ASTIM VE KOAH AKUT ATAKLARINDA ELEKTROLİT DENGESİZLİKLERİ
Obstrüktif akci¤er hastal›klar›n›n seyrinde elektrolit dengesizli¤i meydana gelebilmektedir. Bu dengesizlikler havayolu disfonksiyonuna veya solunum kas zay›fl›¤›na neden olabilmektedir. Çal›flmam›zda ast›m ve kronik obstrüktif akci¤er hastal›¤› (KOAH) akut ataklar›nda elektrolit profillerini araflt›rd›k. KOAH akut ata¤› ve solunum yetmezli¤i olan 35 olgu, ast›m ata¤› olan 27 olgu ve pulmoner semptom tan›mlamayan enfeksiyon bulgusu olmayan 15 kontrol olgusu çal›flmaya dahil edildi. Hastaneye yatt›ktan sonraki 24 saat içinde sodyum, potasyum, klor, fosfor, magnezyum, arter kan› pH, total ve iyonize kalsiyum, total protein ve albümin düzeyleri ölçüldü. Ast›m atak olgular›n›n kontrol olgular›ndan daha düflük albümin ve total protein düzeyleri vard› (p<0.01). KOAH’l› olgular ast›ml›lardan daha düflük pH ve magnezyum ancak daha yüksek iyonize kalsiyum düzeylerine sahiptiler (p<0.01). Tüm grupta pH ile serum magnezyum düzeyleri aras›nda pozitif korelasyon vard› (p<0.01). Ast›ml› olgulardaki azalm›fl albumin düzeyi ileri yafla, akut faz yan›t›na veya bronfllardaki artm›fl vasküler permeabiliteye; KOAH‘l› olgulardaki düflük magnezyum, yüksek iyonize kalsiyum düzeyleri ise solunumsal asidoza bağlı olabilir.
ELECTROLYTE DISTURBANCES IN EXACERBATIONS OF ASTHMA AND COPD
Electrolyte disturbances can occur in the course of obstructive lung diseases. These anomalies can cause airway dysfunction or respiratory muscle weakness. We investigated electrolyte profiles in asthma attacks and chronic obstructive pulmonary disease (COPD) exacerbations in our study. 35 patients with COPD exacerbations with respiratory failure, 27 patients with asthma attack, and 15 control patients with no infectious findings and pulmonary symptoms included the study. Sodium, potassium, chloride, phosphorus, magnesium, total and ionized calcium, arterial blood pH, total protein, albumin levels were measured within the 24 hours after hospitalization. The patients with asthma attack had lower total protein and albumin levels than controls (p<0.01). The patients with COPD had lower pH and magnesium levels but higher ionized calcium levels than asthmatics (p<0.01). There was positive correlation between pH and serum magnesium levels in the entire group (p<0.01). Lower levels of albumin in patients with asthma may be due to higher age, acute phase response or increase of vascular permeability in bronchi and lower levels of magnesium and higher levels of ionized calcium to respiratory acidosis in COPD patients.
___
- 1. Fiaccadori E, Coffrini E, Ronda N, et al.
Hypophosphatemia in course of obstructive
pulmonary disease. Chest 1990; 97: 857-68.
- 2. Gustafson T, Boman K, Rosenhall L, et al. Skeletal
muscle magnesium and potassium in asthmatics
treated with oral beta 2-agonists. Eur Respir J
1996; 9: 237-40.
- 3. Meehan RT. Renin, aldosterone, and vasopressin
responses to hypoxia during 6 hours of mild
exercise. Aviat Space Environ Med 1986; 57: 960-5.
- 4. Burtis CA, Ashwood ER. Tietz textbook of clinical
chemistry, W.B. Saunders Company, 1986.
- 5. Fahy JV, Wong H, Liu J, Boushey HA. Comparison
of samples collected by sputum induction and
bronchoscopy from asthmatic and healthy subjects.
Am J Respir Crit Care Med 1995; 152: 53-8.
- 6. Kushner I, Rzewnicki DL. The acute phase response:
General aspects. Bailliere’s Clin Rheumatol 1994;
8: 513-30.
- 7. Gonlugur U. Eozinofil lökositler, Dilek Ofset Matbaac›l›k,
Sivas, 2001, sayfa:212.
- 8. Kalenci S, Kömürcüo¤lu A, Erer OF ve ark. Kronik
obstrüktif akci¤er hastal›¤›nda plazma ve eritrosit
magnezyum düzeyleri. ‹zmir Gö¤üs Hastanesi
Dergisi 1998; 12: 15-8.
- 9. Ryan MF. The role of magnesium in clinical
biochemistry: an overview. Ann Clin Biochem
1991; 28: 19-26.
- 10. Milionis HJ, Alexandrides GE, Liberopoulos EN, et
al. Hypomagnesemia and concurrent acid-base and
electrolyte abnormalities in patients with congestive
heart failure. Eur J Heart Fail 2002; 4: 167-73.
- 11. Dai LJ, Friedman PA, Quamme GA. Acid-base changes
alter Mg2+ uptake in mouse distal convolutes
tubule cells. Am J Physiol 1997; 272: F759-F766.
- 12. Bos WJW, Postma DS, van Doormaal JJ.
Magnesiuric and calciuric effects of terbutaline in
man. Clin Sci 1988; 74: 595-7.
- 13. Cohen L, Laor A, Shnaider H, Kitzes R. Bone magnesium
in chronic obstructive pulmonary disease
with hypercapnia. Magnesium 1985; 4: 34-9.
- 14. Fiaccadori E, Del Canale S, Arduini U, et al.
Intracellular acid-base and electrolyte metabolism
in skeletal muscle of patients with chronic
obstructive lung disease and acute respiratory
failure. Clin Sci 1986; 71: 703-12.
- 15. Knochel JP. Pathophysiology and clinical
characteristics of severe hypophosphatemia. Arch
Intern Med 1977; 137: 203-20.
- 16. Haffner CA, Kendall MJ. Metabolic effects of b2-
agonists. J Clin Pharm Ther 1992; 17: 155-64.