老年药源性低血钾10例死亡病例分析

老年药源性低血钾１０例死亡病例分析郎江南第一军医大学附属珠江医院（５１０２８２）郎江红江西医学院第一附属医院（３３０００６）近年来我国住院患者中死于药源性疾病的日益增多，每年约１９．２万人。本文仅对最常见的药源性低血钾进行讨论，以引起重视。１临床资料...     

老年人药源性呼吸功能障碍

药源性呼吸功能障碍临床并不少见 ,尤其在老年病人身上 ,往往多系统疾病同时存在 ,病情复杂 ,用药繁多 ,药物对肺功能的影响易被交黄念秋教授叉复杂的临床表现所掩盖 ,不能及时获得诊断和正确处理 ,乃至发生明显的呼吸功能障碍甚或导致呼吸衰竭时还可能归咎于原有的肺部基础疾病 ,或用肺部“感染”来解释 ,造成病人不应有的痛苦和损失。因此 ,临床医生重视和警惕药源性呼吸功能障碍是十分重要的。1　药物引起的肺功能障碍的途径1 1　通过对呼吸中枢的抑制影响肺泡通气　麻醉药、镇痛药、镇静药、催眠药等均可影响中枢的呼吸驱动力 ,它们对肺…     

低血钾引起U波倒置1例

患者女性,63岁,临床诊断:肾炎,尿毒症.入院时血清钾4.5mmol/L.ECG(附图上)示低电压,顺钟向转位,V_3—V _5可见正常微小直立的U波.5天后复查血清钾2.9mmol/L.ECG(附图下)示低电压倾向,逆钟向转位,I导联示见TU融合Q-T间期由正常0.36s延长为0.     

低血钾所致低钾性心肌炎一例报告

病例 :患者 ,女 ,40岁。因发热、恶心、呕吐半月余入院。患者发病前无咳嗽、流涕、咽痛、头痛等上呼吸道感染症状 ,入院前曾行Ｂ超示“胆囊炎、胆囊结石” ,在院外静脉点入菌必治 1 0ｇ每日两次共 7天 ,效果不佳而入院。体检 :Ｔ37 2℃ ,Ｐ 80次 /分 ,Ｒ 18次 /分 ,ＢＰ10 0ｍｍＨｇ/ 80ｍｍＨｇ ,皮肤粘膜无黄染 ,浅表淋巴结无异常 ,双肺呼吸音清 ,无罗音 ,心界无扩大 ,心率 80次 /分 ,律齐规整 ,未闻及杂音 ,腹平软 ,肝脾肋下未及 ,莫菲氏征 ( ) ,四肢肌力Ⅳ级 ,腱反射( ) ,病理征 ( ) ,ＥＣＧ示 :窦性心律 ,Ⅱ、Ⅲ、ａｖＦ、Ｖ1～ 6ＳＴ…     

低血钾致束支性室性心动过速1例

患者女,39岁。因反复心悸1周加重0．5h入院。临床诊断：心律失常。既往身体健康。体检：BP110／70mmHg,表情倦怠,心界不大,心率840次／min,律不齐,两肺无殊。实验室检查：血钾3．38mmol／L,钠130mmol／L、氯102mmol／L,心电图连续记录示：P-P间期0．72s,频率83次／min。图中可见异于主导心律的QRS波,时限0．10s,其形态在V1导联呈R型,在肢导联呈电轴左偏,考虑为室性心律,该室     

低血钾致阵发性室性心动过速1例

患女性，40岁。因腹泻、呕吐2d伴乏力半天入院。体检：T37．20C，P80次／min，R20次／min，BP90／60mmHg。双肺呼吸音清。心界不大，心率80次／min，心律齐，未闻及杂音。腹软、脐周轻触痛，无反跳痛，肠鸣音亢进。血钾3．2mmol／L，血钠138mmol／L．，血氯103mmol／L。临床诊断：①急性胃肠炎；②低钾血症。3导同步伴Ⅱ导联连续描记心电图(图1)示：     

低血钾型周期性麻痹66例护理体会

2003~2007年,我科收治低血钾型周期性麻痹66例,效果满意。现报告护理体会。     

老年人药源性肝病33例

药源性肝损害和药源性肝病为相当常见的一种临床情况 ,但往往被忽视或误诊。据文献报道至少有 10 %拟诊为肝炎的患者中 ,其致病因素为各种药物。老人肝病患者约有 15 %～2 0 %为药物引起〔1〕。本文通过对 3 3例老年人药源性肝病进行临床分析 ,进一步了解老年人药源性肝病的病因和临床特点 ,提高临床医生对药源性肝病的认识。1　临床资料1986～ 2 0 0 4年间我院共诊治 85例药源性肝病患者 ,60岁以上者 3 3例 ,男 2 0例 ,女 13例。诊断根据服药史、临床表现、血象、肝功能试验、病原学标志以及停药后的治疗效果作出综合判断 ,除外非酒精性脂…     

严重低血钾致心电图多种改变1例

患者女性 ,4 3岁。近 3年来食欲差 ,精神欠佳及生活无规律。于 2 0 0 3年 9月 2 3日突发四肢无力 ,继而不能下床 ,遂来院急诊。门诊查血钾为 1 83mmol/L ,血糖 13mmol/L。确诊为 :重度低血钾、周围性麻痹、高血糖。心电图 (图略 )示 :PⅡ、Ⅲ、aVF直立 ,PaVR倒置。心率 12 0次     

老年人心衰诊治体会

<正> 1.临床资料1.1 一般资料:本组288例,其中男152例,女136例,年龄60—88岁,平均年龄71岁.1.2 心衰病因:其中冠状动脉粥样硬化性心脏病(以下简称为冠心病)187例,慢性肺源性心脏病57例(以下简称为肺心病),高血压性心脏病24例,肺心病合并冠心病6例,慢性风湿性心瓣膜病4例,先天性心脏病(房间隔缺损)2例,扩张型心肌病2例,老年性辩膜退性变6例.     

