Imashuku Shinsaku, Kudo Naoko, Kubo Kagekatsu
Division of Hematology, Takasago-seibu Hospital, Takasago, Japan.
J Blood Med. 2013 May 14;4:43-7. doi: 10.2147/JBM.S44091. Print 2013.
A 77-year-old male was admitted to hospital after suffering a pelvic bone fracture in a road traffic accident and was incidentally found to have IgG-kappa-type multiple myeloma with hypercalcemia. The patient was also noted to be hypokalemic and had low HCO3 (-), with possible damage to the distal tubules in the kidneys. When the treatment was begun with bortezomib/dexamethasone/elcatonin and sodium bicarbonate (NaHCO3) in normal saline (equivalent to a daily sodium dose of 200 millimoles per liter [mmol/L]), the patient was in a state of poor oral fluid intake. The patient developed hypernatremia and hyperchloremia, with a peak serum sodium and chloride levels of 183 mmol/L and 153 mmol/L, respectively, at the sixth day after the start of treatment. Following the switch of the intravenous infusions from normal saline to soldem 1 and soldem 3 solutions, these high-electrolyte levels gradually returned to normal over the next 7 days. Although the patient showed disturbed consciousness (Japan Coma Scale = JCS-I-3) during the period of electrolyte abnormality, he eventually fully recovered without sequelae. In this patient, we successfully managed the severe hypernatremia/hyperchloremia, caused by the combined effects of intravenous saline burden in a state of poor oral fluid intake, during the treatment for IgG-kappa type multiple myeloma.
一名77岁男性在道路交通事故中骨盆骨折后入院，偶然发现患有IgG-κ型多发性骨髓瘤并伴有高钙血症。该患者还被发现低钾血症且碳酸氢根离子（HCO3-）水平低，可能存在肾脏远端小管损伤。当开始使用硼替佐米/地塞米松/降钙素和生理盐水（相当于每日钠剂量200毫摩尔/升[mmol/L]）中的碳酸氢钠（NaHCO3）进行治疗时，患者口服液体摄入情况较差。患者出现高钠血症和高氯血症，治疗开始后第6天血清钠和氯水平峰值分别为183 mmol/L和153 mmol/L。在将静脉输液从生理盐水改为索利德姆1和索利德姆3溶液后，这些高电解质水平在接下来的7天内逐渐恢复正常。尽管患者在电解质异常期间出现意识障碍（日本昏迷量表=JCS-I-3），但最终完全康复且无后遗症。在该患者中，我们成功处理了在IgG-κ型多发性骨髓瘤治疗期间，因口服液体摄入不足状态下静脉输注生理盐水负担的综合作用导致的严重高钠血症/高氯血症。
