1例复方磺胺甲唑片联合用药致高钾血症及危险因素分析  

Hyperkalemia Induced by Concomitant Use of Trimethoprim-Sulfamethoxazole and Other Drugs:a Case Report and Analysis of High Risk Factors

作　　者：钟丽英 陈芯莹 杨京华 Zhong Liying;Chen Xinying;Yang Jinghua(The Second Clinical Medical College,Guangzhou University of Chinese Medicine,Guangzhou 510405,China;The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120,China;Lyu Ying Famous Doctor Studio,Guangdong Province Traditional Chinese Medical Hospital,Guangzhou 510120,China)

机构地区：[1]广州中医药大学第二临床医学院,广州510405 [2]广州中医药大学第二附属医院,广州510120 [3]广东省中医院吕英名医工作室,广州510120

出　　处：《儿科药学杂志》2024年第7期8-11,共4页Journal of Pediatric Pharmacy

基　　金：广东省中医院院内项目吕英学术经验传承工作室建设项目,编号E43729。

摘　　要：目的:探讨复方磺胺甲噁唑片(TMP-SMZ)联合用药引起高钾血症的机制。方法:分析1例使用TMP-SMZ联合螺内酯片、贝那普利片治疗致狼疮性肾炎患儿发生高钾血症的诊疗经过,并结合文献分析探讨该患儿血钾水平升高的机制。结果:患儿联合使用TMP-SMZ、螺内酯片及贝那普利片治疗1 d后出现血钾水平升高,立即予停服上述药物及常规降钾处理,其血钾水平仍居高不下,予血液透析治疗后患儿血钾水平逐渐降至正常。结论:高钾血症事件的发生与TMP-SMZ密切相关,而患儿联用相关药物(贝那普利片、螺内酯片)、存在基础肾脏疾病(狼疮性肾炎、肾功能不全)、代谢性酸中毒是促使高钾血症发生的危险因素。对于存在基础肾脏疾病的患者,即使是低剂量TMP-SMZ,在与螺内酯片、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂类药物联合应用时,仍需警惕高钾血症的发生。Objective:To explore the mechanism and characteristics of hyperkalemia induced by concomitant use of trimethoprimsulfamethoxazole(TMP-SMZ)and other drugs.Methods:The diagnosis and treatment of hyperkalemia in a child with lupus-induced nephritis treated with TMP-SMZ combined with spironolactone and benazepril tablets were analyzed,and the mechanism of hyperkalemia was discussed in combination with literature analysis.Results:After 1 d of treatment with the concomitant use of TMP-SMZ,spironolactone and benazepril tablets,the blood potassium was elevated.After immediate withdrawal of the above drugs and routine potassium reduction treatment,the blood potassium was still high.After hemodialysis treatment,the blood potassium decreased to normal level.Conclusion:The occurrence of hyperkalemia events is closely related to TMP-SMZ.The risk factors for hyperkalemia are the concomitant use of benazepril tablets and spironolactone,the presence of underlying renal disease(lupus nephritis,renal insufficiency),and metabolic acidosis.For patients with underlying kidney disease,low-dose TMP-SMZ combined with spironolactone,angiotensinconverting enzyme inhibitors/angiotensinⅡreceptor antagonists still requires vigilance against hyperkalemia.

关 键 词：复方磺胺甲噁唑片 高钾血症 狼疮性肾炎 高危因素 

分 类 号：R97[医药卫生—药品]