Papazian L, Quinsat D, Costello R, Harle J R, François G
Département d'Anesthésie-Réanimation, G.H. Timone-Marseille.
Ann Fr Anesth Reanim. 1989;8(4):355-6. doi: 10.1016/s0750-7658(89)80077-2.
The case is reported of a 47 year old female patient admitted with asthenia, anorexia, nausea and constipation. The poor clinical features contrasted with the severe biological disturbances: 1 mmol.l-1 serum potassium, pH 7.26, 19 mmHg PaCO2, 8 mmol.l-1 bicarbonate, myoglobinaemia and myoglobinuria. The electrocardiogram showed a flattened T wave, an U wave, and a depressed ST segment. Potassium was given intravenously at a rate of 0.38 mmol.kg-1.h-1 during the first 24 h. Renal biopsy confirmed the diagnosis of distal renal tubular acidosis, but no aetiology could be found. This patient's excellent clinical tolerance of a severe hypokalemia suggested that the potassium pool could be replaced at slower rates than those suggested in the literature for patients with severe symptoms and signs.
报告了一例47岁女性患者，因乏力、厌食、恶心和便秘入院。患者临床表现欠佳，但生物学指标紊乱严重：血钾1 mmol.l-1，pH 7.26，动脉血二氧化碳分压19 mmHg，碳酸氢根8 mmol.l-1，存在肌红蛋白血症和肌红蛋白尿。心电图显示T波低平、出现U波以及ST段压低。最初24小时内静脉补钾速度为0.38 mmol.kg-1.h-1。肾活检确诊为远端肾小管酸中毒，但未发现病因。该患者对严重低钾血症具有良好的临床耐受性，提示钾储备的补充速度可低于文献中针对有严重症状和体征患者所建议的速度。
