年約70多歲的病人，因為吃不下，全身虛弱無力，頭暈好幾天後，被家人送來急診。過去有中風過創傷性的蜘蛛膜下腔出血及泌尿道感染病史。此次來急診經醫師檢視後，有嚴重貧血（血紅素7.5 g/dl，正常值12-14g/dl）及泌尿道感染。不僅體重過輕，同時電解質異常，血中的鉀離子偏低。
收治住院後，除了用經驗性的抗生素治療泌尿道感染外，也一起尋找病人營養不良及貧血的原因。然而更需要處理的是，血液中鉀離子過低的電解質異常的情況及病人的肌肉無力，應該也是因此原因而導致。鉀離子正常值為3.5-4.5 (mEq/L)，但病人血中的鉀離子僅為2.3 (mEq/L)，極度的低血鉀不僅導致肌肉無力，同時心電圖也出現異常，心電圖的心肌再極化異常。若不及時處置矯正，可能引發致命性的心律不整。
經3日的小心點滴及飲食補充後，鉀離子由原先的2.3上升到2.9，再上升到3.8（正常範圍內）。鉀離子的補充必須十分小心，若補充得太快太多，除了會造成施打點滴血管的疼痛，甚至會引發病人心跳停止。所以在使用含鉀離子的點滴初步矯正後，即改由飲食補充的方式，穩健的改善病患鉀離子的平衡。
病人的慢性營養不良及貧血，同時合併食慾不振，暗示了病人可能有腸胃道問題。在急診經過緊急輸血後，雖然病人住院中的糞便並無潛血反應，但還是建議家屬進行上腸胃道攝影，果然顯示有胃食道胃酸逆流的食道發炎出血現象，以及膽管膽結石阻塞的問題。給予制酸劑及促進腸胃蠕動藥物後，病人的食慾明顯改善。
慢性的營養不良所引發的後遺症，除了免疫力低下常再次引發的泌尿道感染之外，也合併了皮膚的慢性感染。病患的手指及腳趾都出現甲癬（指甲黴菌感染）現象，甚至出現指甲掉落。經皮膚科醫師會診後，給予抗黴菌藥膏，與每日換藥，病人的手指及腳趾都有明顯改善，最後於住院約一週後穩定出院，於門診追蹤。
臺北市立聯合醫院中興院區腎臟內科醫師劉文勝說明，鉀離子低下合併營養不良、貧血、泌尿道及皮膚感染，使得治療老年患者充滿許多挑戰，除了要迅速且小心校正電解質異常的鉀離子不足，避免後續的併發症加重，也需要同時尋找其他常在老年患者身上的多發病症，如導致貧血的腸胃道問題，慢性營養不良引致的免疫力低下與皮膚感染問題。尤其困難的是，患者經過中風後，言語表達能力不佳，往往由家屬代為轉述，更需依賴有經驗的內科醫師診視，以及團隊的合作（腸胃科及皮膚科會診），才能在短時間內改善病症。
而老年病人的病癥表現，往往不具專一性，而是以倦怠無力為表現。在台灣正式邁向老年化社會後，醫療需求的增加，需要照顧的患者逐年上升，更是有賴具有可近性的社區型醫院及醫療團隊，進行多面向的治療。病人在後續回診後，也由幾乎臥床的狀態，進步到能在家屬攙扶下緩慢行走，聯合醫院的全體醫療團隊也為病人感到高興。
劉文勝說，鉀離子在腎功能正常的一般人身上，較不易出現異常，因為鉀離子多半儲存在細胞內，不易流失。而且正常的腎臟可以調節鉀離子的平衡，將多餘的鉀離子排出，或是在身體缺乏鉀離子時，進行保留鉀離子。然而在老年嚴重營養不良的狀態，雖然腎功能正常，卻因為攝食太少，而造成缺乏鉀離子、肌肉無力以及心電圖異常。此時可用高鉀飲食補充，如香蕉、堅果、菠菜或是柑橘類的果汁。
但在腎功能不良的病人身上，高鉀離子的飲食要十分小心，因為腎功能不良的患者，無法藉由尿液排除鉀離子，極易導致高血鉀。血中鉀離子太高或太低，都會引發心律不整。所以在民眾擔心營養不良，進行”食補”之前，建議先找有專業證照的醫療團隊，透過健康檢查（台北市民40歲以上可以每三年一次成人健檢，而65歲以上可以每年一次到聯合醫院進行老年體檢），先了解自身的狀況，以免在飲食補充時，未蒙其利，先受其害。
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The patient, who was about 70 years old, was unable to eat, and was weak and weak. After a few days of dizziness, he was sent to the emergency department by his family. In the past, there was a history of traumatic arachnoid hemorrhage and urinary tract infection. After the emergency medical examination, there was severe anemia (hemoglobin 7.5 g/dl, normal value 12-14 g/dl) and urinary tract infection. Not only is the body weight too light, but the electrolyte is abnormal and the potassium ions in the blood are low.
