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
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