Papadogiannakis Apostolos, Xydakis Dimitris, Sfakianaki Maria, Kostakis Konstantinos, Zouridakis Antonios
Nephrology Department, Venizeleio Hospital, Heraklion, Crete, Greece.
J Cardiovasc Med (Hagerstown). 2007 Jul;8(7):541-3. doi: 10.2459/01.JCM.0000278451.35107.fa.
Hyperkalemia is a common clinical problem in dialysis patients. We wish to present an unusual case of severe hyperkalemia caused by fragmentation haemolysis in a dialysis patient with a prosthetic aortic valve. A 45-year-old man with a 5-year history of end-stage renal disease under dialysis, a known history of paroxysmal atrioventricular nodal re-entrant tachycardia and aortic valve replacement, presented to our department with a recent history of palpitation and profound generalized muscle weakness. The laboratory evaluation revealed severe hyperkalemia (potassium 8.5 mEq/l), anaemia, high levels of lactate dehydrogenase, indirect bilirubin and low levels of haptoglobin, and the peripheral blood smear showed a high percentage of schistocytes (3.8%). A diagnosis of hyperkalemia caused by fragmentation haemolysis attributed to the haemodynamic turbulence on an artificial surface caused by the supraventricular tachycardia was established. After normal sinus rhythm was restored the patient presented with complete remission to the pre-event values of all haemolysis indices.
高钾血症是透析患者常见的临床问题。我们希望呈现一例不同寻常的严重高钾血症病例，该病例由一名患有人工主动脉瓣的透析患者发生的破碎性溶血所致。一名45岁男性，有5年终末期肾病透析史，已知阵发性房室结折返性心动过速和主动脉瓣置换病史，因近期有心悸和全身严重肌无力前来我院就诊。实验室检查显示严重高钾血症（血钾8.5 mEq/l）、贫血、乳酸脱氢酶、间接胆红素水平升高及触珠蛋白水平降低，外周血涂片显示裂红细胞比例较高（3.8%）。诊断为室上性心动过速导致人工表面血流动力学紊乱引起的破碎性溶血所致的高钾血症。恢复正常窦性心律后，患者所有溶血指标均完全缓解至事件前水平。
