1. 急診護理個案討論 新光醫院 急診科 張志華 醫師 2005 / 09 / 15

2. 常考！ Hyperkalemia

3. Hyperkalemia n Symptoms Generalized fatigue Weakness Paresthesias Paralysis Palpitations Nonspecific ！

4. Hyperkalemia n Etiology Acute or chronic renal failure Crush injuries (rhabdomyolysis), burns Foods (eg, bananas, oranges, high-protein diets, tomatoes, salt substitutes) Redistribution: Acidosis, insulin deficiency, beta- blocker, acute digoxin overdose, succinylcholine, periodic paralysis (PP) Drugs – slow-K, spirinolactone diuretics, NSAIDs 考題！

5. Hyperkalemia n Mild: 5.5-6.5 mEq/L peaked T waves n Moderate: 6.5-7.5 mEq/L prolonged PR interval decreased P wave ST depression or elevation slight widening of the QRS

6. Hyperkalemia (cont.) n Severe: 7.5-8.5 mEq/L wide QRS flat and wide P waves VPCs n Life-threatening: >8.5 mEq/L loss of P AV blocks VT / VF sinusoid patern

8. Hyperkalemia n Specific management: "See BIG Potassium Drop" Calcium Bicarbonate Insulin and Glucose Kayexalate Dialysis 考題！

9. Hyperkalemia n General management: Continuous ECG monitoring DC K-sparing drugs (ACEI, spirinolactone) DC high-K foods

10. Calcium n Stabilize cell membrane n Calcium gluconate 10%, 10 ml over 2-5 min n 2nd dose after 5 min if no response n Effect occurs in minutes and lasts for 1 hour n Further calcium ineffective unless hypocalcemia exists n Digoxin Toxicity  contraindication !

11. Bicarbonate n Shift K+ to intracellular n 3 amp Jusomine IV over 5 min n May repeat q10-15 min n Onset in 30 min; duration: 1-2 hours n Avoid bicarbonate if: Hypocalcemia Severe lung edema

12. Glucose and Insulin n Redistribution n RI 10U + D50GW 50cc over 5 min n Consider Albuterol Neb as adjunct n Onset 50-60 min; duration: several hours n Follow F/S

13. Potassium Removal n Cation-Exchange resin (Kayexalate) 15-30 gm PO q3-4 hrs or 50 gm in 200 ml retention enema for 30-60 min q4hr n Dialysis: May experience significant hyperkalemia on rebound

14. Summary n Hyperkalemia Symptoms? Diagnosis? EKG? Etiology? Treatment?

15. 余謹以至誠 於上帝及會眾面前宣， 終身純潔，忠貞職守 盡力提高護理專業標準， 勿為有損之事， 勿取服或故用有害之藥， 慎守病人及家務之秘密， 竭誠協助醫師之診治， 務謀病者之福利。 謹 誓 南丁格爾誓言

16. 一顆純潔的心會 自由的給予 自由地愛 直到它受到創傷.... 德蕾莎修女

17. 謝謝聆聽