甲状旁腺功能减退症患者服用双氢速固醇引发急性肾衰竭伴高钙血症病例分析  

Acute Renal Failure with Hypercalcemia Caused by Dihydrotachysterol in Hypoparathyroidism:a Case Analysis

作　　者：周佳雁[1] 蒋晓红[1] 王龙[1] ZHOU Jiayan;JIANG Xiaohong;WANG Long(The First People's Hospital of Changzhou,Changzhou 213000,China)

机构地区：[1]江苏省常州市第一人民医院,213000

出　　处：《中国全科医学》2021年第24期3134-3136,3140,共4页Chinese General Practice

摘　　要：双氢速固醇(DHT)中毒是十分罕见的高钙血症病因,主要通过病史及用药史进行排他性诊断。本文报道1例以乏力、食欲不振为首发症状的DHT中毒引起的急性肾衰竭伴高钙血症病例。本例患者既往因甲状腺良性结节行手术治疗,术后并发甲状旁腺功能减退症,自行将用药方案改为DHT,0.5 mg/d,联合碳酸钙D3片,3片/d,整个服药过程中均未监测血钙(SCa)水平。患者此次无明显诱因出现乏力、食欲不振,经查血肌酐(Scr)458μmol/L,SCa 5.1 mmol/L,诊断为急性肾衰竭。在排除其他引起高钙血症的原因后,考虑为DHT中毒,予以停用DHT及碳酸钙D3片、补液、利尿、降钙素注射等治疗,患者Scr及SCa逐渐恢复至参考范围。因此建议临床医生和服用DHT的患者,即使平时SCa在参考范围,也需定期监测,存在其他疾病或联合使用其他药物时应谨防高钙血症的发生。Hypercalcemia induced by dihydrotachysterol(DHT)poisoning is very rare,which is diagnosed based exclusively on medical history and medication history in general.We reported a case of acute renal failure and hypercalcemia caused by DHT poisoning with fatigue and anorexia as the first symptoms.This patient previously received surgery for benign thyroid nodules and suffered from postoperative hypoparathyroidism.Later she changed the medication regimen to DHT(0.5 mg/d)combined with calcium carbonate-vitamin D3(3 tablets/d)by herself.During the whole medication treatment,the serum calcium(SCa)level was not monitored.The patient was admitted to our hospital due to fatigue and anorexia without obvious inducers,who was diagnosed with acute renal failure according to serum creatinine(Scr)(458μmol/L)and SCa(5.1 mmol/L)levels.After excluding other causes for hypercalcemia,DHT poisoning was considered.After terminating the treatment of DHT and calcium carbonate-vitamin D3,and receiving treatment with fluid replacement,diuresis,and calcitonin,the patient's Scr and SCa levels gradually returned to the reference range.So there are suggestions for clinicians and patients that during the treatment of DHT,especially treating for complex conditions(for example,comorbidities),or using DHT with other drugs,it is still necessary to regularly monitor the SCa,even if it has been controlled within the reference range before,thereby preventing the occurrence of hypercalcemia.

关 键 词：双氢速固醇 高钙血症 肾功能不全 甲状旁腺功能减退症症 病例报告 

分 类 号：R582.2[医药卫生—内分泌]