BÖLÜM


DOI :10.26650/B/CH12CH47.2023.014.10   IUP :10.26650/B/CH12CH47.2023.014.10    Tam Metin (PDF)

Yaşlılarda Potasyum Ve Magnezyum Deği̇şi̇kli̇kleri̇ Ve Tedavi̇si̇

Rümeyza Kazancıoğlu

Günümüzde “yaşlanan bir dünya” zorluğuyla karşı karşıyayız. 2050 yılları için epidemiyolojik projeksiyon dünyada 1,6 milyar insanın 65 yaş ve üstü olacağını belirtiyor, dolayısıyla gelecekte yaşlı nüfusu etkileyen kronik hastalıkların önemi artacak ve aktif ve sağlıklı yaşlanmanın doğru cevabını vermek zor olacaktır.1 Yaşlanma ile beraber böbreklerde hacim ve ağırlıkta azalma gibi anatomik değişiklikler yanında arterlerde hiyalinozis, intimada kalınlaşma, nefron sayısının azalma ve sklerotik glomerül oranında artma gibi histopatolojik değişiklikler geliştiği bildirilmiştir.2 Bu değişikliklerin klinik yansıması olarak azalan böbrek fonksiyonları ve elektrolit anormallikleri sıkça karşımıza çıkmaktadır.3 Bu klinik tablolarda yaşlanma ile beraber sıklığı artan beslenme bozuklukları ve çoklu ilaç kullanımının da diğer önemli faktörler olduğu söylenebilir. 3



