Doman K, Perlmutter J A, Muhammedi M, Puschett J B
Department of Medicine, University of Pittsburgh School of Medicine, Pa.
South Med J. 1993 Nov;86(11):1269-72. doi: 10.1097/00007611-199311000-00019.
Angiotensin converting enzyme (ACE) inhibitors have become commonly used medications for hypertension and congestive heart failure. These agents are noted for their low incidence of adverse effects; but in certain cases, these effects can be life-threatening. Severe hyperkalemia is one of the potentially dangerous effects of the ACE inhibitors. While cases of life-threatening hyperkalemia associated with the use of ACE inhibitors have been described previously, in no instance was dialysis required. Herein, we report a case of acute hyperkalemia in a patient with congestive heart failure and renal insufficiency, the resolution of which required hemodialysis. The hyperkalemia in this case occurred without an increase in the patient's azotemia. In addition, the patient did not respond to attempts to effect the intracellular shift of potassium. This suggested that there may have been a defect in internal potassium homeostasis.
血管紧张素转换酶（ACE）抑制剂已成为治疗高血压和充血性心力衰竭的常用药物。这些药物的不良反应发生率较低；但在某些情况下，这些影响可能危及生命。严重高钾血症是ACE抑制剂潜在的危险影响之一。虽然先前已描述过与使用ACE抑制剂相关的危及生命的高钾血症病例，但无一例需要透析。在此，我们报告一例充血性心力衰竭和肾功能不全患者发生急性高钾血症，其缓解需要血液透析。该病例中的高钾血症发生时患者的氮质血症并未加重。此外，患者对促使钾向细胞内转移的尝试无反应。这表明可能存在体内钾稳态缺陷。
