一名终末期肾衰竭患者在腹腔镜胃切除术期间发生由肝梗死引起的顽固性高钾血症：病例报告
Intractable hyperkalemia caused by hepatic infarction developed during laparoscopic gastrectomy in a patient with end-stage renal failure: a case report.
作者信息
Takeyama Eriko, Nishimura Nobuyuki, Amano Eizo, Shibuya Hiromi
机构信息
Department of Anesthesiology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan.
Department of Anesthesiology, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-Ku, Osaka City, Osaka, 543-0035, Japan.
出版信息
JA Clin Rep. 2019 Sep 10;5(1):60. doi: 10.1186/s40981-019-0280-8.
BACKGROUND
Patients with renal failure are susceptible to electrolyte disturbances including life-threatening hyperkalemia, and intraoperative hepatic damage exacerbates it. We report a case on hemodialysis who developed intraoperative remarkable hyperkalemia caused by hepatic damage during laparoscopic gastrectomy.
CASE PRESENTATION
A 48-year-old man underwent laparoscopic gastrectomy for gastric cancer. He had been on hemodialysis for chronic renal failure. Serum K continued to increase to a maximum level of 7.4 mEq/L, despite the infusion of glucose with insulin during surgery. Postoperative computed tomography revealed hepatic infarction. Combined with increased hepatic enzymes, hepatic infarction caused by intraoperative mechanical traction would have exacerbated hyperkalemia.
CONCLUSIONS
We report a case on hemodialysis who developed intraoperative hyperkalemia due to hepatic damage. Our case highlights hepatic damage during laparoscopic gastrectomy as a potential cause of hyperkalemia.
背景
肾衰竭患者易发生电解质紊乱，包括危及生命的高钾血症，而术中肝损伤会使其加重。我们报告一例接受血液透析的患者，在腹腔镜胃切除术期间因肝损伤发生术中显著高钾血症。
病例介绍
一名48岁男性因胃癌接受腹腔镜胃切除术。他因慢性肾衰竭一直在接受血液透析。尽管手术期间输注了葡萄糖加胰岛素，但血清钾持续升高至最高水平7.4 mEq/L。术后计算机断层扫描显示肝梗死。术中机械牵引导致的肝梗死，再加上肝酶升高，会加重高钾血症。
结论
我们报告一例接受血液透析的患者，因肝损伤发生术中高钾血症。我们的病例突出了腹腔镜胃切除术期间的肝损伤是高钾血症的一个潜在原因。
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