电解质紊乱致早产儿严重心律失常一例

患儿男,70 min,以早产儿,反应差70 min入院。胎龄28周,出生体重1300 g,Apgar评分1 min7分,生后即刻预防性应用肺表面活性物质。查体:早产儿貌,胎龄评估31~32周,R 45次/min,双肺呼吸音粗,心音稍低钝,律齐,未闻及杂音,腹部、神经系统无异常。入院后行鼻塞呼气末正压通气、镇     

早产儿高钾血症合并室性心律失常18例临床分析

目的 探讨早产儿高钾血症并室性心律失常的高危因素及预防措施.方法 分析18例除外病理因素、在住院期间发生高钾血症并室性心律失常早产儿的胎龄、体质量、尿量、室性心律失常发生时间、血钾浓度、肌酐浓度对其预后的影响.结果 12例存活儿与6例死亡儿的性别、胎龄、出生体质量及发生高钾血症并室性心律失常时尿量差异无显著性(P>0.05),生后至发生高钾血症并室性心律失常的时间、发生心律失常时血钾浓度及血肌酐浓度差异有显著性(P<0.05).结论 胎龄≤32周的早产儿在生后48 h内是发生高钾血症并室性心律失常的高危窗日期,血肌酐浓度增高是预后严重的实验室指标.对于胎龄≤32周的早产儿在生后48 h内应每6小时监测血钾水平,可以早期发现并及时处理,避免严重心律失常的发生.     

新生儿颅内出血与低钙低镁血症

为了探讨新生儿颅内出血与低钙低镁血症的关系，本文作者对３６例新生儿颅内出血患者进行了血清钙、镁的检测。结果低血钙２２例，低镁６例，钙镁均低者５例。说明新和儿因可导致低钙低镁血症．     

婴儿型低磷酸酶血症1例报告及文献复习

目的 加强对婴儿型低磷酸酶血症的认识.方法 对1例婴儿型低磷酸酶血症的临床特点进行分析,并复习相关文献.结果 婴儿型低磷酸酶血症多在生后最初6个月起病,表现为高钙血症、呼吸道感染、广泛的骨化不全及干骺端的佝偻病改变,病死率高.结论 对婴儿型低磷酸酶血症应加强认识,争取早期诊断,及时治疗,以改善预后.     

遗传性电解质紊乱与猝死

电解质是维持生命的一组重要物质,对于机体内环境及细胞稳定具有重要意义。细胞内外的重要电解质,如钠离子、钾离子、钙离子及镁离子等,在核酸及蛋白质合成、维持血浆渗透压、神经肌肉的兴奋性等方面均有重要作用。电解质紊乱可导致血浆渗透压改变、细胞稳定性下降、神经肌肉兴奋性改变,可表现为烦躁、手足搐搦及心动过速、心律失常等,严重者导致猝死。遗传病所致电解质紊乱较为罕见,但是通过普通生化检查就容易诊断,均为可治疗的疾病,如能及时、正确干预,绝大多数患者预后良好。近年来,随着对遗传性电解质紊乱的相关致病基因研究进展,对疾病的认识逐渐深入。文章就可能导致猝死的严重遗传性电解质紊乱的临床特点、诊疗对策及基因研究进展进行探讨。     

新生儿颅内出血与低血钙：附29例分析

新生儿颅内出血是围产儿常见的疾病,是新生儿早期死亡原因之一。现将本院1980～1992年收治的新生儿颅内出血有血钙化验的29例作一临床分析。     

新生儿颅内出血与低钙血症：附34例分析

新生儿颅内出血(NICH)和缺血缺氧性脑病两者可单独发生亦可并存,皆易并发低钙血症(以下简称低钙),但迄今发病率鲜为人知,其机理及诊治特点尚待探索,为此将50例NICH中查血总钙的34例分析如下。     

新生儿颅内出血与低钙血症关系探讨：附25例分析

新生儿颅内出血（ＮＩＣＨ）是围产儿常见的疾病,易并发低钙血症,其发病率鲜见报道,且机理有待探讨,为此。对我院１９９２─１９９８年收治的ＮＩＣＨ中查过血钙者２５例临床分析如下。临床资料１．一般资料２５例中男１４例,女１１例;早产儿６例,足月产１９例;出生体重＜２５００ｇ９例,～４０００ｇ１４例,＞４０００ｇ２例;分娩方式：正常产５例,异常分娩２０例,２５例中窒息史２０例,其中轻度窒息１２例,重度窒息８例。２．临床表现反应差１０例,激惹烦燥８例,昏迷１例,呕吐３例,体温不升８例,前囟紧张或饱满１２例…     

