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혈액투석 환자에 있어 투석 간격시간 및 투석중 칼륨 제거량이 혈중 칼륨 농도에 미치는 영향
김호중(Ho Jung Kim),노광호(Kwang Ho Roh),이경원(Kyung Won Lee),김진영(Jin Yeong Kim),유준호(Joon Ho Ryu),문중돈(Joong Don Moon),박일규(Il Gyu Park) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
N/A To evaluate potassium(K) homeostasis during in-terdialytic and dialytic phases in chronic hemodialysis patients, we analyzed pre- and post- dialysis plasma K concentration(n=28) over n week with an interdialytic interval of 7Zhrs, 48hrs(l), and 48hrs(II), respectively, and the quantity of total dialytic K removal via dialysate. The predialysis plasma K at 72h interval(prePK72h: 4.89±0.17mEq/L) was significantly higher than those at 48h interval(prePK48h-I: 4.57±0.15mEq/L, and prePK48h-II: 4.40±15mEq/L) (p=0.000, p=0.000). 10.7% in prePK72h were categorized into severe hyperkalemia more than 6.0mEq/L, but none in prePK48h-I, II(p=0.000, p=0.000). In contrast no difference between 72-h and 42-h intervals was found in the postdialysis plasma K(postPK72h: 3.59±0.07 vs postPK48h-I : 3.530±08mEq/L, p>0.05) and in the quantity of total dialytic K removal via dialysate(ΔKtota172h : 74±2.6 vs ΔKtota148h-I:71±2.2mEq, p>0.05). On approach to this with two-compartment model, there was significant difference in dialytic K removal from ECF(ΔKecf72h:22.2±1.6 vs ΔKecf48h-I:17.7±1.6mEq, p<0.01), but not in that from ICF(ΔKicf72h:51.6±3.1 vs ΔKicf48h-I: 53.5±2.7mEq, p>0.05). In all 28 patients, age, sex and body weight were not correlated with either pre- and post- plasma K levels or total K removal per kg body weight. In conclusion, the majority of dialytic K removal is from the replenishment of the ICF potassium and it has rather constant feature in that there was no autoregulatory increment even with the higher predialysis plasma K concentration. So the plasma K concentration on chronic maintenace hemodialysis is more dependent on the potassium gain during interdialytic phase than the potassium removal during dialytic phase. Also it is reasonable to restrict dietary K intake and apply K-exalate orientating to the interdialytic phase of 72hrs because severe hyperkalemia is rare in that of 48hrs.
급성 신우신염 치료시 아미노글라이코사이드(Micronimicin Sulfate)에 의한 유사 Bartter씨 증후군의 발생에 관한 평가
장우영,김진영,최낙원,한상웅,김호중,박석규,문중돈,나경선,윤경택,위형중,최창렬,조형도,안유현 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.5
The aminoglycoside antibiotics is widely used in the treatment of infectious caused by gram-negative bacteria and for synergistic effect with(β-lactam antibiotics. However, its therapeutic usefulness is limited by this potential nephrotoxicity and by disturbance of electrolyte homeostasis resulting in hypomagnesemia, hypokalemia, hypocalcemia such as Bartter-like syndrome. Many case repots have been reported on development of Bartter-like syndrome after aminoglycosides administration. But these reports had the many differences of such as types of aminoglycosides, age of patients, duration and total dose of treatment, combined antibiotics and baseline diseases. Therefore, the purpose of this study is to assess the effects of micronomocin sulfate on magnesium, calcium and potassium status of patients in acute pyelonephritis. Twenty one patients in acute pyelonephritis(18 female/3 male, ages 20-75) was treated with single or combined antibiotics. Eleven of twenty one patients as study group were treated with boh micronomicin sulfate(aminoglycoside, 4mg/kg/day, during 5-8days) and flomoxef sodium (3rd cephalosporine, 2g/day, during 5-8days), and ten of twenty one patients as control group were treated only with flomoxef sodium(3rd cephalosporine. 2g/day. during 5-8days). Renal values, plasma and urinary electrolytes were measured before and at the end of IV antibiotic therapy. After micronomicin sulfate administrated for 6.4±1.5days, serum Mg, Ca, K, FEMG (fractional excretion of Mg), TTKG(transtubular K concentration gradient) and FEca.(fractional excretion of Ca) did not significantly change(p$gt;0.05). Therefore, those results suggest that micromonicin sulfate therapy within dose of 24mg/day(4mg/kg/day) for 6.4±1.5days may not cause disturbance of electrolyte homeostasis such as Bartter-like syndrome in acute pyelonephritis. Howerever, electrolyte disturbance is an important complication when aminoglycosides is given in larges doses over extended periods. Therefore, monitoring of blood concentration and urinary loes of electrolyte should be carried out along with careful observation of Bartter-like syndrome.