Kalemia
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Questions and Answers

What is the primary meaning of the term 'hypokalemia'?

  • Abnormal levels of electrolytes in the blood
  • Higher than normal sodium levels in the blood
  • Lower than normal potassium levels in the blood (correct)
  • Imbalance of fluids in the body
  • What percentage of the body's potassium is intracellular?

  • Around 20%
  • Around 80%
  • Around 98% (correct)
  • Around 50%
  • What is the concentration of potassium inside the cells compared to outside the cells?

  • It's around 33 times higher inside the cells (correct)
  • It's similar inside and outside the cells
  • It's around 30 times higher inside the cells
  • It's higher outside the cells
  • What is the purpose of the sodium-potassium pump in maintaining the internal potassium balance?

    <p>It pumps 2 potassium ions in for every 3 sodium ions out</p> Signup and view all the answers

    What is the result of the difference in potassium concentration inside and outside the cells?

    <p>It leads to a difference in charge</p> Signup and view all the answers

    What is the term for the balance of potassium ions inside and outside the cells?

    <p>Internal potassium balance</p> Signup and view all the answers

    What happens to the membrane potential of muscle cells when there is low potassium in the blood?

    <p>It becomes more negative</p> Signup and view all the answers

    What is a common symptom of diminished skeletal muscle contractions due to hypokalemia?

    <p>Muscle weakness</p> Signup and view all the answers

    What is the typical diagnostic indicator of hypokalemia in an electrocardiogram?

    <p>Prolonged QT interval</p> Signup and view all the answers

    What is the main goal of treatment for patients with severe hypokalemia?

    <p>Normalizing potassium levels</p> Signup and view all the answers

    What type of muscle contractions can be affected by hypokalemia?

    <p>Smooth, skeletal, and cardiac muscle contractions</p> Signup and view all the answers

    What is the typical blood potassium level that indicates hypokalemia?

    <p>Below 3.5 mEq/L</p> Signup and view all the answers

    What percentage of potassium is reabsorbed in the proximal convoluted tubule?

    <p>67%</p> Signup and view all the answers

    What is the primary function of alpha-intercalated cells in the distal tubule and collecting ducts?

    <p>Reabsorption of potassium</p> Signup and view all the answers

    What is the effect of aldosterone on the principal cells in the distal tubule and collecting ducts?

    <p>Increases sodium channels and increases potassium pumps</p> Signup and view all the answers

    What is the result of increased aldosterone levels in the kidneys?

    <p>Increased potassium secretion</p> Signup and view all the answers

    What is the effect of loop diuretics and thiazide diuretics on potassium levels?

    <p>Increases potassium secretion</p> Signup and view all the answers

    What is the primary cause of hypokalemia in cases of chronic diarrhea?

    <p>Direct loss of potassium in the feces</p> Signup and view all the answers

    What is the result of hypokalemia on muscle function?

    <p>Decreased muscle contraction</p> Signup and view all the answers

    What is the role of the principal cells in the distal tubule and collecting ducts?

    <p>Secretion of potassium</p> Signup and view all the answers

    What is the effect of vomiting on potassium levels?

    <p>Metabolic alkalosis</p> Signup and view all the answers

    What is the result of increased potassium secretion in the kidneys?

    <p>Decreased potassium levels in the blood</p> Signup and view all the answers

    What is the main function of the kidneys in maintaining potassium balance?

    <p>Excreting excess potassium in the urine</p> Signup and view all the answers

    What is the typical range of potassium intake through the diet on a daily basis?

    <p>50 mEq/L to 150 mEq/L</p> Signup and view all the answers

    What is the effect of excess insulin on potassium balance?

    <p>It stimulates the uptake of glucose in cells, leading to hypokalemia</p> Signup and view all the answers

    What is the effect of alkalosis on potassium balance?

    <p>It stimulates the uptake of potassium in cells</p> Signup and view all the answers

    What is the role of beta-2-adrenergic receptors in potassium balance?

