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Wei Shi Liang
Intensive Care Unit
About me
Graduated from Shanxi Medical University with a degree in Clinical Medicine in 2006, and has been working in the field of Critical Care Medicine ever since.
Proficient in diseases
Treatment of severe infections, ARDS, severe trauma, MODS, and other diseases.
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Pulmonary Embolism Interventional Treatment Methods
Interventional treatment for pulmonary embolism is mainly used for large pulmonary embolisms in the main trunk or major branches of the pulmonary artery. It is applicable in the following scenarios: contraindications to thrombolysis and anticoagulation therapy, inefficacy after thrombolysis or aggressive medical treatment, or lack of surgical conditions. Interventional therapy for pulmonary embolism can involve removing the embolus or breaking it into fragments, allowing it to move to the distal pulmonary arteries, thereby opening the central pulmonary arteries, rapidly reducing pulmonary artery resistance, significantly increasing total pulmonary blood flow, improving cardiopulmonary hemodynamics, and right ventricular function. The treatment involves catheter fragmentation and suction of large clots in the pulmonary artery or performing balloon angioplasty, and it also enables local administration of small-dose thrombolysis. These are the primary methods of interventional treatment for pulmonary embolism.
Causes of Hypokalemia
Common causes of hypokalemia include insufficient intake or prolonged inability to eat without intravenous supplementation. In such cases, while intake of potassium decreases, the kidneys continue to excrete potassium, leading to a loss of potassium in the blood. Additionally, increased excretion can cause hypokalemia, including losses from the gastrointestinal tract such as vomiting, diarrhea, and continuous gastrointestinal decompression, which results in a loss of digestive fluids rich in potassium. Potassium loss through the kidneys from prolonged use of potassium-wasting diuretics or during the polyuric phase of acute renal failure can also lead to hypokalemia. Furthermore, the shift of potassium from outside to inside the cells can cause hypokalemia.
Can people with hypokalemia smoke?
Hypokalemia is not directly related to smoking. However, once hypokalemia occurs, there is definitely an underlying disease. In the case that the primary disease is not controlled, it is advisable to avoid smoking. Potassium is an essential electrolyte for life, and its physiological functions mainly include maintaining cellular metabolism, regulating osmotic pressure, acid-base balance, and maintaining cell stress functions. Once hypokalemia occurs, active treatment should be implemented, primarily addressing the primary disease, symptomatic treatment with potassium supplementation, and avoiding the occurrence of hyperkalemia. The principle of potassium supplementation is that for mild hypokalemia without clinical manifestations, oral potassium should be given; in cases of severe hypokalemia, intravenous potassium supplementation should be administered immediately. Intravenous potassium should ideally not use peripheral veins but establish a central vein, and the speed of potassium supplementation and the monitoring of potassium levels should be controlled.
Hypokalemia belongs to the department of nephrology.
Hypokalemia is seen in various clinical departments and can affect the nervous system, muscles, heart, digestive system, kidneys, as well as carbohydrate metabolism and acid-base balance. If hypokalemia occurs, it is important to first identify the primary disease and treat it specifically in the corresponding department. In cases of severe hypokalemia, patients should be admitted to the intensive care unit. Treatment involves addressing the primary disease and promptly supplementing potassium. Severe hypokalemia, especially if accompanied by arrhythmias or muscle paralysis, requires immediate potassium supplementation. Potassium deficiency within cells recovers slowly; treatment may take four to six days to gradually reach a balance. Additionally, it is important to timely correct other electrolyte imbalances. The specific department to which the patient is admitted mainly depends on the primary disease, but in cases of very severe conditions, potassium supplementation should be managed in the intensive care unit.
The earliest clinical symptoms of respiratory failure
The clinical symptoms of respiratory failure mainly manifest as hypoxemia and carbon dioxide retention. Looking at their clinical manifestations, mild hypoxia may not show any clinical symptoms. As the severity of the disease increases, there can be signs of increased respiratory drive, such as rapid breathing or difficulty breathing, along with symptoms of sympathetic nervous system activation, such as anxiety and sweating. Hypoxemia can cause dilation of peripheral arteries and constriction of veins, leading to an increased heart rate, or even severe arrhythmias. Furthermore, considering the clinical manifestations of carbon dioxide retention, they are directly related to the levels of carbon dioxide in the body, mainly depending on the rate of occurrence. Clinically, this primarily affects myocardial contractility, the contractile ability of respiratory muscles, and increases in intracranial blood flow. In mild to moderate cases, it can stimulate the respiratory center causing increased and shallow breathing, but in severe cases, it may suppress the respiratory center.
