Williams P S, Davenport A, Bone J M
Renal Unit, Royal Liverpool Hospital, UK.
Postgrad Med J. 1988 Jan;64(747):30-2. doi: 10.1136/pgmj.64.747.30.
We describe four patients who developed symptomatic hypoglycaemia following treatment of hyperkalaemia with insulin and dextrose. Two patients had a delayed onset of hypoglycaemia, between 5 and 6 hours after treatment despite use of a 'soluble' type of insulin. A review of the literature revealed a variety of insulin and dextrose regimes but no research to assess the metabolic effects of such therapy in patients with renal failure. The possibility of significant hypoglycaemia following use of insulin and dextrose in the recommended dosages is rarely mentioned. The cases we describe demonstrate that there is no 'correct' dose of insulin and dextrose to suit every circumstance. Regular blood glucose estimations should be performed in all patients receiving such therapy for hyperkalaemia.
我们描述了4例在使用胰岛素和葡萄糖治疗高钾血症后出现症状性低血糖的患者。尽管使用了“可溶性”胰岛素，但仍有2例患者在治疗后5至6小时出现低血糖延迟发作。文献综述显示了多种胰岛素和葡萄糖治疗方案，但尚无研究评估此类治疗对肾衰竭患者的代谢影响。很少有人提及按推荐剂量使用胰岛素和葡萄糖后出现严重低血糖的可能性。我们描述的病例表明，不存在适合所有情况的“正确”胰岛素和葡萄糖剂量。对于所有接受此类高钾血症治疗的患者，都应定期进行血糖测定。
