# 一名ESRD個案K+ 7.2，ECG出現尖峰T波。優先藥物是哪一項？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391824&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名ESRD個案K+ 7.2，ECG出現尖峰T波。優先藥物是哪一項？

## 選項

1. 只給insulin，不給dextrose
2. 口服KCl
3. 先給IV葡萄糖酸鈣穩定心肌膜，接著用insulin + dextrose與β2促效劑將K移入細胞內，再進行排鉀治療（kayexalate/patiromer/sodium zirconium或透析） **✔ 正確答案**
4. Spironolactone（保鉀利尿劑）

**正確答案: 3**

## 解析

正確（2）：有ECG變化的嚴重高血鉀，第一步是給IV葡萄糖酸鈣穩定心肌膜（快速，但不移除K）。接著以insulin + dextrose、β2（albuterol）、酸中毒時的bicarbonate讓K進入細胞。最後用sodium polystyrene sulfonate/patiromer/sodium zirconium或透析排除K。（1）會低血糖。（3、4）會惡化。

## 深入解析

記憶提示 高血鉀階梯：鈣保護心臟，insulin/β2把K推進細胞，結合劑或透析移除K。鈣不會降低K，只是保護心臟。

## 臨床情境

情境 65歲男性ESRD漏做血液透析。K+ 7.2 mEq/L、尖峰T波、QRS變寬。

## 重要概念

- **葡萄糖酸鈣** — 高血鉀時穩定心肌膜；不會降低血鉀。
- **insulin促進K轉移** — 將K推入細胞內；一定要搭配dextrose避免低血糖。
- **高血鉀鉀結合劑** — 包括sodium polystyrene sulfonate（kayexalate）、patiromer、sodium zirconium cyclosilicate。

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