一位第 4 期慢性腎臟病病人的鉀離子濃度為 6.2 mEq/L。護理師預期應投予下列哪種藥物？
A client with stage 4 chronic kidney disease has a potassium level of 6.2 mEq/L. Which medication should the nurse expect to administer?
- AFurosemideFurosemide（呋塞米）
- BSpironolactoneSpironolactone（螺內酯）
- CCalcium gluconate✓ 正解Calcium gluconate（葡萄糖酸鈣）
- DSodium polystyrene sulfonateSodium polystyrene sulfonate（聚苯乙烯磺酸鈉）
高血鉀（K+ ≥ 6.0 mEq/L）的緊急處置採三階段：(1) **穩定心肌** — calcium gluconate（C）為首選，可立即穩定心肌細胞膜以防致命心律不整，雖不會降低血鉀濃度但是保命動作；(2) **細胞內移** — insulin + dextrose、β2 致效劑（如 albuterol）促鉀離子進入細胞；(3) **體外排出** — sodium polystyrene sulfonate (D) 經腸道排出（作用較慢），或 furosemide (A) 經腎排出（CKD 病人效果有限），透析。本題選 C，因為「最先給予」的標準動作是穩定心肌。D Spironolactone 為保鉀利尿劑，禁忌使用。
Emergency management of hyperkalemia (K+ ≥ 6.0 mEq/L) follows three stages: (1) **Stabilize the myocardium** — calcium gluconate (C) is the first-line choice; it immediately stabilizes cardiac cell membranes to prevent fatal dysrhythmias and, although it does not lower the serum potassium level, it is a life-saving action; (2) **Shift potassium intracellularly** — insulin plus dextrose and beta-2 agonists (such as albuterol) drive potassium into the cells; (3) **Remove potassium from the body** — sodium polystyrene sulfonate (D) eliminates potassium via the gut (slower onset), furosemide (A) excretes it through the kidneys (limited effectiveness in CKD), and dialysis may be used. The answer is C because the standard "first action" is myocardial stabilization. Spironolactone (B) is a potassium-sparing diuretic and is contraindicated.
美台醫師針對高鉀血症的處置順序一致，但在美國護理師執行靜脈給予葡萄糖酸鈣的權限與流程更明確。