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1 病例介绍 患者,女,73岁。因高心病、心衰Ⅱ度入院。1997年元月1日夜及次晨,两次共误饮10％氯化钾80ml。次日9时查房,诉昨夜服药水后开始双手发抖、四肢畏冷、坐立不安,睡眠差,今晨服药水后双下肢疼痛,无力行走,烦躁不安,恐惧感,不能平卧,喘气,胸闷,心慌。体查:T36.4℃,R22次/min,P42次/min,BP13kPa/9kPa,精神差,面色苍白,高枕位,口唇紫绀,颈静脉怒张,肺底湿罗音,心律齐,HR42次/min,心界向左扩大,未闻杂音,腹软,四肢冰冷,肌无力(上肢Ⅲ级、下肢Ⅱ级),膝腱反射消失,巴氏征阴性。急查EKG:T波高尖,帐蓬状,P波消失,窦室传导,HR43次/min,提示:高钾血症。立即抽血查K~+、Na~+、C0_2cp+BUN。抢救处理:吸氧,心电监护,开静脉通道。5％碳酸氢钠125ml快速静脉滴注,隔1h重复,计3次。另用50％葡萄糖40ml+10％葡萄糖酸钙10ml静脉推注隔1h重复,计3次。下午
1 case description Patient, female, 73 years old. Due to high heart disease, heart failure Ⅱ degree admission. On the night of January 1, 1997 and next morning, two times in total, 80ml of 10% potassium chloride was misunderstood. The next day at 9 am rounds of investigation, v. Whipped cream last night after serving his hands, cold limbs, restless, poor sleep, morning after taking medicine, lower extremity pain, unable to walk, irritability, fear, can not lie down, gasping, chest tightness , Palpitation. Physical examination: T36.4 ℃, R22 times / min, P42 times / min, BP13kPa / 9kPa, poor spirit, pale, high pillow position, cyanotic lips, jugular vein distention, / min, heart left to expand, unheard noise, soft belly, cold limbs, weakness (upper extremity Ⅲ, lower extremity Ⅱ), knee tendon reflex disappeared, Pakistan’s sign negative. Urgent search EKG: T wave tip, tepee, P wave disappears, sinus conduction, HR43 times / min, suggesting: hyperkalemia. Immediately check the blood K ~ +, Na ~ +, C0_2cp + BUN. Rescue treatment: oxygen, ECG monitoring, open venous access. 5% sodium bicarbonate 125ml rapid intravenous infusion, repeated every 1h, counted 3 times. Another 50% glucose 40ml + 10% calcium gluconate 10ml intravenous infusion repeated 1h, count 3 times. in the afternoon