pump is itself favored by various stimuli physiological and especially hormonal, such as the action of insulin and catecholamines;
- On the other hand, the passive ion exchange between H + and K +, the intracellular passage of an ion promoting the output of the other to maintain the electroneutrality of the intracellular medium: that is why potassium and pH vary in the opposite direction.
Potassium ion is involved in several cellular physiological processes regarding membrane (electrical) stability and action potentials. He intervenes in particular in the muscular contraction of the striated myocytes, at the same time of the common skeletal striated myocytes and the cardiomyocytes, explaining the observable clinical signs in the hyperkalemia.
causes:
Hyperkalaemia is a fairly common anomaly since in hospital, it can affect up to one in ten hospitalized patients2.
The etiological diagnosis can often be deduced from the clinical context if one has the notion of a pathology or a treatment at risk of hyperkalemia in the patient. When the diagnosis is not obvious, measurement of kaliuresis may provide etiological guidance.
Differential diagnosis:
False hyperkalaemias are due to potassium transfer from the intracellular medium to the plasma that occurs during or after sampling, leading to an overestimate of the patient's actual serum potassium. They mainly occur:
- In the case of laborious, prolonged sampling, with a tight tourniquet: the cell lysis is accompanied by a release of intracellular potassium in the venous blood taken downstream of the withers; in case of doubt or technical difficulties, the sample may be taken without tourniquet or even by arterial means;
- when the time between sampling and centrifugation is prolonged, for example if the blood is taken at home;
- during massive leukocytosis and thrombocytosis, particularly in a context of haematological disease in which the compromised blood cells are more likely to undergo spontaneous lysis (acute leukemias and myeloproliferative syndromes in particular).
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