糖水+5g钾片=3小时后人体失水死亡。值班护士被要求赔偿20万。

2024-03-24 生活常识关注公众号

患者四肢无力入院急诊，值班护士1小时后在5%葡萄糖溶液中滴注15毫升10%氯化钾，结果导致患者死亡。该案例突显了医疗护理中出现的问题以及与之相关的法律纠纷。案例分析中提到了低钾血症的处理方式，并指出正确配制氯化钾溶液的重要性。最后提出了两个可能的问题：氯化钾是否应在葡萄糖中静滴以预防高钾血症和纠正钾缺乏症；氯化钾应使用哪种溶媒来快速补充细胞外钾。

患者四肢无力入院急诊，值班护士给1.5g 钾配 500mL 糖水抢救。

3 小时后患者死亡，值班护士被索赔20万元！

案例回顾

患者李某，于 11:15 分因「突发四肢乏力 5+ 小时，不能行走」入院急诊。

12:12 实验室结果显示血钾 2.06 mmol/L，诊断为「低钾血症」。值班护士小丽当即给予 10% 氯化钾 15 mL 加入 5% 葡萄糖液 500 mL 中缓慢静脉滴注并口服氯化钾缓释片对症治疗。

12:55 患者突发意识不清、呼吸浅慢不规则、心电监护显示血压监测不出及心率为零。医院抢救未果，于 15:50 宣布临床死亡。

患者家属认为小丽在抢救过程中将氯化钾加入葡萄糖中静滴，有加重低血钾的可能，故以小丽存在医疗过错为由，向法院提起诉讼要求小丽赔偿20万元。

上述病例到底有没有问题？护士小丽哎哪一步出了差错？补钾时氯化钾究竟应该用糖配还是用盐配呢？

我们先来看一下氯化钾用于静脉补钾时，溶媒如何选择？

（4）人卫第 9 版《内科学》

低钾血症时将氯化钾加入生理盐水中静滴，如钾已正常，则将氯化钾加入葡萄糖液中静滴，可预防高钾血症和纠正钾缺乏症。

（5）廖二元主编第 3 版《内分泌代谢病学》

那么，关于此案例我们应该注意什么呢？

上述病例是个例，但却由此引出一个问题，临床上补钾时氯化钾究竟应该用糖配还是用盐配呢？

综上所述：

急性低钾血症患者，若按说明书使用 5% 葡萄糖溶液，也可快速补充细胞外钾，但是葡萄糖会刺激胰岛素的分泌，而胰岛素可通过激活 Na+-K+-ATP 酶促使细胞外钾离子流向细胞内。而使用生理盐水作为溶媒可快速补充细胞外钾，减少细胞内钾的外流，阻止膜静息电位-阈电位间距的改变。

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