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2015 | OriginalPaper | Buchkapitel

12. Elektrolyt- und Säure-Basen-Haushalt

verfasst von : Nicole Forster, Dr., Marc Bodenstein, Dr.

Erschienen in: NeuroIntensiv

Verlag: Springer Berlin Heidelberg

Zusammenfassung

In diesem Kapitel werden die intensivmedizinisch relevanten Aspekte der Physiologie und Pathophysiologie des Elektrolyt- und Säure-Basen-Haushalts zusammengefasst. Dabei werden die Homöostase und Regulation des Natrium-, Kalium-, Calcium-, Magnesium-, Phosphat- und Chloridhaushalts beschrieben. Pathophysiologie, Differenzialdiagnose und Therapie von Elektrolytmangel- und -überschusszuständen werden gemäß aktueller Literatur differenziert dargestellt. Im Rahmen der Betrachtung des Natriumhaushalts wird außerdem auf den allgemeinen Flüssigkeitshaushalt eingegangen und die hyper- und hypotone De- und Hyperhydratation entsprechend diskutiert. Analog dazu werden respiratorische und metabolische Alkalose und Azidose betrachtet.
Literatur
1.
Zurück zum Zitat Adrogué HJ (1981) Changes in plasma potassium concentration during acute acid-base disturbances. Am J Med 71:456–467CrossRefPubMed Adrogué HJ (1981) Changes in plasma potassium concentration during acute acid-base disturbances. Am J Med 71:456–467CrossRefPubMed
2.
Zurück zum Zitat Adrogué HJ, Madias NE (1998) Management of life-threatening acid-base disorders – first of two parts. N Engl J Med 338:26–34CrossRefPubMed Adrogué HJ, Madias NE (1998) Management of life-threatening acid-base disorders – first of two parts. N Engl J Med 338:26–34CrossRefPubMed
3.
Zurück zum Zitat Adrogué HJ, Madias NE (1998) Management of life-threatening acid-base disorders – second of two parts. N Engl J Med 338:107–111CrossRefPubMed Adrogué HJ, Madias NE (1998) Management of life-threatening acid-base disorders – second of two parts. N Engl J Med 338:107–111CrossRefPubMed
5.
Zurück zum Zitat Adrogué HJ, Tannen RL (1996) Ketoacidosis, hyperosmolar states, and lactic acidosis. In: Kokko JP, Tannen RL (Hrsg) Fluids and electrolytes, 3. Aufl. Saunders, Philadelphia, S 643–674 Adrogué HJ, Tannen RL (1996) Ketoacidosis, hyperosmolar states, and lactic acidosis. In: Kokko JP, Tannen RL (Hrsg) Fluids and electrolytes, 3. Aufl. Saunders, Philadelphia, S 643–674
6.
Zurück zum Zitat Adrogué HJ, Chap Z, Okuda Y et al (1988) Acidosis-induced glucose intolerance is not prevented by adrenergic blockade. Am J Physiol 255:E812–823PubMed Adrogué HJ, Chap Z, Okuda Y et al (1988) Acidosis-induced glucose intolerance is not prevented by adrenergic blockade. Am J Physiol 255:E812–823PubMed
7.
Zurück zum Zitat Ayus JC, Arieff AI (1996) Abnormalities of water metabolism in the elderly. Semin Nephrol 16:277–288PubMed Ayus JC, Arieff AI (1996) Abnormalities of water metabolism in the elderly. Semin Nephrol 16:277–288PubMed
8.
Zurück zum Zitat Berend KM, van Hulsteijn LH, Gans RO (2012) Chloride: the queen of electrolytes? Eur K Intern Med 23:203–211CrossRef Berend KM, van Hulsteijn LH, Gans RO (2012) Chloride: the queen of electrolytes? Eur K Intern Med 23:203–211CrossRef
9.
Zurück zum Zitat Berendes E, Walter M, Cullen P et al (1997) Secretion of brain natriuretic peptide in patients with subarachnoid haemorrhage. Lancet 349:245–249CrossRefPubMed Berendes E, Walter M, Cullen P et al (1997) Secretion of brain natriuretic peptide in patients with subarachnoid haemorrhage. Lancet 349:245–249CrossRefPubMed
10.
