Urine is alkaline

Introduction Urine test for hyperkalemia diagnosed an increase in urinary potassium concentration and urinary potassium excretion, urinary alkali, and reduced urinary sodium excretion. Serum potassium above 5.5mmol / L is hyperkalemia.

Cause

Etiology classification

(1) Reduction of renal potassium excretion

1. Acute renal failure during oliguria or chronic renal failure.

2. Adrenal cortical hormone deficiency, such as Addison disease, low renin low aldosteronism, al-hydroxylase deficiency.

3. Long-term application of potassium-sparing diuretics, such as chlorpheniramine steep, snail meat ester (Ampson), ampicillin (amiloride).

(2) Removal of potassium from cells

1. Hemolysis, tissue damage, massive necrosis of tumor or inflammatory cells, tissue hypoxia, shock, burns, excessive muscle contracture, etc.

2. Acidosis.

3. Hyperkalemia periodic paralysis.

4. After injection of hypertonic saline and mannitol, the intracellular potassium is removed due to intracellular dehydration, changes in cell membrane permeability or cellular metabolism. It has been reported that high blood potassium occurs when arginine hydrochloride is applied, which may be caused by arginine entering the cells and excreting potassium.

(3) Potassium-containing drugs input too much penicillin potassium salt (per 1 million units of K1.5mmol) large dose application or potassium-containing solution input too much, too urgent.

(4) Too much blood in the input stock.

(5) Digitalis poisoning

Excessive digitalis can reduce the activity of the ion pump and affect the entry of potassium into the cells.

mechanism

Potassium in the body is mainly excreted through the kidneys. Therefore, renal failure is the most important cause of clinically caused hyperkalemia. Hyperkalemia is common in acute renal failure during oliguria, and potassium in the absence of urine will increase at a rate of 0.7 mmol/L per day. Progressive hyperkalemia is rare in chronic renal failure, but in the late stage of chronic renal failure, severe renal function disorder, decreased urine output, increased potassium levels, but markedly increased potassium levels, often due to this. Excessive potassium intake or a large amount of potassium in the cells is removed.

The function of aldosterone is mainly to preserve sodium and potassium, and mainly acts on the renal distal convoluted tubule. Adison disease is an adrenal insufficiency oil with a decrease in adrenocortical hormone (mainly mineralocorticoid deficiency), showing hyperkalemia. Low renin low aldosteronism can be seen in patients with mild renal insufficiency and diabetes with renal insufficiency. The reduction of aldosterone secretion can also be caused by the inhibition of the activity of the renin-angiotensin-aldosterone system by the use of p-blockers, non-steroidal anti-inflammatory drugs, and conversion enzyme inhibitors.

The potassium in the intracellular fluid is about 30 times higher than the extracellular fluid. The maintenance of this concentration gradient requires constant replenishment of energy. In addition, it is also affected by factors such as hypoxia, catabolism or anabolic enhancement, and pH. In any case, if the energy supply is insufficient, the catabolism of the cells is enhanced, and the cells are damaged and acidemia, the potassium in the cells can be swollen in a large amount, resulting in hyperkalemia of the extracellular fluid.

Oral potassium salts, usually do not cause hyperkalemia. However, excessive potassium supplementation, input of a large amount of blood for a long time in stock, the use of a large number of potassium-containing drugs, can increase blood potassium, especially in patients with renal insufficiency, more likely to occur hyperkalemia.

an examination

Related inspection

Serum potassium urine routine

Serum potassium (K+, K) -- refers to the concentration of potassium ions in the serum. Potassium in human body is mainly distributed in cells. Potassium is used to maintain cell metabolism, regulate body fluid osmotic pressure, and maintain acid-base balance. The main source of potassium in human body is dependent on the intake from the outside. In addition to the small amount of potassium used for tissue cells, most of it is excreted by the kidneys, so the change of serum potassium reflects the kidney function.

Differential diagnosis

Hyperuricemia metabolism: hyperuricemia is caused by hyperuricemia. Hyperuricemia, also known as gout, is a group of diseases caused by dysbial metabolic disorders. Its clinical features are hyperuricemia and the resulting recurrent attacks of gouty acute arthritis and tophi deposits. Chronic arthritis and joint deformity, often involving the kidney caused by chronic interstitial nephritis and uric acid kidney stones. The disease can be divided into two major categories: primary and secondary. The cause of primary disease is mostly unclear due to a small number of enzyme defects. It is often accompanied by hyperlipidemia, obesity, diabetes, hypertension, arteriosclerosis and crown. Heart disease, etc., is a hereditary disease. Secondary people can be caused by a variety of causes such as kidney disease, blood diseases and drugs.

There are more urinary porphyrins in the urine: it is caused by porphyria. Porphyria is a disorder of porphyrin metabolism disorder characterized by increased excretion of porphyrin and porphyrin precursors in urine and feces. Porphyria is a congenital disease that is mainly caused by a lack of various enzymes involved in heme synthesis and has a family history.

Increased urinary estrogen: Determination of estrogen in urine: There are three main types of estrogen in the urine, namely estrone, estradiol and estriol. Estrogen has different normal values in different stages of menstrual cycle in women of childbearing age. In the first 7 days of menstrual cycle, estrogen levels are very low, and then rise with the development of follicles, reaching a peak on the 13th day, called ovulation peak. After a sudden decline, it gradually rose, and reached the peak on the 21st day, called the peak of the corpus luteum. Later, it will drop to menstrual cramps. Functional uterine bleeding estrogen levels are maintained below normal levels. The level of estrogen in uterine amenorrhea is normal, but the ovarian function is defective or the congenital ovary is not developed and causes amenorrhea. The estrogen level is low, but there is no periodic change. The pituitary or subthalamic amenorrhea, the estrogen level is generally lower. .

Persistent sodium excretion in the urine: belongs to the antidiuretic hormone abnormal syndrome (SIADH), which means that when the plasma osmotic concentration and blood sodium are normal or low, the vasopressin is still secreted, resulting in a decrease in free water clearance, water retention, and low A syndrome of a series of clinical manifestations such as sodiumemia, hypotonic blood pressure, and the like. In addition to the primary disease manifestations, SIADH children are parallel with the degree of hyponatremia. When serum sodium is above 120mmol/L, the clinical symptoms are asymptomatic. When the blood sodium drops below 120mmol/L, there may be loss of appetite and nausea. Symptoms such as vomiting, when the urine sodium content is high, blood sodium is lower than 110mmol / L, neuropsychiatric symptoms, even convulsions, coma until death, when blood sodium is lower than 95 ~ 109mmol / L, for 3 days can cause irreversible Brain Injury.

Increased histamine excretion in the urine: Histamine is a reactive amine compound with a chemical formula of C5H9N3 and a molecular weight of 111. As a chemical conductive substance in the body, it can affect the reaction of many cells, including allergies, inflammatory reactions, gastric acid secretion, etc. It can also affect the nerve conduction in the brain, which can cause sleep and other effects. The metabolites after taking H1 receptor antagonists (ie, antihistamines) are excreted in the kidneys for a few to several tens of hours, and the urine excretion accounts for a large part. This leads to an increase in histamine excretion in the urine.

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