Thay i ECG do nng kali mu bt thng

Nhiu tc ng ca chuyn ho c th to ra s thay i nng kali mu. Kali

l mt cation chim u th ni bo v n c vai tr quan trng trong vic xc
nh in th mng t bo. S ph v gradient nng kali qua mng t bo s
gy suy gim chc nng t bo. N nh hng n cc c quan khc nhau bao
gm thn kinh v tim mch do to ra cc triu chng thn kinh v gy lon
nhp.
Mc d xt nghim in gii l tiu chun vng trong chn on nng cc
cht in gii nhng c tr ngi gy chm tr khi ch kt qu. ECG c th l
mt xt nghim ch li nu thy thuc cnh gic v cc thay i c th c do bt
thng nng kali mu.
Trong bi bo ny tc gi A Webster v cs a ra 3 trng hp lm sng c
bt thng nng kali mu to ra mt s hnh nh ECG c trng m t
nhng hnh nh ny s gip cc bc s lm sng ghi nhn sm nhng nguy c
m do tng hoc gim kali mu gy nn.

Hnh 1: Kai li mu tng mc va (7,6mmol/l) mt bnh nhn suy thn

giai on cui km tiu ng c triu chng nn v bun nn nhng b qua
mt t chy thn nhn to. ECG cho thy khng c sng P, QRS dn rng, T
cao nhn V3-V4. Hnh nh ny ph hp vi tng kali mu va phi.

Hnh 2: bnh nhn 83 tui xut hin ph chi di, kh th v ang c iu

tr vi furosemide, lisinopril, digoxin ngoi ra khng khai thc tin s chi tit
c. Trn ECG cho thy khng thy sng P, QRS d dng dn rng nghi ng
tng kali mu nn x tr 20ml calcium chloride 20%, 10 n v actrapid v
50ml dextrose 50%, 100mg furosemide v nitrate IV iu tr ph phi.
Xt nghim in gii cho thy kalimu tng cao 9,3mmol/l v creatinine mu
800mmol/l, bicarbonate 8 mmol/l. o li ECG , QRS gim rng nhng sau
lm sng ti t hn v bnh nhn t vong.

Hnh 3: Hnh nh ECG vi QRS hp ST chnh xung V3-V5, QT" ko di"

sng T trng vi sng U bnh nhn n s dng thuc nhun trng. Xt
nghim cho thy kali mu gim r rt vi kali mu 1,8mmol/l. iu tr bng
cch truyn normal saline km b sung kali.
Tng kali mu:

Khi tng nh kali mu: hnh nh ECG thung gp l sng T c hnh lu

hoc nhn
Khi tng kali mu nh n va:Do ri lon dn truyn trong t bo c tim
hnh nh ECG biu hin PR ko di v QRS dn rng, sng P bin mt.
Khi nng ka li mu cng gia tng th s c ch dn truyn xoang nh
v nh tht hn na nn s to ra nhp thot , QRS tip tc dn rng v
cng sng T to hnh sine . Nu khng iu tr rung tht s xut hin

Hnh 4: Din tin theo nng kali mu

Hnh 4A: ECG bnh thng
Hnh 4B: mt sng P, sng T hnh lu
Hnh 4C: QRS dn rng
Hnh 4D: QRS hnh sine
iu cn lu lthay i ECG kinh in nh trn khng phi lc no cng nh
vy v lin quan ECG v nng kali s thay i theo tng bnh nhn. Do
cn ghi nhn rng ECG khng phi lun lun l xt nghim chc chn cho
nhng trng hp tng kali nh v va. K c khi tng kali nng c khi thay i
ECG ch ti thiu. Tng kali mu c khi gi hnh nh nhi mu c tim cp trn
ECG. y l iu quan trng i vi cc bc s cp cu v c th x tr tiu si
huyt khng ng.
X tr tng kali mu gm 4 bc:
Xc nh v iu tr cc nguyn nhn nu c th
S dng bin php lm gim kch thch mng nh calcium chloride tnh
mch.

Cc bin php lm gim kali mu: khi u vi dextrose 50% truyn tnh
mch vi insuline. Sau salbutamol c th s dng ng ht hoc tnh
mch. Natri Bicarbonate c th ch li khi bnh nhn nhim toan.
Chy thn nhn to l bin php quyt nh lm gim kali mu.
H kali mu
Hnh nh ECG h kali mu bao gm:
Gim bin sng T
ST chnh xung
Sng U (+) i theo sau sng T, tt nht xem V2, V3. Trong nhng
trng hp h kali mu nng sng U khng l c th gp lm nhm ln
vi sng T. phn bit tnh hung ny, c th da vo mt s qui lut
sau:
Sng T nhn trong tng kali c khuynh hng nn hp, nh cao v nhn
u th , QT bnh thng hoc ngn
Sng U trong h kali th nn rng v ko di QT (m thc cht l khong
QU, xem hnh 5)
4. H kali mu c th gy lon nhp tht quan trng v rung tht

Hnh 5: Sng U khg l, ST chnh xung, sng T dt

iu tr h kali mu nh c th ch cn ung b sung kali. Trng hp gim kali

mu nng e do tnh mng nn b ka li bng ng tnh mch c theo di kali
mu thng xuyn.
Ngun t liu:
A. Wester, W Brady, F Morris. Recognising signs of danger : ECG changes
resulting from an abnormal serum potassium concentration. Emergency
Medicine Journal, Feb 2002, 19:74-77