Referanslar

  • 1. Kowal W, Goodkind P, He D (2016) An aging world: 2015. International Population Reports. U.S. Gov. Print. Off, Washington, DC google scholar
  • 2. Altum B. Bobrek ve yaslanama. Turk Jour of Geriat. 1998; 1 (2): 68-71, 1998 google scholar
  • 3. Gursu M, Kazancioglu R, Ozturk S. Yaslanan bobrek: Yaslanma mi hastalik mi?. Nobel Med 2013; 9(2): 10-14 google scholar
  • 4. Heybeli C, Tan G S, Prevalence of Electrolyte Impairments Among Outpatient Elderly Subjects, Bezmi-alem Science 2022;10(3):305-11 google scholar
  • 5. Barragan R, Llopis J, Portoles O, et al. Influence of Demographic and Lifestyle Variables on Plasma Magnesium Concentrations and Their Associations with Cardiovascular Risk Factors in a Mediterranean Population. Nutrients 2020;12. google scholar
  • 6. Boddy K, King PC, Hume R, Weyers E. The relation of total body potassium to height, weight, and age in normal adults. J Clin Pathol 1972; 25:512. google scholar
  • 7. Gumz ML, Rabinowitz L, Wingo CS. An Integrated View of Potassium Homeostasis. N Engl J Med. 2015; 373(18): 1787-8. google scholar
  • 8. Aygencel G. Potasyum Metabolizmasi Bozukluklari. Yoğun Bakım Dergisi 2018;12(1):31-42. google scholar
  • 9. Perazelle MA, Rastegar M (2014) Disorders of potassium homeostasis. In: Reilly RF, Perazella MA (eds) Nephrology in 30 days, 2nd edn. McGraw-Hill Education, New York, pp 86-103 google scholar
  • 10. Eliacik E, Yildirim T, Sahin U,et al. Potassium abnormalities in current clinical practice: frequency, causes, severity and management. Med Princ Pract. 2015;24(3):271-5. google scholar
  • 11. Bardak S, Turgutalp K, Koyuncu MB, et al. Community-acquired hypokalemia in elderly patients: related factors and clinical outcomes. Int Urol Nephrol. 2017 Mar;49(3):483-489. google scholar
  • 12. Mount DM (2016) Disorders of potassium balance. In: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL (eds) Brenner & Rector’s The Kidney, 10th edn. Elsevier Saunders, Philadelphia, pp 559-600 google scholar
  • 13. Kaplan NM (2004) The current epidemic of primary aldosteronism: causes and consequences. J Hypertens 22:863-869 google scholar
  • 14. Liamis G, Rodenburg EM, Hofman A, Zietse R, Stricker BH, Hoorn EJ. Electrolyte disorders in community subjects: prevalence and risk factors. Am J Med 2013; 126: 256-63 google scholar
  • 15. Kaplan NM, Carnegie A, Raskin P, Heller JA, Simmons M. Potassium supplementation in hypertensive patients with diureticinduced hypokalemia. N Engl J Med 1985; 312: 746-9 google scholar
  • 16. Franse LV, Pahor M, Di Bari M, Somes GW, Cushman WC, Applegate WB. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program. Hypertension 2000; 35: 1025-30. google scholar
  • 17. Wright JT. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enz-yme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and LipidLowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981-97 google scholar
  • 18. Palmer BF. Metabolic complications associated with use of diuretics. Semin Nephrol 2011; 31: 542-52 google scholar
  • 19. Zillich AJ, Garg J, Basu S, Bakris GL, Carter BL. Thiazide diuretics, potassium, and the development of diyabetes: a quantitative review. Hypertension 2006; 48: 219-24 google scholar
  • 20. Cohn JN, Kowey PR, Whelton PK, Prisant LM. New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice. Arch Intern Med 2000; 160:2429. google scholar
  • 21. Wahr JA, Parks R, Boisvert D, et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. Multicenter Study of Perioperative Ischemia Research Group. JAMA 1999; 281:2203. google scholar
  • 22. Kardalas E, Paschou SA, Anagnostis P, Muscogiuri G, Siasos G, Vryonidou A. Hypokalemia: a clinical update. Endocr Connect. 2018;7(4):135-146. google scholar
  • 23. David B Mount, MD. Clinical manifestations and treatment of hypokalemia in adults. UpToDate, Jan 2023 google scholar
  • 24. Chen EH, Hollander JE. When do patients need admission to a telemetry bed? J Emerg Med 2007; 33:53. google scholar
  • 25. Castellino P, Bia MJ, DeFronzo RA. Adrenergic modulation of potassium metabolism in uremia. Kidney Int 1990; 37:793. google scholar
  • 26. Buurman BM, Frenkel WJ, Abu-Hanna A, Parlevliet JL, de Rooij SE. Acute and chronic diseases as part of multimorbidity in acutely hospitalized older patients. Eur J Intern Med. 2016;27:68-75. google scholar
  • 27. Choudhury D, Raj DSC, Levi M. Effect of aging on renal function and disease. In: Brenner BM editor. Brenner & Rector’s The Kidney. Philadelphia: Saunders; 2004. 2305-41. google scholar
  • 28. Ateş K. Sıvı elektrolit denge bozuklukları. İn: Gökçe-Kutsal Y editor. Temel geriatri 1st ed. Ankara: Güneş Tıp kitapevi; 2007;211-30. google scholar
  • 29. Baker M, Perazella MA. NSAIDs in CKD: Are They Safe? Am J Kidney Dis. 2020;76(4):546-557. google scholar
