高鉀血症

高鉀血症
高鉀血症
	高血鉀症患者的心電圖。
類型	mineral metabolism disease[*]、電解質不平衡
分類和外部資源
醫學專科	重症醫學、腎臟科
ICD-11	5C76
ICD-10	E87.5
ICD-9-CM	276.7
DiseasesDB	6242
MedlinePlus	001179
eMedicine	emerg/261
MeSH	D006947
	[編輯此條目的維基數據]

高鉀血症（拉丁語：hyperkalemia、hyperkalaemia），即生物體內血中含鉀離子（K⁺）含量過多^[1]。人體 95%的鉀元素位於細胞內，僅 5%位於血液中，而鈉鉀泵正是保持此濃度差的主要機制。血清正常血鉀值介於 3.5至 5.5 mEq/L之間，血漿正常血鉀值則介於 3.5至 5.0 mEq/L之間，若高於正常值則稱為高鉀血症^[2]^[3]。外科學上，血清鉀濃度超過5.5mmol/L^[4]或5.0mmol/L^[5]^[6]即為高鉀血症。^[7]通常高鉀血症不會有症狀^[1]，但可能引發心悸、肌肉疼痛、肌肉無力（英語：muscle weakness），或感覺麻木（拉丁語：Paresthesia)等^[1]^[8]。嚴重時將引發心律不整，進一步導致病患死亡^[1]^[2]。

病因及診斷

高鉀血症最常見的原因包含腎功能衰竭、醛固酮過低（英語：hypoaldosteronism），或橫紋肌溶解症等等^[1]。某些藥物包含螺內酯、非甾體抗炎藥，以及血管緊張肽I轉化酶抑制劑（ACEI）也會造成血鉀提升^[1]。

高鉀血症能以血鉀濃度分為輕度（5.5-5.9 mmol/L）、中度（6.0-6.4 mmol/L），及重度（>6.5 mmol/L）^[2]。劑量高時甚至能以心電圖偵測^[2]。檢驗必須排除因採血過程破壞細胞所造成的假性高血鉀^[1]^[8]。

症狀

症狀不明顯，但一般包括身體不適、心悸、及肌肉無力。輕微的過度換氣可能是代謝性酸中毒──高鉀血症的症狀之一──引起的補償機制。然而此種情形通常僅在血液篩檢、或是心律不整等併發症產生時才得以偵測。

在問診時，醫生會聚焦於腎臟疾病及用藥上，因為此二者皆為此症主因。然而若伴隨腹痛、低血糖症及色素大量沉着，則病患可能同時患有其他自體免疫性疾病或愛迪生氏病。

治療

立即停止外源性鉀攝入和針對可逆病因的治療通常是高鉀血症處置的第一步^[9]，建議進行低鉀飲食^[1]。

葡萄糖酸鈣

由於鈣離子對於鉀離子有對抗作用，若心電圖發生變化，可給予葡萄糖酸鈣以對抗心率失常^[1]^[2]。

聯用葡萄糖和胰島素

靜脈注射胰島素和葡萄糖是有證據支持的治療緊急高鉀血症的一線療法之一。^[10]該方法促進鉀離子向細胞內的轉運從而降低血鉀。^[11]低血糖是該療法可能的併發症。^[12]

碳酸氫鈉

陽離子交換樹脂

陽離子交換樹脂（英語：polystyrene sulfonate）用於通過加速腸道中鉀的流失來治療高鉀血症，特別是在尿量不足或透析之前的情況下。^[13]負載有鈉或鈣的樹脂傾向於和胃腸液中的鉀離子結合，釋放出鈉或鈣離子，隨後樹脂隨糞便排除，從而實現降低血鉀的目的。在施用的同時需要考慮鈉或鈣超載的風險。^[13]亦有觀點認為該方法效果太差而不推薦使用。^[14]