Zurück zum Zitat Boniatti MM, Cardoso PR, Castilho RK, Vieira SR (2011) Is hyperchloremia associated with mortality in critically ill patients? A prospective cohort study. J Crit Care 26:175–179CrossRefPubMed Boniatti MM, Cardoso PR, Castilho RK, Vieira SR (2011) Is hyperchloremia associated with mortality in critically ill patients? A prospective cohort study. J Crit Care 26:175–179CrossRefPubMed
11.
Zurück zum Zitat Brown EM, Chen CJ (1989) Calcium, magnesium and the control of PTH secretion. Bone Miner 5:249–257CrossRefPubMed Brown EM, Chen CJ (1989) Calcium, magnesium and the control of PTH secretion. Bone Miner 5:249–257CrossRefPubMed
12.
Zurück zum Zitat Brown MJ, Brown DC, Murphy MB (1983) Hypokalemia from β-receptor stimulation by circulating epinephrine. N Engl J Med 309:414–419CrossRef Brown MJ, Brown DC, Murphy MB (1983) Hypokalemia from β-receptor stimulation by circulating epinephrine. N Engl J Med 309:414–419CrossRef
13.
Zurück zum Zitat Brüssel T, Lawin P (1994) Störungen des Wasser- und Elektrolythaushalts. In: Lawin P (Hrsg) Praxis der Intensivbehandlung. Thieme, Stuttgart, New York, S 594–595 Brüssel T, Lawin P (1994) Störungen des Wasser- und Elektrolythaushalts. In: Lawin P (Hrsg) Praxis der Intensivbehandlung. Thieme, Stuttgart, New York, S 594–595
14.
Zurück zum Zitat Chernow B, Zaloga G, McFadden E et al (1982) Hypocalcemia in critically ill patients. Crit Care Med 10:848CrossRefPubMed Chernow B, Zaloga G, McFadden E et al (1982) Hypocalcemia in critically ill patients. Crit Care Med 10:848CrossRefPubMed
15.
Zurück zum Zitat Cholst IN, Steinberg SF, Tropper PJ et al (1984) The influence of hypermagnesemia on serum calcium and parathyroid hormone levels in human subjects. N Engl J Med 310:1221–1225CrossRefPubMed Cholst IN, Steinberg SF, Tropper PJ et al (1984) The influence of hypermagnesemia on serum calcium and parathyroid hormone levels in human subjects. N Engl J Med 310:1221–1225CrossRefPubMed
16.
Zurück zum Zitat Cohen RD (1994) Lactic acidosis: new perspectives on origins and treatment. Diabetes Rev 2:86–97 Cohen RD (1994) Lactic acidosis: new perspectives on origins and treatment. Diabetes Rev 2:86–97
17.
Zurück zum Zitat Connor TB, Rosen BL, Blaustein MP et al (1982) Hypocalcemia precipitating congestive heart failure. N Engl J Med 307:869CrossRefPubMed Connor TB, Rosen BL, Blaustein MP et al (1982) Hypocalcemia precipitating congestive heart failure. N Engl J Med 307:869CrossRefPubMed
18.
Zurück zum Zitat Ferlinz R, Schmidt W (1977) Klinik der respiratorischen Azidose. In: Zumkley H (Hrsg) Klinik des Wasser- Elektrolyt- und Säure-Basen-Haushalts. Thieme, Stuttgart, S 190–209 Ferlinz R, Schmidt W (1977) Klinik der respiratorischen Azidose. In: Zumkley H (Hrsg) Klinik des Wasser- Elektrolyt- und Säure-Basen-Haushalts. Thieme, Stuttgart, S 190–209
19.
Zurück zum Zitat Gennari FJ, Kassirer JP (1982) Respiratory alkalosis. In: Cohen JJ, Kassirer JP (Hrsg) Acid-base. Little Brown, Boston, S 349–376 Gennari FJ, Kassirer JP (1982) Respiratory alkalosis. In: Cohen JJ, Kassirer JP (Hrsg) Acid-base. Little Brown, Boston, S 349–376
21.
