.

+

( 1X 106/L)

+ 6.7mEq/L, Na+ 140mEq/L, 0.8mg/dl. .

(1)(+ >5.3mEq/L)

1) +:

2) PLT

48 (50mg/)

. QRS . : 450mg/dl, 2.8mg/dl, 190mg/dl, + 8.3mEq/L, Na+ 136mEq/L, pH 7.07, HCO3- 14mEq/L

(2)

3) + :

- (

+

+-+ ATP

(3)

3) + :

- (

+

+

Posm H2O + +

(4)

3) + :

(+)

- (

+ PO43- o Ca2+

A tumor lysis-like syndrome during therapy of visceral leishmaniasis

3

9.8mg/dl ( 5.1mg/dl)

+ 5.9 mEq/L ( 4.1mEq/L)

PO43- 5.2mg/dl ( 3.1mg/dl)

E. Liberopoulos et al: Ann Clin Lab Sci 2002;32: 419-421

+

(5)

4) +

3Na+

2K+

Na+

K+

Aldo-RecALDO

- +

Cl-

( Addison)

( )

(50% )

63 , (Septrin forte 1X2 ). . : :160mg/dl, : 60mg/dl, : 1.6mg/dl, +: 7.2mmol/L,Cl-: 110mmol/L, Na+:134mmol/L, pH: 7.33, PCO2: 32mmHg HCO3-: 16mmol/L.

)

)

) K+

) K+

+

+ , :

)

)

)

)

Siamopoulos KC, Elisaf M, Katopodis K

Iatrogenic hyperkalemia - points to consider in diagnosis and management

Nephrol Dial Transplant 1997;13: 2402-2406

+

+ : - -:

+:

+

+ (0.4mmol/L)

, , o +

+

+ : - -:

+:

3Na+

2K+

Na+

K+

Aldo-RecALDO

- +

Cl-

3Na+Na+

K+

2K+

ALDO

: + V +

-

Aldo-Rec

, :

)

)

)

) -

Na+

K+ ALDO,-

Cl-

- +

Aldo-Rec

3Na+

2K+

: +

+ ( )

+ ()- + ( )

+ ( ) + ( )

: 2004;4: 167-176

: -

+

+

Hyperkalemia (K+>5.3mEq/L) in 9.3% of CHF patientsHJ Milionis et al: Eur J Heart Fail 2002;4: 167-173

:

: 1.5mg/dl, K+: 5.7mmol/L, Cl-: 109mmol/L, Na+: 134mmol/L pH: 7.34

9 ++

9 (0.2-1mg/)

-

(1)

9 Ca2+ (10ml 10% 2 3 )

(2)

+ :

) 1L + 15-20 + 0.5-1.5mEq/L, 1h

) NaHCO3 (44-50mEq)

) -

+ :

9 9 9

(3)

(+

+

+

+

+

+-+ ATP

(+

(1)

( +)

(/)

Cushing- ACTH

+ ( )

3Na+Na+

K+

Aldo-Rec

2K+

ALDO

- +

Cl-

+ + (, , , +)

(3)

: , , ,

+ (+ ): , ,

(n=76)

8

4

8

9

3

3

H Milionis et al: Southern Med J 2002;95: 1280-1287

( )

Milionis HJ, Bourantas KL, SiamopoulosKC, Elisaf MS

Acid-base and electrolyte abnormalities in patients with acute leukemia

Am J Hematol 1999;62: 201-207

63%

30.3%

31.8%

45.4%

9%

Am J Hematol, 1999;62:201-207

Alterations in electrolyte equilibrium in

patients with acute leukemiaFilippatos TD et al: Eur J Haematol 2005;75: 449-460

Na+

Cl-

-48mV

+-

Na+

-83mV

+-

V +

-

(4)

: , , ,

+ : .. ( )

52 . . : 82mg/dl, K+ : 2.5mmol/L, pH: 7.52, PCO2: 46mmHg HCO3-: 32mmol/L.

:

)

)

)

)

, :

) +

) Mg2+

)

) a+

+

Mg2+

+ :

/

(1)

+ :

(2)

(3)

+

Mg2+

+ ..

+ (25mmol/L)

M. Elisaf et al: Postgrad Med J 1995;71: 211-212

M Elisaf et al: Q J Med 2000;93: 318

(4)

+

Mg2+

( , cisplatin, ,

, )

+

(+ )

Elisaf M, Milionis H, Siamopoulos KC

Hypomagnesemic hypokalemia and hypocalcemia: Clinical and laboratory characteristics

Miner Electrolyte Metab 1997;23: 105-112

Elisaf M, Merkouropoulos M, TsianosEV, Siamopoulos KC

Acid-base and electrolyte abnormalities in alcoholic patients

Miner Electrolyte Metab 1994;20: 274-281

(n=127)

12.6%

29.9%

17.3%

29.1%

20.5%

M. Elisaf et al: Miner Electrolyte Metab 1994;20: 274-281

+ 55mmo/L Mg2+ 1mmol/L. 140/90mmHg

K+

Na+ (, .)

