Kalium

Wetenschappelijke naam

Kalium; K, Atoomnummer 19.

Kalium

Kalium is de meest voorkomende intracellulaire elektrolyt die in het lichaam wordt aangetroffen. Het is belangrijk voor verschillende acties in het lichaam, waaronder spiercontractie, cardiovasculaire functie, urogenitale functie, gebruik in het zenuwstelsel en spijsverteringsstelsel, zuur-base balans, isotoniciteit en verschillende enzymatische reacties.

Gebruik

Oraal wordt kalium gebruikt voor het behandelen en voorkomen van hypokaliëmie, hypertensie, de ziekte van Menière, thalliumvergiftiging, insulineresistentie, myocardinfarct, beroertepreventie, symptomen van de menopauze en koliek bij kinderen. Het wordt ook oraal gebruikt voor allergieën, hoofdpijn, acne, alcoholisme, de ziekte van Alzheimer, artritis, wazig zien, kanker, chronisch vermoeidheidssyndroom, colitis, verwardheid, constipatie, tandpijn, dermatitis, diabetes, verminderde glucosetolerantie (prediabetes), oedeem, koorts, jicht, slapeloosheid, prikkelbaarheid, mononucleosis, spierzwakte, spierdystrofie, stress en als hulpmiddel bij de behandeling van myasthenia gravis.

Intraveneus wordt kalium gebruikt voor het behandelen en voorkomen van hypokaliëmie, hartritmestoornissen waaronder atriale tachycardie, ventriculaire aritmieën en myocardiaal infarct.

Topisch wordt kalium gebruikt voor waterwratten.

Veiligheid

VEELZIJDIG VEILIG: bij orale toediening in doses tot 100 mEq totaal kalium per dag, niet meer dan 200 mEq in een periode van 24 uur. Oraal kaliumchloride is een door de FDA goedgekeurd recept. Grotere hoeveelheden verhogen het risico op hyperkaliëmie. Bij intraveneuze toediening (IV) met geschikte infusiesnelheden. Ouderlijk kalium is een door de FDA goedgekeurd recept.

ONVEILIG: bij orale of intraveneuze toediening in buitensporige hoeveelheden. Doses die de kaliumspiegel in het bloed verhogen tot meer dan 6 mEq / L zijn mogelijk levensbedreigend.

ZWANGERSCHAP EN LACTATIE: WAARSCHIJNLIJK VEILIG: bij orale toediening in hoeveelheden van 40-80 mEq per dag. ONVEILIG: wanneer gebruikt in buitensporige hoeveelheden. Doses die de kaliumspiegel in het bloed verhogen tot meer dan 6 mEq / L zijn mogelijk levensbedreigend.

Effectiviteit

Hypokaliëmie: het oraal of intraveneus toedienen van kalium is effectief voor de behandeling en preventie van hypokaliëmie.

Hypertensie: uit het meeste klinische onderzoek blijkt dat kalium, oraal ingenomen als onderdeel van het dieet of als supplement, de systolische bloeddruk met ongeveer 3-9,5 mmHg en de diastolische bloeddruk met ongeveer 2-6,4 mmHg verhoogt bij patiënten met of zonder hypertensie. In de meeste van deze onderzoeken varieerde de dagelijkse inname van kalium tussen de 1500 en 7800 mg, waarbij de meest gebruikelijke inname ongeveer 2340-2540 mg per dag was. Sommige onderzoeken tonen echter aan dat het nemen van kalium de systolische of diastolische bloeddruk niet significant verlaagt. Verschillen in de patiëntenpopulaties, inname van kalium en zoutinname zouden kunnen hebben bijgedragen tot de tegenstrijdige resultaten. Kalium lijkt effectiever te zijn voor mensen met hypertensie, lage kaliumspiegels, hoge dagelijkse inname van natrium en voor Afro-Amerikanen. Sommige onderzoeken tonen aan dat de grootste bloeddrukverlagende effecten van kalium optreden bij doses van ongeveer 3900-7800 mg per dag. In 2017 publiceerden het American College of Cardiology en de American Heart Association (ACC / AHA) richtlijnen waarin wordt geadviseerd dat patiënten met hypertensie dagelijks 3500-5000 mg kalium consumeren. De inname van kalium zal naar verwachting de systolische bloeddruk met ongeveer 4-5 mmHg verlagen bij patiënten met hypertensie en met ongeveer 2 mmHg bij normotensieve patiënten.

