急診護理個案討論新光醫院 急診科 張志華 醫師

2005 / 09 / 15

常考！

HyperkalemiaHyperkalemia

Hyperkalemia

Symptoms• Generalized fatigue• Weakness• Paresthesias• Paralysis• Palpitations

NonspecificNonspecific ！！

Hyperkalemia

Etiology• Acute or chronic renal failure

• Crush injuries (rhabdomyolysis), burns

• Foods (eg, bananas, oranges, high-protein diets, tomatoes, salt substitutes)

• Redistribution: Acidosis, insulin deficiency, beta-blocker, acute digoxin overdose, succinylcholine, periodic paralysis (PP)

• Drugs – slow-K, spirinolactone diuretics, NSAIDs

考題！

Hyperkalemia

Mild: 5.5-6.5 mEq/L • peaked T waves

Moderate: 6.5-7.5 mEq/L • prolonged PR interval• decreased P wave• ST depression or elevation• slight widening of the QRS

Hyperkalemia (cont.)

Severe: 7.5-8.5 mEq/L• wide QRS • flat and wide P waves• VPCs

Life-threatening: >8.5 mEq/L• loss of P• AV blocks• VT / VF• sinusoid patern

Hyperkalemia

Specific management: "See BIG Potassium Drop" • Calcium • Bicarbonate • Insulin and Glucose • Kayexalate • Dialysis

考題！

Hyperkalemia

General management:• Continuous ECG monitoring• DC K-sparing drugs (ACEI, spirinolactone)• DC high-K foods

Calcium

Stabilize cell membrane Calcium gluconate 10%, 10 ml over 2-5 min 2nd dose after 5 min if no response Effect occurs in minutes and lasts for 1 hour Further calcium ineffective unless hypocalcemia

exists Digoxin Toxicity contraindication !

Bicarbonate

Shift K+ to intracellular 3 amp Jusomine IV over 5 min May repeat q10-15 min Onset in 30 min; duration: 1-2 hours Avoid bicarbonate if:

• Hypocalcemia • Severe lung edema

Glucose and Insulin

Redistribution RI 10U + D50GW 50cc over 5 min Consider Albuterol Neb as adjunct Onset 50-60 min; duration: several hours Follow F/S

Potassium Removal

Cation-Exchange resin (Kayexalate) • 15-30 gm PO q3-4 hrs or 50 gm in 200 ml ret

ention enema for 30-60 min q4hr Dialysis: May experience significant hype

rkalemia on rebound

Summary

Hyperkalemia• Symptoms?

• Diagnosis?

• EKG?

• Etiology?

• Treatment?

余謹以至誠於上帝及會眾面前宣，終身純潔，忠貞職守盡力提高護理專業標準，勿為有損之事，勿取服或故用有害之藥，慎守病人及家務之秘密，竭誠協助醫師之診治，務謀病者之福利。

謹 誓

南丁格爾誓言

一顆純潔的心會自由的給予自由地愛直到它受到創傷 ....

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