环硅酸锆钠散治疗慢性高钾血症1例

A case of chronic hyperkalemia treated with sodium zirconium cyclosilicate powder

1例55岁女性患者因“反复高钾血症2年,全身抽搐1 d”入院。患者2年前诊断为慢性肾脏病,近2年多次出现恶心、呕吐及双足、双小腿麻木不适等症状,血钾水平波动于4.50~7.14 mmol/L。入院前1天出现全身抽搐,血肌酐715.71μmol/L,血钾6.18 mmol/L。入院时血钾6.64 mmol/L、血肌酐690.51μmol/L、空腹血糖8.6 mmol/L。完善检查后诊断为慢性肾脏病,高钾血症,糖尿病肾病,2型糖尿病,糖尿病视网膜病变,高血压。予静脉注射葡萄糖+胰岛素、呋塞米、碳酸氢钠,口服环硅酸锆钠散等对症治疗。患者住院期间血钾水平维持在正常范围内。出院后随访1年,患者未再出现高钾血症。

A 55-year-old female patient was admitted to hospital for "recurrent hyperkalemia for 2 years and systemic convulsions for 1 d". The patient had been diagnosed with chronic kidney disease 2 years ago and suffered from nausea, vomiting and discomfort and numbness in both lower legs anf feet for nearly 2 years. The level of serum potassium fluctuated was 4.50-7.14 mmol/L. She had generalized convulsions 1 d before admission, with serum creatinine 715.71 μmol/L and serum potassium 6.18 mmol/L. On admission, serum potassium was 6.64 mmol/L, serum creatinine was 690.51 μmol/L and fasting blood glucose was 8.6 mmol/L. After examination, she was diagnosed as chronic kidney disease, hyperkalemia, diabetic nephropathy, type 2 diabetes mellitus, diabetic retinopathy and hypertension. Symptomatic treatment such as intravenous injection of glucose+insulin, furosemide and sodium bicarbonate, and oral sodium zirconium cyclosilicate powder was given. The serum potassium level of the patient remained within the normal range during hospitalization. The patient was followed-up for 1 year after discharge, and there was no hyperkalemia.