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中华卫生应急电子杂志 ›› 2023, Vol. 09 ›› Issue (04) : 193 -198. doi: 10.3877/cma.j.issn.2095-9133.2023.04.001

专家共识

高危低钾血症患者加速治疗专家共识(东湖共识)
湖北省基层医学联盟, 朱元州(), 尚游, 祝伟, 魏捷, 夏剑, 甘泉, 曹锋生, 赵慧, 蔡小芳, 杜宇, 瞿星光, 王冰, 王成, 刘伯毅, 林彬, 孙昊, 岳茂兴, 马静, 孙志辉, 王斌, 王夜明, 常超, 刘欢   
  1. 430077 湖北武汉,华中科技大学同济医学院附属梨园医院心内科
    430022 湖北武汉,华中科技大学同济医学院附属协和医院重症医学科
    430030 湖北武汉,华中科技大学同济医学院附属同济医院急诊重症科
    430060 湖北武汉,武汉大学人民医院急诊科
    430062 湖北武汉,武汉大学附属中南医院急诊科
    430064 湖北武汉,湖北省妇幼保健院成人重症医学科
    441021 湖北襄阳,襄阳市中心医院急诊重症医学科
    430064 湖北武汉,湖北省妇幼保健院急诊科
    430015 湖北武汉,武汉市儿童医院急诊科
    610041 四川成都,四川大学华西第四医院急诊重症医学科
    443008 湖北宜昌,宜昌市中心人民医院重症医学科
    434020 湖北荆州,荆州市中心医院重症医学科
    570102 海南海口,海南医学院附属医院急诊科
    442000 湖北十堰,十堰市太和医院重症医学科
    310005 浙江杭州,浙江中医药大学附属第三医院急诊科
    210029 江苏南京,南京医科大学第一附属医院急诊科
    213161 江苏常州,南京医科大学附属常州第二人民医院创伤中心
    430077 湖北武汉,华中科技大学同济医学院附属梨园医院重症医学科
    215129 江苏苏州,苏州高新区人民医院国际医学部
    310005 浙江杭州,浙江省中医药大学附属第三医院急诊科
    430050 湖北武汉,泰康同济医院重症医学科
    056002 河北邯郸,邯郸市第一医院心内科
    430010 湖北武汉,湖北省中西医结合医院急诊科
  • 收稿日期:2023-06-29 出版日期:2023-08-18
  • 通信作者: 朱元州

Expert consensus in accelerated treatment for patients with high-risk hypokalemia(East Lake Consensus)

Primary Medical Union of Hubei Province, Yuanzhou Zhu(), You Shang, Wei Zhu, Jie Wei, Jian Xia, Quan Gan, Fengsheng Cao, Hui Zhao, Xiaofang Cai, Yu Du, Xingguang Qu, Bing Wang, Cheng Wang, Boyi Liu, Bin Lin, Hao Sun, Maoxing Yue, Jing Ma, Zhihui Sun, Bin Wang, Yeming Wang, Chao Chang, Huan Liu   

  1. Department of Cardiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
    Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
    Department of Emergency Intensive Care, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
    Department of Emergency, Wuhan University People’s Hospital, Wuhan 430060, China
    Department of Emergency, Central South Hospital, Wuhan University, Wuhan 430062, China
    Department of Adult Intensive Medicine, Hubei Maternal and Child Health Hospital, Wuhan 430064, China
    Department of Emergency and Critical Care, Xiangyang Central Hospital, Xiangyang 441021, China
    Department of Emergency, Hubei Maternal and Child Health Hospital, Wuhan 430064, China
    Emergency Department of Wuhan Children’s Hospital, Wuhan 430015, China
    Department of Emergency and Critical Care, West China Fourth Hospital, Sichuan University, Chengdou 610041, China
    Department of Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443008, China
    Department of Intensive Care, Jingzhou Central Hospital, Wuhan 434020, China
    Department of Emergency, Hainan Medical College Hospital, Haikou 570102, China
    Department of Critical Care Medicine, Taihe Hospital, Shiyan 442000, China
    Department of Emergency, the Third Affiliated Hospital to the Zhejiang University of Traditional Chinese Medicine, Hangzhou 310005, China
    Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
    Trauma Center, Changzhou Second People’s Hospital, Nanjing Medical University, Changzhou 213161, China
    Department of Critical Care Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
    Department of International Medicine, Suzhou High tech Zone People’s Hospital, Suzhou 215129, China
    Department of Critical Care Medicine, Taikang Tongji Hospital, Wuhan 430050, China
    Department of Cardiology, First Hospital of Handan City, Handan 056002, China
    Department of Emergency, Hubei Integrated Traditional Chinese and Western Medicine Hospital, Wuhan 430010, China
  • Received:2023-06-29 Published:2023-08-18
  • Corresponding author: Yuanzhou Zhu
引用本文:

湖北省基层医学联盟, 朱元州, 尚游, 祝伟, 魏捷, 夏剑, 甘泉, 曹锋生, 赵慧, 蔡小芳, 杜宇, 瞿星光, 王冰, 王成, 刘伯毅, 林彬, 孙昊, 岳茂兴, 马静, 孙志辉, 王斌, 王夜明, 常超, 刘欢. 高危低钾血症患者加速治疗专家共识(东湖共识)[J]. 中华卫生应急电子杂志, 2023, 09(04): 193-198.

