Kao K C, Huang C C, Tsai Y H, Lin M C, Tsao T C
Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.
Chang Gung Med J. 2000 Sep;23(9):555-9.
Severe hyperkalemia is a potential life-threatening cardiac emergency especially in the patients who suffer from a defective renal capacity to excrete potassium such as the dialysis patient. Various conventional therapies including intravenous sodium bicarbonate, insulin with glucose and several beta-2 agonists are commonly employed as transient measures to enhance shift of potassium from the extracellular to the intracellular compartment. If the potassium load is massive and situation is critical, emergency hemodialysis may be useful. During cardiopulmonary resuscitation, the external cardiac compression can support adequate blood flow for hemodialysis. We report a case of a 68-year-old woman who developed sudden cardiac arrest secondary to hyperkalemia with renal insufficiency. Despite 100 minutes of cardiopulmonary resuscitation and conventional treatment for hyperkalemia, the cardiac arrest still persisted. Hemodialysis was then initiated during cardiopulmonary resuscitation and the patient restored spontaneous heart beat 20 minutes later. There was no neurologic sequela after her recovery. Hemodialysis should be considered early in the course of cardiopulmonary resuscitation in severe hyperkalemia induced cardiac arrest if conventional therapies were judged to be ineffective.
严重高钾血症是一种潜在的危及生命的心脏急症，尤其在患有肾脏排钾功能缺陷的患者中，如透析患者。包括静脉注射碳酸氢钠、胰岛素加葡萄糖以及几种β-2激动剂在内的各种传统疗法通常被用作临时措施，以促进钾从细胞外转移到细胞内。如果钾负荷巨大且情况危急，紧急血液透析可能会有所帮助。在心肺复苏期间，体外心脏按压可为血液透析提供足够的血流。我们报告一例68岁女性患者，因高钾血症继发肾功能不全而发生心脏骤停。尽管进行了100分钟的心肺复苏和高钾血症的常规治疗，但心脏骤停仍持续存在。随后在心肺复苏期间开始进行血液透析，患者在20分钟后恢复自主心跳。康复后无神经后遗症。如果判断传统疗法无效，在严重高钾血症所致心脏骤停的心肺复苏过程中应尽早考虑进行血液透析。
