Features of approaches to the treatment of secondary hypokalemic paralysis in emergency neurology. Review

T.G. Sakovets

FSBEI HE “Kazan State Medical University” of the Ministry for Public Health of Russian Federation, Kazan, Russia

For correspondence: Tatiana G. Sakovets — M.D., associate professor of Department of neurology and rehabilitation of Kazan State Medical University, Kazan; e-mail: tsakovets@yandex.ru

For citation: Sakovets TG. Features of approaches to the treatment of secondary hypokalemic paralysis in emergency neurology. Review. Annals of Critical Care. 2019;4:113–122.

DOI: 10.21320/1818-474X-2019-4-113-122


Abstract

Secondary hypokalemic myoplegia may be due redistribution of potassium between extracellular and intracellular fluid, loss of potassium through the gastrointestinal tract, elevated renal excretion of potassium. Mortality in hypokalemic myoplegia is determined by fatal cardiac arrhythmias, in patients, as a rule, suffering from a pathology of the cardiovascular system (ischemic heart disease, chronic heart failure, left ventricular hypertrophy), respiratory failure. The emergence of prognostically unfavorable rhythm disturbances (ventricular fibrillation, bigeminy, trigymenia, “pirouette” ventricular tachycardia) is provoked by even a slight K deficiency in the blood (less than 3.5 mmol/l). The arrhythmogenic effect of hypokalemia is potentiated by taking digitalis preparations. With ventricular arrhythmias that have arisen on the background of hypokalemia, emergency therapeutic measures are required to restore the content of potassium in the blood serum. The most effective is the use of a diet rich in potassium in combination with taking potassium chloride or potassium-saving diuretics. Late arrest of cardiac arrhythmias with hypokalemic myoplegia, especially in patients with cardiovascular pathology, determines an increase in the frequency of deaths.

Keywords: hypokalemia, secondary hypokalemic myoplegia, treatment of hypokalemia

Received: 01.04.2019

Accepted: 05.11.2019


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