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8/16/2019 9.ECG Si Diselectrolitemiile
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Dr Camelia Diaconu
UMF Carol Davila
Spitalul Clinic de Urgenta Bucuresti
ECG in diselectrolitemii
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Hiper K
Poate conduce la stop cardiac daca K seric> 7 mE!"
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Modi#cari ECG
$%Prelungirea intervalului P& ' > ( patratele)
*%Prelungirea comple+ului ,&S ' > - patratele)-%Unde . inalte
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Hiper K
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Hiper K
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.ratamentul /iper K
1. Regula 10-10-10: 10 ml de gluconatde calciu 10% IV in 10 min
*% Gluco0a /ipertona $12 3 insulina iv 4la
pacientii nondia5etici-% Bicar5onat de sodiu in acido0a meta5olica
6% Daca nu se ameliorea0a se ace/emodiali0a
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Hipo K 8 modi#cari ECG
1. Unda T aplatizata
2. Prezenta undelor U
. !u"deni#elarea !T $in
cazuri e#ere&
44 ma9oritatea pacientilorcu /ipoK pot pre0enta
e+trasistole ventriculare:ta/icardiesupraventriculara sau#5rilatie atriala pe ECG
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.ratamentul /ipo K
;n /ipo K usoare se adm% KCl -<6 g!0i sau serecomanda suc de ructe
;n /ipoK severe se adm% KCl iv $11 mmol!0i
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Calciul
Calciul seric normal =%(<$1%( mg!dl
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Hiper Ca 8 ,. scurt
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Hiper Ca
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.ratamentul /iper Ca
!' 0.(% in primele 2) ore
'uroemid )0 mgCalcitonina
BiosonatiPrednisolon
Daca nu e+ista raspuns: se ace /emodiali0a
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Hipo Ca < prelungirea intervalului ,.
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.ratamentul /ipo Ca
$% Corectarea alcalo0ei prin respiratia inpunga
*% &olul $1<$1<$1
-% Daca nu e+ista raspuns se adm% clorurade calciu sau clorura de magne0iu
6% la < $ colecalcierol
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Ce anomalie electrolitica va sugerea0a ECG?a) /iponatremie5) /ipernatremiec) /iperpotasemie
d) /ipopotasemiee) /ipercalcemie
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Bar5at 6@ ani: a#rma atiga5ilitate musculara si constipatie% Faradurere toracica sau dispnee% Ce indica ECG?a) /ipoK 5) /iperK c) /ipoCa
d) /iperCae) /ipotiroidie
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Femeie 77 ani
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anomalie S si unde . inalte: ,. lung: su5denivelare S. nespeci#ca in derivatiiiala stanga 'HBS)alte sugerea0a /iperK: ,. lung sugerea0a /ipoCaS sugerea0a ;& cu H.
. inalte 3 ,. lung 3 HAS ;&
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t ( ani% ;M? ;l trimitem de urgenta la cardiolog?
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. inalte '/iperK): P& lung: HAS nu toate undele .inalte sunt /iperacuteK @: mE!"
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Bar5at -1 ani: ara tratament am5ulator% ECG?
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e U: prelungirea ,.: /ipoK severa '$:( mE!") crescut de torsada varurilor
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Bar5at -( ani daca ati putea ace un singur test dela5orator: care ar # acela?
ECG l i /i l i 'i $- @
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ECG clasic pentru /ipercalcemie 'in acest ca0 $-:@mg!d")%S. scurt: supradeniv% S. in A*: A-% ;n /iperCaeste invers 8 ,. lung datorita S. lung
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-$ ani cu ECG care simulea0a isc/emia% Ce anomalie electrolitica susp
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HipoK 'aici *:* mE!")% HipoK severa poate determinasu5denivelare S. si negativarea undei .: mimandisc/emia% Se o5serva unda U%
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Aa multumesc