(.. )

/

ACTH

Konstantinidis A, Elisaf M, Panteli K, Constantopoulos S

Severe muscle weakness due to hypokalemia as a manifestation of small-cell carcinoma

Respiration 1999;66: 269-272

76

. .: 2004; 21: 51-62

:-

--

(+ )

(+

KCl Per os

KCl

+: 60mEq/L ( 4amp) K+: 40mEq/L ( 3amp) K+: 10-20mEq/h

+(, )

KCl vs KHCO3

+

50-65 mEq K+/teaspoon Cl-

/

H2O:

&

Posm=2 X Na+ (mg/dl) (mg/dl)(mosmol/kg) (mmol/L)

18 6+ +

Posm=2 X Na+ + /18 + /6

Posm +

+ 2

Posm 2

:

Posm 2O

+ =+e + K+e

H2O

Na+e + K+e : + +

+ =+e + Ke+

H2O

+ ( +) > 2[]

H2O

H2O

Posm

ADH

H2O

2 ()

2

ADH

SIADH

( )

( , )

H2O

H2O

ADH +

+

+

+

H2O

33.7%(+

ADH

ADH

H2O Na+

+

+ 2

( ) ADH ( /)

:

SSRIs . a+

: 110mmol/L, 0.6mg/dl, + 4mmol/L,

, :

) Posm

) ,

) Uosm

) ADH

Milionis HJ, Liamis GL, Elisaf MS

The hyponatremic patient:

A systematic approach to laboratory diagnosis

CMAJ 2002;166: 1056-1062

-

Posm: /

Posm: ,

Posm ,

Na+

Posm H2O +

2 ( Na+)

H2O

H2O

(2)

( ):

Uosm

, , 1006

) Na+

) +

) Mg2+

) Ca++

(3)

Na+ (40mmol/L):

ADH

+ (25/1)

(>5mg/dl)

a+

56mmol/L

ADH, :

)

)

) PO43-

) pH

ADH

(+ FE )

(

:

+ 110mmol/L

Na+ 56mmol/L

2.3mg/dl (FE 20%)

PO43- 2.1mg/dl

21mg/dl (FE 64%)

SIADH

Multiple metabolic abnormalities in a

patient with SIADHE. Rizos et al: Nephron 2002;91: 339-340

ADH

( )

, , , .)

NaCl H2O

SIADH

9 +

+ +

SIADH

(.. )

H2O

NaCl

:

(, , , , )

+

80kg + 110mmol/L

: + 130mmol/L

+: 20mmol/L

40h

+ (mmol) 20mmol/L: 0.6 X 80 X 20=960mmol

NaCl (3%) : 960/514=1.8L

NaCl 3% 1.8L/40h=45ml/h + (0.5-1mg/kg)

ADH H2O

H2O

+ = +e + +e

H2O

: 2 > + + + =

+ ()

: , ,

ADH ADH

85 (=80 kg) . NaCl0.9% (1L /). 380C. 3 + : 164mmol/L, : 170mg/dl, + : 3.4mmol/L, : 90mg/dl, : 1.9mg/d,

, :

) H2O

)

)

)

)

H2O ( +)

( + ?)

+

+

H2O

[ H2O Na+]

)

)

)

)

Na+

) 40mmol/L

+

+ (

H2O a+

1L NaCl 0.9%

: / Na+

vs

: ( Na+ )

: 2 +

HYPERNATREMIA DURING CORRECTION OF HYPERCALCEMIA

2.5LNaCl 0.9% +2amp KCl/L

[osmolality 360mosmol/kg] 2.2mg/dl 1.4mg/dlCa2+ 167mg/dl 13.1mg/dl+ 143mmol/L 157mmol/L

G. Liamis et al: Nephron 2000;86: 358

;

) +

) +

) Uosm ( )

) pH

Uosm

>800mosmol/kg +

H2O

Uosm 440mosmol/Kg

,

) ( 1mmol/L/h)

)

) H2O

:

) 5% (+ KCl)

) NaCl 0.45% (+Cl)

) NaCl 0.9% (+KCl)

) NaCl 3% (+Cl)

( NaCl 0.9%)

Na+

-

H2O :

) 2L

) 5L

) 8L

) 10L

(1)

H2O:

0.5 (0.4) -1Na+

140

)

) NaCl 0.9%

) NaCl (N/4) + KCl (3amp/L)

) NaCl (N/2) + KCl (3amp/L)

(2)

.. /4: 1L N/4 +3 Cl 140mosmol 0.5 L H2O

60kg, + : 170mmol/L

: + 140mmol/L ( 30mmol/L)

: 60h

H2O = 0.5 X -1 = 6L

140

6L 2/60h=100ml/h 30-50ml/h( )

H2O 140ml/h /4 750ml2 180ml/h

/4 3KCL 500ml H2O 280ml/h