Yamamoto Takeshi, Hatanaka Masaki, Matsuda Jun, Kadoya Hiroyuki, Takahashi Atsushi, Namba Tomoko, Takeji Masanobu, Yamauchi Atsushi
Division of Nephrology, Osaka Rosai Hospital, Japan.
Nihon Jinzo Gakkai Shi. 2010;52(1):80-5.
Although hypokalemia is a common clinical problem, symptoms generally do not become manifest unless the serum potassium (K) falls rapidly. We encountered five cases with symptomatic severe hypokalemia (K<2.0 mEq/L) hospitalized for the past 15 months at our hospital. We examined the clinical characteristics and treatment of these patients. All five patients were women, and their mean age was 77.8 (73-82)years. They suffered from hypertension. Mean K level at admission was 1.66 (1.4-1.9) mEq/L and HCO3(-) was 48.3 (33.6-56.1) mmol/L. Plasma aldosterone level was low and plasma rennin activity was suppressed. All patients developed progressive muscle weakness with elevated creatinine phosphokinase. Three of the patients had received Chinese medicine which contained licorice, one received glycyrrhizin and the other one had received both. We diagnosed these cases as pseudoaldosteronism induced by glycyrrhizin. With discontinuation of the drugs and intravenous as well as oral K supplementation, serum K were normalized and clinical symptoms improved within 12 days. For one patient who developed cardiac dysfunction, concentrated K solution (230 mEq/L) was infused into the central vein. These findings show that glycyrrhizin ingestion should be kept in mind as a cause of an extreme degree of an hypokalemia, especially in elderly patients.
尽管低钾血症是常见的临床问题，但一般血清钾（K）迅速下降时症状才会显现。过去15个月我院收治了5例有症状的严重低钾血症（K<2.0 mEq/L）患者。我们对这些患者的临床特征及治疗情况进行了检查。5例患者均为女性，平均年龄77.8（73 - 82）岁。她们患有高血压。入院时平均血钾水平为1.66（1.4 - 1.9）mEq/L，HCO3(-)为48.3（33.6 - 56.1）mmol/L。血浆醛固酮水平低，血浆肾素活性受抑制。所有患者均出现进行性肌无力，肌酸磷酸激酶升高。其中3例患者服用过含甘草的中药，1例服用过甘草酸，另1例两者都服用过。我们将这些病例诊断为甘草酸诱发的假性醛固酮增多症。停用药物并静脉及口服补钾后，血清钾在12天内恢复正常，临床症状改善。对于1例出现心脏功能障碍的患者，将高浓度钾溶液（230 mEq/L）经中心静脉输注。这些结果表明，应注意甘草酸摄入是导致严重低钾血症的一个原因，尤其在老年患者中。
