— 生理適應 · MEDIUM · MCQ —
慢性腎臟病病人血鉀值為 6.2 mEq/L，護理師應預期醫囑開立何種藥物？
A client with chronic kidney disease (CKD) has a serum potassium level of 6.2 mEq/L. Which medication should the nurse anticipate?
- ASpironolactone螺內酯
- BSodium polystyrene sulfonate✓ 正解聚苯乙烯磺酸鈉
- CCalcium gluconate葡萄糖酸鈣
- DFurosemide福祿塞米
— Explanation · 中文詳解 —
高血鉀 6.2 mEq/L 屬危險水平，需強制排鉀。Sodium polystyrene sulfonate（Kayexalate）為離子交換樹脂，可結合腸道鉀離子排出體外。Furosemide 可排鉀但效果較慢；Spironolactone 為保鉀利尿劑，絕對禁用；Calcium gluconate 用於保護心肌，但無法降鉀。
Sodium polystyrene sulfonate is the appropriate intervention as it acts as an ion-exchange resin to bind potassium in the gastrointestinal tract and promote its excretion. Spironolactone is contraindicated because it is a potassium-sparing diuretic that would worsen hyperkalemia. While calcium gluconate stabilizes the cardiac membrane, it does not lower serum potassium levels.
✦ 台美臨床差異
美方現多使用較新之降鉀藥物如 Patiromer，台灣臨床仍多見使用 Kayexalate。