Er is ook enige interesse in het nemen van kalium om hypertensie te voorkomen. Bevolkingsonderzoek toont aan dat een lage inname van kalium in de voeding gepaard gaat met een verhoogd risico op hypertensie. Consumptie van kalium uit voedingsbronnen lijkt het risico op het ontwikkelen van hypertensie te verminderen. Levensmiddelen die ten minste 350 mg kalium per portie bevatten en die weinig natrium, verzadigd vet en cholesterol bevatten kunnen het risico op het ontwikkelen van een hoge bloeddruk helpen verlagen. Er is echter geen bewijs dat het nemen van kaliumsupplementen hypertensie kan helpen voorkomen.

Beroerte: een hogere inname van kalium in de voeding lijkt in verband te staan ​​met een lager risico op een beroerte. Uit bevolkingsonderzoek is gebleken dat het verhogen van de dagelijkse kaliuminname met 1-1,5 gram per dag gepaard gaat met een tot 20% lager risico op beroerte.

Hogere aanvullende inname van kalium lijkt ook te worden geassocieerd met een lager risico op een beroerte, maar de resultaten zijn nog voorlopig. Uit een aantal populatieonderzoeken is gebleken dat een hogere supplementaire inname van kalium gepaard gaat met een 29% lager risico op ischemische beroerte. Er is echter geen verband tussen een aanvullende kaliuminname en een lager risico op hemorragische of totale beroerte. Klinische proeven van hoge kwaliteit zijn nodig om deze associatie te bevestigen.

Er zijn ook aanwijzingen dat de verhoogde inname van kalium het neurologische herstel van patiënten na een beroerte kan verbeteren, maar de resultaten zijn voorlopig.

Dosering & gebruik

Volwassen

Oraal:

Algemeen: De adequate inname van kalium, zoals vastgesteld door het Voedsel- en Voedingscomité van het National Institute for Medicine, is voor volwassenen 4,7 gram per dag, 4,7 gram per dag voor zwangere vrouwen en 5,1 gram per dag voor vrouwen die borstvoeding geven.

Hypokaliëmie: voor het voorkomen van hypokaliëmie, wordt kalium 20 mEq (ongeveer 780 mg elementair kalium) gewoonlijk eenmaal per dag ingenomen. Voor de behandeling van hypokaliëmieën wordt kalium 40-100 mEq (ongeveer 1560-3900 mg elementair kalium) doorgaans dagelijks in 2-5 verdeelde doses ingenomen. Doses moeten worden beperkt tot 40 mEq (ongeveer 780 mg elementair kalium) en de totale dosis mag niet hoger zijn dan 200 mEq (ongeveer 7800 mg elementair calcium) in 24 uur. Kaliumsuppletie moet geïndividualiseerd worden en gebaseerd op het serumkaliumniveau van de persoon, dat gehouden moet worden tussen 3,5-5 mEq / L.

Hypertensie: kalium 1500-7800 mg dagelijks is gebruikt in klinisch onderzoek, waarbij de meest gebruikelijke dosis 2340-2540 mg dagelijks was. Er zijn aanwijzingen dat het voordeel het grootst is bij doses van 3900-7800 mg per dag. De huidige richtlijnen adviseren dagelijks kalium 3500-5000 mg, bij voorkeur uit voedingsbronnen, voor patiënten met hypertensie.

Hypokaliëmie: de dosering en toedieningssnelheid voor intraveneus kaliumchloride voor de preventie of behandeling van hypokaliëmie varieert en is afhankelijk van de toestand van elke patiënt. In de meeste gevallen mag de infusiesnelheid niet hoger zijn dan 10 mEq / uur (ongeveer 390 mg / uur) of 200 mEq (ongeveer 7800 mg elementair kalium) in een periode van 24 uur.

