托吡酯诱发代谢性酸中毒和肾结石——病例报告
Topiramate induced metabolic acidosis and kidney stones - a case study.
作者信息
Salek Tomas, Andel Ivan, Kurfurstova Irena
机构信息
Medical Faculty of the University of Ostrava in Ostrava, Ostrava - Zábřeh, Czech Republic.
Department of Clinical Biochemistry, Tomas Bata Hospital in Zlín a. s., Zlín, Czech Republic.
出版信息
Biochem Med (Zagreb). 2017 Jun 15;27(2):404-410. doi: 10.11613/BM.2017.042.
INTRODUCTION
The aim of this study is to present a case of 44 years old woman with topiramate induced metabolic acidosis and kidney stones.
MATERIALS AND METHODS
The laboratory features of topiramate caused renal tubular acidosis in blood and urine during topiramate treatment, with correction of metabolic acidosis by potassium citrate, and after topiramate withdrawal are presented. Differential diagnosis of all possible causes of metabolic acidosis is discussed.
RESULTS
The results revealed negative base excess in extracellular fluid of - 9.2 mmol/L, low serum HCO concentration (18.6 mmol/L), trend to alkaline urine (pH 6.39) and low urine citrate concentration (0.3 mmol/24h). After topiramate withdrawal, all parameters of the internal environment normalized.
CONCLUSIONS
This study has shown that long-term topiramate administration could induce metabolic acidosis and consequently urholithiasis. Thus, we could recommend testing blood acid base balance, urinary pH and citrates in patients taking topiramate and suffering from kidney stones.
引言
本研究旨在介绍一例44岁女性因托吡酯导致代谢性酸中毒和肾结石的病例。
材料与方法
呈现了托吡酯治疗期间血液和尿液中托吡酯引起的肾小管酸中毒的实验室特征，以及用柠檬酸钾纠正代谢性酸中毒后和停用托吡酯后的情况。讨论了代谢性酸中毒所有可能病因的鉴别诊断。
结果
结果显示细胞外液碱剩余为-9.2 mmol/L，血清碳酸氢根浓度低（18.6 mmol/L），尿液呈碱性趋势（pH 6.39）且尿柠檬酸盐浓度低（0.3 mmol/24小时）。停用托吡酯后，内环境的所有参数恢复正常。
结论
本研究表明长期服用托吡酯可诱发代谢性酸中毒，进而导致尿石症。因此，对于服用托吡酯且患有肾结石的患者，我们建议检测血液酸碱平衡、尿液pH值和柠檬酸盐。
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