腹膜透析合併低血鉀之營養照護個案報告

Nutritional Care for a Patient Receiving Peritoneal Dialysis With Hypokalemia: A Case Report

黃宜蓁(Yi-Chen Huang) ； 劉金華(Chin-Hua Liu) ； 陳珮鈴(Pei-Ling Chen) ； 林美珍(Mei-Chen Lin) ； 林素如(Su-Ju Lin) ； 張弘育(Hung-Yu Chang) ； 李佩賢(Pei-Hsien Lee) ； 林俊良(Chun-Liang Lin)

《臺灣膳食營養學雜誌》 10卷2期 (2018/12) Pp. 11-19

https://doi.org/10.6709/TJD.201812_10(2).0002

摘要

低血鉀是長期接受腹膜透析常見的併發症，而當病患接受腹膜透析及管灌餵食時，飲食中不當的限制或攝取量不足時易是造成低血鉀發生的重要因素。因此給予足夠的熱量、蛋白質及鉀離子攝取是必要的。本個案是一位74歲的女性病人，平日住家裡並接受居家腹膜透析和管灌餵食，平日乾體重47 kg，在腹膜透析門診追蹤時因營養狀況差及低血鉀，經醫師轉介營養師營養介入。營養診斷個案主要的營養問題為礦物質（鉀離子）攝取不足（problem, P）。病因為個案目前在接受腹膜透析或對於含鉀離子食物和補充品來源之食物與營養相關知識不足。症候為估算從飲食中攝取的鉀離子低於建議量（每日攝取量為建議量之55.7%）及血鉀過低。熱量建議：每日17.5 kcal/kg dry body weight（DBW）提升至20.6 kcal/kg DBW，蛋白質建議：每日1.4 g/kg DBW提升至1.6 g/kg DBW，鉀離子建議：12.9 mEq/day增加至33.4 mEq/day，每日定量給於低鈉鹽3.0 g，追蹤病患血液中鉀離子，2個月後達到了正常值（＞ 3.5 mEq/L），並改善營養狀況。

關鍵字

腹膜透析 ； 低血鉀 ； 營養不良 ； 營養照護

並列摘要

Hypokalemia is a common complication for long-term peritoneal dialysis patient. When patients receive peritoneal dialysis and enteral feeding, suboptimal dietary intake is an important contributor to cause hypokalemia. Thus, it is necessary to provide optimal levels of dietary energy, protein and other nutrients. A 74-year-old female patient of has received home peritoneal dialysis and with nasal gastric tube feeding. Her usual dry weight was 47 kg. Poor nutritional status and hypokalemia was noted as she admitted to peritoneal dialysis clinics. She was then referred to a registered dietitian for nutritional counseling. Nutritional diagnosis was the insufficient intake of minerals (potassium ions). The etiology was due to either the physiological factors or lack of food and nutrition knowledge related to potassium contents from foods or supplement. Sign and symptoms included estimated potassium ions of the diet being lower than the recommended amount (55.7% of the recommendation) and hypokalemia. Nutrition plan suggested by dietitian was to increase energy intake from 17.5 to 20.6 kcal/kg dry body weight (DBW)/day, protein intake from 1.4 to 1.6 g/kg DBW/day, potassium ion intake from 12.9 to 33.4 mEq/day, and to restrict sodium at 3.0 g/day. After two months, potassium level was back to normal level (＞ 3.5 mEq/L), and nutritional status was improved.

並列關鍵字

peritoneal dialysis ； hypokalemia ； poor nutritional ； nutrition care