儿童高钾及低钾血症发生机制及危重处置要点

钾是体内含量最多的细胞内离子,具有重要的生理功能,维持体内钾浓度的稳定具有十分重要的意义。钾离子失衡可影响肌肉的收缩力、神经传导和心肌电生理。无论是高钾血症还是低钾血症都可产生严重后果,快速明确病因并给予有效治疗可挽救患儿生命。     

Potassium disorders in pediatric emergency department: Clinical spectrum and management

IntroductionPotassium abnormalities are frequent in intensive care but their incidence in the emergency department is unknown.AimWe describe the spectrum of potassium abnormalities in our tertiary-level pediatric emergency department.MethodsRetrospective case-control study of all the patients admitted to a single-center tertiary emergency department over a 2.5-year period. We compared patients with hypokalemia (< 3.0 mEq/L) and patients with hyperkalemia (> 6.0 mEq/L) against a normal randomized population recruited on a 3:1 ratio with potassium levels between 3.5 and 5 mEq/L.ResultsBetween January 1, 2013 and August 31, 2016 we admitted 108,209 patients to our emergency department. A total of 9342 blood samples were tested and the following potassium measurements were found: 60 cases of hypokalemia (2.8 ± 0.2 mEq/L) and 55 cases of hyperkalemia (6.4 ± 0.6 mEq/L). In total, 200 patients with normokalemia were recruited (4.1 ± 0.3 mEq/L). The main causes of the disorders were non-specific: lower respiratory tract infection (23%) and fracture (15%) for hypokalemia, lower respiratory tract (21.8%) and ear–nose–throat infections (20.0%) for hyperkalemia. Patients with hyperkalemia had an elevated creatinine level (0.72 ± 1.6 vs. 0.40 ± 0.16 mg/dL, P < 0.0001) with lower bicarbonate (19.4 ± 3.8 vs. 21.8 ± 2.8 mmol/L, P = 0.0001) and higher phosphorus levels (1.95 ± 0.6 vs. 1.42 ± 0.27 mg/dL, P = 0.0001). Patients with hypokalemia had an elevated creatinine level (0.66 ± 0.71 vs. 0.40 ± 0.16 mg/dL, P < 0.0001) and a lower phosphorus level (1.12 ± 0.31 vs. 1.42 ± 0.27 mg/dL, P = 0.0001). We did not observe significant differences in pH, PCO₂, base excess and lactate, or in the mean duration of hospitalization in general wards and pediatric intensive care units according to the PIM and PRISM scores.DiscussionDyskalemia is rare in emergency department patients: 0.64% for hypokalemia and 0.58% for hyperkalemia. This condition could be explained by a degree of renal failure due to transient volume disturbance. The main mechanism is dehydration due to digestive losses, polypnea in young patients, and poor intake. In the case of hypokalemia, poor intake and digestive losses could be the main explanation. These disorders resolve easily with feeding or perfusion and do not impair development.ConclusionDyskalemia is rare in emergency department patients and is easily resolved with feeding or perfusion. A plausible etiological mechanism is a transient volume disturbance. Dyskalemia is not predictive of poor development in the emergency pediatric population.     

Neonatal arrhythmias

Objective: Neonatal arrhythmias are not uncommon; however, they rarely cause hemodynamic compromise. This paper aims to study the etiology, spectrum and outcome of neonates with arrhythmias who presented to a pediatric department.Methods: All neonates, either inborn or brought to the pediatric emergency with rhythm disorders, between August 1999 to August 2002, were included prospectively. Evaluation including a search for secondary causes of rhythm disorder and a chest X-ray, standard 12-lead electrocardiography and echocardiography in all. The management required in each and the outcomes were noted.Results: Nine neonates were identified, of which 4 were inborn. Tachycardia was seen in 8 neonates, and bradycardia in only one. Three neonates had an antenatal onset of arrhythmias; in the rest it was postnatal in onset. Five neonates had a secondary rhythm disorder, secondary to metabolic derangements in 4 and a cardiac mass in 1. Five had ventricular arrhythmias, and 5 had hemodynamic compromise due to the arrhythmia. The outcome was poor in 4 and was related to the underlying illness.Conclusion: Tachyarrhythmia is more common than bradyarrhythmia in the neonate. Arrhythmias secondary to various metabolic causes are more common than primary rhythm disorders.     