Zurück zum Zitat Harrington JT, Kassirer JP (1982) Metabolic alkalosis. In: Cohen JJ, Kassirer JP (Hrsg) Acid-base. Little Brown, Boston, S 227–306 Harrington JT, Kassirer JP (1982) Metabolic alkalosis. In: Cohen JJ, Kassirer JP (Hrsg) Acid-base. Little Brown, Boston, S 227–306
22.
Zurück zum Zitat Hood VL, Tannen RL (1994) Maintenance of acid base homeostasis during ketoacidosis and lactic acidosis: implications for therapy. Diabetes Rev 2:177–194 Hood VL, Tannen RL (1994) Maintenance of acid base homeostasis during ketoacidosis and lactic acidosis: implications for therapy. Diabetes Rev 2:177–194
23.
Zurück zum Zitat Kerber RE, Pandian NG, Hoyt R et al (1983) Effect of ischemia, hypertrophy, hypoxia, acidosis, and alkalosis on canine defibrillation. Am J Physiol 244:H825–H831PubMed Kerber RE, Pandian NG, Hoyt R et al (1983) Effect of ischemia, hypertrophy, hypoxia, acidosis, and alkalosis on canine defibrillation. Am J Physiol 244:H825–H831PubMed
24.
Zurück zum Zitat Klein G (1994) Störungen des Säure-Basen-Haushalts. In: Lawin P (Hrsg) Praxis der Intensivbehandlung. Thieme, Stuttgart, New York, S 619 Klein G (1994) Störungen des Säure-Basen-Haushalts. In: Lawin P (Hrsg) Praxis der Intensivbehandlung. Thieme, Stuttgart, New York, S 619
25.
Zurück zum Zitat Knochel JP (1981) Hypophosphatemia. West J Med 125:15 Knochel JP (1981) Hypophosphatemia. West J Med 125:15
26.
Zurück zum Zitat Krapf R, Beeler I, Hertner D, Hulter HN (1991) Chronic respiratory alkalosis. The effect of sustained hyperventilation on renal regulation of acid-base equilibrium. N Engl J Med 324:1394–1401CrossRefPubMed Krapf R, Beeler I, Hertner D, Hulter HN (1991) Chronic respiratory alkalosis. The effect of sustained hyperventilation on renal regulation of acid-base equilibrium. N Engl J Med 324:1394–1401CrossRefPubMed
28.
31.
Zurück zum Zitat Madias NE, Wolf CJ, Cohen JJ (1985) Regulation of acid-base equilibrium in chronic hypercapnia. Kidney Int 27:538–543CrossRefPubMed Madias NE, Wolf CJ, Cohen JJ (1985) Regulation of acid-base equilibrium in chronic hypercapnia. Kidney Int 27:538–543CrossRefPubMed
32.
Zurück zum Zitat Malcolm DS, Zaloga GP, Holaday JW (1989) Calcium administration increases the mortality of endotoxic shock in rats. Crit Care Med 17:900–903CrossRefPubMed Malcolm DS, Zaloga GP, Holaday JW (1989) Calcium administration increases the mortality of endotoxic shock in rats. Crit Care Med 17:900–903CrossRefPubMed
33.
Zurück zum Zitat Marik P, Varon J (1998) Acid-base disorders. N Engl J Med 338:1626–1629PubMed Marik P, Varon J (1998) Acid-base disorders. N Engl J Med 338:1626–1629PubMed
34.
Zurück zum Zitat Marik PE, Kussman BD, Lipman J, Kraus P (1991) Acetazolamide in the treatment of metabolic alkalosis in critically ill patients. Heart Lung 20:455–459PubMed Marik PE, Kussman BD, Lipman J, Kraus P (1991) Acetazolamide in the treatment of metabolic alkalosis in critically ill patients. Heart Lung 20:455–459PubMed
35.