Primary Medical Union of Hubei Province, Yuanzhou Zhu, You Shang, Wei Zhu, Jie Wei, Jian Xia, Quan Gan, Fengsheng Cao, Hui Zhao, Xiaofang Cai, Yu Du, Xingguang Qu, Bing Wang, Cheng Wang, Boyi Liu, Bin Lin, Hao Sun, Maoxing Yue, Jing Ma, Zhihui Sun, Bin Wang, Yeming Wang, Chao Chang, Huan Liu. Expert consensus in accelerated treatment for patients with high-risk hypokalemia(East Lake Consensus)[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2023, 09(04): 193-198.

高危低钾血症属于临床急症,无论何种病因,均需积极纠正。常规补钾治疗需要3~4 d时间,病程中易发生恶性心律失常而危及患者生命。本共识针对低钾血症发生过程将其分为急性低钾血症、慢性低钾血症和慢性低钾血症急性发作三种情况,采取口服补钾为主,葡萄糖联合胰岛素加快血清钾转运到细胞内,达到尽快纠正高危低钾血症的目的,降低患者死亡风险,同时强调了补钾过程中出现低钙血症的处理,合并呼吸衰竭、心跳骤停的处理,反跳性高钾和常见补钾药物的特点,以规范高危低钾血症的加速治疗。

High-risk hypokalemia is a clinical emergency, which needs to be actively corrected regardless of etiology. Routine potassium therapy takes 3-4 days, and malignant arrhythmia is prone to occurrence in the course of the disease, which endangers the life of the patients. This consensus classifies hyperkalemia into acute hyperkalemia, chronic hyperkalemia and acute exacerbation of chronic hyperkalemia, and adopts oral potassium supplementation as the mainstay, and glucose combined with insulin to accelerate the transfer of serum potassium into the cells to achieve the purpose of correcting high-risk hyperkalemia as soon as possible and to reduce the risk of death of the patients, and at the same time, the management of hypocalcemia during potassium supplementation, management of combined respiratory failure and cardiac arrest, rebound hyperkalemia and the characteristics of common potassium supplementation drugs are also emphasized.