  • 30. Elgendy IY, Huo T, Chik V, Pepine CJ, Bavry AA. Efficacy and safety of angiotensin receptor blockers in older patients: A meta-analysis of randomized trials. Am J Hypertens. 2015;28:576-585. google scholar
  • 31. Mandic D, Nezic L, Skrbic R. Severe hyperkalemia induced by propranolol. Med Pregl. 2014;67(5-6):181-4 google scholar
  • 32. Shibata S. 30 YEARS OF THE MINERALOCORTICOID RECEPTOR: mineralocorticoid receptor and NaCl transport mechanisms in the renal distal nephron. J Endocrinol. 2017;234:T35-47. google scholar
  • 33. Takaichi K, Takemoto F, Ubara Y, Mori Y. Analysis of factors causing hyperkalemia. Intern Med. 2007;46:823-829. google scholar
  • 34. Jain N, Kotla S, Little BB, et al. Predictors of hyperkalemia and death in patients with cardiac and renal disease. Am J Cardiol. 2012;109:1510-1513. google scholar
  • 35. Clase CM, Carrero JJ, Ellison DH, et al. Potassium homeostasis and management of dyskalemia in kid-ney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2020; 97:42. google scholar
  • 36. Long B, Warix JR, Koyfman A. Controversies in Management of Hyperkalemia. J Emerg Med 2018; 55:192. google scholar
  • 37. Mount DB. Disorders of potassium balance. In: Brenner and Rector’s The Kidney, 11th ed, Yu A, Chertow G, Luyckx V, et al (Eds), W.B. Saunders & Company, Philadelphia 2020. p.537. google scholar
  • 38. Pergola PE, DeFronzo R. Clinical disorders of hyperkalemia. In: The Kidney: Physiology and Pathophysi-ology, Seldin DW, Giebisch G (Eds), Lippincott Williams & Wilkins, 2000. Vol 2, p.1647. google scholar
  • 39. Harel Z, Kamel KS. Optimal Dose and Method of Administration of Intravenous Insulin in the Manage-ment of Emergency Hyperkalemia: A Systematic Review. PLoS One 2016; 11:e0154963. google scholar
  • 40. Sterns RH, Grieff M, Bernstein PL. Treatment of hyperkalemia: something old, something new. Kidney Int 2016; 89:546. google scholar
  • 41. Rafique Z, Liu M, Staggers KA, et al. Patiromer for Treatment of Hyperkalemia in the Emergency Depart-ment: A Pilot Study. Acad Emerg Med 2020; 27:54. google scholar
  • 42. Peacock WF, Rafique Z, Vishnevskiy K, et al. Emergency Potassium Normalization Treatment Inclu-ding Sodium Zirconium Cyclosilicate: A Phase II, Randomized, Double-blind, Placebo-controlled Study (ENERGIZE). Acad Emerg Med 2020; 27:475. google scholar
  • 43. Packham DK, Rasmussen HS, Lavin PT, et al. Sodium zirconium cyclosilicate in hyperkalemia. N Engl J Med 2015; 372:222. google scholar
  • 44. Hagan AE, Farrington CA, Wall GC, Belz MM. Sodium polystyrene sulfonate for the treatment of acute hyperkalemia: a retrospective study. Clin Nephrol 2016; 85:38. google scholar
  • 45. Sowinski KM, Cronin D, Mueller BA, Kraus MA. Subcutaneous terbutaline use in CKD to reduce potas-sium concentrations. Am J Kidney Dis 2005; 45:1040. google scholar
  • 46. Ahee P, Crowe AV. The management of hyperkalaemia in the emergency department. J Accid Emerg Med 2000; 17:188. google scholar
  • 47. Saris NEL, Mervaala E, Karppanen H, Kwawaja JA, Lewenstam A. Magnesium: An update on physio-logical, clinical and analytical aspects. Clin Chim Acta 2000;294:1-26. google scholar
  • 48. Tong GM, Rude DK. Magnesium deficiency in critical illness. J Intensive Care Med 2005;20:3-17 google scholar
  • 49. Greenberg A. Diuretic complications. Am J Med Sci 2000; 319: 10-24 google scholar
  • 50. Arinzon Z, Peisakh A, Schrire S, Berner YN. Prevalence of hypomagnesemia (HM) in a geriatric long-term care (LTC) setting. Arch Gerontol Geriatr 2010; 51: 36-40 google scholar
  • 51. Sica DA. Current concepts of pharmacotherapy in hypertension: thiazide-type diuretics: ongoing conside-rations on mechanism of action. J Clin Hypertens (Greenwich) 2004; 6: 661-4. google scholar
  • 52. Elisaf M, Merkouropoulos M, Tsianos EV, Siamopoulos KC. Pathogenetic mechanisms of hypomagnese-mia in alcoholic patients. J Trace Elem Med Biol 1995; 9: 210-4. google scholar
  • 53. Negri AL, Valle EE. Hypomagnesaemia/hypokalemia associated with the use of esomeprazole. Curr Drug Saf 2011; 6: 204-6 google scholar
  • 54. Ford ES, Mokdad AH. Dietary magnesium intake in a national sample of US adults. J Nutr 2003; 133: 2879-82. google scholar
  • 55. Barbagallo M, Belvedere M, Dominguez LJ. Magnesium homeostasis and aging. Magnes Res. 2009;22(4):235-46. google scholar
  • 56. Touyz Rm. Magnesium in Clinical Medicine. Front Biosci 2004; 9: 1278-93. google scholar
  • 57. Gupta A, Yu L. S. A. Hypermagnesemia: Causes, symptoms, and treatment. UpToDate. Oct 2022 google scholar
  • 58. Neumar RW, Otto CW, Link MS, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S729. google scholar
  • 59. Kraft MD, Btaiche IF, Sacks GS, Kudsk KA. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm 2005; 62:1663. google scholar
  • 60. Alan S L Yu, MB, BChir. Hypomagnesemia: Evaluation and treatment. UpToDate, Oct 2022 google scholar


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