# 一名CKD個案使用calcium acetate後出現高血鈣。護理師會預期哪一項醫囑？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391826&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名CKD個案使用calcium acetate後出現高血鈣。護理師會預期哪一項醫囑？

## 選項

1. 加用IV葡萄糖酸鈣
2. 增加飲食鈣攝取
3. 增加calcium acetate劑量
4. 改用不含鈣的磷結合劑（sevelamer、lanthanum、ferric citrate） **✔ 正確答案**

**正確答案: 4**

## 解析

正確（2）：含鈣磷結合劑（acetate/carbonate）在CKD可能造成高血鈣與血管鈣化。Ca升高時應改用不含鈣的磷結合劑，如sevelamer、lanthanum、ferric citrate、sucroferric oxyhydroxide。（1、3、4）會惡化。

## 深入解析

記憶提示 含鈣磷結合劑便宜但增加鈣負荷。Ca上升或出現血管鈣化時，改用sevelamer/lanthanum。

## 臨床情境

情境 70歲女性CKD使用calcium acetate作為磷結合劑。新出現Ca 11.5與便祕，PTH穩定。

## 重要概念

- **含鈣磷結合劑** — 便宜的磷結合劑，但有高血鈣與血管鈣化風險。
- **CKD高血鈣** — 可由磷結合劑或維生素D類似物引起；改用不含鈣的結合劑。
- **血管鈣化** — CKD-MBD的心血管併發症；使用不含鈣結合劑可能降低風險。

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