2.高钾血症的一线治疗用药是静注葡酸钙、胰岛素+高渗糖与雾化吸入沙丁胺醇； 3.高钾合并心电图异常者应予葡酸钙静注以保护心肌； 4.胰岛素+高渗糖静注与雾化吸入沙丁胺醇可促进钾离子向细胞内转移； 5.部分患者可考虑碳酸氢钠、襻利尿剂、透析和口服钾结合剂排钾治疗。 投稿：tangshixuan@dxy.cn题图：站酷海洛 首发：丁香园用药指南 参考文献 1. Peacock WF, Rafique Z, Clark CL, Singer AJ, Turner S, Miller J, et al. Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL-ED): A Multicenter, Prospective, Observational Study. J Emerg Med 2018;55:741–50. doi: 10.1016/j.jemermed.2018.09.007.2. 王辰，王建安. 内科学[M]. 第3版. 人民卫生出版社，2015.3. Clase CM, Carrero J-J, Ellison DH, Grams ME, Hemmelgarn BR, Jardine MJ, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2020;97:42–61. doi: 10.1016/j.kint.2019.09.018.4. Lemoine L, Le Bastard Q, Batard E, Montassier E. An Evidence-Based Narrative Review of the Emergency Department Management of Acute Hyperkalemia. J Emerg Med 2021;60:599–606. doi: 10.1016/j.jemermed.2020.11.028.5. Rossignol P, Legrand M, Kosiborod M, Hollenberg SM, Peacock WF, Emmett M, et al. Emergency management of severe hyperkalemia: Guideline for best practice and opportunities for the future. Pharmacol Res 2016;113:585–91. doi: 10.1016/j.phrs.2016.09.039.6. Jameson JL, editor. Harrison’s principles of internal medicine., Twentieth edition. New York: McGraw-Hill Education; 2018.7. Alfonzo A, Soar J, MacTier R, et al. Clinical practice guidelines: treatment of acute hyperkalaemia in adults. Bristol, UK: UK Renal Association; 2014. https://renal.org/wp-content/uploads/2017/06/hyperkalaemiaguideline-1.pdf. Accessed October 9, 2019.8. 中国医师协会心力衰竭专业委员会; 国家心血管病专家委员会心力衰竭专业委员会; 中华心力衰竭和心肌病杂志编辑委员会; 中国心力衰竭患者离子管理专家共识. Chinese Expert Consensus on the Management of Ion Homeostasis in Patients with Heart Failure 2020;04:16–31. doi: 10.3760/cma.j.cn101460-20200114-00004.9. Allon M, Copkney C. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients. Kidney Int 1990;38:869–72. doi: 10.1038/ki.1990.284.10. Viera AJ, Wouk N. Potassium Disorders: Hypokalemia and Hyperkalemia. Am Fam Physician 2015;92:487–95.11. 中华医学会肾脏病学分会专家组; 中国慢性肾脏病患者血钾管理实践专家共识. Expert consensus on the management of serum potassium in chronic kidney disease patients in China 2020;36:781–92. doi: 10.3760/cma.j.cn441217-20200721-00139.12. Palmer BF, Carrero JJ, Clegg DJ, Colbert GB, Emmett M, Fishbane S, et al. Clinical Management of Hyperkalemia. Mayo Clin Proc 2021;96:744–62. doi: 10.1016/j.mayocp.2020.06.014.
