高血压伴低钾血症1例  

Hypertension with hypokalemia:a case report

作　　者：骆睿翔 吴旸[2] 张晨 LUO Ruixiang;WU Yang;ZHANG Chen(The Second Clinical College,Beijing University of Chinese Medicine,Beijing100029,China;Department of Cardiology,Dongfang Hospital of Beijing University of Chinese Medicine,Beijing100078,China;the Third Clinical College of Beijing University of Chinese Medicine,Beijing100029,China)

机构地区：[1]北京中医药大学第二临床医学院,北京100029 [2]北京中医药大学东方医院心内科,北京100078 [3]北京中医药大学第三临床医学院,北京100029

出　　处：《中国医药导报》2021年第29期182-184,188,共4页China Medical Herald

基　　金：国家自然科学基金面上项目(81573900)。

摘　　要：高血压伴低钾血症在临床上常考虑原发性醛固酮增多症。本文通过报道1例高血压伴低钾血症而非原发性醛固酮增多症的病例,以提醒临床医生勿入"陷阱"。该患者主因"间断头晕乏力3个月"入院,入院检查后发现血钾偏低,停用氯沙坦钾氢氯噻嗪片,改用非洛地平缓释片并联合氯化钾缓释片,发现血压明显升高且血钾持续偏低,初步考虑原发性醛固酮增多症,遂在此基础上加用螺内酯,最终患者的血压和血钾恢复正常。追溯病史发现患者曾服复方甘草酸苷,该药与噻嗪类利尿剂同时使用时可能出现低钾血症、假性醛固酮症等不良反应。本文旨在提醒临床医生详细询问病史尤其是用药史的重要性,并应具备完善的临床思维及诊疗模式,同时提高对原发性醛固酮增多症的认识。For hypertension with hypokalemia,primary aldosteronism is given priority clinically.This article reports a case of hypertension with hypokalemia rather than primary aldosteronism to remind clinicians not to fall into the "trap".The patient was admitted to the hospital for "intermittent dizziness and fatigue for three months".After admission,he was found to be low in blood potassium.Losartan potassium and Hydrochlorothiazide Tablets were discontinued,and Felodipine Sustained-release Tablets combined with Potassium Chloride Sustained-release Tablets were found to have blood pressure significantly elevated and persistently low serum potassium,primary aldosteronism was initially considered,and Spironolactone was added on this basis,and eventually the patient’s blood pressure and serum potassium returned to normal.A retrospective medical history revealed that the patient had taken Compound Glycyrrhizin,and adverse reactions such as hypokalemia and pseudoaldosteronism might occur when the drug was used simultaneously with Thiazide Diuretics.This article aims to remind clinicians of the importance of detailed medical history,especially medication history,and should have a sound clinical thinking and diagnosis and treatment model,and at the same time improve the understanding of primary aldosteronism.

关 键 词：原发性醛固酮增多症 高血压 低钾血症 病例报道 

分 类 号：R5[医药卫生—内科学]