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Elektrolytstörungen in der Intensivmedizin

Electrolyte disorders in intensive care medicine

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Die Nephrologie Aims and scope

Zusammenfassung

Elektrolytstörungen sind häufig in der Intensivmedizin und können Mortalität und Morbidität beeinflussen. Eine rasche Diagnostik ist für eine adäquate Therapie notwendig, darf allerdings im Einzelfall nicht die notwendige Korrektur der Elektrolytstörung verzögern. Die Hyponatriämie mit schweren Symptomen wie Krampfanfällen oder Koma sollte in der Regel durch Gabe von 3 % NaCl behandelt werden, weniger klinisch ausgeprägte Formen sollten zunächst diagnostisch beurteilt und dann spezifisch behandelt werden. Die Hypernatriämie tritt insbesondere in der Intensivmedizin häufig auf und sollte in Abhängigkeit von der Genese therapiert werden, da die Hypernatriämie mit einer erhöhten Mortalität einhergeht. Hyperkaliämie und Hypokaliämie müssen insbesondere wegen Herzrhythmusstörungen rasch erkannt und therapiert werden. Während die Hypophosphatämie auf der Normalstation eine untergeordnete Rolle spielt, muss sie auf der Intensivstation diagnostiziert und substituiert werden, da hierdurch die Mortalität gesenkt werden kann.

Abstract

Electrolyte disorders frequently occur in intensive care medicine and can influence mortality and morbidity. A rapid diagnostic evaluation is required for adequate treatment but in individual cases, this should not delay the necessary correction of the electrolyte disorder. Hyponatremia with severe symptoms, such as seizures or coma usually requires the administration of 3% NaCl, while less clinically severe forms should initially be diagnostically assessed and then be specifically treated. Hypernatremia occurs particularly frequently in intensive care medicine and should be treated based on the genesis as hypernatremia is associated with increased mortality. Hyperkalemia and hypokalemia should be rapidly diagnosed and treated given the increased risk of cardiac arrhythmia. While hypophosphatemia plays a subordinate role on normal wards, on the intensive care unit it must be diagnosed and subsequently substituted as this can reduce mortality.

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  1. Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    Heiko Schenk,  Kai M. Schmidt-Ott &  Julius J. Schmidt

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  1. Heiko Schenk
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Correspondence to Heiko Schenk.

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H. Schenk, K.M. Schmidt-Ott und J.J. Schmidt geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Schenk, H., Schmidt-Ott, K.M. & Schmidt, J.J. Elektrolytstörungen in der Intensivmedizin. Nephrologie 18, 7–13 (2023). https://doi.org/10.1007/s11560-022-00619-1

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