其它藥物

如呋塞米、沙丁胺醇。^{[來源請求]}

透析

透析包括腹膜透析和血液透析，通常在上述方法均無效或病症嚴重的情況下使用^[15]^[16]，或為最有效的方式^[2]。

流行病學

正常個體很少會發生高血鉀的狀況^[17]，但在醫院病患中發生的概率高達1%至 2.5%^[8]，且會將死亡風險拉高十倍以上^[8]^[17]。

相關介紹影片

另見

低鉀血症

參考文獻

^ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 ^1.7 ^1.8 Lehnhardt, A; Kemper, MJ. Pathogenesis, diagnosis and management of hyperkalemia.. Pediatric nephrology (Berlin, Germany). March 2011, 26 (3): 377–84. PMC 3061004  . PMID 21181208. doi:10.1007/s00467-010-1699-3.
^ ^2.0 ^2.1 ^2.2 ^2.3 ^2.4 ^2.5 Soar, J; Perkins, GD; Abbas, G; Alfonzo, A; Barelli, A; Bierens, JJ; Brugger, H; Deakin, CD; Dunning, J; Georgiou, M; Handley, AJ; Lockey, DJ; Paal, P; Sandroni, C; Thies, KC; Zideman, DA; Nolan, JP. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution.. Resuscitation. October 2010, 81 (10): 1400–33. PMID 20956045. doi:10.1016/j.resuscitation.2010.08.015.
^ Pathy, M.S. John. Principles and practice of geriatric medicine 4. Chichester [u.a.]: Wiley. 2006: Appendix [2017-03-17]. ISBN 9780470090558. （原始內容存檔於2016-10-01）.
^ 吳夢超. 外科学. 北京: 人民衛生出版社. 2018: 14. ISBN 978-7-117-26639-0.
^ Townsend, Courtney M. (編). Shock, Electrolytes, and Fluid. Sabiston textbook of surgery: the biological basis of modern surgical practice 21st. St. Louis, Missouri: Elsevier. 2022: 86. ISBN 978-0-323-64062-6. Hyperkalemia is defined as [K+] of more than 5.0 mmol/L.
^ Bansal, Shweta; Pergola, Pablo E. Current Management of Hyperkalemia in Patients on Dialysis. Kidney International Reports. 2020-06, 5 (6). doi:10.1016/j.ekir.2020.02.1028 （英語）. generally defined as serum potassium (K+) concentrations of >5.0 mmol/l
^ Simon, Leslie V.; Hashmi, Muhammad F.; Farrell, Mitchell W. Hyperkalemia. StatPearls. Treasure Island (FL): StatPearls Publishing. 2024. PMID 29261936. Hyperkalemia is defined as a serum or plasma potassium level above the upper limits of normal, usually greater than 5.0 mEq/L to 5.5 mEq/L
^ ^8.0 ^8.1 ^8.2 ^8.3 McDonald, TJ; Oram, RA; Vaidya, B. Investigating hyperkalaemia in adults.. BMJ (Clinical research ed.). 20 October 2015, 351: h4762. PMID 26487322.
^ Simon, Leslie V.; Hashmi, Muhammad F.; Farrell, Mitchell W. Hyperkalemia. StatPearls. Treasure Island (FL): StatPearls Publishing. 2024. PMID 29261936. Exogenous sources of potassium should be immediately discontinued.
^ Mahoney, BA; Smith, WA; Lo, DS; Tsoi, K; Tonelli, M; Clase, CM. Emergency interventions for hyperkalaemia.. The Cochrane database of systematic reviews. 18 April 2005, (2): CD003235. PMID 15846652. doi:10.1002/14651858.CD003235.pub2.
^ Sterns, Richard H.; Grieff, Marvin; Bernstein, Paul L. Treatment of hyperkalemia: something old, something new. Kidney International. 2016-03, 89 (3). doi:10.1016/j.kint.2015.11.018 （英語）.
^ Moussavi, Kayvan; Fitter, Scott; Gabrielson, Stephen Walter; Koyfman, Alex; Long, Brit. Management of Hyperkalemia With Insulin and Glucose: Pearls for the Emergency Clinician. The Journal of Emergency Medicine. 2019-07, 57 (1). doi:10.1016/j.jemermed.2019.03.043 （英語）.
^ ^13.0 ^13.1 O'Shaughnessy, Kevin M. Kidney and genitourinary tract. Clinical Pharmacology. Elsevier. 2012: 452–466. ISBN 978-0-7020-4084-9. doi:10.1016/b978-0-7020-4084-9.00066-5 （英語）.
^ Kamel, Kamel S.; Lin, Shih-Hua; Halperin, Mitchell L. Clinical Disorders of Hyperkalemia. Seldin and Giebisch's The Kidney. Elsevier. 2008: 1387–1405. ISBN 978-0-12-088488-9. doi:10.1016/b978-012088488-9.50052-8 （英語）. Thus, there is little if any benefit of using resins for the treatment of acute hyperkalemia and little benefit of adding resins to cathartics in the setting of chronic hyperkalemia.
^ Hyperkalemia Treatment & Management: Approach Considerations, Initial Emergency Management, Pharmacologic Therapy and Dialysis. 2023-10-16. Any patient with significantly elevated potassium levels should undergo dialysis
^ Bansal, Shweta; Pergola, Pablo E. Current Management of Hyperkalemia in Patients on Dialysis. Kidney International Reports. 2020-06, 5 (6). PMC 7270720  . PMID 32518860. doi:10.1016/j.ekir.2020.02.1028 （英語）.
^ ^17.0 ^17.1 Kovesdy, CP. Updates in hyperkalemia: Outcomes and therapeutic strategies.. Reviews in endocrine & metabolic disorders. 6 September 2016. PMID 27600582. doi:10.1007/s11154-016-9384-x.

外部連結

[Leh2011-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 ^1.7 ^1.8 Lehnhardt, A; Kemper, MJ. Pathogenesis, diagnosis and management of hyperkalemia.. Pediatric nephrology (Berlin, Germany). March 2011, 26 (3): 377–84. PMC 3061004  . PMID 21181208. doi:10.1007/s00467-010-1699-3.

