Allon M, Shanklin N
Nephrology Research and Training Center, University of Alabama at Birmingham 35294, USA.
Am J Kidney Dis. 1996 Oct;28(4):508-14. doi: 10.1016/s0272-6386(96)90460-6.
Acute treatment of hyperkalemia in patients with end-stage renal disease requires temporizing measures to shift potassium rapidly from the extracellular to the intracellular fluid compartments until hemodialysis can be initiated. Whereas insulin and albuterol are effective in lowering plasma potassium acutely, bicarbonate by itself is not. Bicarbonate administration may, however, potentiate the effects of insulin and albuterol on plasma potassium. Using a prospective cross-over design, we investigated the acute effects of (1) isotonic bicarbonate, (2) isotonic saline, (3) insulin + bicarbonate, (4) insulin + saline, (5) albuterol + bicarbonate, and (6) albuterol + saline on plasma potassium as well as blood bicarbonate and pH in nondiabetic hemodialysis patients. After obtaining a baseline blood sample, the subjects received one of the six treatment protocols, with plasma potassium measured every 15 minutes over 1 hour. Neither isotonic bicarbonate nor isotonic saline decreased plasma potassium significantly (-0.03 +/- 0.06 mmol/L v -0.01 +/- 0.10 mmol/L at 60 minutes; P = 0.60). Intravenous insulin decreased plasma potassium by a similar degree when given in conjunction with bicarbonate or saline (-0.81 +/- 0.05 mmol/L v -0.85 +/- 0.06 mmol/L at 60 minutes; P = 0.65). Likewise, nebulized albuterol decreased plasma potassium by a similar degree when given with bicarbonate or saline (-0.71 +/- 0.16 mmol/L v -0.53 +/- 0.15 mmol/L at 60 minutes; P = 0.18). The three protocols that included bicarbonate administration resulted in significant increases in blood bicarbonate (P < 0.005) and pH (P < 0.01), whereas the three protocols that included saline did not affect blood bicarbonate or pH. These observations suggest that bicarbonate administration does not potentiate the potassium-lowering effects of insulin or albuterol in hemodialysis patients.
终末期肾病患者高钾血症的急性治疗需要采取临时措施，迅速将钾从细胞外液转移至细胞内液，直至能够开始血液透析。胰岛素和沙丁胺醇可有效急性降低血浆钾水平，而碳酸氢盐本身则无此作用。然而，给予碳酸氢盐可能会增强胰岛素和沙丁胺醇对血浆钾的作用。我们采用前瞻性交叉设计，研究了（1）等渗碳酸氢盐、（2）等渗盐水、（3）胰岛素+碳酸氢盐、（4）胰岛素+盐水、（5）沙丁胺醇+碳酸氢盐和（6）沙丁胺醇+盐水对非糖尿病血液透析患者血浆钾以及血液碳酸氢盐和pH的急性影响。在采集基线血样后，受试者接受六种治疗方案之一，在1小时内每15分钟测量一次血浆钾。等渗碳酸氢盐和等渗盐水均未显著降低血浆钾水平（60分钟时分别为-0.03±0.06 mmol/L和-0.01±0.10 mmol/L；P = 0.60）。静脉注射胰岛素与碳酸氢盐或盐水联用时，降低血浆钾的程度相似（60分钟时分别为-0.81±0.05 mmol/L和-0.85±0.06 mmol/L；P = 0.65）。同样，雾化吸入沙丁胺醇与碳酸氢盐或盐水联用时，降低血浆钾的程度相似（60分钟时分别为-0.71±0.16 mmol/L和-0.53±0.15 mmol/L；P = 0.18）。包含碳酸氢盐给药的三种方案导致血液碳酸氢盐显著升高（P < 0.005）和pH升高（P < 0.01），而包含盐水的三种方案对血液碳酸氢盐或pH无影响。这些观察结果表明，在血液透析患者中，给予碳酸氢盐并不能增强胰岛素或沙丁胺醇的降钾作用。
