丙戊酸钠致高乳酸血症伴代谢性酸中毒  

Sodium valproate-induced hyperlactatemia with metabolic acidosis

作　　者：王之舟[1] 程红勤[1] 白向荣[1] 金颖[1] 姜德春[1] 张嵊鹏[1] Wang Zhizhou;Cheng Hongqin;Bai Xiangrong;Jin Ying;Jiang Dechun;Zhang Shengpeng(Department of Pharmacy,Xuanwu Hospital,Capital Medical University,National Clinical Research Center for Geriatric Disorder,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院药学部/国家老年病学临床研究中心,北京100053

出　　处：《药物不良反应杂志》2020年第6期379-380,共2页Adverse Drug Reactions Journal

基　　金：北京市科学技术委员会“北京老年人健康评估及维护关键技术研究”项目(D181100000218002)。

摘　　要：1例45岁男性患者因颅内病变行开颅活检术,术后为预防癫痫先给予丙戊酸钠800 mg溶于0.9%氯化钠注射液8 ml静脉推注,继之用该浓度丙戊酸钠溶液以0.6 ml/h的速度持续静脉泵入。给药1 h后,患者血清乳酸水平逐渐升高,最高达到14.7 mmol/L,伴代谢性酸中毒和代偿性呼吸性碱中毒,酸碱度最低7.09,剩余碱最低-26.3,导致患者昏迷。考虑患者的高乳酸血症及代谢性酸中毒可能与丙戊酸钠有关,停用丙戊酸钠,给予5%碳酸氢钠注射液静脉滴注和血液净化治疗。3 d后,患者的乳酸水平恢复正常,代谢性酸中毒基本纠正,神志转清。A 45-year-old male patient underwent craniotomy and biopsy for intracranial lesions.In order to prevent epilepsy,sodium valproate 800 mg dissolved in 0.9%sodium chloride injection 8 ml was injected intravenously after operation,and then the sodium valproate solution of this concentration was continuously pumped at a speed of 0.6 ml/h.One hour after administration,the serum lactate level of the patient increased gradually,reaching the highest level of 14.7 mmol/L,accompanied by metabolic acidosis and compensatory respiratory alkalosis,and with the lowest pH of 7.09 and the lowest base excess of-26.3.The patient fell into a coma.The hyperlactatemia and metabolic acidosis were considered to be related to sodium valproate.Sodium valproate was stopped,intravenous infusion of 5%sodium bicarbonate injection and blood purification were given at the same time.After 3 days,the lactate level of the patient returned to normal,metabolic acidosis was basically corrected,and his mind was clear.

关 键 词：丙戊酸 癫痫 酸中毒 乳酸性 

分 类 号：R971[医药卫生—药品]