[EU2010-2] 2.0 ^2.1 ^2.2 ^2.3 ^2.4 ^2.5 Soar, J; Perkins, GD; Abbas, G; Alfonzo, A; Barelli, A; Bierens, JJ; Brugger, H; Deakin, CD; Dunning, J; Georgiou, M; Handley, AJ; Lockey, DJ; Paal, P; Sandroni, C; Thies, KC; Zideman, DA; Nolan, JP. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution.. Resuscitation. October 2010, 81 (10): 1400–33. PMID 20956045. doi:10.1016/j.resuscitation.2010.08.015.

[3] Pathy, M.S. John. Principles and practice of geriatric medicine 4. Chichester [u.a.]: Wiley. 2006: Appendix [2017-03-17]. ISBN 9780470090558. （原始內容存檔於2016-10-01）.

[4] 吳夢超. 外科学. 北京: 人民衛生出版社. 2018: 14. ISBN 978-7-117-26639-0.

[5] Townsend, Courtney M. (編). Shock, Electrolytes, and Fluid. Sabiston textbook of surgery: the biological basis of modern surgical practice 21st. St. Louis, Missouri: Elsevier. 2022: 86. ISBN 978-0-323-64062-6. Hyperkalemia is defined as [K+] of more than 5.0 mmol/L.

[6] Bansal, Shweta; Pergola, Pablo E. Current Management of Hyperkalemia in Patients on Dialysis. Kidney International Reports. 2020-06, 5 (6). doi:10.1016/j.ekir.2020.02.1028 （英語）. generally defined as serum potassium (K+) concentrations of >5.0 mmol/l

[7] Simon, Leslie V.; Hashmi, Muhammad F.; Farrell, Mitchell W. Hyperkalemia. StatPearls. Treasure Island (FL): StatPearls Publishing. 2024. PMID 29261936. Hyperkalemia is defined as a serum or plasma potassium level above the upper limits of normal, usually greater than 5.0 mEq/L to 5.5 mEq/L

[BMJ2015-8] 8.0 ^8.1 ^8.2 ^8.3 McDonald, TJ; Oram, RA; Vaidya, B. Investigating hyperkalaemia in adults.. BMJ (Clinical research ed.). 20 October 2015, 351: h4762. PMID 26487322.

[9] Simon, Leslie V.; Hashmi, Muhammad F.; Farrell, Mitchell W. Hyperkalemia. StatPearls. Treasure Island (FL): StatPearls Publishing. 2024. PMID 29261936. Exogenous sources of potassium should be immediately discontinued.

[10] Mahoney, BA; Smith, WA; Lo, DS; Tsoi, K; Tonelli, M; Clase, CM. Emergency interventions for hyperkalaemia.. The Cochrane database of systematic reviews. 18 April 2005, (2): CD003235. PMID 15846652. doi:10.1002/14651858.CD003235.pub2.

[11] Sterns, Richard H.; Grieff, Marvin; Bernstein, Paul L. Treatment of hyperkalemia: something old, something new. Kidney International. 2016-03, 89 (3). doi:10.1016/j.kint.2015.11.018 （英語）.

[12] Moussavi, Kayvan; Fitter, Scott; Gabrielson, Stephen Walter; Koyfman, Alex; Long, Brit. Management of Hyperkalemia With Insulin and Glucose: Pearls for the Emergency Clinician. The Journal of Emergency Medicine. 2019-07, 57 (1). doi:10.1016/j.jemermed.2019.03.043 （英語）.

[:0-13] 13.0 ^13.1 O'Shaughnessy, Kevin M. Kidney and genitourinary tract. Clinical Pharmacology. Elsevier. 2012: 452–466. ISBN 978-0-7020-4084-9. doi:10.1016/b978-0-7020-4084-9.00066-5 （英語）.

[14] Kamel, Kamel S.; Lin, Shih-Hua; Halperin, Mitchell L. Clinical Disorders of Hyperkalemia. Seldin and Giebisch's The Kidney. Elsevier. 2008: 1387–1405. ISBN 978-0-12-088488-9. doi:10.1016/b978-012088488-9.50052-8 （英語）. Thus, there is little if any benefit of using resins for the treatment of acute hyperkalemia and little benefit of adding resins to cathartics in the setting of chronic hyperkalemia.

[15] Hyperkalemia Treatment & Management: Approach Considerations, Initial Emergency Management, Pharmacologic Therapy and Dialysis. 2023-10-16. Any patient with significantly elevated potassium levels should undergo dialysis

[16] Bansal, Shweta; Pergola, Pablo E. Current Management of Hyperkalemia in Patients on Dialysis. Kidney International Reports. 2020-06, 5 (6). PMC 7270720  . PMID 32518860. doi:10.1016/j.ekir.2020.02.1028 （英語）.

[Kov2016-17] 17.0 ^17.1 Kovesdy, CP. Updates in hyperkalemia: Outcomes and therapeutic strategies.. Reviews in endocrine & metabolic disorders. 6 September 2016. PMID 27600582. doi:10.1007/s11154-016-9384-x.

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