Kinderen

Oraal:

De referentie inname, zoals vastgesteld door het Voedsel- en Voedingscomité van het National Institute for Medicine, 0,4 gram per dag voor baby's tot 6 maanden oud, 0,7 gram per dag voor baby's van 6-12 maanden oud, 3 gram per dag voor kinderen van 1-3 jaar oud, 3,8 gram per dag voor kinderen van 4-8 jaar oud en 4,5 gram per dag voor kinderen van 9-13 jaar oud. Patiënten moeten worden geadviseerd om voldoende hoeveelheden kalium te blijven consumeren om aan de dagelijkse behoefte te voldoen, maar niet aan te grote hoeveelheden.

Bijwerkingen

Oraal of intraveneus (IV), kalium kan maagklachten, misselijkheid, diarree, braken, oprispingen, winderigheid en ulceraties veroorzaken. Hyperkaliëmie, meestal serumkalium boven de 5 mEq / L, kan paresthesie, gegeneraliseerde zwakte, slappe verlamming, lusteloosheid, duizeligheid, mentale verwardheid, hypotensie, bloed in de ontlasting, hartritmestoornissen en hartblokkades veroorzaken.

Interactie

Medicijnen

ACE-REMMERS (ACEI's)

ACEI's blokkeren de werking van het renine-angiotensine-aldosteronsysteem en verminderen de kaliumuitscheiding. Gelijktijdig gebruik van deze geneesmiddelen met kaliumsupplementen verhoogt het risico op hyperkaliëmie. Gelijktijdig gebruik van deze geneesmiddelen met matige kaliuminname via de voeding (ongeveer 3775-5200 mg per dag) verhoogt de serumkaliumspiegels echter niet.

De ACE-remmers omvatten benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace) en trandolapril (Mavik).

ANGIOTENSIN RECEPTOR BLOCKERS (ARB's)

ARB's blokkeren de werking van het renine-angiotensine-aldosteronsysteem en verminderen de kaliumuitscheiding. Gelijktijdig gebruik van deze geneesmiddelen met kaliumsupplementen verhoogt het risico op hyperkaliëmie. Gelijktijdig gebruik van deze geneesmiddelen met matige kaliuminname via de voeding (ongeveer 3775-5200 mg per dag) verhoogt de serumkaliumspiegels echter niet.

Sommige ARB's zijn losartan (Cozaar), valsartan (Diovan), irbesartan (Avapro), candesartan (Atacand), telmisartan (Micardis), eprosartan (Teveten) en anderen.

POTASSIUM-SPARING DIURETICS

Sommige kaliumsparende diuretica omvatten amiloride (Midamor), spironolacton (Aldactone) en triamterene (Dyrenium) en anderen.

AMPHOTERICINE-B (Abelcet, Amphotec, AmBisome, Amphocin, Fungizone)

Depletie Rating = Major Depletion Een supplement is nodig voor de meeste patiënten.

Amphotericine-B verhoogt urinaire kaliumverliezen als gevolg van toxische effecten op renaal tubulair epitheel. Hypokaliëmie kan voorkomen bij tot 50% van de patiënten (9519). Monitor serumkalium en geef supplementen wanneer nodig. Als hypokaliëmie gepaard gaat met een verslechtering van de nierfunctie, kan het zijn dat amfotericine-B moet worden gestaakt.

DIURETISCHE DRUGS, LUS en THIAZIDE

Depletie Rating = Major Depletion Een supplement is nodig voor de meeste patiënten.

Lus en thiazidediuretica verhogen de uitscheiding van kalium in de urine. Houd de serumkaliumspiegels in de gaten en geef indien nodig kaliumsupplementen (4412,4425,4449). Diuretica in de lus omvatten furosemide (Lasix), bumetanide (Bumex), ethacrynzuur (Edecrin) en torsemide (Demadex). Thiazidediuretica omvatten chloorthiazide (Diuril), hydrochloorthiazide (HydroDiuril, Esidrix), indapamide (Lozol), metolazon (Zaroxolyn), chlorthalidon (Hygroton) en anderen.

Kruiden en supplementen

VITAMINE B12: Voorbijgaande hypokaliëmie kan optreden wanneer ernstige megaloblastaire bloedarmoede wordt behandeld met parenteraal vitamine B12. De toename van de productie van rode bloedcellen creëert nieuwe intracellulaire plaatsen die extracellulaire plaatsen van kalium kunnen afvoeren. De resulterende hypokaliëmie is meestal tijdelijk en gecorrigeerd door normale homeostatische mechanismen . Ook kan het nemen van kaliumsupplementen de absorptie van vitamine B12 bij sommige personen verminderen. Monitor serumkaliumspiegels bij mensen met andere risicofactoren voor hypokaliëmie.

