# 一名CKD個案因次發性副甲狀腺機能亢進服用calcitriol。哪個檢驗結果最需要暫停用藥？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391829&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名CKD個案因次發性副甲狀腺機能亢進服用calcitriol。哪個檢驗結果最需要暫停用藥？

## 選項

1. PTH 220 pg/mL（副甲狀腺素）
2. 血紅素10.5
3. 血鈣11.0且磷5.5，合併增加轉移性鈣化風險 **✔ 正確答案**
4. 白蛋白3.8

**正確答案: 3**

## 解析

正確（2）：Calcitriol是活性維生素D，可抑制PTH但會升高Ca和磷；高血鈣加高血磷會增加Ca×P乘積，導致血管與軟組織轉移性鈣化。Ca >10.5或Ca×P >55時考慮暫停。（1）是治療適應症。（3、4）無關。

## 深入解析

記憶提示 維生素D類似物（calcitriol、paricalcitol、doxercalciferol）要看Ca和P；calcimimetic如cinacalcet可降PTH而不升Ca。

## 臨床情境

情境 62歲男性CKD第4期，使用calcitriol 0.25 mcg PO daily。例行檢驗：Ca 11.0、phosphate 5.5、PTH 220。

## 重要概念

- **Calcitriol 活性維生素D** — 活性維生素D；抑制PTH但會升高Ca與磷。
- **Ca×P 乘積** — Ca和P相乘；大於55會增加轉移性鈣化風險。
- **次發性副甲狀腺機能亢進** — 與CKD相關；可用維生素D類似物、calcimimetic與磷結合劑治療。

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