Overdose : מינון יתר

4.9   Overdose
Potassium intoxication occurs if the renal potassium excretion stops or is blocked, i.e. in the case of acute kidney failure, Addison's disease or kidney failure occurring for other reasons, for example, particularly in the case of simultaneous excessive iatrogenic reduction of the potassium excretion, e.g. as a result of aldosterone antagonists or other potassium-saving diuretics. Where normal renal potassium excretion is possible, no intoxication is to be expected as a result of oral potassium intake.
In addition to cardiovascular changes (bradycardia, arrhythmia, blood pressure decrease with clammy extremities and peripheral circulatory collapse; eventually ventricular fibrillations and diastolic cardiac arrest), potassium intoxication leads to non-specific general symptoms: feeling of malaise, restlessness and general weakness, states of confusion. In addition, there is also paraesthesia in the extremities and in the perioral region; in some cases, flaccid paralysis also occurs, a metallic taste is often reported.
Depending on the severity of the intoxication, the treatment of hyperkalaemia has different objectives:
1.     Immediate "detoxification" of the potassium through administration of an antidote (sodium or calcium salt), e.g. 10–20 ml of 10% calcium gluconate solution intravenously.
2.     Reduction of the serum potassium level by relocating potassium from the extracellular to intracellular space, e.g. through a glucose insulin drip and acidosis treatment.
3.     Elimination of potassium through dialysis or via the gastrointestinal tract by means of a cation exchanger (e.g. Resonium A).