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Kalium

Wat is 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.

Wetenschappelijke naam

Kalium; K, Atoomnummer 19.

Wat is kalium?

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, chronisch vermoeidheidssyndroom, colitis, verwardheid, constipatie, tandpijn, dermatitis, diabetes, verminderde glucosetolerantie (prediabetes), oedeem, koorts, jicht, slapeloosheid, prikkelbaarheid, mononucleosis infectiosa , 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 aritmie en myocardiaal infarct.

Topisch wordt kalium gebruikt voor waterwratten.

Gebruik

Werking

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).

Werking

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 verlaagt 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.

Veiligheid

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.

Bijwerkingen

Interacties

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)
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
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

Kalium 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).

Kalium bevattende 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).

Dialyse
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).

Gastro-intenstinale motiliteit problemen
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).

Interacties

Dosering

Voor kalium is de Referentie Inname (RI) 2000 milligram per dag. Dit is een grove schatting van de hoeveelheid die volwassenen gemiddeld nodig hebben op een dag.

De Gezondheidsraad heeft voor specifieke doelgroepen een aanbevolen dagelijkse hoeveelheid (ADH) opgesteld:

Leeftijd ADH (mg per dag)
Kinderen
6-11 maanden 1.100
1-2 jaar 1.400
2-5 jaar 1.800
6-9 jaar 2.000
Mannen
10-13 jaar 3.300
14 jaar en ouder 3.500
Vrouwen
10-13 jaar 2.900
14-17 jaar 3.100
18 jaar en ouder 3.500
Zwangere vrouwen 3.500
Vrouwen die borstvoeding geven 3.100
Dosering
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