Gutierrez R, Schlessinger F, Oster J R, Rietberg B, Perez G O
Veterans Administration Medical Center, Miami, Fla.
Miner Electrolyte Metab. 1991;17(5):297-302.
The purpose of the study was to evaluate the potassium-lowering effect of hypertonic versus isotonic sodium bicarbonate (NaHCO3) in patients with end-stage renal disease (ESRD) receiving chronic maintenance hemodialysis. Immediately prior to dialysis, we infused isotonic (1.4%, 150 mEq/l) NaHCO3 in H2O (1 mEq/kg body weight over 2 h) to 10 patients with ESRD. Blood was drawn in heparinized tubes, without the use of a tourniquet, from the angioaccess for Na, K, pH, PCO2, HCO3, and osmolality at baseline (x 3) and after 10, 20, 40, 60, 90, 120, and 180 min of infusion. All patients were acidotic (HCO3 13-21 mEq/l, pH 7.25-7.38) prior to the study. In these patients, plasma HCO3 increased by an average of 3 mEq/l, and plasma K decreased by 0.35 mEq/l at 180 min. Plasma osmolality did not change. In 8 patients, a bolus of hypertonic (8.4%, 1,000 mEq/l) NaHCO3 (1 mEq/kg body weight over 5 min) tended to cause a transient increase in plasma HCO3, an increase in plasma osmolality, and minor changes in the K levels (an initial small and transient albeit significant decrease, followed by a tendency to increase). Finally, plasma K tended to increase in patients receiving infusions of either isotonic (n = 6) or hypertonic (n = 6) sodium chloride. Our data do not support the efficacy of the common practice of administering NaHCO3 for the emergency treatment of hyperkalemia in patients with ESRD receiving maintenance dialysis.
本研究的目的是评估高渗与等渗碳酸氢钠（NaHCO₃）对接受慢性维持性血液透析的终末期肾病（ESRD）患者的降钾效果。在透析前即刻，我们将等渗（1.4%，150 mEq/L）的NaHCO₃溶于水中（2小时内按1 mEq/kg体重）输注给10例ESRD患者。在基线时（3次）以及输注后10、20、40、60、90、120和180分钟，从血管通路抽取置于肝素化管中的血液，检测钠、钾、pH、PCO₂、HCO₃和渗透压。所有患者在研究前均为酸中毒（HCO₃ 13 - 21 mEq/L，pH 7.25 - 7.38）。在这些患者中，180分钟时血浆HCO₃平均升高3 mEq/L，血浆钾降低0.35 mEq/L。血浆渗透压未改变。在8例患者中，静脉推注高渗（8.4%，1000 mEq/L）的NaHCO₃（5分钟内按1 mEq/kg体重）往往会导致血浆HCO₃短暂升高、血浆渗透压升高以及钾水平轻微变化（最初有小幅度短暂但显著的下降，随后有升高趋势）。最后，接受等渗（n = 6）或高渗（n = 6）氯化钠输注的患者血浆钾有升高趋势。我们的数据不支持在接受维持性透析的ESRD患者中，常规给予NaHCO₃用于紧急治疗高钾血症的有效性。
