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动物实验中发现,输入高张氯化钠或甘露醇溶液可引起高钾血症,其原因可能涉及到血液酸碱变、渗透玉及调节钾代谢的激素。作者进行本研究旨在探索慢性肾功能衰竭(CRF)时的情况。方法和结果对10例 CRF 患者按6mEq/kg 的剂量在120分钟内经静脉输入5%和2.5%氯化钠液后,血钾增高的平均值分别为0.6和0.3mmol/L(P<0.01)。输5%氯化钠液时的血钾和渗透压显著高于输2.5%氯化钠液时(P<0.01)。血钾和渗透压之间呈显著的直线相关。输5%氯化钠液时尿钾排泄增多的程度与输2.5%氯化钠液时相似。输氯化钠液后的高钾血症与静脉血酸碱度、血浆碳酸氢盐、阴离子隙、胰岛素水平以及尿去甲肾上腺素和肾上腺素排泄量无关;但与血浆醛固酮水平相关。另外对9例患者在输氯化钠之前先用醋酸去氧皮质酮(DOCA),该药可纠正醛固酮低下症的高钾血症,但未能防止本试验中9例患者在继后输入5%氯化钠液后的高钾血症,这9例患者血钾的增高依然与血浆渗透压相关(P<0.01)。
Animal experiments found that the importation of high sodium chloride or mannitol solution can cause hyperkalemia, the reasons may be related to blood acid-base change, jade and regulate the metabolism of potassium hormones. The authors conducted this study to explore the situation in chronic renal failure (CRF). Methods and Results The mean increase in serum potassium was 0.6 and 0.3 mmol / L (P <0.01) after intravenous infusion of 5% and 2.5% sodium chloride solution at 6 mEq / kg in 10 CRF patients, respectively. . Blood potassium and osmotic pressure were significantly higher when 5% sodium chloride solution was lost than when 2.5% sodium chloride solution was lost (P <0.01). There was a significant linear correlation between serum potassium and osmotic pressure. When 5% sodium chloride solution was lost, urinary potassium excretion increased to a similar extent as when it was lost by 2.5% sodium chloride solution. Hypokalemia after infusion of sodium chloride solution was not associated with venous blood pH, plasma bicarbonate, anion gap, insulin levels, and urinary norepinephrine and adrenergic excretion; but was associated with plasma aldosterone levels. In addition, deoxycorticosterone acetate (DOCA) was administered to 9 patients prior to sodium chloride infusion to correct hyperkalemia in patients with aldosteronism, but failed to prevent 9 patients in this study from subsequently entering 5 % Sodium chloride solution after hyperkalemia, 9 patients with elevated serum potassium is still related to plasma osmolality (P <0.01).