Ngugi N N, McLigeyo S O, Kayima J K
Department of Medicine College of Health Sciences, University of Nairobi, Nairobi.
East Afr Med J. 1997 Aug;74(8):503-9.
Ten patients with acute and 60 with chronic renal failure (both groups having hyperkalaemia), were managed at Kenyatta National Hospital in the medical wards and Renal Unit between August, 1995 and January, 1996. They were divided into seven different treatment groups, each consisting of ten patients. Treatment A glucose 25g i.v. with insulin 10 units i.v., treatment B 50 mmol of 8.4% sodium bicarbonate infusion, treatment C 0.5mg of salbutamol i.v. in 50mls 5% dextrose, treatment D was a combination of treatments A and B, treatment E was a combination of treatment B and C, treatment F was a combination of treatments A and C while treatment G was a combination of treatments A and B and C. Serum potassium was measured, 30 minutes, 1 hour, 2 hours, 4 hours and 8 hours after treatment. Plasma glucose concentration was measured before treatment was given and 1 hour after in all patients. Electrocardiography was done before treatment on all patients and repeated 30 minutes and 1 hour after treatment for the patients with hyperkalaemic changes on the initial recording. All treatment modalities had satisfactory potassium lowering effects. Of the single therapeutic approaches, treatment A and C were equieffective, but better than treatment B (P < 0.001). Amongst the two regimen combinations, treatment D and F were more efficacious than treatment E and all the single therapeutic approaches (P < 0.001). Treatment G was the most efficacious in lowering serum potassium in this study. All treatment modalities had maximum serum potassium lowering effect at 1-2 hours. A fall in plasma glucose concentration was a notable feature of treatments A and D, but significant hypoglycaemia occurred in 20% of patients receiving treatment A and in none on treatment D. The ECG changes of hyperkalaemia did not correlate with serum potassium levels. The normalisation of hyperkalaemic ECG alteration occurred within the first 30 minutes after treatment. In conclusion, combination therapies for hyperkalaemia appear to be more efficacious than single therapeutic approaches. Inclusion of salbutamol seems to protect against insulin induced hypoglycaemia. The maximum potassium lowering effect is observed 1-2 hours of administration of either agents. The potassium reducing effect remains significant compared to baseline values even after 8 hours. If dialysis cannot be instituted early enough it seems reasonable to repeat treatment every 4-6 hours to sustain the effect. Repeated administration of glucose with insulin may not be safe because of the hypoglycaemic effect. Other single and combination therapies can theoretically be repeated regularly until dialysis is initiated although this requires further clinical evaluation.
1995年8月至1996年1月期间，在肯雅塔国家医院的内科病房和肾脏科对10例急性肾衰竭患者和60例慢性肾衰竭患者（两组均有高钾血症）进行了治疗。他们被分为七个不同的治疗组，每组10例患者。治疗A：静脉注射25g葡萄糖加10单位静脉胰岛素；治疗B：输注50mmol 8.4%的碳酸氢钠；治疗C：在50ml 5%葡萄糖中静脉注射0.5mg沙丁胺醇；治疗D：治疗A和B联合；治疗E：治疗B和C联合；治疗F：治疗A和C联合；治疗G：治疗A、B和C联合。治疗后30分钟、1小时、2小时、4小时和8小时测量血清钾。所有患者在治疗前及治疗后1小时测量血浆葡萄糖浓度。所有患者在治疗前进行心电图检查，初始记录有高钾血症改变的患者在治疗后30分钟和1小时重复检查。所有治疗方式均有满意的降钾效果。在单一治疗方法中，治疗A和C效果相当，但优于治疗B（P<0.001）。在两种联合治疗方案中，治疗D和F比治疗E及所有单一治疗方法更有效（P<0.001）。在本研究中，治疗G降血清钾效果最显著。所有治疗方式在1 - 2小时时降血清钾效果最大。血浆葡萄糖浓度下降是治疗A和D的显著特征，但接受治疗A的患者中有20%发生显著低血糖，而接受治疗D的患者中无一例发生。高钾血症的心电图改变与血清钾水平无关。高钾血症心电图改变在治疗后30分钟内恢复正常。总之，高钾血症的联合治疗似乎比单一治疗方法更有效。加入沙丁胺醇似乎可预防胰岛素诱导的低血糖。两种药物给药1 - 2小时时观察到最大降钾效果。即使在8小时后，与基线值相比，降钾效果仍显著。如果不能尽早进行透析，每4 - 6小时重复治疗以维持效果似乎是合理的。由于低血糖作用，重复给予葡萄糖加胰岛素可能不安全。理论上，其他单一和联合治疗可以定期重复，直到开始透析，尽管这需要进一步的临床评估。