    <p>They stimulate the uptake of potassium in cells</p> Signup and view all the answers

    What is the effect of respiratory alkalosis on potassium balance?

    <p>It has no effect on potassium balance</p> Signup and view all the answers

    What is the main cause of hypokalemia due to an external potassium balance shift?

    <p>Dietary potassium deficiency</p> Signup and view all the answers

    What is the role of the sodium-potassium pump in maintaining potassium balance?

    <p>It pumps potassium into cells</p> Signup and view all the answers

    What is the effect of catecholamines on potassium balance?

    <p>They stimulate the uptake of potassium in cells</p> Signup and view all the answers

    What is the consequence of insulin overdose on potassium balance?

    <p>It leads to hypokalemia</p> Signup and view all the answers

    What is the primary component of the total body potassium?

    <p>Intracellular potassium</p> Signup and view all the answers

    What is the term that refers to the balance of potassium ions inside and outside the cells?

    <p>Internal potassium balance</p> Signup and view all the answers

    What is the approximate concentration of potassium inside the cells?

    <p>150 mEq/L</p> Signup and view all the answers

    What is the function of the sodium-potassium pump in maintaining potassium balance?

    <p>To pump 2 potassium ions in for every 3 sodium ions out</p> Signup and view all the answers

    What is the space between cells where you typically find fibrous proteins and long chains of carbohydrates?

    <p>Interstial space</p> Signup and view all the answers

    What is the approximate percentage of the body's potassium that is extracellular?

    <p>2%</p> Signup and view all the answers

    What is the primary mechanism by which the kidneys maintain external potassium balance?

    <p>Excretion of excess potassium into the urine</p> Signup and view all the answers

    What is the effect of insulin on potassium balance in the body?

    <p>Increases potassium uptake into cells</p> Signup and view all the answers

    What is the result of an internal potassium balance shift in the body?

    <p>Decreased potassium levels in the blood</p> Signup and view all the answers

    What is the effect of catecholamines on potassium balance in the body?

    <p>Increases potassium uptake into cells</p> Signup and view all the answers

    What is the primary cause of hypokalemia due to an external potassium balance shift?

    <p>Increased potassium secretion in the kidneys</p> Signup and view all the answers

    What is the effect of respiratory alkalosis on potassium balance in the body?

    <p>Has no effect on potassium balance</p> Signup and view all the answers

    What is the role of the sodium-potassium pump in maintaining potassium balance in the body?

    <p>Pulls potassium into cells from the blood</p> Signup and view all the answers

    What is the effect of anorexia on potassium balance in the body?

    <p>Decreases potassium intake through the diet</p> Signup and view all the answers

    What is the primary mechanism by which the body regulates potassium balance?

    <p>Internal potassium balance shifts</p> Signup and view all the answers

    What is the effect of excess insulin on potassium balance in the body?

    <p>Increases potassium uptake into cells</p> Signup and view all the answers

    What is the primary function of the alpha-intercalated cells in the distal tubule and collecting ducts?

    <p>To reabsorb potassium</p> Signup and view all the answers

    What is the effect of aldosterone on the principal cells?

    <p>Increases sodium-potassium pumps</p> Signup and view all the answers

    What is the result of increased potassium secretion in the kidneys?

    <p>Increased potassium excretion</p> Signup and view all the answers

    What is the role of the principal cells in the distal tubule and collecting ducts?

    <p>To regulate potassium secretion</p> Signup and view all the answers

    What is the effect of diuretics on potassium levels?

    <p>Increased potassium secretion</p> Signup and view all the answers

    What is the consequence of hypokalemia on muscle function?

    <p>Decreased muscle contractions</p> Signup and view all the answers

    What is the primary cause of hypokalemia in cases of primary hyperaldosteronism?

    <p>Increased aldosterone levels</p> Signup and view all the answers

    What is the effect of metabolic alkalosis on potassium levels?

