Tsukamoto Sakiko, Maruyama Koichi, Nakagawa Hideyuki, Iwase Yoshinori, Kitamura Akira, Hayashida Masakazu
Department of Anesthesiology, International Medical Center, Saitama Medical University, Haidaka-city, Saitama, Japan.
J Nippon Med Sch. 2009 Oct;76(5):258-64. doi: 10.1272/jnms.76.258.
A 60-year-old woman in severe hemorrhagic shock underwent urgent laparotomy to control massive hematemesis. Severe metabolic acidosis due to hemorrhagic shock and hyperkalemia as well as hypocalcemia associated with rapid blood transfusion were aggressively corrected with administration of sodium bicarbonate, insulin, and calcium chloride. Following rapid transfusion of the last 8 units of red cell concentrate (RCC), however, cardiac arrest occurred because of hyperkalemia and did not respond to cardiopulmonary resuscitation. Blood gas analysis revealed that the serum K(+) concentration had increased from 4.05 to 8.24 mEq/L over a 7-minute period, while the Ca(2+) concentration had decreased from 1.43 to 0.53 mmol/L. Rapid transfusion of irradiated RCC containing a high concentration of K(+), an extreme decrease in the circulating blood volume to dilute the exogenously administered K(+) and citrate, and severe metabolic acidosis impeding the intracellular shift of K(+) seemed to have contributed to the extremely rapid development of fetal hyperkalemia accompanied by hypocalcemia. Anesthesiologists must be aware that hyperkalemia due to rapid blood transfusion can develop extremely rapidly in patients in severe hemorrhagic shock.
一名60岁严重失血性休克女性接受紧急剖腹手术以控制大量呕血。通过给予碳酸氢钠、胰岛素和氯化钙，积极纠正了失血性休克导致的严重代谢性酸中毒、高钾血症以及与快速输血相关的低钙血症。然而，在快速输注最后8单位红细胞浓缩液（RCC）后，因高钾血症发生心脏骤停，且心肺复苏无效。血气分析显示，血清钾（K⁺）浓度在7分钟内从4.05 mEq/L升至8.24 mEq/L，而钙（Ca²⁺）浓度从1.43 mmol/L降至0.53 mmol/L。快速输注含高浓度钾的辐照RCC、循环血容量极度减少以稀释外源性给予的钾和柠檬酸盐，以及严重代谢性酸中毒阻碍钾向细胞内转移，似乎共同导致了伴有低钙血症的高钾血症极其迅速地发展。麻醉医生必须意识到，在严重失血性休克患者中，快速输血引起的高钾血症可能极其迅速地发生。
