Critical Care, St. Vincent's Medical Center, Jacksonville, FL, USA.
Am J Health Syst Pharm. 2013 Sep 15;70(18):1588-91. doi: 10.2146/ajhp130086.
An episode of acute hypokalemic paralysis associated with the use of inhaled albuterol is described.
A 34-year-old woman admitted to the emergency department reported the development of pain and diffuse paralysis of the extremities and torso shortly after using an albuterol inhaler. At age 18, she had been diagnosed with hyokalemic periodic paralysis (HPP), a disorder of muscle membrane excitability caused by serum potassium depletion that can lead to life-threatening neuromuscular and cardiovascular complications. After a 15-year period of episodically recurring HPP symptoms despite long-term acetazolamide use, she was switched to spironolactone therapy and had experienced no HPP exacerbations for about 1 year. On her arrival in the emergency department, the patient's serum potassium concentration was 1.8 meq/L and she was mildly tachycardic (heart rate of 125 beats/min). After careful supplementation to gradually increase the serum potassium concentration to 5.4 meq/L, the patient slowly regained movement and strength in her extremities. Application of the adverse drug reaction probability scale of Naranjo et al. to this case yielded a score of 3, indicating that albuterol was possibly the cause of the patient's HPP exacerbation. Beta-2-adrenergic agonists and several other medications can affect serum potassium levels; although the potential risks posed by the use of such drugs in patients with a history of HPP are unclear, cautious use in the context of known HPP is advised.
A patient previously diagnosed with HPP experienced an exacerbation of HPP possibly induced by inhaled albuterol treatment.
描述一例与吸入性沙丁胺醇使用相关的急性低钾性瘫痪发作病例。
一名 34 岁女性因使用沙丁胺醇吸入器后出现疼痛和四肢及躯干广泛瘫痪，被收入急诊科。18 岁时，她被诊断患有低钾性周期性瘫痪（HPP），这是一种由血清钾耗竭引起的肌肉膜兴奋性障碍，可导致危及生命的神经肌肉和心血管并发症。尽管长期使用乙酰唑胺，但她仍间歇性反复发作 HPP 症状，15 年后，她改用螺内酯治疗，约 1 年来未发生 HPP 加重。患者到达急诊科时，血清钾浓度为 1.8 meq/L，且轻度心动过速（心率为 125 次/分）。在仔细补充钾以逐渐将血清钾浓度提高至 5.4 meq/L 后，患者四肢逐渐恢复运动和力量。应用 Naranjo 等不良反应概率量表对该病例进行评估，得出的评分为 3，表明沙丁胺醇可能是导致患者 HPP 加重的原因。β2-肾上腺素能激动剂和其他几种药物可影响血清钾水平；尽管在已知有 HPP 病史的患者中使用此类药物的潜在风险尚不清楚，但建议在已知 HPP 的情况下谨慎使用。
一名既往诊断为 HPP 的患者在吸入性沙丁胺醇治疗后可能发生 HPP 加重。
