Department of Clinical Pharmacology, Princess Alexandra Hospital, Brisbane, Australia.
Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia.
Clin Toxicol (Phila). 2021 Nov;59(11):963-968. doi: 10.1080/15563650.2021.1898631. Epub 2021 Mar 23.
Severe toxicity from ingestions of oral sustained-release potassium is rare. While acute hyperkalaemia requires urgent intervention given the risk of cardiac toxicity, there is a lack of clinical consensus on optimal management. The aim of this study was to characterise the clinical manifestations of acute potassium overdose and its management approach.
This is a retrospective case series of patients presenting following oral potassium overdose of ≥6000mg between January 2009 and December 2020 in Queensland, Australia as recorded in the state's Poisons Information Centre database and a tertiary Clinical Toxicology Unit database. Patients were identified from prospective databases maintained by both units and data were extracted from these in addition to medical records.
Thirteen presentations in eleven patients occurred in the twelve-year period. The median age was 35 years (range 14-55 years). The median dose ingested was 6.4 mmol/kg (range 0.9-30.8 mmol/kg). Severe hyperkalaemia >7mmol/L occurred in five patients, four with ingestions ≥60,000mg. All patients with hyperkalaemia received multiple modes of intracellular potassium shifting therapy. Four patients had endoscopic removal of pharmacobezoars. One also underwent whole bowel irrigation. Three presentations were managed with haemodialysis. All patients were discharged home with a median length of stay of 20 h.
Aggressive medical therapy to shift potassium into cells appears to be the mainstay of treatment in patients with normal renal function. Early decontamination may limit peak potassium concentrations. It is unclear if haemodialysis provides significant additional benefit in patients with normal renal function.
口服缓释钾摄入的严重毒性较为罕见。由于存在心脏毒性的风险，急性高钾血症需要紧急干预，但对于最佳治疗方法尚未达成临床共识。本研究旨在描述急性钾过量的临床表现及其治疗方法。
这是一项回顾性病例系列研究，纳入了 2009 年 1 月至 2020 年 12 月期间在澳大利亚昆士兰州因摄入≥6000mg 口服缓释钾而在该州毒物信息中心数据库和三级临床毒理学单位数据库中记录的病例。从两个单位的前瞻性数据库中确定患者，并从这些数据库和病历中提取数据。
在 12 年期间，11 名患者中有 13 人出现 13 次就诊。中位年龄为 35 岁（范围 14-55 岁）。中位摄入剂量为 6.4mmol/kg（范围 0.9-30.8mmol/kg）。5 名患者出现严重高钾血症（>7mmol/L），其中 4 名患者摄入剂量≥60000mg。所有高钾血症患者均接受了多种细胞内钾转移治疗。4 名患者行内镜下取出药物性胃石。1 名患者还接受了全肠灌洗。3 名患者行血液透析治疗。所有患者均出院回家，中位住院时间为 20 小时。
对于肾功能正常的患者，积极的将钾转移到细胞内的药物治疗似乎是治疗的主要方法。早期清除可能会限制钾的峰值浓度。对于肾功能正常的患者，血液透析是否能提供显著的额外益处尚不清楚。
