Inada Mitsuo, Iwasaki Keiko, Imai Chihiro, Hashimoto Satoshi
Department of Internal Medicine, Kizuyabashi Takeda Hospital, Kyoto.
Intern Med. 2010;49(4):307-13. doi: 10.2169/internalmedicine.49.2416. Epub 2010 Feb 15.
A bedridden 85-year-old woman had hyperpotassemia (7.7 mEq/L) and bradycardia (30/min). Endocrinologic findings revealed a decrease in the renin-aldosterone system and normal adrenoglucocorticoid function. The results were consistent with the abnormalities seen in selective hypoaldosteronism with low renin activity. In addition, 9 of 11 patients, selected randomly from 72 bedridden elderly patients with normal serum sodium and potassium levels in our hospital, had diminished plasma renin activity (PRA) and plasma aldosterone concentration (PAC). The present patient was prescribed nonsteroidal anti-inflammatory drug (NSAID). NSAID reduces renal potassium excretion through the inhibition of renal prostaglandin synthesis. Therefore, the use of NSAID in bedridden elderly patients might intensify the underlying asymptomatic hypoaldosteronism and cause life-threatening hyperpotassemia.
一名85岁的卧床女性出现高钾血症（7.7 mEq/L）和心动过缓（30次/分钟）。内分泌学检查结果显示肾素 - 醛固酮系统功能减退，肾上腺糖皮质激素功能正常。这些结果与低肾素活性选择性醛固酮缺乏症中所见的异常情况一致。此外，从我院72名血清钠钾水平正常的卧床老年患者中随机选取的11名患者中有9名血浆肾素活性（PRA）和血浆醛固酮浓度（PAC）降低。该患者服用了非甾体抗炎药（NSAID）。NSAID通过抑制肾前列腺素合成减少肾脏钾排泄。因此，在卧床老年患者中使用NSAID可能会加重潜在的无症状性醛固酮缺乏症并导致危及生命的高钾血症。
