原发性肾上腺功能不全中继发于高钾血症和低钠血症的Brugada综合征拟表型。
Brugada phenocopy secondary to hyperkalemia and hyponatremia in primary adrenal insufficiency.
作者信息
Amusina Olga, Mehta Sandeep, Nelson Michael E
机构信息
NorthShore University HealthSystem Evanston Illinois USA.
College of Nursing University of Illinois at Chicago Chicago Illinois USA.
出版信息
J Am Coll Emerg Physicians Open. 2022 Aug 10;3(4):e12800. doi: 10.1002/emp2.12800. eCollection 2022 Aug.
INTRODUCTION
The Brugada phenocopy represents electrocardiogram (ECG) changes nearly identical to the Brugada syndrome but without the congenital abnormality associated with lethal arrhythmias and normalizes with treatment of the underlying etiology. This case highlights the Brugada phenocopy in the setting of moderate hyperkalemia and severe hyponatremia from adrenal insufficiency that resolves with treatment of the underlying metabolic disturbance.
CASE REPORT
A 26-year-old man with no prior medical history presented to the emergency department with syncope, and his ECG revealed a Brugada-like pattern. The patient was found to have significant metabolic derangements, including severe hyponatremia (94 mEq/L), moderate hyperkalemia (6.1 mEq/L), severe hypochloremia (<60 mEq/L), acute kidney injury, and rhabdomyolysis. The patient was diagnosed with primary adrenal insufficiency, and electrolyte correction led to resolution of the Brugada phenocopy.
CONCLUSION
The Brugada phenocopy on ECG can occur with severe hyponatremia and moderate hyperkalemia and quickly resolves with electrolyte correction.
引言
Brugada 综合征拟表型是指心电图（ECG）变化与 Brugada 综合征几乎相同，但不存在与致死性心律失常相关的先天性异常，且随着潜在病因的治疗而恢复正常。本病例强调了在肾上腺功能不全导致中度高钾血症和重度低钠血症情况下出现的 Brugada 综合征拟表型，随着潜在代谢紊乱的治疗而得到缓解。
病例报告
一名既往无病史的 26 岁男性因晕厥就诊于急诊科，其心电图显示出类似 Brugada 综合征的图形。该患者存在明显的代谢紊乱，包括重度低钠血症（94 mEq/L）、中度高钾血症（6.1 mEq/L）、重度低氯血症（<60 mEq/L）、急性肾损伤和横纹肌溶解。患者被诊断为原发性肾上腺功能不全，电解质纠正后 Brugada 综合征拟表型得以缓解。
结论
心电图上的 Brugada 综合征拟表型可在重度低钠血症和中度高钾血症时出现，并随着电解质纠正而迅速缓解。
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