Celebi Yamanoglu Nalan Gokce, Yamanoglu Adnan
Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.
Turk J Emerg Med. 2022 Apr 11;22(2):75-82. doi: 10.4103/2452-2473.342812. eCollection 2022 Apr-Jun.
Intravenous (IV) calcium salts are routinely recommended as a cardio-protective therapy in the emergency treatment of severe hyperkalemia. However, this recommendation is supported by a low level of evidence and is anecdotal. The aim of this study is to determine the effectiveness of IV Calcium (Ca) gluconate in the treatment of hyperkalemia.
Patients with hyperkalemia and with the electrocardiogram (ECG) changes due to hyperkalemia over a 1 year period were included in this prospective observational study. Patients' ECGs were measured, before and after IV Ca-gluconate treatment and after normalization of potassium levels. Wilcoxon test and McNemar's test were used to compare the ECG parameters before and after Ca-gluconate therapy.
The mean potassium value of 111 patients who met the inclusion criteria was 7.1 ± 0.6 mmol/l. In this study, a total of 243 ECG pathology related to hyperkalemia, 79 of which included main rhythm disorders, and the remaining 164 were nonrhythm disorders in ECG parameters, were analyzed. No statistically significant changes were determined in patients' nonrhythm ECG disorders with IV Ca-gluconate treatment ( = 0.125). However, nine of the 79 main rhythm disorders due to hyperkalemia improved with calcium gluconate treatment and this change was statistically significant ( < 0.004).
IV Ca-gluconate therapy was found to be effective, albeit to a limited degree, in main rhythm ECG disorders due to hyperkalemia, but it was not found to be effective in nonrhythm ECG disorders due to hyperkalemia. Therefore, Ca-gluconate may be effective only in the main rhythm disorders due to hyperkalemia.
静脉注射钙盐在严重高钾血症的紧急治疗中通常被推荐作为一种心脏保护疗法。然而，这一推荐的证据水平较低且多为轶事性的。本研究的目的是确定静脉注射葡萄糖酸钙治疗高钾血症的有效性。
本前瞻性观察性研究纳入了在1年期间患有高钾血症且因高钾血症出现心电图（ECG）变化的患者。在静脉注射葡萄糖酸钙治疗前、治疗后以及血钾水平恢复正常后测量患者的心电图。采用Wilcoxon检验和McNemar检验比较葡萄糖酸钙治疗前后的心电图参数。
符合纳入标准的111例患者的平均血钾值为7.1±0.6 mmol/l。在本研究中，共分析了243项与高钾血症相关的心电图病变，其中79项包括主要节律紊乱，其余164项为心电图参数中的非节律紊乱。静脉注射葡萄糖酸钙治疗后，患者的非节律性心电图紊乱无统计学显著变化（P = 0.125）。然而，79例因高钾血症导致的主要节律紊乱中有9例经葡萄糖酸钙治疗后有所改善，且这一变化具有统计学显著性（P < 0.004）。
静脉注射葡萄糖酸钙治疗在因高钾血症导致的主要节律性心电图紊乱中虽有一定效果，但在因高钾血症导致的非节律性心电图紊乱中未发现有效。因此，葡萄糖酸钙可能仅对因高钾血症导致的主要节律紊乱有效。
