Tsai Weng-Sheng, Wu Chien-Ping, Hsu Yu-Juei, Lin Shih-Hua
Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Am J Med Sci. 2004 Mar;327(3):152-5. doi: 10.1097/00000441-200403000-00007.
Although modest hypokalemia is frequently observed in asthmatic patients being treated with bronchodilators, profound hypokalemia and metabolic alkalosis are rarely reported in patients receiving high-dose hydrocortisone (HC). We describe a 66-year-old man who complained of generalized muscle weakness, shallow respiration, and palpitations after receiving high-dose intravenous HC (total dose, 2400 mg over 4 days) to treat a severe asthma attack. During this therapy, there was a weight gain of 1.0 kg. An electrocardiogram revealed ventricular arrhythmia with frequent premature ventricular contractions. Hypokalemia was profound, with plasma potassium (K+) concentration of 1.7 mEq/L, and associated with renal potassium wasting, as evidenced by a transtubular potassium concentration gradient of 12; metabolic alkalosis (plasma HCO3-, 37 mEq/L) was also present. When treated with spironolactone, KCl supplementation, and substitution of HC with prednisolone, his plasma K+ concentration rapidly normalized, metabolic alkalosis was corrected, and arrhythmia disappeared within 3 days. Because of unwanted mineralocorticoid side-effects, high-dose HC may cause life-threatening hypokalemia in asthmatic patients. Because of these potential risks, plasma acid-base and electrolyte concentrations should be monitored frequently in any patient treated with high-dose HC.
尽管在接受支气管扩张剂治疗的哮喘患者中经常观察到轻度低钾血症，但在接受大剂量氢化可的松（HC）治疗的患者中，严重低钾血症和代谢性碱中毒却鲜有报道。我们描述了一名66岁男性，在接受大剂量静脉注射HC（4天内总量为2400mg）治疗严重哮喘发作后，出现全身肌无力、呼吸浅促和心悸。在此治疗期间，体重增加了1.0kg。心电图显示室性心律失常，频发室性早搏。低钾血症严重，血浆钾（K+）浓度为1.7mEq/L，并伴有肾性钾丢失，肾小管钾浓度梯度为12可证明；同时还存在代谢性碱中毒（血浆HCO3-，37mEq/L）。当使用螺内酯、补充氯化钾并将HC替换为泼尼松龙进行治疗后，他的血浆K+浓度迅速恢复正常，代谢性碱中毒得到纠正，心律失常在3天内消失。由于存在不良的盐皮质激素副作用，大剂量HC可能会在哮喘患者中导致危及生命的低钾血症。鉴于这些潜在风险，在任何接受大剂量HC治疗的患者中，都应频繁监测血浆酸碱和电解质浓度。
