Putcha Nirupama, Allon Michael
Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Semin Dial. 2007 Sep-Oct;20(5):431-9. doi: 10.1111/j.1525-139X.2007.00312.x.
Hyperkalemia is common in patients with end-stage renal disease, and may result in serious electrocardiographic abnormalities. Dialysis is the definitive treatment of hyperkalemia in these patients. Intravenous calcium is used to stabilize the myocardium. Intravenous insulin and nebulized albuterol lower serum potassium acutely, by shifting it into the cells. Despite their widespread use, neither intravenous bicarbonate nor cation exchange resins are effective in lowering serum potassium acutely. Prevention of hyperkalemia currently rests largely upon dietary compliance and avoidance of medications that may promote hyperkalemia. Prolonged fasting may provoke hyperkalemia, which can be prevented by administration of intravenous dextrose.
高钾血症在终末期肾病患者中很常见，可能导致严重的心电图异常。透析是这些患者高钾血症的确定性治疗方法。静脉注射钙剂用于稳定心肌。静脉注射胰岛素和雾化吸入沙丁胺醇可通过将钾转移到细胞内来急性降低血清钾水平。尽管它们被广泛使用，但静脉注射碳酸氢盐和阳离子交换树脂在急性降低血清钾方面均无效。目前，高钾血症的预防主要依赖于饮食依从性以及避免使用可能促进高钾血症的药物。长时间禁食可能引发高钾血症，可通过静脉注射葡萄糖来预防。