Common causes of hyperkalemia
Hyperkalemia is caused by increased intake or decreased excretion, or by the transfer of potassium ions from inside the cells to the outside. Increased intake generally does not cause hyperkalemia in individuals with normal kidney function, unless potassium is supplemented intravenously in excessive amounts or too quickly. Moreover, decreased excretion is a major cause of hyperkalemia, typically seen in renal failure, deficiency of adrenocortical hormones, and primary renal tubular disorders in potassium secretion. Additionally, a large transfer of potassium ions from inside the cells to the outside can occur in conditions such as massive cell breakdown, acidosis, tissue hypoxia, periodic paralysis, and insulin deficiency.
Common symptoms of hypokalemia and hyperkalemia
The common symptoms of hyperkalemia and hypokalemia, mainly seen in severe cases of high or low potassium, manifest as neurological and muscular symptoms as well as circulatory system symptoms, which are fairly similar in both conditions. If the blood potassium is particularly low, less than 2.0 mmol per liter, it can lead to reduced or absent reflexes. In severe cases, this may progress to paralysis of the respiratory muscles, causing respiratory pump failure. For hyperkalemia, particularly severe cases may also present with swallowing difficulties and respiratory distress. These central nervous system issues can lead to confusion and fainting. Another similar issue is the impact on the circulatory system; severe hypokalemia can cause ventricular tachycardia and even ventricular fibrillation, leading to death. In hyperkalemia, the impact on the cardiovascular system primarily causes malignant tachycardia and can also result in ventricular fibrillation. The main cause of sudden death in hyperkalemia is ventricular fibrillation and cardiac arrest, demonstrating that severe hyperkalemia and hypokalemia similarly cause significant arrhythmic conditions in the heart.
Pulmonary embolism is caused by what?
The most common cause of pulmonary embolism is a thrombus, with approximately 70%-95% of cases occurring when a deep vein thrombosis dislodges and enters the pulmonary arteries and their branches via the bloodstream, leading to pulmonary embolism. Conditions such as prolonged bed rest or immobilization of the lower limbs can lead to the occurrence of deep vein thrombosis. Therefore, the primary site of origin is mainly the deep veins of the lower limbs. Additionally, other types of emboli can also cause pulmonary embolism, such as fat emboli, air emboli, amniotic fluid emboli, parasitic emboli, and bacterial emboli, as well as detachment of cardiac tumors; all these can lead to pulmonary embolism.
Why does heart failure cause edema?
Edema caused by heart failure is mainly due to heart dysfunction, resulting in systemic circulation, venous congestion, and excessive fluid accumulation in the body's tissue spaces. The primary cause is right heart failure or total heart failure, and some special cases of pericarditis. The edema caused by this type of heart failure is often symmetrical, indenting, and sagging, and usually worsens with activity and lessens with rest. The common locations for fluid accumulation are in the sacral and perineal areas, while bedridden patients often show it in the ankle area. In severe cases, patients may experience generalized edema, and even develop ascites and pleural effusion. This condition is known as heart failure, and the type of edema it causes is called cardiogenic edema.
How to radically cure hypokalemia?
Hypokalemia must be treated with potassium supplementation while simultaneously addressing the primary condition. For mild hypokalemia, oral potassium can be given in doses of 40 to 80 mmol/day. In cases of severe hypokalemia, where blood potassium is less than 2.0 mmol/L or when life-threatening symptoms are present, intravenous potassium should be administered at a rate of 10 to 20 mmol/L per hour. Regular monitoring of blood potassium levels is necessary, especially in cases of renal dysfunction and cellular uptake impairment. For life-threatening severe hypokalemia, potassium can be administered via central venous lines with close monitoring of blood potassium levels, and the infusion rate can reach up to 40 mmol/L, which can effectively cure hypokalemia.