复方聚乙二醇电解质散(Ⅳ)引起电解质紊乱、代谢性酸中毒和低钠血症性脑病  

Electrolyte disorder,metabolic acidosis,and hyponatremia encephalopathy caused by polyethylene glycol electrolytes powder(Ⅳ)

作　　者：邢曼 史士强 高静[2] 王娜 Xing Man;Shi Shiqiang;Gao Jing;Wang Na(Department of Pharmacy,the Second Affiliated Hospital of Xi′an Jiaotong University(Xibei Hospital),Xi′an 710004,China;Department of Pharmacy,the Third People′s Hospital of Qingdao,Shandong Province,Qingdao 266041,China;Department of Pharmacy,the Affiliated Hospital of Qingdao University,Shandong Province,Qingdao 266071,China)

机构地区：[1]西安交通大学第二附属医院(西北医院)药学部,710004 [2]山东省青岛市第三人民医院药学部,266041 [3]山东省青岛大学附属医院药学部,266071

出　　处：《药物不良反应杂志》2020年第4期270-271,共2页Adverse Drug Reactions Journal

摘　　要：1例61岁女性患者电子结肠镜检查前行肠道准备,分6次服用复方聚乙二醇电解质散(Ⅳ)(A剂24袋+B剂24袋溶入3000 ml温水、口服,500 ml/30 min)。肠道准备期间,患者5.5 h尿量约4500 ml,腹泻8次,呕吐2次。患者于当日14:00昏迷,伴四肢抽搐、牙关紧闭,实验室检查示血钠从治疗前140 mmol/L下降至120 mmol/L,血钾从治疗前4.0 mmol/L下降至2.7 mmol/L,氯化物87.2 mmol/L、碳酸氢根11.5 mmol/L;血气分析示酸碱度7.29 mmHg(1 mmHg=0.133 kPa)、二氧化碳分压31 mmHg、氧分压105 mmHg、剩余碱-10.4 mmol/L,头颅CT及MRI检查均未见异常,考虑为复方聚乙二醇电解质散(Ⅳ)导致电解质紊乱、代谢性酸中毒和低钠血症性脑病。立即给予吸氧、持续心电监护、纠正电解质紊乱、纠正酸中毒、补液等对症支持治疗。治疗4 h后患者生命体征逐渐平稳,处于昏睡状态。治疗第3天,患者意识清醒,血清电解质恢复正常,未再出现癫痫发作。A 61-year-old female patient underwent intestinal preparation before electronic colonoscopy.She took polyethylene glycol electrolytes powder(Ⅳ)in 6 times(dissolved content A 24 bags and B 24 bags in warm water 3000 ml and then took 500 ml orally per 30 minutes).During the intestinal preparation,the patient′s urine output was about 4500 ml,diarrhea occurred 8 times,and she vomited 2 times within 5.5 hours.The patient fell into a coma at 14:00 on the day,accompanied by limb convulsion and trismus.Laboratory tests showed that the serum sodium and potassium decreased from 140 mmol/L and 4.0 mmol/L to 120 mmol/L and 2.7 mmol/L before and after treatment,respectively.In addition,his chloride was 87.2 mmol/L and bicarbonate was 11.5 mmol/L.Blood gas analysis showed pH 7.29 mmHg,partial pressure of carbon dioxide 31 mmHg,partial pressure of oxygen 105 mmHg,and base excess-10.4 mmol/L.Metabolic acidosis was diagnosed.Head CT and MRI showed no abnormalities.Electrolyte disorder,metabolic acidosis,and hyponatremia encephalopathy due to hyponatremia caused by polyethylene glycol electrolytes powder(Ⅳ)was considered.Oxygen inhalation,continuous ECG monitoring,correction of electrolyte disorders,correction of acidosis,rehydration,and other symptomatic and supportive treatments were given immediately.After 4 hours of treatments,the vital signs of the patient were gradually stable but she was still in a coma.On the third day of treatments,the patient was conscious,her serum electrolytes returned to normal,and no seizures occurred.

关 键 词：聚乙烯二醇类 散剂 低钠血症 水电解质失调 癫痫 

分 类 号：R74[医药卫生—神经病学与精神病学]