甘草制剂致低钾血症的临床特征分析  

Analysis of clinical characteristics of licorice-induced hypokalemia

作　　者：王沁 王晓倩 马丹妍 楼雪勇[1] WANG Qin;WANG Xiaoqian;MA Danyan;LOU Xueyong(Department of Endocrinology and Metabolism,Jinhua Municipal Central Hospital,Jinhua 321000,Zhejiang,China)

机构地区：[1]金华市中心医院内分泌代谢科,浙江金华321000

出　　处：《中国现代医生》2023年第33期57-61,共5页China Modern Doctor

摘　　要：目的探讨甘草制剂致低钾血症的临床特点及危险因素。方法回顾性分析金华市中心医院2021年6月至2022年10月由急诊收治的12例甘草制剂相关低钾血症的临床特征、实验室检查结果、治疗及预后情况。结果12例患者中男女各6例,平均年龄(63.80±15.17)岁;合并症:便秘7例,高血压病9例,2型糖尿病3例;平均血钾(2.25±0.35)mmol/L。治疗原发病以肝病最多,其次为湿疹、慢性支气管炎和慢性胃炎。临床表现均有乏力,6例伴纳差或腹胀,5例伴头晕。12例患者均有尿钾排出增多、低醛固酮及低肾素表现;其他常见实验室异常为低白蛋白血症、低钙血症、乳酸脱氢酶升高和血脂异常。患者均予口服及静脉补钾治疗,4例加用螺内酯。停用甘草制剂后,血钾恢复时间最短4d,最长17d。本研究中重度低钾血症多见,此类患者男性比例更高、用药时间更长、肌酸激酶和三酰甘油水平更高、合并低钙血症及使用醛固酮受体拮抗剂的比例更高。结论使用甘草制剂患者出现乏力及腹胀等不适时,应警惕获得性表观盐皮质激素过多的可能,尽早监测电解质。老年、用药时间长、高血压、糖尿病、便秘和低白蛋白血症均可能与甘草制剂诱导低钾血症相关。Objective To investigate clinical characteristics and risk factors of licorice-induced hypokalemia.Methods To retrospectively analyzed the clinical data of 12 cases of licorice-induced hypokalemia by emergency admission in Jinhua Municipal Central Hospital,including clinical characteristics,laboratory test,treatment and prognosis.Results There were 6 males and 6 females in 12 patients,the average age was(63.80±15.17)years old.7 patients had a history of constipation,9 patients with hypertension and 3 patients with type 2 diabetes.The mean blood potassium concentration was(2.25±0.35)mmol/L.Primary diseases of licorice treatment were hepatopathy,eczema,chronic bronchitis and chronic gastritis.All patients had fatigue,6 patients had poor appetite and abdominal distension,5 patients were accompanied by dizziness.All patients were characterized by high urinary potassium excretion levels and low plasma aldosterone and renin levels.Other common laboratory abnormalities were hypoalbuminemia,hypocalcemia,elevated lactate dehydrogenase and dyslipidemia.All patients were treated with oral and intravenous potassium supplement,4 patients were treated with spironolactone.The recovery time of blood potassium concentration was at least 4 days and at most 17 days once intake of licorice was stopped.Severe hypokalemia was common.Higher proportion of men,hypocalcemia,using aldosterone receptor antagonists,and longer medication time,and higher creatine kinase and triglyceride levels were seen in patients with severe hypokalemia.Conclusion When the patients treated with licorice had fatigue or abdominal distension,we should pay attention to the possibility of acquired apparent mineralocorticoid excess and test blood electrolyte as soon as possible.Older age,long-term use,hypertension,diabetes,constipation and hypoalbuminemia may be associated with licorice-induced hypokalemia.

关 键 词：甘草 低钾血症 高血压 表观盐皮质激素过多 

分 类 号：R589[医药卫生—内分泌]