Life-threatening hypokalemia in an asthmatic patient treated with high-dose hydrocortisone

Although modest hypokalemia is frequently observed in asthmatic patients being treated with bronchodilators, profound hypokalemia and metabolic alkalosis are rarely reported in patients receiving high-dose hydrocortisone (HC). We describe a 66-year-old man who complained of generalized muscle weakness, shallow respiration, and palpitations after receiving high-dose intravenous HC (total dose, 2400 mg over 4 days) to treat a severe asthma attack. During this therapy, there was a weight gain of 1.0 kg. An electrocardiogram revealed ventricular arrhythmia with frequent premature ventricular contractions. Hypokalemia was profound, with plasma potassium (K+) concentration of 1.7 mEq/L, and associated with renal potassium wasting, as evidenced by a transtubular potassium concentration gradient of 12; metabolic alkalosis (plasma HCO3-, 37 mEq/L) was also present. When treated with spironolactone, KCl supplementation, and substitution of HC with prednisolone, his plasma K+ concentration rapidly normalized, metabolic alkalosis was corrected, and arrhythmia disappeared within 3 days. Because of unwanted mineralocorticoid side-effects, high-dose HC may cause life-threatening hypokalemia in asthmatic patients. Because of these potential risks, plasma acid-base and electrolyte concentrations should be monitored frequently in any patient treated with high-dose HC.     

Delirium: masquerades and misdiagnosis in elderly inpatients

Delirium is an organic mental disorder defined as transient, fluctuating global dysfunction of cognition. It is common in elderly medical inpatients, yet its varied presentation is often missed or misdiagnosed.     

Attending rounds: patient with hypokalemia and metabolic acidosis

Hypokalemic paralysis represents a medical emergency requiring both rapid diagnosis and treatment. In this Attending Rounds a patient with hypokalemia and metabolic acidosis is presented to emphasize the role of routine laboratory studies in the assessment of such patients so that a correct diagnosis can be made and appropriate treatment can be initiated promptly.     

Diuretic use in the elderly: potential for diuretic-induced hypokalemia

The more potent "loop" diuretics are being used with increasing frequency. The elderly constitute a growing portion of the population undergoing treatment with diuretics. The alterations in renal function and pharmacokinetics in the elderly (over 60 years of age) may result in the development of certain adverse effects. In patients over 70 years old, there is a progressive decline in overall renal function, resulting in a more than 50% decrease in glomerular filtration rate. Most of the pharmacokinetic changes in the elderly consist of alterations resulting in enhanced plasma levels of any given drug; diminished hepatic drug extraction, detoxification/metabolism or prodrug conversion; decreased renal excretion of drug; and diminished volume of distribution of drug. Adverse reactions to diuretics may be grouped into metabolic changes (e.g., hypokalemia), physiologic alteration (e.g., volume contraction), toxic manifestation (e.g., interstitial nephritis) and allergic or idiosyncratic phenomena (e.g., rash or thrombocytopenia). There is general agreement that significant hypokalemia, particularly among elderly patients receiving digitalis glycosides, is significant and requires therapy. Diuretic-associated hypokalemia reflects the potency and duration of action of a diuretic, factors modulating potassium balance including dietary intake and concurrent medical processes. The short duration of action and greater natriuresis relative to kaliuresis characteristic of loop diuretics may result in a lesser degree of hypokalemia than that seen with traditional thiazide diuretics.     

Pharmacological pain management in the elderly patient

With the increasing number of elderly patients the issue of pain management for older people is of increasing relevance. The alterations with aging of the neurobiology of pain have impacts of pain threshold, tolerance and treatment. In this review the available evidence from animal and human experimentation is discussed to highlight the differences between young and older subjects along with consideration of how these changes have practical effect on drug treatment of pain. Cognitive impairment, physical disability and social isolation can also impact on the accessibility of treatment and have to be considered along with the biological changes with ageing. Conventional pain therapies, while verified in younger adults cannot be automatically applied to the elderly without consideration of all these factors and in no other group of patients is a holistic approach to treatment more important.     

Pathophysiology and management of hypokalemia: a clinical perspective

Potassium (K(+)) ions are the predominant intracellular cations. K(+) homeostasis depends on external balance (dietary intake [typically 100 mmol per day] versus excretion [95% via the kidney; 5% via the colon]) and internal balance (the distribution of K(+) between intracellular and extracellular fluid compartments). The uneven distribution of K(+) across cell membranes means that a mere 1% shift in its distribution can cause a 50% change in plasma K(+) concentration. Hormonal mechanisms (involving insulin, β-adrenergic agonists and aldosterone) modulate K(+) distribution by promoting rapid transfer of K(+) across the plasma membrane. Extrarenal K(+) losses from the body are usually small, but can be marked in individuals with chronic diarrhea, severe burns or prolonged sweating. Under normal circumstances, the kidney's distal nephron secretes K(+) and determines final urinary excretion. In patients with hypokalemia (plasma K(+) concentration <3.5 mmol/l), after the exclusion of extrarenal causes, alterations in sodium ion delivery to the distal nephron, mineralocorticoid status, or a specific inherited or acquired defect in distal nephron function (each of which affects distal nephron K(+) secretion), should be considered. Clinical management of hypokalemia should establish the underlying cause and alleviate the primary disorder. This Review aims to inform clinicians about the pathophysiology and appropriate treatment for hypokalemia.