Hovland Anders, Fagerheim Anne Kristine, Hardersen Randolf, Nielsen Erik Waage
Avdeling Hjerte, Medisinsk klinikk, Nordlandssykehuset, Bodø, Norway.
Tidsskr Nor Laegeforen. 2010 Jul 1;130(13):1352-4. doi: 10.4045/tidsskr.09.0384.
A 75-year-old man with post-MI heart failure and an ejection fraction of 15 % was treated with an ACE-inhibitor, spironolactone and a beta-blocker. He had reduced his intake of food and water due to an intercurrent illness the days before admission. He was admitted to our coronary care unit due to bradycardia and hypotension. On arrival his blood pressure was 60/40 mm Hg, and he was in a cardiogenic shock. The electrocardiogram showed broad QRS-complexes and large T waves. Serum-potassium was 9.1 mmol/L and he had acute renal failure with oliguria, probably caused by reduced cardiac output due to hypovolemia combined with taking an ACE inhibitor and spironolactone. Haemodialysis was started and during dialysis QRS complexes became more narrow and heart rate and blood pressure normalized. The patient was discharged 10 days later with normal potassium and creatinine levels. Patients treated with ACE-inhibitors and spironolactone should be monitored closely. During intercurrent illness dehydration may occur and this can lead to renal failure and hyperkalemia which can be life-threatening. The condition should be recognized and addressed promptly, and if indicated haemodialysis should be performed.
一名75岁男性，患有心肌梗死后心力衰竭，射血分数为15%，接受了ACE抑制剂、螺内酯和β受体阻滞剂治疗。入院前几天，由于并发疾病，他减少了食物和水的摄入量。因心动过缓和低血压，他被收治入我们的冠心病监护病房。入院时，他的血压为60/40 mmHg，处于心源性休克状态。心电图显示QRS波群增宽和T波高大。血清钾为9.1 mmol/L，他患有急性肾衰竭伴少尿，可能是由于低血容量导致的心输出量减少，再加上服用ACE抑制剂和螺内酯所致。开始进行血液透析，透析过程中QRS波群变窄，心率和血压恢复正常。10天后患者出院，血钾和肌酐水平正常。接受ACE抑制剂和螺内酯治疗的患者应密切监测。在并发疾病期间，可能会发生脱水，这可能导致肾衰竭和高钾血症，而这可能危及生命。应及时识别并处理这种情况，如有必要应进行血液透析。
