复方甘草酸苷致严重低血钾、横纹肌溶解和肾功能损伤  

Severe hypokalemia,rhabdomyolysis,and acute renal injury due to compound glycyrrhizin

作　　者：李长青[1] 哈斯[1] 刘东华[1] 曹中朝[1] 

机构地区：[1]内蒙古医科大学附属医院保健中心,呼和浩特010050

出　　处：《药物不良反应杂志》2015年第3期225-226,共2页Adverse Drug Reactions Journal

摘　　要：1例55岁男性患者因高血压合并2型糖尿病伴肝功能异常（丙氨酸转氨酶74 U/L，γ谷氨酰胺转肽酶712 U/L]和低血钾（3.40 mmol/L），给予硝苯地平缓释片30 mg、1次/d口服，贝那普利10 mg、1次/d口服，阿卡波糖片25 mg/次、三餐前嚼服，复方甘草酸苷60 ml（120 mg）/d静脉滴注，氯化钾片1.0 g、3次/d口服。用药第14天患者出现下肢无力伴全身肌肉疼痛，四肢肌力为Ⅳ级，血钾1.1 mmol/L。停用复方甘草酸苷和贝那普利，口服氯化钾片2.0 g并将10%氯化钾40 ml入0.9%氯化钠注射液1000 ml缓慢静脉滴注。停用复方甘草酸苷后4 h，血钾为1.5 mmol/L，给予螺内酯40 mg、3次/d口服；24 h，血钾2.9 mmol/L，患者四肢无力明显减轻；48 h，血钾3.1 mmol/L，但患者全身肌肉疼痛加重，双下肢胀痛伴胸部憋闷，尿液外观呈深茶色改变，实验室检查示血清肌酸激酶（ CK）50904 U/L，CK 同工酶441 U/L，乳酸脱氢酶1992 U/L，天冬氨酸转氨酶441 U/L，肌钙蛋白 T 0.20 ng/ml，肌酐317μmol/L，尿素氮18.2 mmol/L，尿酸533μmol/L，二氧化碳结合力35.5 mmol/L。考虑为严重低血钾、横纹肌溶解合并肾功能不全。继续给予补钾补液、营养支持、保护肾功能等对症治疗。停用复方甘草酸苷后5 d，患者血钾3.3 mmol/L，CK 10292 U/L，肌肝252μmo/L，尿素氮16.3 mmol/L，尿酸472μmo/L；10 d，血钾4.6 mmol/L、CK 107 U/L，肌肝116μmo/L，尿素氮6.4 mmol/L，尿酸189μmol/L。此间患者血压维持在130~160/70~90 mmHg（1 mmHg =0.133 kPa），四肢无力、全身肌肉疼痛等症状消失。A 55-year-old man with hypertension,type 2 diabetes,abnormal liver function[ alanine aminotransferase（ALT）74 U/L,γ-glutamytransferase（γ-GT）712 U/L）]and hypokalemia（3. 40 mmol/L）received extended release nifedipine 30 mg once daily,benazepril 10 mg once daily,acarbose 25 mg three times a day before each meal,potassium chloride tablets 1. 0 g three time daily,and an IV infusion of compound glycyrrhizin 60 ml（120 mg）once daily. On day 14 after administration the patient developed lower legs weakness and myalgia. The result of examination of animal force of limbs wasⅣlevel. The serum potassium was 1. 1 mmol/L. Compound glycyrrhizin and benazepril were stopped. The patient was given potassium chloride tablets 2. 0 g orally and an IV infusion of 10% potassium chloride 40 ml dissolved in more than 1 000 ml of 0. 9% sodium chloride. The speed of IV infusion was 1. 0 g potassium chloride/hour. The serum potassium was 1. 5 mmol/L four hours after drug withdrawal. The spirolactone 40 mg three times daily was added. Twenty four hours later,the patient′s serum potassium increased to 2. 9 mmol/L,his symptom of myasthenia of limbs improved. Forty eight hours later,his serum potassium was 3. 1 mmol/L,but he developed whole body myalgia,distending pain in both lower extremities and choking sensation in chest. Laboratory test showed creatine kinase（ CK）50 940 U/L,CK-MB 441 U/L,lactate dehydrogenase（ LDH） 1 992 U/L,aspartate aminotransferase（ AST）441 U/L,T（ cTnT）0. 20 ng/ml,serum creatinine（ SCr） 317 μmol/L,blood urine nitrogen（ BUN）18. 2 mmol/L,uric acid（ UA）533 mol/L,and carban dioxide-combining Power（CO2-CP）35. 5 mmol/L. Myoglobins in blood and urine did not tested. The color of urine was dark brown. The patient was diagnosed severe hypokalemic,rhabdomyolysis,and renal injury. He received the symptomatic treatments of potassium supplement, fluid infusion, nutritional support, and protection of renal function. On day 5 of compound glycyrrhizin withdrawal,the laboratory test

关 键 词：甘草酸 低血钾症 横纹肌溶解 急性肾损伤 

分 类 号：R974[医药卫生—药品]