Ponce S P, Jennings A E, Madias N E, Harrington J T
Medicine (Baltimore). 1985 Nov;64(6):357-70. doi: 10.1097/00005792-198511000-00001.
After reviewing the available data on drug-induced hyperkalemia, we conclude that the situation has not improved since Lawson quantitatively documented the substantial risks of potassium chloride over a decade ago (90). As discussed, the risk of developing hyperkalemia in hospital remains at least at the range of 1 to 2% and can reach 10%, depending on the definition used (Table 2). Potassium chloride supplements and potassium-sparing diuretics remain the major culprits but they have been joined by a host of new actors, e.g., salt substitutes, beta-blockers, converting enzyme inhibitors, nonsteroidal antiinflammatory agents, and heparin, among others. Readily identifiable risk factors (other than drugs) for developing hyperkalemia are well-known but seem to be consistently ignored, even in teaching hospitals. The presence of diabetes mellitus, renal insufficiency, hypoaldosteronism, and age greater than 60 years results in a substantial increase in the risk of hyperkalemia from the use of any of the drugs we have reviewed. If prevention of hyperkalemia is the goal, as it should be, the current widespread and indiscriminate use of potassium supplements and potassium-sparing diuretics will need to end. We remain intrigued by Burchell's prescient pronouncement of over a decade ago that "more lives have been lost than saved by potassium therapy" (28).
在回顾了有关药物性高钾血症的现有数据后，我们得出结论，自劳森在十多年前定量记录氯化钾的重大风险以来（90），情况并未得到改善。如前所述，住院患者发生高钾血症的风险至少仍在1%至2%的范围内，根据所使用的定义，这一风险可能高达10%（表2）。氯化钾补充剂和保钾利尿剂仍然是主要罪魁祸首，但现在又出现了许多新的因素，例如盐替代品、β受体阻滞剂、转换酶抑制剂、非甾体抗炎药和肝素等。导致高钾血症的易于识别的风险因素（除药物外）是众所周知的，但即使在教学医院，这些因素似乎也一直被忽视。糖尿病、肾功能不全、醛固酮减少症以及年龄大于60岁会使使用我们所审查的任何一种药物导致高钾血症的风险大幅增加。如果像应该的那样，将预防高钾血症作为目标，那么目前广泛且不加区分地使用钾补充剂和保钾利尿剂的情况将需要终止。我们仍然对伯切尔十多年前有先见之明的论断很感兴趣，即“钾治疗导致的死亡多于挽救的生命”（28）。
