Department of Anesthesiology and Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Am J Emerg Med. 2011 Nov;29(9):1237.e1-2. doi: 10.1016/j.ajem.2010.08.029. Epub 2010 Nov 13.
Potassium chloride and other potassium compounds are used by the general public as salt substitutes, muscle-building supplements, and panacea. Severe hyperkalemia from oral potassium is extremely rare if kidney function is normal because of potassium adaptation. The oral potassium dose has to be large enough to overcome the normal renal excretory mechanisms to cause severe hyperkalemia. This occurs most commonly in patients with renal impairment or those who take potassium-sparing diuretics, angiotensin receptor blockers, or angiotensin-converting enzyme inhibitors. We present two unique cases of near-fatal hyperkalemia from nutritional supplements containing potassium. The first case was due to salt-substitute intake, whereas the second case was from a muscle-building supplement. Both patients suffered cardiac arrest, but were successfully resuscitated and survived. The acuity of intake and excessive quantity overwhelmed the kidneys' ability for adaptation. Potassium toxicity affects multiple organ systems and manifests in characteristic, acute cardiovascular changes with electrocardiographic abnormalities. Neuromuscular manifestations include general muscular weakness and ascending paralysis may occur, whereas gastrointestinal symptoms manifest as nausea, vomiting, paralytic ileus, and local mucosal necrosis that may lead to perforation. Once an urgent situation has been handled with intravenous push of a 10% calcium salt, short-term measures should be started with agents that cause a transcellular shift of potassium, namely, insulin with glucose, β2-agonist, and NaHCO(3). Patients are unaware of these potentially serious adverse effects, and there are inadequate consumer warnings. Clinicians should be vigilant in monitoring potassium intake from over-the-counter supplements.
氯化钾和其他钾化合物被公众用作盐替代品、肌肉增强补充剂和万灵药。如果肾功能正常，由于钾适应，口服钾引起的严重高钾血症极为罕见。口服钾剂量必须足够大，以克服正常的肾脏排泄机制，导致严重的高钾血症。这种情况最常见于肾功能受损的患者或服用保钾利尿剂、血管紧张素受体阻滞剂或血管紧张素转换酶抑制剂的患者。我们报告了两例因含钾营养补充剂引起的近乎致命性高钾血症的独特病例。第一例是由于盐替代品的摄入，而第二例是由于肌肉增强补充剂。两名患者均发生心脏骤停，但均成功复苏并存活。摄入的急性和过量超过了肾脏的适应能力。钾毒性影响多个器官系统，并表现出特征性的急性心血管变化，伴有心电图异常。神经肌肉表现包括全身肌肉无力和进行性瘫痪，而胃肠道症状表现为恶心、呕吐、麻痹性肠梗阻和局部黏膜坏死，可能导致穿孔。一旦通过静脉推注 10％钙盐处理紧急情况，就应开始使用可引起钾细胞内转移的短期措施，即胰岛素与葡萄糖、β2-激动剂和 NaHCO3。患者不知道这些潜在的严重不良反应，而且消费者警告不足。临床医生应警惕监测来自非处方补充剂的钾摄入。