After admission to hospital, in addition to the use of empirical antibiotics to treat urinary tract infections, but also to find the reasons for malnutrition and anemia. However, it is more necessary to deal with the abnormal electrolyte of potassium in the blood and the muscle weakness of the patient, which should also be caused by this reason. The normal value of potassium ion is 3.5-4.5 (mEq/L), but the potassium ion in the patient's blood is only 2.3 (mEq/L). Extreme hypokalemia not only causes muscle weakness, but also abnormal electrocardiogram, electrocardiogram myocardial re Polarization is abnormal. If the correction is not handled in time, it may cause a fatal arrhythmia.
After careful care and dietary supplements on the 3rd, potassium ions rose from the original 2.3 to 2.9 and then rose to 3.8 (normal range). Potassium ion supplementation must be very careful. If it is added too fast, it will cause pain in the blood vessels and even cause the patient to stop heartbeat. Therefore, after the initial correction of the potassium-containing ions, the dietary supplementation method is used to improve the balance of potassium ions in the patient.
The patient's chronic malnutrition and anemia, combined with loss of appetite, suggest that the patient may have gastrointestinal problems. After the emergency blood transfusion in the emergency department, although the patient's feces in the hospital did not have occult blood reaction, it is recommended that the family perform upper gastrointestinal photography, which shows that there is a gastroesophageal acid reflux in the esophagus, and the obstruction of the bile duct gallstone. After the administration of the antacid and the promotion of gastrointestinal motility drugs, the appetite of the patient is significantly improved.
The sequelae caused by chronic malnutrition, in addition to the urinary tract infections often caused by low immunity, also incorporate chronic infection of the skin. The patient's fingers and toes have hyperthyroidism (nail mold infection), and even nails fall. After consultation with the dermatologist, the anti-mold ointment was given, and the daily change of the medicine, the patient's fingers and toes were significantly improved, and finally discharged from the hospital about one week after the hospitalization, and tracked in the clinic.
Liu Wensheng, a kidney physician at the Zhongxing Hospital of Taipei City United Hospital, said that low potassium levels combined with malnutrition, anemia, urinary tract and skin infections make the treatment of elderly patients full of many challenges, in addition to quickly and carefully correcting electrolyte abnormalities of potassium deficiency, avoiding Subsequent complications are also aggravated, and it is also necessary to find other frequently-occurring conditions in elderly patients, such as gastrointestinal problems leading to anemia, low immunity caused by chronic malnutrition and skin infections. Especially difficult is that after a stroke, patients have poor verbal ability, often by family members, and rely on experienced physicians and team cooperation (gastrointestinal and dermatology consultation) in a short time. Improve the condition.
The symptoms of elderly patients are often not specific, but are manifested by burnout. After Taiwan officially moved to an aging society, the demand for medical care increased and the number of patients needing care increased year by year. It also relied on the proximity of community-based hospitals and medical teams to carry out multi-faceted treatment. After the follow-up visit, the patient also progressed from being almost in bed to being able to walk slowly with the help of the family. The medical team of the United Hospital was also happy for the patient.
Liu Wensheng said that potassium ions are less prone to abnormalities in the average person with normal renal function, because potassium ions are mostly stored in cells and are not easily lost. And the normal kidney can regulate the balance of potassium ions, discharge excess potassium ions, or retain potassium ions when the body lacks potassium ions. However, in the severely malnourished state of the elderly, although the kidney function is normal, it is caused by a lack of potassium ions, muscle weakness, and abnormal electrocardiogram because of too little food intake. This can be supplemented with a high-potassium diet such as bananas, nuts, spinach or citrus juices.
However, in patients with renal dysfunction, the diet of high potassium ions should be very careful, because patients with poor renal function cannot eliminate potassium ions by urine, which can easily lead to hyperkalemia. If the potassium ion in the blood is too high or too low, it will cause arrhythmia. Therefore, before people are worried about malnutrition and carry out "food supplement", it is recommended to first find a medical team with a professional license to pass the health check (Taipei citizens can be adult health check every three years, and 65 years old can join the joint annual The hospital conducts a physical examination for the elderly. First, understand the situation of the elderly, so as not to benefit from the supplement when eating and drinking.
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