— 生理適應 · HARD · MCQ —
一位患有慢性腎臟病（CKD）的病人，血鉀濃度為 6.5 mEq/L。護理師預期會優先給予下列哪種藥物？
A client with chronic kidney disease (CKD) has a serum potassium level of 6.5 mEq/L. Which medication should the nurse anticipate administering first?
- ASodium polystyrene sulfonate (Kayexalate)聚苯乙烯磺酸鈉 (Kayexalate)
- BFurosemide吠塞米
- CCalcium gluconate✓ 正解葡萄糖酸鈣
- DRegular insulin and 50% dextrose常規胰島素與 50% 葡萄糖
— Explanation · 中文詳解 —
高血鉀造成心臟傳導異常時，首要目標是保護心肌，防止心律不整。鈣離子製劑（Calcium gluconate）無法降鉀，但可穩定心肌細胞膜電位，應優先給予。隨後再使用胰島素與葡萄糖使鉀進入細胞內，或使用排鉀樹脂與利尿劑排出體外。
Severe hyperkalemia poses an immediate risk of life-threatening cardiac dysrhythmias, making cardiac stabilization the priority. Calcium gluconate is administered first to stabilize the cardiac cell membrane, even though it does not lower serum potassium levels. Other interventions, such as insulin with glucose or potassium binders, are used subsequently to shift or remove potassium from the body.
✦ 台美臨床差異
美國護理師常需在緊急情況下根據床邊 protocol 給予靜脈鈣劑；台灣醫師對於鈣劑的使用通常更加謹慎且需立即監控。