Charytan D, Goldfarb D S
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass, USA.
Arch Intern Med. 2000 Jun 12;160(11):1605-11. doi: 10.1001/archinte.160.11.1605.
Although the methods for the appropriate management of patients with hyperkalemia are well established, no criteria for hospital admission of patients with this common electrolyte disorder have been promulgated.
To examine the current practices regarding hospitalization of patients with hyperkalemia and to consider appropriate criteria for admission.
We evaluated a consecutive series of patients hospitalized for hyperkalemia and excluded patients who developed hyperkalemia after admission. For comparison, we selected a series of patients with a similar degree of hyperkalemia who were treated as outpatients. Hyperkalemia was classified as minimal, moderate, or severe. The causes of hyperkalemia were identified, and the therapeutic maneuvers used were ascertained. Although the study did not have the power to determine the relative safety of the 2 therapeutic approaches, we compared the outcomes of the 2 groups of patients.
The inpatient group consisted of 11 patients who were admitted for the treatment of hyperkalemia, and we identified 12 patients who received outpatient therapy for hyperkalemia. The patients in the 2 treatment groups were similar with respect to age and the values of serum urea nitrogen, creatinine, and potassium prior to the identification of hyperkalemia. The mean +/-SD potassium concentrations at baseline were 5.4+/-0.7 mmol/L in the inpatients and 5.5+/-0.5 mmol/L in the outpatients. The mean +/-SD potassium concentration in the inpatients was 6.7+/-0.8 mmol/L at the time of hospital admission, compared with 6.7+/-0.5 mmol/L in the outpatients at the time that hyperkalemia occurred. Similar proportions of both groups (6 of 11 inpatients and 7 of 12 outpatients) had moderate or severe hyperkalemia.
Patients admitted to the hospital were clinically indistinguishable from patients treated as outpatients. The justification for the decision to admit patients to the hospital or to treat them as outpatients was often not evident. We suggest criteria for hospitalization, which include severe hyperkalemia (> or =8.0 mmol/L, with changes other than peaked T waves on the electrocardiogram), acute worsening of renal function, and supervening medical problems.
尽管高钾血症患者的恰当管理方法已确立，但针对这种常见电解质紊乱患者的住院标准尚未公布。
探讨高钾血症患者住院治疗的当前做法，并考虑合适的入院标准。
我们评估了一系列因高钾血症住院的连续患者，并排除入院后发生高钾血症的患者。为作比较，我们选取了一系列血钾升高程度相似的门诊治疗患者。高钾血症分为轻度、中度或重度。确定高钾血症的病因，并确定所采用的治疗手段。尽管该研究无力确定两种治疗方法的相对安全性，但我们比较了两组患者的结局。
住院组包括11例因高钾血症入院治疗的患者，我们确定了12例接受高钾血症门诊治疗的患者。两个治疗组的患者在年龄以及高钾血症确诊前的血清尿素氮、肌酐和钾值方面相似。住院患者基线时的平均±标准差钾浓度为5.4±0.7 mmol/L，门诊患者为5.5±0.5 mmol/L。住院患者入院时的平均±标准差钾浓度为6.7±0.8 mmol/L，而门诊患者高钾血症发生时为6.7±0.5 mmol/L。两组中相似比例的患者（11例住院患者中的6例和12例门诊患者中的7例）患有中度或重度高钾血症。
入院患者与门诊治疗患者在临床上并无差异。决定患者入院或门诊治疗的理由往往并不明确。我们建议了住院标准，包括严重高钾血症（≥8.0 mmol/L，心电图除T波高尖外还有其他变化）、肾功能急性恶化以及并发的医疗问题。