Zurück zum Zitat McCluskey SA, Karkouti K, Wijeysundera D, Minkovich L, Tait G, Beattie WS (2013) Hyperchloremia after noncardiac surgery is indepently associated with increased mobidity and mortalitiy: a propensity-matched cohort study. Anesth Analg 117:412–421CrossRefPubMed McCluskey SA, Karkouti K, Wijeysundera D, Minkovich L, Tait G, Beattie WS (2013) Hyperchloremia after noncardiac surgery is indepently associated with increased mobidity and mortalitiy: a propensity-matched cohort study. Anesth Analg 117:412–421CrossRefPubMed
36.
Zurück zum Zitat Neill WA, Hattenhauer M (1975) Impairment of myocardial O2-supply due to hyperventilation. Circulation 52:854–859CrossRefPubMed Neill WA, Hattenhauer M (1975) Impairment of myocardial O2-supply due to hyperventilation. Circulation 52:854–859CrossRefPubMed
37.
Zurück zum Zitat Orchand CH, Cingolani HE (1994) Acidosis and arrhythmias in cardiac muscle. Cardiovasc Res 28:1312–1319CrossRef Orchand CH, Cingolani HE (1994) Acidosis and arrhythmias in cardiac muscle. Cardiovasc Res 28:1312–1319CrossRef
38.
Zurück zum Zitat Orchand CH, Kentish JC (1990) Effects of changes of pH on the contractile function of cardiac muscle. Am J Physiol 258:C967–981 Orchand CH, Kentish JC (1990) Effects of changes of pH on the contractile function of cardiac muscle. Am J Physiol 258:C967–981
39.
Zurück zum Zitat Peterson LN, Levi M (1997) Disorders of potassium metabolism. In: Schrier RW (Hrsg) Renal and electrolyte disorders. Lippincott-Raven, Philadelphia, S 192–240 Peterson LN, Levi M (1997) Disorders of potassium metabolism. In: Schrier RW (Hrsg) Renal and electrolyte disorders. Lippincott-Raven, Philadelphia, S 192–240
40.
Zurück zum Zitat Ralston SH, Gardner MD, Dryburgh FJ et al (1985) Comparison of aminohydroxypropylidene diphosphonate, mithramycin, and corticosteroids/calcitonin in treatment of cancer-associated hypercalcemia. Lancet 326:907CrossRef Ralston SH, Gardner MD, Dryburgh FJ et al (1985) Comparison of aminohydroxypropylidene diphosphonate, mithramycin, and corticosteroids/calcitonin in treatment of cancer-associated hypercalcemia. Lancet 326:907CrossRef
41.
Zurück zum Zitat Rimmer JM, Gennari FJ (1987) Metabolic alkalosis. J Int Care Med 2:137–150CrossRef Rimmer JM, Gennari FJ (1987) Metabolic alkalosis. J Int Care Med 2:137–150CrossRef
42.
Zurück zum Zitat Ross EJ, Christie SBM (1969) Hypernatremia. Medicine (Baltimore) 48:441–473CrossRef Ross EJ, Christie SBM (1969) Hypernatremia. Medicine (Baltimore) 48:441–473CrossRef
43.
Zurück zum Zitat Rubeiz GJ, Thill-Baharozian M, Haride D et al (1993) Association of hypomagnesemia and mortality in acutely ill medical patients. Crit Care Med 21:203–209CrossRefPubMed Rubeiz GJ, Thill-Baharozian M, Haride D et al (1993) Association of hypomagnesemia and mortality in acutely ill medical patients. Crit Care Med 21:203–209CrossRefPubMed
45.
Zurück zum Zitat Snyder N, Feigal D, Arieff A (1987) Hypernatremia in elderly patients. A heterogenous, morbid, and iatrogenic entity. Ann Intern Med 107:309CrossRefPubMed Snyder N, Feigal D, Arieff A (1987) Hypernatremia in elderly patients. A heterogenous, morbid, and iatrogenic entity. Ann Intern Med 107:309CrossRefPubMed
46.