    <p>Increased potassium secretion</p> Signup and view all the answers

    What is the role of the sodium-potassium pump in maintaining potassium balance?

    <p>To pump potassium into the cell and sodium out</p> Signup and view all the answers

    What is the percentage of potassium reabsorbed in the proximal convoluted tubule?

    <p>67%</p> Signup and view all the answers

    What is the likely effect of hyperpolarization of muscle cell membranes on muscle contractions?

    <p>Muscle contractions become weaker</p> Signup and view all the answers

    What is the primary function of the sodium-potassium pump in maintaining potassium balance?

    <p>To maintain the concentration gradient of potassium ions across the cell membrane</p> Signup and view all the answers

    What is the consequence of diminished skeletal muscle contractions due to hypokalemia?

    <p>Muscle weakness, cramps, and flaccid paralysis</p> Signup and view all the answers

    What is the primary way the body maintains external potassium balance?

    <p>Through the kidneys excreting excess potassium in the urine</p> Signup and view all the answers

    What is the typical range of potassium levels in the blood that indicates hypokalemia?

    <p>Below 3.5 mEq/L</p> Signup and view all the answers

    What is the effect of hypokalemia on cardiac muscle contractions?

    <p>It leads to cardiac arrhythmias and cardiac arrest</p> Signup and view all the answers

    What is the role of potassium leak channels in maintaining internal potassium balance?

    <p>To allow potassium ions to leak out of the cell</p> Signup and view all the answers

    What is the consequence of respiratory muscle weakness due to hypokalemia?

    <p>Respiratory depression</p> Signup and view all the answers

    What is the primary source of potassium intake in the body?

    <p>The diet</p> Signup and view all the answers

    What is the term for the balance of potassium ions inside and outside the cells, maintained by the sodium-potassium pump and other channels?

    <p>Internal potassium balance</p> Signup and view all the answers

    What is one possible cause of an internal potassium balance shift that leads to hyperkalemia?

    <p>Insulin deficiency</p> Signup and view all the answers

    What is the primary mechanism of hyperkalemia in acidosis?

    <p>Exchange of hydrogen ions for potassium ions across the cell membrane</p> Signup and view all the answers

    What is the effect of beta-2-adrenergic antagonists on potassium balance?

    <p>They decrease potassium uptake in cells</p> Signup and view all the answers

    What is the result of cell lysis on potassium balance?

    <p>It increases potassium levels in the blood</p> Signup and view all the answers

    What is the effect of exercise on potassium balance?

    <p>It increases potassium levels in the blood</p> Signup and view all the answers

    What is the effect of alpha-adrenergic receptors on potassium balance?

    <p>They decrease potassium uptake in cells</p> Signup and view all the answers

    What is the effect of hyperosmolarity on potassium balance?

    <p>It increases potassium levels in the blood</p> Signup and view all the answers

    What is the effect of catecholamines on potassium balance?

    <p>They decrease potassium uptake in cells</p> Signup and view all the answers

    What is the primary mechanism of hyperkalemia in patients with type I diabetes?

    <p>Insulin deficiency</p> Signup and view all the answers

    What is the effect of acidosis on potassium balance in respiratory acidosis?

    <p>It has no effect on potassium balance</p> Signup and view all the answers

    What is the typical effect of high potassium levels on muscle contractions?

    <p>It causes weakness and flaccid paralysis</p> Signup and view all the answers

    What is the primary diagnostic indicator of hyperkalemia in an electrocardiogram?

    <p>Tall, peaked T waves with a narrow base</p> Signup and view all the answers

    What is the effect of hyperkalemia on cardiac muscle contractions?

    <p>It leads to cardiac arrhythmias and cardiac arrest</p> Signup and view all the answers

    What is the typical treatment for severe hyperkalemia?

    <p>Calcium, insulin, glucose, and sodium bicarbonate</p> Signup and view all the answers

    What is the typical blood potassium level that indicates hyperkalemia?

