急重症藥物簡介(高低血鉀的治療 )

加護病房查房日誌

低血鉀會怎樣 ?

2

肌肉無力

鉀離子濃度低， T波平坦、 U波出現

影響腎功能影響胰島素分泌

Potassium Chloride (KCl) 15% 20 mEq/10 ml/amp

3Ref: Potassium Chloride: Drug information Copyright 1978-2006 Lexi-Comp, Inc. All rights reserved.

KCl甚麼時候用 pump?

4

一袋中 > 40 mEq KCl

> 10 meq/hr

Ref: Mount DB. Clinical manifestations and treatment of hypokalemia. In: UpToDate, Sheridan AM (Ed), UpToDate, Waltham, MA, 2010.

低血鉀怎麼補不起來 ?

5

低血鉀40-60%低血鎂的病人也會有低血鉀

低血鎂

Ref: Agus ZS. Signs and symptoms of magnesium depletion. In: UpToDate, Sheridan AM (Ed), UpToDate, Waltham, MA, 2010.

Magnesium Sulfate (MgSO4) 10% 2 gm/20 ml/amp

6Ref: Magnesium Sulfate: Drug information Copyright 1978-2006 Lexi-Comp, Inc. All rights reserved.

高血鉀會怎樣 ?

7

T wave 高 肌肉無力

Ref: Mount DB. Treatment and prevention of hyperkalemia In: UpToDate, Sheridan AM (Ed), UpToDate, Waltham, MA, 2010.

治療高血鉀的效果整理治療方法 降血鉀效果 在 ESRD的效果

Insulin + glucose 降 0.5-1.2 meq/L 0.85 meq/LBeta2-agonist 降 0.5-1.5 meq/L 0.3 meq/LBeta2-agonist (albuterl)+insulin+glucose

加成效果 1.2-1.5 meq/L 效果好

Sodium bicarbonate

在代酸的情況下 , 降 0.6-0.7 meq/L 不會降

利尿劑(loop and thiazide)

依病人情況不一定但如果加 hydration,效果會更好腎功能越差 ,劑量要更高

陽離子交換樹脂 1g的藥可換 1meq的鉀一般前 24小時可降 0.4 meq/L

影響吸收的情況同左 ,但如果沒尿 ,可能不會排鉀洗腎 每小時可洗 25-50 meq的鉀 同左

8Ref: Mount DB. Treatment and prevention of hyperkalemia In: UpToDate, Sheridan AM (Ed), UpToDate, Waltham, MA, 2010.

Ca gluconate (Glucal Black) 20% 5 ml/amp

9Ref: Ca gluconate: Drug information Copyright 1978-2006 Lexi-Comp, Inc. All rights reserved.

Calcium chloride (Vitacal) Ca: 0.272 mEq/ml, 20ml/amp

10Ref: Ca gluconate: Drug information Copyright 1978-2006 Lexi-Comp, Inc. All rights reserved.

Sodium bicarbonate (Rolikan) 7% 20 ml/amp

11Ref: Ca gluconate: Drug information Copyright 1978-2006 Lexi-Comp, Inc. All rights reserved.

感恩聆聽