Egom Emmanuel Eroume A, Wong Kenneth Y-K, Clark Andrew L
Academic Cardiology, University of Hull, Hull and East Yorkshire Hospitals, Kingston upon Hull, UK.
BMJ Case Rep. 2011 May 16;2011:bcr1220103594. doi: 10.1136/bcr.12.2010.3594.
A 31-year-old hypertensive woman was admitted to hospital with palpitations. Her hypertension was treated with bendroflumethiazide, which had been increased from 2.5 to 5 mg daily by her general practitioner about 18 months prior to her admission. She was also on ramipril 10 mg once daily. There were no abnormal findings on examination, and a 12-lead ECG showed sinus rhythm, rate 75, with Q waves in leads V1-V2. Telemetry (over 24 h) showed ventricular bigeminy when she had her typical palpitations. Her admission serum sodium and potassium concentrations were 132 and 3.4 mmol/l, respectively. Immediately prior to planned discharge the following day, she experienced paraesthesiae, weakness, confusion and seizures accompanied by 10 s asystole on the ECG monitor. Her serum sodium had fallen to 120 mmol/l and potassium to 2.3 mmol/l. Bendroflumethiazide and ramipril were discontinued and the patient was restricted to fluids of 1.5 l/24 h. She also received potassium supplements. Her serum sodium concentration rose to normal over 6 days, and she was discharged on feeling well.
一名31岁的高血压女性因心悸入院。她的高血压用苄氟噻嗪治疗，在入院前约18个月，她的全科医生将剂量从每日2.5毫克增至5毫克。她还每天服用一次10毫克雷米普利。体格检查未发现异常，12导联心电图显示窦性心律，心率75次/分，V1 - V2导联有Q波。遥测（超过24小时）显示，当她出现典型心悸时存在室性二联律。她入院时血清钠和钾浓度分别为132 mmol/L和3.4 mmol/L。在计划于次日出院前，她出现感觉异常、虚弱、意识模糊和癫痫发作，心电图监护显示有10秒的心脏停搏。她的血清钠降至120 mmol/L，钾降至2.3 mmol/L。停用苄氟噻嗪和雷米普利，患者限制每日液体摄入量为1.5升。她还接受了补钾治疗。6天内她的血清钠浓度升至正常，随后她感觉良好出院。
