Department of Pharmaceutical Services (KNF), Emory University Hospital Midtown, Atlanta, Georgia; Department of Pharmacy and Drug Information (TW), Grady Health System, Atlanta, Georgia; and Renal Division (JJD), Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia.
Am J Med Sci. 2014 Feb;347(2):93-100. doi: 10.1097/MAJ.0b013e318279b105.
The aim of this study was to determine the incidence of treatment of hyperkalemia in hospitalized patients.
This is a prospective chart review of adults in a tertiary care hospital with hyperkalemia (serum potassium [K] ≥5.1 mEq/L) over a 6-month period. The treatments and their effectiveness, causative factors and associated electrocardiographic (ECG) changes were examined.
There were 154 hyperkalemic episodes, 32 with K ≥6.5 mEq/L and 122 with K<6.5 mEq/L. Overall, 97% received treatment for an average K of 5.9 mEq/L. Sodium polystyrene sulfonate (SPS) was included in 95% of the regimens. Incremental doses of SPS monotherapy yielded potassium reductions between 0.7 and 1.1 mEq/L, and inadequate responses (K <0.5 mEq/L) were less frequent with higher doses. There were no differences in the effectiveness of SPS among dialysis-dependent, chronic kidney disease, or nonchronic kidney disease patients. Greater reductions in potassium were observed using a combination of treatments. ECGs were performed in 44% of patients, and 50% showed no ECG changes despite K being ≥6.5 mEq/L. The most common abnormality, peaked T waves, was associated with a higher frequency of calcium administration but not with the number of K+-lowering therapies.
Almost all the patients were treated for hyperkalemia. Oral SPS monotherapy was the predominant treatment with the best response at the highest dose. Some combination therapies had greater K reductions but were used infrequently. An ECG was obtained in about 50% of the cases, but two thirds showed no K-related changes. Reduced kidney function was associated with 70% of hyperkalemic episodes. Angiotensin-converting enzyme inhibitors and trimethoprim were the most commonly implicated medications.
本研究旨在确定住院患者高钾血症的治疗发生率。
这是一项在 6 个月期间对一家三级保健医院中出现高钾血症（血清钾[K]≥5.1mEq/L）的成年人进行的前瞻性图表回顾研究。研究检查了治疗方法及其效果、病因及相关心电图（ECG）变化。
共发生 154 例高钾血症发作，其中 32 例 K≥6.5mEq/L，122 例 K<6.5mEq/L。总体而言，97%的患者接受了治疗，平均 K 值为 5.9mEq/L。95%的方案中包含聚苯乙烯磺酸纳（SPS）。SPS 单药递增剂量治疗可使钾降低 0.7-1.1mEq/L，高剂量治疗时反应不足（K<0.5mEq/L）的情况较少。透析依赖、慢性肾脏病或非慢性肾脏病患者中 SPS 的疗效无差异。联合治疗的钾降低幅度更大。44%的患者进行了心电图检查，尽管 K 值≥6.5mEq/L，仍有 50%的患者心电图无变化。最常见的异常为尖峰 T 波，与钙给药频率较高有关，但与降低 K+的治疗次数无关。
几乎所有患者都接受了高钾血症的治疗。口服 SPS 单药治疗是主要治疗方法，最高剂量效果最佳。一些联合治疗方法的钾降低幅度更大，但使用频率较低。约 50%的病例进行了心电图检查，但三分之二的病例没有显示与 K 相关的变化。肾功能减退与 70%的高钾血症发作有关。血管紧张素转换酶抑制剂和甲氧苄啶是最常涉及的药物。
