Department of Endocrinology and Metabolic Diseases, Harran University, School of Medicine, Sanliurfa, Turkey.
Wien Klin Wochenschr. 2011 Sep;123(17-18):566-8. doi: 10.1007/s00508-011-0011-2. Epub 2011 Jul 7.
Drug-associated hypocalcemia is rare, but may occur during routinely administered drugs. We reported a case of vertebral brucellosis, which developed two hypocalcemic episodes associated with hypokalemic alkalosis with two drug combinations including rifampicin. Possible underlying mechanisms of hypocalcemia were discussed. The patient had carpopedal spasm at both hypocalcemic presentations. Laboratory analysis revealed hypocalcemia, hypokalemia, alkalosis with hypercalciuria, and low-normal parathormone (PTH) at first and elevated PTH at the second admission. The patient improved with cessation of drugs and appropriate management of hypocalcemia and hypokalemia with calcium, vitamin D, magnesium, and potassium replacement. The underlying mechanism of hypocalcemia in this patient seemed to be due to tubular damage resulting with Bartter-like syndrome, which is well defined with aminogylcosides. But the recurrence of hypocalcemia with an aminoglycoside-free antibiotic combination including rifampicin suggests a possible role of rifampicin on hypocalcemia associated Bartter-like syndrome that has never been reported before.
药物相关性低钙血症较为罕见，但可能在常规用药期间发生。我们报告了一例椎体布鲁氏菌病病例，该病例出现了两例与两种药物组合（包括利福平）相关的低钙血症伴低钾性碱中毒。讨论了低钙血症的可能潜在机制。该患者在两次低钙血症发作时均出现了掌跖痉挛。实验室分析显示，首次就诊时血钙降低、血钾降低、碱中毒伴高钙尿症和甲状旁腺激素（PTH）水平正常偏低，第二次就诊时 PTH 水平升高。患者停止用药并适当补钙、补维生素 D、补镁和补钾治疗后，病情改善。该患者低钙血症的潜在机制似乎是由于管状损伤导致 Bartter 样综合征，这种综合征与氨基糖苷类药物有关。但在不包括利福平的氨基糖苷类抗生素组合中再次出现低钙血症提示利福平可能在以前从未报道过的与 Bartter 样综合征相关的低钙血症中发挥作用。
