Diuretics and potassium metabolism: a reassessment of the need, effectiveness and safety of potassium therapy.
Diuretics and potassium metabolism: a reassessment of the need, effectiveness and safety of potassium therapy.
复制标题
利尿剂和钾代谢：钾治疗的必要性、有效性和安全性的重新评估。
DOI：
10.1038/ki.1977.67
复制
发表时间：
1977
影响因子：
19.6
通讯作者：
J. Harrington
中科院分区：
文献类型：
--
作者：
J. Kassirer;J. Harrington
在过去的十年中，单个药物制造商已经生产和销售了大约480亿毫当量的单一口服氯化钾制剂（WETTER MS，Ciba Pharmaceutical Co.，1976年6月，个人通信）。目前还没有每年处方钾总量的精确数字，但估计200亿至300亿毫当量可能是合理准确的。这也是一个合理的假设，这种电解质补充剂的相当大一部分是为了预防或治疗低钾血症和钾缺乏症，通常认为这是由利尿剂治疗引起的。考虑到大量的钾处方，结论似乎是不可避免的，大多数医生相信口服钾制剂的常规治疗是必要的，在接受利尿剂治疗的患者。尽管最近的几项研究对这种治疗的必要性提出了严重的问题，并指出了治疗的潜在风险，但这种观点仍然存在[1-6]。事实上，钾给药的随意性与使用氯霉素等药物的谨慎性形成鲜明对比，尽管钾盐的风险与获益之比可能比抗生素高得多。本文就利尿剂引起的钾缺乏的程度、利尿剂引起的酸碱失衡对钾平衡的影响、钾盐和保钾药物治疗的必要性和有效性以及治疗的效益和成本进行综述。
In the past decade approximately forty-eight billion milliequivalents of a single oral potassium chloride preparation have been produced and sold by a single pharmaceutical manufacturer (WETTER MS, Ciba Pharmaceutical Co., June, 1976, personal communication). Precise figures for the total quantity of potassium prescribed annually are not available, but an estimate of 20 to 30 billion milliequivalents is probably reasonably accurate. It is also a reasonable assumption that a substantial fraction of this electrolyte supplement is prescribed to prevent or to treat the hypokalemia and potassium deficiency generally thought to result from diuretic therapy. The conclusion seems inescapable, considering the enormous amounts of potassium prescribed, that the majority of physicians feel confident that routine treatment with an oral potassium preparation is warranted in patients receiving diuretic therapy. This opinion is maintained even though several recent studies have raised serious question about the need for such therapy and have also pointed out the potential risk of treatment [1–6]. Indeed, the casual approach to the administration of potassium contrasts sharply with the cautious approach to the use of a drug such as chloramphenicol, even though the ratio of risk to benefit is probably considerably higher for potassium salts as compared to the antibiotic. The purpose of this review is to discuss the magnitude of potassium deficiency in patients receiving diuretics, the influence of diuretic-induced acid-base derangements on potassium balance, the necessity and effectiveness of therapy with potassium salts and potassium conserving drugs and, finally, the benefits and costs of therapy.