托伐普坦致代谢性碱中毒  

Metabolic alkalosis caused by tolvaptan

作　　者：黄燕[1] 周素琴[1] 宋霞[1] 姚媛[2] Huang Yan;Zhou Suqin;Song Xia;Yao Yuan(Department of Pharmacy,Lan zhou University Second Hospital,Lanzhou 730000,China;Department of Pharmacy,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]兰州大学第二医院药剂科,兰州730000 [2]广州中医药大学第一附属医院药学部,广州510405

出　　处：《药物不良反应杂志》2023年第10期635-637,共3页Adverse Drug Reactions Journal

摘　　要：1例86岁男性慢性心力衰竭急性加重患者,因长期使用利尿剂出现利尿剂抵抗,加用托伐普坦3.75 mg口服、1次/d,利尿效果明显;次日加量至7.5 mg口服、1次/d,患者尿量增加、心力衰竭症状改善;第3天患者出现口干口渴,一过性烦躁不安,四肢抽动,实验室检查示pH 7.51、血氧分压(PaO2)67.4 mmHg(1 mmHg=0.133 kPa)、标准碳酸氢根(SB)28.4 mmol/L、实际碳酸氢根(AB)28.5 mmol/L、血钾3.0 mmol/L、血钠143 mmol/L、血氯104 mmol/L。考虑为托伐普坦导致代谢性碱中毒和呼吸性酸中毒,停用该药,给予精氨酸注射液、0.9%氯化钠、补钾等对症治疗,同时不限制患者饮水。停药当天,患者口干口渴症状明显减轻、精神好转,无四肢抽动,下肢及颜面水肿消退;停药1 d后,pH 7.49,SB 31.1 mmol/L,AB 31.4 mmol/L,血钾3.6 mmol/L;停药3 d后,患者嗜睡、精神差,呼吸较前减弱,考虑患者继发Ⅱ型呼吸衰竭,予尼可刹米静脉泵入;停药5 d后,患者24 h尿量3285 ml,AB、SB、pH值均稍有下降,但患者病情改善不明显;停药13 d后予气管插管、呼吸机辅助通气等对症支持治疗,但患者病情持续加重。An 86‑year‑old male patient with acute exacerbation of chronic heart failure developed diuretic resistance due to long‑term use of diuretics,and was added tolvaptan 3.75 mg once daily orally,with significant diuretic effect.The next day,the dose was increased to 7.5 mg once daily orally.After taking medication,the patient′s urine volume increased and the symptoms of heart failure were improved.On the third day,the patient developed frequent dry mouth,thirst,transient restlessness,and convulsion of extremities.Laboratory tests showed pH 7.51,partial pressure of blood oxygen(PaO2)67.4 mmHg,standard bicarbonate concentration(SB)28.4 mmol/L,actual bicarbonate concentration(AB)28.5 mmol/L,blood potassium 3.0 mmol/L,blood sodium 143 mmol/L,and blood chlorine 104 mmol/L.It was considered that the metabolic alkalosis and respiratory acidosis were caused by tolvaptan.Tolvaptan was stopped and arginine injection,0.9%sodium chloride,potassium supplementation,and other symptomatic treatments were given,and the patient′s water drinking was not restricted.On the day of tolvaptan discontinuation,the patient′s dry mouth and thirst were significantly reduced,his mental state was improved,with no convulsion of extremities,and lower limb and facial edema subsided.After 1 day of drug withdrawal,the laboratory tests showed pH 7.49,SB 31.1 mmol/L,AB 31.4 mmol/L,and blood potassium 3.6 mmol/L.After 3 days of drug withdrawal,the patient developed drowsiness,poor mental state,and weakened breathing compared to before,which was considered that the patient suffered from metabolic alkalosis combined with respiratory acidosis and secondary type II respiratory failure.Intravenous pumping of nikethamide was given.After 5 days of drug withdrawal,the patient′s 24‑hour urine volume was 3285 ml,and the levels of AB,SB,and pH slightly decreased.However,the patient′s condition was not improved significantly.After 13 days of drug withdrawal,symptomatic and supportive treatments such as tracheal intubation and ventilation assistance

关 键 词：碱中毒 心力衰竭 托伐普坦 

分 类 号：R969[医药卫生—药理学]