Zurück zum Zitat Soupart A, Decaux G (1996) Therapeutic recommendations for management of severe hyponatremia: current concepts on pathogenesis and prevention of neurologic complications. Clin Nephrol 45:149–169 Soupart A, Decaux G (1996) Therapeutic recommendations for management of severe hyponatremia: current concepts on pathogenesis and prevention of neurologic complications. Clin Nephrol 45:149–169
47.
Zurück zum Zitat Sterns RH (1992) Severe hyponatremia: the case for conservative management. Crit Care Med 20:534–539CrossRefPubMed Sterns RH (1992) Severe hyponatremia: the case for conservative management. Crit Care Med 20:534–539CrossRefPubMed
48.
Zurück zum Zitat Tani M, Morimatsu H, Takatsu F, Morita K (2012) The incidence and prognostic value of hypochloremia in critically ill patients. Sci World J2012:474185 Tani M, Morimatsu H, Takatsu F, Morita K (2012) The incidence and prognostic value of hypochloremia in critically ill patients. Sci World J2012:474185
49.
Zurück zum Zitat Vandergheynst F, Sakr Y, Felleiter P, Hering R, Groeneveld J, Vanhems P, Taccone FS, Vincent JL (2013) Incidence and prognosis of dysnatraemia in critically ill pations: analysis of a large prevalence study. Eur J Clin Invest 43:933–948CrossRefPubMed Vandergheynst F, Sakr Y, Felleiter P, Hering R, Groeneveld J, Vanhems P, Taccone FS, Vincent JL (2013) Incidence and prognosis of dysnatraemia in critically ill pations: analysis of a large prevalence study. Eur J Clin Invest 43:933–948CrossRefPubMed
50.
Zurück zum Zitat Vaughan RS (1991) Potassium in the perioperative period. Br J Anesth 67:194–200CrossRef Vaughan RS (1991) Potassium in the perioperative period. Br J Anesth 67:194–200CrossRef
51.
Zurück zum Zitat White RE, Hartzell HC (1989) Magnesuim ions in cardiac function: Regulator of ion channels and second messengers. Biochem Pharmacol 38:859–867CrossRefPubMed White RE, Hartzell HC (1989) Magnesuim ions in cardiac function: Regulator of ion channels and second messengers. Biochem Pharmacol 38:859–867CrossRefPubMed
52.
Zurück zum Zitat Wisneski LA (1990) Calcitonin in the acute management of hypercalcemia. Calcif Tissue Int 46(Suppl):26–30CrossRef Wisneski LA (1990) Calcitonin in the acute management of hypercalcemia. Calcif Tissue Int 46(Suppl):26–30CrossRef
53.
Zurück zum Zitat Wrenn KD, Slovis CM, Minion GE, Rutkowski R (1991) The syndrome of alcoholic ketoacidosis. Am J Med 91:119–128CrossRefPubMed Wrenn KD, Slovis CM, Minion GE, Rutkowski R (1991) The syndrome of alcoholic ketoacidosis. Am J Med 91:119–128CrossRefPubMed
54.
Zurück zum Zitat Zaloga GP, Roberts PR et al (2000) Calcium, magnesium, and phosphorus disorders. In: Shoemaker WC (Hrsg) Textbook of critical care, 4. Aufl. W.B. Saunders Company, Philadelphia, S 862–875 Zaloga GP, Roberts PR et al (2000) Calcium, magnesium, and phosphorus disorders. In: Shoemaker WC (Hrsg) Textbook of critical care, 4. Aufl. W.B. Saunders Company, Philadelphia, S 862–875
55.
Zurück zum Zitat Zaloga GP, Sager A, Prielipp R, Ward K (1992) Low dose calcium administration increases mortality during septic peritonitis. Circ Shock 37:226–229PubMed Zaloga GP, Sager A, Prielipp R, Ward K (1992) Low dose calcium administration increases mortality during septic peritonitis. Circ Shock 37:226–229PubMed
Metadaten
Titel
Elektrolyt- und Säure-Basen-Haushalt
verfasst von
Nicole Forster, Dr.
Marc Bodenstein, Dr.
Copyright-Jahr
2015
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-46500-4_12

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