    <p>Above 5.5 mEq/L</p> Signup and view all the answers

    What is the primary effect of hyperkalemia on skeletal muscle contractions?

    <p>It causes weakness and flaccid paralysis</p> Signup and view all the answers

    What is the typical cause of hyperkalemia resulting from excessive potassium infusion?

    <p>Rapid, excessive infusion of potassium into the bloodstream</p> Signup and view all the answers

    What percentage of potassium is reabsorbed in the proximal convoluted tubule and the thick ascending limb?

    <p>67% and 20% respectively</p> Signup and view all the answers

    What is the role of aldosterone in the kidneys?

    <p>Increases the number of sodium channels and potassium channels on the lumen side of the principal cell</p> Signup and view all the answers

    What is the consequence of acute kidney injury on potassium levels?

    <p>Increased potassium retention leading to hyperkalemia</p> Signup and view all the answers

    What is the primary function of the principal cells in the distal tubule and collecting ducts?

    <p>Secretion of potassium</p> Signup and view all the answers

    What is the effect of hyperkalemia on muscle contractions?

    <p>Decreased muscle contractions</p> Signup and view all the answers

    What is the term for the balance of potassium ions inside and outside the cells?

    <p>Potassium homeostasis</p> Signup and view all the answers

    What is the consequence of hypoaldosteronism on potassium levels?

    <p>Increased potassium retention leading to hyperkalemia</p> Signup and view all the answers

    What is the role of alpha-intercalated cells in the distal tubule and collecting ducts?

    <p>Reabsorption of potassium</p> Signup and view all the answers

    What is the effect of drugs that reduce the effect of aldosterone on potassium levels?

    <p>Increased potassium retention leading to hyperkalemia</p> Signup and view all the answers

    Study Notes

    Hyperkalemia i hipokalemia - podstawy

    • Hipokalemia to stan, gdzie poziom potasu we krwi jest niższy niż 3,5 mEq/L
    • W organizmie ludzkim większość potasu (około 98%) znajduje się wewnątrz komórek
    • Stężenie potasu wewnątrz komórki wynosi około 150 mEq/L, a na zewnątrz komórki tylko 4,5 mEq/L
    • Różnica stężeń potasu między wnętrzem i zewnątrzem komórki tworzy gradient elektrochemiczny

    Różnice w stężeniu potasu

    • Stężenie potasu we krwi: 4,5 mEq/L
    • Stężenie potasu wewnątrz komórki: 150 mEq/L

    Wewnętrzny równowaga potasu

    • Utrzymywany przez pompę sodowo-potasową, która pompuje 2 jony potasu do komórki za każde 3 jony sodu na zewnątrz
    • Równowaga potasu jest ważna dla utrzymania potencjału spoczynkowego błony komórkowej

    Zewnętrzny równowaga potasu

    • Uzyskiwany z diety: 50-150 mEq/L dziennie
    • Większość potasu jest wydalana przez nerki do moczu
    • Nerki regulują ilość potasu we krwi przez filtrację, reabsorpcję i sekrecję w nefronie

    Przyczyny hipokalemii

    • Zewnętrzna nierównowaga potasu:
      • Nadmierna wydzielina potasu przez nerki
      • Niewystarczająca ilość potasu w diecie
    • Wewnętrzna nierównowaga potasu:
      • Insulina powoduje przeniesienie potasu do komórki
      • Zmiana pH krwi (alkaloza) powoduje wymianę jonów wodorowych na jony potasu

