Al Aseri Zohair
Department of Emergency Medicine and Critical Care, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia.
Saudi J Anaesth. 2019 Jul-Sep;13(3):240-242. doi: 10.4103/sja.SJA_708_18.
Patients with severe hyperkalemia may present hemodynamic instability. The use of intravenous (IV) calcium for the treatment of hyperkalemia is based on sparse evidence. We hypothesized that the administration of calcium salts would decrease mortality in patients with severe hyperkalemia and circulatory shock. We report a case of a 56-year-old female who presented to an academic emergency department with acute confusion, lethargic mental status, and circulatory shock. Venous blood gas showed a potassium concentration of 7.9 mmol/L. The patient was given 2 g of IV calcium gluconate. The patient started to regain consciousness, and her blood pressure began to normalize. This emergency management led to an almost immediate resolution of the circulatory shock without the need for cardiac pacing. We conclude that hyperkalemia should be suspected in any patient presenting with acute onset of hypotension and bradycardia. IV calcium salts should be used for hemodynamic instability due to hyperkalemia.
重度高钾血症患者可能会出现血流动力学不稳定。静脉注射钙剂治疗高钾血症的依据并不充分。我们推测，给予钙盐可降低重度高钾血症合并循环性休克患者的死亡率。我们报告一例56岁女性患者，她因急性意识模糊、精神状态嗜睡和循环性休克就诊于一家学术性急诊科。静脉血气显示血钾浓度为7.9 mmol/L。该患者接受了2 g静脉注射葡萄糖酸钙。患者开始恢复意识，血压也开始恢复正常。这种紧急处理几乎立即缓解了循环性休克，无需心脏起搏。我们得出结论，对于任何出现急性低血压和心动过缓的患者，都应怀疑有高钾血症。静脉注射钙盐应用于因高钾血症导致的血流动力学不稳定。
