一位 65 歲男性處於敗血性休克所引起的急性腎損傷（AKI）寡尿期。護理師計算其過去 24 小時總尿量為 250 mL。由於腎臟過濾與排泄功能受損，護理師應優先監測下列哪一項最直接、最危險的生化併發症？
A 65-year-old male is in the oliguric phase of acute kidney injury (AKI) caused by septic shock. The nurse calculates that his total urinary output has been 250 mL over the past 24 hours. Because the kidneys are not effectively filtering or excreting, the nurse should prioritize monitoring for which most immediate, life-threatening biochemical complication?
- AHypocalcemia causing spontaneous fractures因自發性骨折引起的低血鈣
- BHypokalemia due to lack of renal filtration因缺乏腎臟過濾引起的低血鉀
- CHyperkalemia leading to lethal cardiac dysrhythmias✓ 正解導致致命性心律不整的高血鉀
- DHypernatremia causing cerebral hemorrhage導致腦出血的高血鈉
急性腎損傷（AKI）的寡尿期定義為每日尿量 < 400 mL。此時最立即威脅生命的併發症是高血鉀（hyperkalemia），因為人體攝入的鉀有 80-90% 須由腎臟排出，當尿量大幅減少，血中鉀離子濃度會迅速上升。高血鉀會導致心電圖異常（peaked T waves、QRS 增寬），最終可能引發致命性心律不整與心臟停止跳動。其他選項：B 應為高血鉀而非低血鉀；C 骨質流失屬慢性腎病的長期表現，非急性致命併發症；D 寡尿時水分滯留通常導致血鈉稀釋（低血鈉或正常），高血鈉較不典型。
The oliguric phase of acute kidney injury (AKI) is defined as urine output < 400 mL/day. The most immediately life-threatening complication at this time is hyperkalemia, because 80-90% of ingested potassium must be excreted by the kidneys; when urine output drops sharply, serum potassium rises rapidly. Hyperkalemia produces ECG abnormalities (peaked T waves, widened QRS) and ultimately may precipitate lethal arrhythmias and cardiac arrest. Regarding the other options: A should be hyperkalemia rather than hypokalemia; C bone loss is a long-term manifestation of chronic kidney disease, not an acute lethal complication; D in oliguria, fluid retention typically dilutes serum sodium (producing hyponatremia or normal levels), so hypernatremia is atypical.
「無尿（Oliguria）＝高血鉀（Hyperkalemia）＝心臟隨時會停（Cardiac Arrest）」。這是一個如同反射動作般的重症腎臟科推論題，連帶要求護理師第一時間一定要掛上 EKG 監視器提防被高血鉀突襲。