    Objawy hipokalemii

    • Osłabienie mięśni szkieletowych
    • Skurcze mięśni
    • Problemy z oddychaniem
    • Arrythmia serca
    • Zatrzymania akcji serca### Zmiany w równowadze potasu w organizmie
    • Najpierw potas jest swobodnie filtrowany z krwi do moczu w kłębuszku nerkowym
    • Następnie około 67% jest wchłaniane w zwoju spiralnym kanalika proksymalnego, a dodatkowe 20% w zwoju thick ascending limb
    • Pozostałe 13% wchłaniania lub wydzielania potasu w kanaliku dalszym i kolektorycznym zależy od potrzeb organizmu
    • Reabsorpcja w tej strefie jest prowadzona przez α-interkalowane komórki, a wydzielanie przez główne komórki
    • Hormonem regulującym reabsorpcję lub wydzielanie potasu w nerkach jest aldosteron

    Hipokaliemia

    • Przyczyny hipokaliemii:
      • Niedostateczna podaż potasu
      • Zwiększony napływ potasu do komórek
      • Utrata potasu przez nerki
    • Skutki hipokaliemii:
      • Osłabienie mięśni szkieletowych
      • Zaparcie
      • Depresja oddechowa
      • Arytmie sercowe

    Nadmiar potasu w organizmie

    • Przyczyny hiperkaliemii:

      • Zewnętrzna zmiana równowagi potasu
      • Wewnętrzna zmiana równowagi potasu
    • Zewnętrzna zmiana równowagi potasu:

      • Zmniejszenie wydalania potasu przez nerki
      • Zwiększone wchłanianie potasu z pożywienia
    • Wewnętrzna zmiana równowagi potasu:

      • Insulinooporność
      • Kwasica
      • Catecholaminy
      • Hyperosmolarność
      • Liza komórek
      • Aktywność fizyczna
    • Skutki hiperkaliemii:

      • Osłabienie mięśni szkieletowych
      • Zaparcie
      • Arytmie sercowe
      • Zatrzymanie krążenia### Upośledzenie wydalania K+ przez nerki
    • Upośledzenie wydalania K+ przez nerki organiczne AKI lub PChN prowadzi do hiperkaliemii

    • Najczęściej spotykane, gdy GFR < 15 ml/min/1,73m2

    • Hiperkaliemia rzadko spotykana, chyba że występuje oliguria, podaż K+, rozpad tkanek, spadek aldosteronu

    • CKD > 900 G/l, leukocytoza > 70 G/l, hemoliza

    Objawy hiperkaliemii

    • Pojawiają się, gdy K+ > 7 mmol/l
    • Zmniejszony stosunek ICF/ECF
    • Upośledzone wyładowania nerwowe
    • Osłabienie, parestezje, apatia
    • Porażenie wiotkie, podobne do zespołu Guillain-Barré
    • Zmiany EKG

    Zmiany EKG

    • Wzrost K+ średniego stopnia powoduje częściową depolaryzację
    • Wzrost potencjału spoczynkowego do granicy z potencjałem czynnościowym
    • Łatwa aktywowalność szybkich kanałów sodowych Nav1,5
    • Wzrost pobudliwości oraz prędkości przewodzenia
    • Przedwczesna repolaryzacja

    Fizjologia wody

    • Prawo elektroobojętności płynów ustrojowych (prawo Gamble’a)
    • Prawo izoosmolarności
    • Prawo izojonów
    • Prawo izohydrii
    • Osmolity efektywne: glukoza, Na+
    • Osmolity nieefektywne: etanol, mocznik

    Odwodnienie izotoniczne

    • Etiopatogeneza: utrata izotonicznych płynów
    • Przyczyny:
      • Utrata płynów przez PP (biegunka, wymioty, utrata soku żołądkowego)
      • Przetoki jelitowe
      • Niedrożność porażenna jelit
      • Odsysanie żołądka
    • Skutki:
      • Utrata płynów izotonicznych, bogatych w białko i elektrolity
      • Utrata komórek morfotycznych
      • Utrata płynów z równoczesną utratą elektrolitów

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    Description

    Get familiar with the concepts of water-electrolyte balance, including the calculation of pH and the causes of hypokalemia. Learn about the importance of potassium supply and the effects of pH changes on the body.

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