腹泻后高钾血症致窦室传导心电图演变一例报道

摘要

In this paper,an old man presented with long -term and repeated dyspnea and edema of double lower limbs,sought medical advice due to recently developed diarrhea,palpitations and fatigue symptoms. Based on the results of rele-vant checks,the case was initial diagnosed as senile valvular heart disease,atrial fibrillation,cardiac insufficiency,prerenal renal insufficiency and hyperkalemia. The patient took long-term medication to treat heart disease. The initial symptom was diar-rhea,abnormal severe hyperkalemia was observed,which may due to the usage of drugs under the hydrated condition. Through the dynamic observation of ECG variation and supportive treatment,hyperkalemia was corrected,and ECG returned to the level before this onset. Diarrhea is a common clinical cause for hypokalemia. In this case,hyperkalemia caused by long-term cardiac insufficiency and diarrea is worthy of special attention in clinical treatment. After rehydration treatment,urinary output increased, serum potassium concentration gradually returned to normal,characteristic changes of ECG was observed. The case might be use-ful in teaching and learning.%本文报道了1例老年男性因长期反复呼吸困难伴双下肢水肿，近期出现腹泻、心悸乏力症状就诊，完善相关检查初步诊断为：老年退行性心脏瓣膜病，心房纤颤，心功能不全；肾前性肾功能不全；高钾血症。患者长期服用药物治疗心脏基础疾病，本次因腹泻起病，反常出现严重的高钾血症，分析可能与脱水状态下使用药物有关，动态观察心电图演变并对症支持治疗后纠正了高钾血症，心电图恢复到本次起病前水平。因腹泻起病，临床上引起低钾血症多见，本例因长期心功能不全，腹泻引起高钾血症，所以临床上治疗要特别注意。在补液增加尿量等治疗后，血钾逐渐恢复正常，心电图也呈特征性变化，具有一定的教学意义。