高钾血症

高钾血症
高钾血症
	高血钾症患者的心电图。
类型	mineral metabolism disease[*]、电解质不平衡
分类和外部资源
医学专科	重症医学、肾脏科
ICD-11	5C76
ICD-10	E87.5
ICD-9-CM	276.7
DiseasesDB	6242
MedlinePlus	001179
eMedicine	emerg/261
MeSH	D006947
	[编辑此条目的维基数据]

高钾血症（拉丁语：hyperkalemia、hyperkalaemia），即生物体内血中含钾离子（K⁺）含量过多^[1]。人体 95%的钾元素位于细胞内，仅 5%位于血液中，而钠钾泵正是保持此浓度差的主要机制。血清正常血钾值介于 3.5至 5.5 mEq/L之间，血浆正常血钾值则介于 3.5至 5.0 mEq/L之间，若高于正常值则称为高钾血症^[2]^[3]。外科学上，血清钾浓度超过5.5mmol/L^[4]或5.0mmol/L^[5]^[6]即为高钾血症。^[7]通常高钾血症不会有症状^[1]，但可能引发心悸、肌肉疼痛、肌肉无力（英语：muscle weakness），或感觉麻木（拉丁语：Paresthesia)等^[1]^[8]。严重时将引发心律不整，进一步导致病患死亡^[1]^[2]。

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高钾血症最常见的原因包含肾功能衰竭、醛固酮过低（英语：hypoaldosteronism），或横纹肌溶解症等等^[1]。某些药物包含螺内酯、非甾体抗炎药，以及血管紧张肽I转化酶抑制剂（ACEI）也会造成血钾提升^[1]。

高钾血症能以血钾浓度分为轻度（5.5-5.9 mmol/L）、中度（6.0-6.4 mmol/L），及重度（>6.5 mmol/L）^[2]。剂量高时甚至能以心电图侦测^[2]。检验必须排除因采血过程破坏细胞所造成的假性高血钾^[1]^[8]。

症状不明显，但一般包括身体不适、心悸、及肌肉无力。轻微的过度换气可能是代谢性酸中毒──高钾血症的症状之一──引起的补偿机制。然而此种情形通常仅在血液筛检、或是心律不整等并发症产生时才得以侦测。

在问诊时，医生会聚焦于肾脏疾病及用药上，因为此二者皆为此症主因。然而若伴随腹痛、低血糖症及色素大量沉着，则病患可能同时患有其他自体免疫性疾病或爱迪生氏病。

立即停止外源性钾摄入和针对可逆病因的治疗通常是高钾血症处置的第一步^[9]，建议进行低钾饮食^[1]。

葡萄糖酸钙

由于钙离子对于钾离子有对抗作用，若心电图发生变化，可给予葡萄糖酸钙以对抗心率失常^[1]^[2]。

联用葡萄糖和胰岛素

静脉注射胰岛素和葡萄糖是有证据支持的治疗紧急高钾血症的一线疗法之一。^[10]该方法促进钾离子向细胞内的转运从而降低血钾。^[11]低血糖是该疗法可能的并发症。^[12]

碳酸氢钠

阳离子交换树脂

阳离子交换树脂（英语：polystyrene sulfonate）用于通过加速肠道中钾的流失来治疗高钾血症，特别是在尿量不足或透析之前的情况下。^[13]负载有钠或钙的树脂倾向于和胃肠液中的钾离子结合，释放出钠或钙离子，随后树脂随粪便排除，从而实现降低血钾的目的。在施用的同时需要考虑钠或钙超载的风险。^[13]亦有观点认为该方法效果太差而不推荐使用。^[14]

其它药物

如呋塞米、沙丁胺醇。^{[来源请求]}

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严重的情况下使用^[15]^[16]，或为最有效的方式^[2]。

正常个体很少会发生高血钾的状况^[17]，但在医院病患中发生的几率高达1%至 2.5%^[8]，且会将死亡风险拉高十倍以上^[8]^[17]。

相关介绍影片

低钾血症

[1]
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]
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. （原始内容存档于2016-10-01）.
[4]
吴梦超. 外科学. 北京: 人民卫生出版社. 2018: 14. ISBN 978-7-117-26639-0.
[5]
Townsend, Courtney M. (编). 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 （英语）. 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
[8]
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 （英语）.
[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 （英语）.
[13]
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 （英语）.
[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 （英语）. 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 （英语）.
[17]
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.

[Leh2011-1] [1]
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]
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] [3]
Pathy, M.S. John. Principles and practice of geriatric medicine 4. Chichester [u.a.]: Wiley. 2006: Appendix [2017-03-17]. ISBN 9780470090558. （原始内容存档于2016-10-01）.

[4] [4]
吴梦超. 外科学. 北京: 人民卫生出版社. 2018: 14. ISBN 978-7-117-26639-0.

[5] [5]
Townsend, Courtney M. (编). 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] [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 （英语）. generally defined as serum potassium (K+) concentrations of >5.0 mmol/l

[7] [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]
McDonald, TJ; Oram, RA; Vaidya, B. Investigating hyperkalaemia in adults.. BMJ (Clinical research ed.). 20 October 2015, 351: h4762. PMID 26487322.

[9] [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] [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] [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 （英语）.

[12] [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 （英语）.

[:0-13] [13]
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 （英语）.

[14] [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 （英语）. 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] [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] [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 （英语）.

[Kov2016-17] [17]
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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