Department of Emergency Medicine, Christiana Care Health System, Newark, DE 19718, USA.
Am J Emerg Med. 2012 Jan;30(1):247.e1-3. doi: 10.1016/j.ajem.2010.07.026. Epub 2010 Oct 14.
Patients with renal failure who are taking trimethoprim have an increased risk of developing hyperkalemia, which can cause muscle weakness. In patients with postpolio syndrome, a normal creatinine level could be abnormally high, renal failure is possible because of lack of creatinine production, and the muscle weakness from resultant hyperkalemia could be more severe because of their underlying condition. This abnormally high creatinine level has been termed from this point relative renal failure. The objective of the study was to review a case in which relative renal failure and hyperkalemia caused muscle weakness that manifested as shortness of breath and confusion with electrocardiographic changes. A dehydrated patient with relative renal failure and postpolio syndrome had taken trimethoprim-sulfamethoxazole that caused symptomatic hyperkalemia. The patient presented with muscle weakness, shortness of breath, and confusion, with her postpolio syndrome compounding the situation and likely making the muscle weakness more severe. A patient on trimethoprim with renal failure is at an increased risk of developing hyperkalemia. Patients with postpolio syndrome could have severe muscle weakness from the hyperkalemia and could have renal failure even with a normal creatinine level. This case report will remind treating physicians to evaluate such patients for hyperkalemia if they present with muscle weakness, especially if the patient has renal failure and is on trimethoprim.
肾衰竭患者服用甲氧苄啶会增加发生高钾血症的风险，这可能导致肌肉无力。在肌萎缩侧索硬化症后综合征患者中，正常的肌酐水平可能异常升高，由于缺乏肌酐生成，可能会发生肾衰竭，并且由于潜在疾病，由此导致的高钾血症引起的肌肉无力可能更为严重。这种异常升高的肌酐水平从此被称为相对肾衰竭。本研究的目的是回顾一例相对肾衰竭和高钾血症导致肌肉无力的病例，其表现为呼吸困难和意识模糊伴心电图改变。一名患有相对肾衰竭和肌萎缩侧索硬化症后综合征的脱水患者服用了甲氧苄啶-磺胺甲噁唑，导致症状性高钾血症。该患者出现肌肉无力、呼吸困难和意识模糊，其肌萎缩侧索硬化症使情况更加复杂，可能使肌肉无力更为严重。肾衰竭患者服用甲氧苄啶会增加发生高钾血症的风险。高钾血症可能导致肌萎缩侧索硬化症后综合征患者出现严重的肌肉无力，即使肌酐水平正常，也可能发生肾衰竭。本病例报告将提醒治疗医生，如果出现肌肉无力的患者存在肾衰竭并且正在服用甲氧苄啶，应评估其是否患有高钾血症。
