高鉀血症

高鉀血症
	高血鉀症患者的心電圖。
?型	mineral metabolism disease [*]
分?和外部?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
	[ ??此?目的?基?据 ]

高鉀血症 （拉丁語： hyperkalemia 、 hyperkalaemia ），?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 ?鉀? 正是保持此濃度差的主要機制。血? 正常血鉀?介於 3.5至 5.5 mEq/L之間，血漿正常血鉀?則介於 3.5至 5.0 mEq/L 之間，若高於正常?則稱?高鉀血症 ^[2]^[3]。外科?上，血???度超?5.5mmol/L ^[4]或5.0mmol/L ^[5]^[6]??高?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? ： 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??

高?血症最常見的原因包含腎功能衰竭、 ?固?過低（英? ： hypoaldosteronism ），或 ??肌溶解症等等 ^[1]。某些藥物包含螺?? 、非??抗炎? ，以及血管???I?化?抑制? （ACEI）也會造成血鉀提升 ^[1]。

高鉀血症能以血鉀濃度分?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?? 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?發症?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?此二者皆?此症主因。然而若伴隨腹痛、低血糖症及色素大量?著，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?

立?停止外源性??入和??可逆病因的治?通常是高?血症?置的第一步 ^[9]，建議進行低鉀?食 ^[1]。

葡萄糖酸? [ ?? ]

由于??子?于??子有?抗作用，若心電圖發生變化，可?予葡萄糖酸? 以?抗心率失常 ^[1]^[2]。

?用葡萄糖和??素 [ ?? ]

??注射 ??素和葡萄糖是有?据支持的治??急高?血症的一??法之一。 ^[10]?方法促???子向?胞?的???而降低血?。 ^[11]低血糖是??法可能的??症。 ^[12]

?酸?? [ ?? ]

??子交??脂 [ ?? ]

??子交??脂（英? ： polystyrene sulfonate ）用于通?加速?道中?的流失?治?高?血症，特?是在尿量不足或透析之前的情?下。 ^[13]??有?或?的?脂?向于和胃?液中的??子?合，?放出?或??子，?后?脂??便排除，?而??降低血?的目的。在施用的同?需要考??或?超?的??。 ^[13]亦有?点???方法效果太差而不推?使用。 ^[14]

其??物 [ ?? ]

如 ?塞米、沙丁?醇。 ^{[來源請求]}

透析 [ ?? ]

透析包括腹膜透析和血液透析，通常在上述方法均无效或病症?重的情?下使用 ^[15]^[16]，或?最有效的方式 ^[2]。

流行病? [ ?? ]

正常個體?少會發生高血鉀的狀況 ^[17]，但在醫院病患中發生的機率高達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

?? [ ?? ]

低?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?容存? 于2016-10-01）.
^ ??超. 外科?. 北京: 人民?生出版社. 2018: 14. ISBN 978-7-117-26639-0 .
^ Townsend, Courtney M. (?). 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?） . 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?） .
^ 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?） .
^ ^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?） .
^ 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?） . 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?） .
^ ^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?容存? 于2016-10-01）.

[4] ??超. 外科?. 北京: 人民?生出版社. 2018: 14. ISBN 978-7-117-26639-0 .

[5] Townsend, Courtney M. (?). 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?） . 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?） .

[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?） .

[: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?） .

[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?） . 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?） .

[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 .

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]