Wessel K, Schumm F, Peiffer J, Schlote W
Nervenarzt. 1985 Dec;56(12):696-702.
The case of a 42-year-old man is reported, who on four occasions developed a hypokalaemic periodic paralysis after an intramuscular injection of "Ambene". The detailed examination of this patient shows, that it is the primary, autosomal dominant inherited form of hypokalaemic periodic paralysis, and not the secondary form, which is caused by a renal or gastrointestinal loss of potassium. Clinical and electrophysiological, as well as histopathological and electron microscopic findings are presented, showing the typical vacuolar myopathy with submicroscopic tubular structures. In the literature there is evidence for an increased sensitivity of the muscle membrane to insulin with an increased potassium-shift inside the cell in hypokalaemic periodic paralysis. "Ambene" is a combination, which contains amongst other substances dexamethasone and the local anaesthetic drug lidocain. In the present case the paresis was possibly caused by a combined effect of dexamethasone with a consequent hyperglycaemia and lidocain with a change in the excitability of the muscle membrane. The pathophysiological mechanism of hypokalaemic periodic paralysis is discussed in terms of the release by the combination of these two drugs. It has not previously been reported that "Ambene" can provoke a hypokalaemic periodic paralysis. This is a severe side effect because of the resulting cardiac and respiratory problems.
报告了一例42岁男性病例，该患者在肌肉注射“安贝那”后四次发生低钾性周期性麻痹。对该患者的详细检查表明，这是低钾性周期性麻痹的原发性常染色体显性遗传形式，而非由肾脏或胃肠道钾丢失引起的继发性形式。文中展示了临床、电生理以及组织病理学和电子显微镜检查结果，呈现出典型的伴有亚微观管状结构的空泡性肌病。文献中有证据表明，在低钾性周期性麻痹中，肌膜对胰岛素的敏感性增加，细胞内钾转移增加。“安贝那”是一种复方制剂，除其他物质外，还含有地塞米松和局部麻醉药利多卡因。在本病例中，麻痹可能是由地塞米松导致的高血糖以及利多卡因引起的肌膜兴奋性改变共同作用所致。本文从这两种药物联合作用导致钾释放的角度探讨了低钾性周期性麻痹的病理生理机制。此前尚无“安贝那”可引发低钾性周期性麻痹的报道。由于会导致心脏和呼吸问题，这是一种严重的副作用。