内分泌疾病相关的电解质紊乱及救治措施

内分泌疾病由于机体内分泌激素的异常可导致电解质紊乱,这将不同程度损害机体的健康,如不能及时正确认识疾病并给予有效的处理措施,严重者可危及生命。本文概述了内分泌疾病相关的电解质紊乱及相应的救治措施,希望引起临床医生的重视,有效提高临床医师的诊治能力。     

Electrolyte disturbance with omeprazole therapy

Omeprazole is an antagonist to the H⁺K⁺ ATPase of the gastric parietal cell. We report a case of severe electrolyte disturbance in a 5-year-old child treated with omeprazole associated with excessive urinary sodium loss, that responded completely to omeprazole with-drawal.     

小儿晕厥与代谢异常

晕厥是儿科常见急症,代谢异常所致的晕厥是儿童晕厥鉴别诊断的重要原因之一.导致儿童晕厥的代谢异常主要有低血糖、过度换气、电解质紊乱、低氧血症等,其中低血糖病因包括高胰岛素血症、垂体和肾上腺疾病、糖尿病、酮症性低血糖及糖和有机酸、氨基酸代谢缺陷病等.本文介绍导致儿童晕厥常见的代谢异常及病因、疾病诊断和治疗.     

新生儿成熟度和产后日龄对血清钾水平的影响

目的　探讨新生儿成熟度和产后日龄对血清钾浓度的影响。方法　回顾性分析了胎龄为 2 4～ 2 8周 (A组 ) ,2 9～ 3 2周 (B组 ) ,3 3～ 3 6周 (C组 )和 3 7～ 4 2周 (D组 )新生儿生后 1～ 72h内的血清钾水平及其变化。结果　①新生儿的胎龄、体重和尿量与血清钾水平存在着线性关系。②生后 1～ 2 4h ,A组新生儿的血清钾水平最高 ,B组次之 ,C和D组相当 ,为最低。生后 4 8h内 ,A和B组的血清钾水平开始下降 ,并于 72h内下降至C和D组新生儿水平。C和D组新生儿生后 72h内的血清钾水平无明显变化。③A ,B和C组早产儿生后 2 4h内高钾血症 (≥7.0mmol/L)发生率分别为 2 0 .0 % ,12 .5%和 4 .0 % ;2 4例高钾血症患儿经常规治疗后 ,14例 (58.3 % )于 72h内血钾降至 7.0mmol/L以下并存活 ;10例 (4 1.7% )高钾血症状态持续存在 ,其中 7例死亡。D组足月儿于生后 72h内未出现高钾血症。结论　新生儿的成熟度和产后胎龄影响血清钾水平 ;极不成熟新生儿 (2 4～ 3 2周 )在生后 2 4h内具有较高的血清钾水平 ,继之随生后日龄的增加而降低 ;早产儿可有致命性高钾血症存在 ,常规治疗仅部分有效。     

儿童肾性高钾血症的诊断与鉴别诊断

肾脏是维持血钾平衡的最主要器官,多种急慢性肾脏疾病因肾小球滤过率降低或肾小管排钾功能障碍,导致血钾升高,使得高钾血症成为儿童肾脏疾病容易伴发的电解质紊乱,甚至危及生命。因此肾性高钾血症的诊断与鉴别诊断,对于临床医师尤为重要。     

Hypokalemia and Hyperkalemia in Infants and Children: Pathophysiology and Treatment

Potassium is the second most abundant cation in the body. About 98% of potassium is intracellular and that is particularly in the skeletal muscle. Electrical disturbances associated with disorders of potassium homeostasis are a function of both the extracellular and intracellular potassium concentrations. Clinical disorders of potassium homeostasis occur with some regularity, especially in hospitalized patients receiving many medications. This article will review the pathophysiology of potassium homeostasis, symptoms, causes, and treatment of hypo- and hyperkalemia.     

严重高钙血症发生机制及救治

钙是人体中必不可少的元素,在骨形成、激素释放和肌肉收缩神经传导方面具有重要作用。高钙危象属于内分泌急症,需要进行紧急救治,以免产生严重后果。儿童高钙危象发生虽然远远低于成人,但由于其临床症状重,更应引起临床医生警惕。本文对严重高钙血症的诊断、鉴别诊断及治疗原则等方面进行归纳总结。