低钾性周期性麻痹补钾探讨

通过对32例低钾性周期性麻痹患者补钾治疗的临床观察,发现本病大多数患者虽然血清钾含量降低,但体内总钾量不低,因此,不必常规高浓度、快速度静脉补钾.且在补钾过程中应加强心电监护及血钾监测,以免造成高血钾.     

醋酸去氨加压素致1例昏迷的分析

70岁女性患者行左侧副鼻窦开放术,使用醋酸去氨加压素致昏迷,血钠、血钾分别低至120.7 mmol·L^-1和2.85 mmol·L^-1,停药给予对症治疗后恢复正常。     

低钾血症合并低T3综合征导致横纹肌溶解

目的探讨低钾血症,合并低T3综合征导致横纹肌溶解的临床特点和可能的发病机制。方法报道2015年本院收入1例低钾血症合并低T3综合征的患者的病例资料特点、辅助检查、临床治疗效果并复习相关文献。结果患者存在肢体近端为主的无力,肌酶10000U·L~(-1),肌红蛋白900ng·mL~(-1),血钾1.5mmol·L~(-1)伴低T3综合征,给与碱化尿液、水化等治疗,患者血钾正常、肌酶正常,症状好转。结论低钾血症导致横纹肌溶解临床少见,低T3综合征可能导致肌细胞膜代谢紊乱从而加重横纹肌溶解。治疗中及时补充有效循环血量、及时碱化尿液促进肌红蛋白排出可以减少肾功能不全发生率。     

原发性醛固酮增多症31例临床分析

目的探讨原发性醛固酮增多症（primary adosteronism,PA）的特点、诊断及治疗要点,以提高诊治水平。方法对我院31例术后病理确诊PA的临床资料进行总结,并结合文献分析。结果31例均行手术治疗,其中肾上腺腺瘤28例,肾上腺皮质增生3例;以高血压为首发症状最多,低血钾表现次之;血浆醛固酮浓度／血浆肾素活性均〉25／1;29例行后腹腔镜手术切除病灶及。肾上腺组织,2例因自体瘤大行开放手术。结论PA病程长,早期无特异临床症状,易误诊。ARR试验筛查可早期发现PA,CT扫描在定位及定性方面均优于B超,后腹腔镜手术是有效治疗手段,治疗效果良好。     

A woman with red eyes and hypokalemia: A case of acquired Gitelman syndrome

Gitelman syndrome is a rare hereditary disorder of the thiazide-sensitive NaCl transporter in the distal renal tubular cells, but mimicking of such hereditary tubular disorders has been described in different autoimmune diseases (Sj?gren syndrome, SLE, ...). A 62-year-old woman with painful red eyes and sicca syndrome presented at the ophthalmological department. The diagnostic evaluation identified a Sj?gren syndrome with early endophthalmitis as the reason for the red eyes. Results of laboratory examination indicated severe hypokalemia, metabolic alkalosis and hypomagnesemia, although this had not been seen years earlier. Together with the urine analysis, a rare case of an acquired Gitelman syndrome was diagnosed. Substitution with potassium and magnesium improved the initial symptoms of weakness, but renal electrolyte wasting persisted even after treatment of Sj?gren syndrome. In patients with autoimmune disease, laboratory analysis of serum electrolytes should be performed because different acquired tubular disorders can lead to severe hypokalemia.     

青壮年低钾血症心电图改变与临床病因关系

目的 探讨青壮年低钾血症患者心电图改变与临床病因关系.方法 将104例青壮年患者的心电图改变与临床病因及血清钾浓度作对比分析.结果 青壮年低钾血症患者心电图异常改变80例(76.92%),其中以U波增高80例(76.92%)、ST段改变64例(61.54%)、T波改变62例(59.62%);心电图异常发生率随血清钾浓度的降低而呈递增.结论 青壮年低钾血症患者的病因以原发疾病造成的钾摄入不足为主,随着血钾浓度的降低,心电图异常发生率增加,改变随之加重.     

Hypokalemia and hypomagnesaemia related to levetiracetam use

Levetiracetam (LEV), used for both partial and generalized seizures, is a frequently preferred antiepileptic because of its few side effects. We present a 23-year-old man who developed hypokalemia after switching from valproate to LEV. The patient was sent to our clinic due to hypokalemia 1 month after initiation of LEV, and his neurological examination was normal. Further examinations revealed hypokalemia (3.1 mmol/L) and hypomagnesaemia (0.56 mmol/L). His hemogram, blood urea nitrogen, creatinine, total cortisol, thyroid function tests, creatinine clearance, and renal Doppler ultrasound were normal. LEV was tapered off and treatment with 200 mg/day lamotrigine begun. Potassium and magnesium levels returned to normal ranges in subsequent tests. While hypokalemia and hypomagnesaemia have not been reported before to our knowledge, interstitial nephritis and renal failure after the use of LEV have been. Hypokalemia, found in the early period in this case, may be an indicator of a recently developed renal tubular disorder. This experience indicates that unpredictable side effects of increasingly used new antiepileptic drugs should be taken into consideration.     

吉非替尼致严重腹泻和低钾血症

1例83岁女性患者因右肺腺癌左肺转移和可疑肝转移口服吉非替尼0.25 g、1次/d。用药27 d后患者出现严重腹泻伴恶心呕吐,实验室检查示血钾2.1 mmol/L,粪培养结果为阴性,排除感染性腹泻。未停用吉非替尼,给予补钾、止泻等治疗4 d,患者痊愈。4 d后患者再次出现上述症状,实验室检查示血钾2.96 mmol/L,考虑腹泻和低钾血症与吉非替尼有关。停用该药,给予补钾、止泻、止吐、护胃等对症治疗。停药9 d后,患者腹泻、恶心呕吐症状减轻,实验室检查示血钾3.52 mmol/L;停药22 d后,患者腹泻、恶心呕吐症状消失,实验室检查示血钾4.69 mmol/L。     

Hypokalemic Cardiac Arrest: Narrative Review of Case Reports and Current State of Science

PurposeHypokalemic cardiac arrest is an uncommon occurrence in the emergency department. Electrocardiogram findings related to hypokalemic cardiac arrest include prolonged QT, U waves, and preventricular contractions leading to Torsades de Pointes and then arrest. Literature evaluating the prevalence of hypokalemic cardiac arrest is scarce, and its management is lacking. This review provides a summary of current literature, recommendations from current guidelines, and proposed management strategies of hypokalemic cardiac arrest.SummaryIntravenous potassium administration is the treatment for hypokalemic cardiac arrest. Although the treatment for hypokalemic cardiac arrest is known, there is limited evidence on the proper procedure for administering intravenous potassium appropriately and safely. Owing to the time-sensitive nature of treating hypokalemic cardiac arrest, rapid administration of intravenous potassium (10 mEq/100 mL of potassium chloride over 5 minutes) is warranted. Concerns regarding rapid potassium administration are not without merit; however, a risk-benefit analysis and potential mitigation strategies for unwanted side effects need to be considered if hypokalemic cardiac arrest is to remain a reversible cause. It is imperative to identify hypokalemia as the cause for arrest as soon as possible and administer potassium before systemic acidosis, ischemia, and irreversible cell death.ConclusionsMore evidence is necessary to support treatment recommendations for hypokalemic cardiac arrest; however, it is the authors' opinion that, if identified early during cardiac arrest, intravenous potassium should be administered to treat a reversible cause for cardiac arrest.