Voedsel

POTASSIUM-BEVATTENDE VOEDING: Theoretisch kan gelijktijdig gebruik de kaliumspiegels en het risico op bijwerkingen verhogen, vooral bij personen met nierfunctiestoornissen, ACE-remmers of kaliumsparende diuretica. Kaliumbevattende voedingsmiddelen omvatten fruit (vooral gedroogd), granen, bonen, melk en groenten (16).

KALIUMBEVATTENDE ZOUTTRANSULTATEN: Theoretisch kan gelijktijdig gebruik de kaliumspiegels en het risico op bijwerkingen verhogen, vooral bij personen met nierstoornissen, ACE-remmers of kaliumsparende diuretica.

Lab testen

Geen bijwerkingen bekend.

Ziektes

ASPIRIN OF TARTRAZINE GEVOELIGHEID: Vermijd orale kaliumproducten die tartrazine bevatten (15).

DIALSYSE: Bloedkaliumspiegels kunnen fluctueren bij patiënten die chronische dialyse ondergaan. Elke dialysemodaliteit kan een specifieke invloed hebben op de kaliumspiegels, waarbij hemodialyse het risico op hyperkaliëmie verhoogt en peritoneale dialyse het risico op hypokaliëmie verhoogt. Kaliumsuppletie of -beperking kan nodig zijn voor sommige patiënten die dialyse ondergaan (95625).

GI-MOTI- LITEITSOMSTANDIGHEDEN: Orale kaliumtabletten en -capsules zijn gecontraïndiceerd bij personen met gastro-intestinale motiliteitscondities (15).

NIER DYSFUNCTIE: Kaliumsuppletie kan gevaarlijk zijn bij patiënten met nierdisfunctie (die ook een kalium-beperkt dieet volgen) vanwege het risico op kaliumaccumulatie leidend tot hyperkaliëmie. Volg nauwlettend serumelektrolyten wanneer kalium wordt gebruikt door mensen met nierdisfunctie.

NIERTRANSPLANTATIE: Er zijn twee meldingen van symptomatische hyperkaliëmie na het gebruik van kaliumcitraat onmiddellijk na de niertransplantatie. Kaliumcitraat wordt vaak gebruikt als een middel voor het alkaliseren van urine in de niertransplantatiepopulatie, maar moet met voorzichtigheid worden toegediend wanneer het onmiddellijk na de transplantatie wordt verstrekt. Volg nauwlettend serumelektrolyten wanneer kaliumcitraat wordt toegediend voor alkalisatie van de urine na niertransplantatie (95623).

Werkingsmechanisme

Algemeen: Kalium is een element dat essentieel is in fysiologische processen, inclusief transmissie van zenuwimpulsen; cardiale, gladde en skeletspiercontractie; maag secretie; nierfunctie; weefselsynthese; en koolhydraatsynthese (15). Onvoldoende inname van kalium in de voeding kan een rol spelen bij de ontwikkeling van hypertensie, beroerte en hart- en vaatziekten. Het is waarschijnlijk dat kalium samen met andere voedingsstoffen gunstige fysiologische effecten produceert (1310,8817).

Cardiovasculaire effecten: een beperking van de natriuminname die gepaard gaat met een verhoogde inname van kalium is aanbevolen om hypertensie en hart- en vaatziekten te voorkomen (69591,92104). Hoge natriumgehaltes in het plasma verstijven endotheelcellen en blokkeren de synthese van stikstofmonoxide, terwijl hoge plasma-kaliumspiegels endotheelcellen verzachten en NO-afgifte activeren. Bovendien zijn natrium- en kaliumpompen nodig om de water- en elektrolytenbalans te handhaven. Kalium moet mogelijk worden verhoogd in situaties met een hoge natriuminname om de effecten van hoog natriumgehalte, zoals een verhoogd volume, tegen te gaan, wat kan leiden tot hypertensie (92106).

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Gerelateerde aandoeningen

Aandoening Dagdosering*
Hartritmestoornissen 3 x daags 100 mg
Hypotensie 1 x daags 100 mg