Hamill R J, Robinson L M, Wexler H R, Moote C
Division of Critical Care Medicine, University of Western Ontario, London, Canada.
Crit Care Med. 1991 May;19(5):694-9. doi: 10.1097/00003246-199105000-00016.
To evaluate the efficacy and safety of potassium replacement infusions in critically ill patients.
Prospective cohort study.
Multidisciplinary critical care unit.
Forty-eight critically ill adult patients, age 25 to 86 yrs. Patients entered the study when hypokalemia (potassium less than 3.5 mmol/L) was noted on routine laboratory blood analysis. Most common primary diagnoses on ICU admission included postoperative cardiac surgery (n = 9), sepsis and multiple organ system failure (n = 9), complicated myocardial infarction (n = 7), and respiratory failure (n = 5).
Potassium chloride infusions (20, 30, or 40 mmol in 100 mL normal saline over 1 hr) were administered to patients for serum potassium levels of less than 3.5 but greater than 3.2 mmol/L (n = 26), 3.0 to 3.2 mmol/L (n = 11), and less than 3.0 mmol/L (n = 11), respectively. Serum and urine potassium levels were monitored during and for 1 hr after the infusion.
All patients tolerated the infusions without evidence of hemodynamic compromise, ECG change, or new dysrhythmia requiring treatment. The mean maximum potassium increase was 0.5 +/- 0.3 mmol/L, 0.9 +/- 0.4 mmol/L, and 1.1 +/- 0.4 mmol/L in the 20-, 30-, and 40-mmol groups, respectively. The increase in serum potassium was maximal at the completion of the infusion and was significant (p less than .05) compared with baseline in all groups. Peak potassium levels were the same in patients with normal renal function (n = 33) compared with those with renal insufficiency (n = 15). Urinary excretion of potassium increased in all groups during the infusion and was significant (p less than .05) in the 30- and 40-mmol groups, but was no greater in those patients who had received diuretics (n = 8) compared with those patients who had not (n = 40).
In the select group of hypokalemic patients studied, potassium infusions of 20 to 40 mmol delivered over 1 hr were safe to administer and effectively increased serum potassium levels in a dose-dependent and predictable fashion. Furthermore, these results were independent of the patient's underlying renal function or associated diuretic administration.
评估重症患者静脉补钾的疗效和安全性。
前瞻性队列研究。
多学科重症监护病房。
48例成年重症患者，年龄25至86岁。患者在常规实验室血液分析发现低钾血症（血钾低于3.5 mmol/L）时进入研究。入住重症监护病房时最常见的主要诊断包括心脏术后（n = 9）、脓毒症和多器官系统功能衰竭（n = 9）、复杂性心肌梗死（n = 7）以及呼吸衰竭（n = 5）。
对于血钾水平低于3.5但高于3.2 mmol/L（n = 26）、3.0至3.2 mmol/L（n = 11）以及低于3.0 mmol/L（n = 11）的患者，分别给予氯化钾静脉输注（100 mL生理盐水中含20、30或40 mmol，1小时输完）。输注期间及输注后1小时监测血清和尿钾水平。
所有患者均耐受输注，未出现血流动力学不稳定、心电图改变或需要治疗的新的心律失常。20 mmol组、30 mmol组和40 mmol组的平均最大血钾升高分别为0.5±0.3 mmol/L、0.9±0.4 mmol/L和1.1±0.4 mmol/L。输注结束时血清钾升高最大，与基线相比，所有组均有显著差异（p<0.05）。肾功能正常患者（n = 33）与肾功能不全患者（n = 15）的血钾峰值相同。输注期间所有组尿钾排泄均增加，30 mmol组和40 mmol组有显著差异（p<0.05），但与未使用利尿剂的患者（n = 40）相比，使用利尿剂的患者（n = 8）尿钾排泄增加并不更明显。
在所研究的低钾血症患者组中，1小时内输注氯化钾20至40 mmol安全可行，且能以剂量依赖且可预测的方式有效提高血清钾水平。此外，这些结果与患者的基础肾功能或是否使用利尿剂无关。
