Latière M, Dumont J C, Olmer M, François G
Département d'Anesthésie-Réanimation, Hôpital Timone-Adultes, Marseille.
Ann Fr Anesth Reanim. 1989;8(2):133-6. doi: 10.1016/s0750-7658(89)80166-2.
A case is reported of an acute episode of severe hypokalaemia (K+ = 1.1 mmol.l-1) associated with hyperchloraemic acidosis and simultaneous high urine pH (pH = 7) in a 24 year old woman with type I distal tubular acidosis and nephrocalcinosis. The flaccid paralysis involved the trunk, neck, facial and pharyngeal muscles. She was in areflexic quadriplegia, coma and respiratory failure requiring endotracheal intubation and positive pressure ventilation. There were no cardiac disturbances, presumably because of the chronic potassium depletion, the patient's youth and healthy myocardium. Despite the usually recommended maximal potassium infusion rate (0.25 mmol.kg-1.h-1), there was a transient worsening of her neuromuscular status. Only 12 h later, the first movements were noticed. In order to prevent such a deterioration, a more rapid potassium infusion could have been used. However, in our case, the occurrence of hypokalaemic extrasystoles was reduced and the patient was still intubated and ventilated. It was therefore decided not to run the risk of myocardial inexcitability carried out with supramaximal infusion rates and to keep the usual protocol. Besides, several pitfalls have to be avoided during the treatment of the numerous metabolic disorders coexisting with severe hypokalaemia, such as metabolic acidosis and hyperglycaemia.
报告了一例24岁患有I型远端肾小管酸中毒和肾钙质沉着症的女性，出现严重低钾血症（钾离子=1.1mmol/L）急性发作，伴有高氯性酸中毒且同时尿pH值高（pH=7）。弛缓性麻痹累及躯干、颈部、面部和咽部肌肉。她处于无反射性四肢瘫、昏迷和呼吸衰竭状态，需要气管插管和正压通气。未出现心脏紊乱，推测是由于慢性钾缺乏、患者年轻且心肌健康。尽管按照通常推荐的最大钾输注速率（0.25mmol·kg⁻¹·h⁻¹），她的神经肌肉状态仍出现短暂恶化。仅12小时后，才注意到首次出现动作。为防止这种恶化，本可采用更快的钾输注速度。然而，在我们的病例中，低钾性期前收缩的发生减少，且患者仍在插管和通气。因此决定不冒因超最大输注速率导致心肌兴奋性丧失的风险，维持通常的方案。此外，在治疗与严重低钾血症并存的多种代谢紊乱（如代谢性酸中毒和高血糖症）时，必须避免一些陷阱。
