Kotera Atsushi, Irie Hiroki, Iwashita Shinsuke, Taniguchi Junichi, Kasaoka Shunji, Sagishima Katsuyuki, Kamohara Hidenobu, Kinoshita Yoshihiro
Department of Emergency and General Medicine Kumamoto University Hospital Kumamoto Japan.
Department of Intensive Care Medicine Kumamoto University Hospital Kumamoto Japan.
Acute Med Surg. 2014 May 19;1(4):234-237. doi: 10.1002/ams2.45. eCollection 2014 Oct.
In Case 1, a 63-year-old woman was admitted with muscular weakness. She had hypertension, diabetes mellitus, and chronic renal failure on hemodialysis. She was taking a beta-blocker. Her pulse rate was 42 b.p.m. (irregular rhythm); serum potassium level was 9.8 mmol/L; electrocardiogram revealed widening of the QRS complex (0.256 s). In Case 2, a 59-year-old man was admitted with muscular weakness. He had hypertension and chronic renal failure, and was taking a renin-angiotensin-aldosterone system inhibitor. His pulse rate was 42 b.p.m. (irregular rhythm); serum potassium level was 10.1 mmol/L; electrocardiogram revealed widening of the QRS complex (0.180 s).
Life-threatening arrhythmia did not occur, and patients survived under appropriate treatment.
Chronic renal failure, diabetes mellitus, or medications affecting extrarenal potassium homeostasis can produce a tolerance to hyperkalemia. This tolerance may help prevent life-threatening arrhythmia despite fatal levels of serum potassium.
病例1中，一名63岁女性因肌肉无力入院。她患有高血压、糖尿病以及正在接受血液透析的慢性肾衰竭。她正在服用一种β受体阻滞剂。她的脉搏率为42次/分钟（心律不齐）；血清钾水平为9.8 mmol/L；心电图显示QRS波群增宽（0.256秒）。病例2中，一名59岁男性因肌肉无力入院。他患有高血压和慢性肾衰竭，正在服用肾素 - 血管紧张素 - 醛固酮系统抑制剂。他的脉搏率为42次/分钟（心律不齐）；血清钾水平为10.1 mmol/L；心电图显示QRS波群增宽（0.180秒）。
未发生危及生命的心律失常，患者在适当治疗下存活。
慢性肾衰竭、糖尿病或影响肾外钾稳态的药物可产生对高钾血症的耐受性。尽管血清钾水平达到致命程度，但这种耐受性可能有助于预防危及生命的心律失常。