表1 低钾的治疗
1
Bamgbola OF.Review of the pathophysiologic and clinical aspects of hypokalemia in children and young adults: an update[J].Curr Treat Options Pediatr20228(3):96-114.
2
Vasquez-Rios GWestrich DJ JrPhilip I,et al.Distal renal tubular acidosis and severe hypokalemia:a case report and review of the literature[J].J Med Case Rep201913(1):103.
3
Nora NABerns AS.Hypokalaemic,hypophosphatemic thyrotoxic periodic paralysis[J].Am J Kidney Dis198913(3):247-249.
4
Warnock DGBubien JK.Liddle syndrome:clinical and cellular abnormalities[J].Hosp Pract(Off Ed)199429(7):95-8,104-105.
5
Thakkar RBOparil S. Primary aldosteronism: a practical approach to diagnosis and treatment[J].J Clin Hypertens (Greenwich)20013(3):189-95.
6
Blanchard A.Pathophysiologic approach in genetic hypokalemia:an update[J].Ann Endocrinol (Paris)202384(2):298-307.
7
Lin ZWong LYFCheung BMY.Diuretic-induced hypokalaemia:an updated review[J].Postgrad Med J202298(1160):477-482.
8
Buño AOliver P.POCT errors can lead to false potassium results[J].Adv Lab Med20213(2):142-152.
9
Nilsson EGasparini AÄrnlöv J,et al.Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system[J].Int J Cardiol2017(245):277-284.
10
Medford-Davis LRafique Zubaid.Derangements of potassium[J].Emerg Med Clin North Am201432(2):329-347.
11
Pepin JShields C.Advances in diagnosis and management of hypokalemic and hyperkalemic emergencies[J].Emerg Med Pract201214(2):1-17.
12
Martin HEWertman MWestover L,et al.Clinical potassium problems[J].Calif Med195072(3):133-141.
13
Elliott TLBraun M.Electrolytes:potassium disorders[J].FP Essent, 2017(459):21-28.
14
吴其夏,余应年,卢建.病理生理学[M].北京:中国协和医科大学出版社,2003:179-189.
15
Unwin RJLuft FCShirley DG. Pathophysiology and management of hypokalemia:a clinical perspective[J].Nat Rev Nephrol20117(2):75-84.
16
Alfonzo AVIsles CGeddes C,et al.Potassium disorders--clinical spectrum and emergency management[J].Resuscitation200670(1):10-25.
17
Rastegar ASoleimani M.Hypokalaemia and hyperkalaemia[J].Postgrad Med J200177(914):759-764.
18
Gennari FJ.Hypokalemia[J].N Engl J Med1998339(7):451-458.
19
Kardalas EPaschou SAAnagnostis P, et al.Hypokalemia:a clinical update[J].Endocr Connect20187(4):R135-R146.
20
Foreman JW.Fanconi syndrome[J].Pediatr Clin North Am201966(1):159-167.
21
Gruber SBeuschlein F.Hypokalemia and the prevalence of primary aldosteronism[J].Horm Metab Res202052(6):347-356.
22
Tetti MMonticone SBurrello J, et al.Liddle syndrome:review of the literature and description of a new case[J].Int J Mol Sci201819(3):812.
23
Stimson LReynolds T.Differential diagnosis for chronic hypokalaemia[J].BMJ Case Rep2018(2018):bcr2017223680.
24
Jain GOng SWarnock DG.Genetic disorders of potassium homeostasis[J].Semin Nephrol201333(3):300-309.
25
安振梅,魏松全,张存泓.低钾血症[J].国外医学内科学分册200128(1):32-35.
26
雷招宝.药源性低钾血症及其防治[J].药物不良反应杂志2003,(1):18-21.
27
Naseer MKania BGhrewati M,et al.Rare case of refractory hypokalemia in a patient with acute monocytic leukemia[J].Am J Case Rep2023(24):e938775.
28
Palmer BFClegg DJ.Physiology and pathophysiology of potassium homeostasis:core curriculum 2019[J].Am J Kidney Dis201974(5):682-695.
29
Buse SBlancher MViglino D,et al.The impact of hypothermia on serum potassium concentration:a systematic review[J]. Resuscitation2017(118):35-42.
30
Willard M.Therapeutic approach to chronic electrolyte disorders[J].Vet Clin North Am Small Anim Pract200838(3):535-541.
31
Kim GHHan JS.Therapeutic approach to hypokalemia[J].Nephron2002(92 Suppl 1):28-32.
32
朱元州,林彬,王斌,等.2例高温诱发低钾血症的补钾治疗比较[J].中国工业医学杂志202134(1):39-40.
33
Kodra NKhella RNudelman BG,et al.Oral potassium malabsorption following bariatric surgery[J].Cureus202214(8):e28607.
34
Huang CLKuo E.Mechanism of hypokalemia in magnesium deficiency[J].J Am Soc Nephrol200718(10):2649-2652.
35
Palmer BFKelepouris EClegg DJ.Renal tubular acidosis and management strategies:a narrative review[J].Adv Ther202138(2):949-968.
36
Clausen T.Clinical and therapeutic significance of the Na+,K+ pump[J].Clin Sci (Lond)199895(1):3-17.
37
van der Horst ICTimmer JROttervanger JP,et al.Glucose and potassium derangements by glucose-insulin-potassium infusion in acute myocardial infarction[J].Neth Heart J200614(3):89-94.
38
Heller SRRobinson RT.Hypoglycaemia and associated hypokalaemia in diabetes: mechanisms, clinical implications and prevention[J].Diabetes Obes Metab20002(2):75-82.
39
Rüdel RLehmann-Horn FRicker K,et al.Hypokalemic periodic paralysis: in vitro investigation of muscle fiber membrane parameters[J]. Muscle Nerve19847(2):110-120.
40
Hinderling Peter H.The Pharmacokinetics of potassium in humans is unusual[J].J Clin Pharmacol201656(10):1212-1220.
41
Meyer-Lehnert HEvers WMKrück F.Potassium substitution via the oral route:does its efficacy depend on the anion of the potassium salt?[J]. Klin Wochenschr199169(17):797-801.
42
Iezhitsa INSpasov AAZhuravleva NV, et al.Comparative study of the efficacy of potassium magnesium L-,D-and DL-aspartate stereoisomers in overcoming digoxin- and furosemide-induced potassium and magnesium depletions[J].Magnes Res200417(4):276-292.
43
Watson B Jr.Genetics of the kidney and hypertension[J].Curr Hypertens Rep20035(3):273-276.
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