Kitahiro Yumi, Hashimoto Mari, Sonda Yukako, Yagi Miki, Itohara Kotaro, Kido Takumi, Fujioka Kazumichi, Imafuku Hitomi, Omura Tomohiro, Yano Ikuko
Department of Pharmacy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Department of Pediatrics, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
J Pharm Health Care Sci. 2025 Apr 11;11(1):31. doi: 10.1186/s40780-025-00436-3.
Torasemide, a loop diuretic, is rarely used for pregnant women because of the risk of reduced placental blood flow resulting from decreased circulating plasma volume. We experienced a case of a newborn with metabolic alkalosis and mild polyuria. The mother was suspected of self-medicating as we detected torasemide in the neonatal serum by LC-MS/MS method.
A Japanese pregnant woman in her 20s with mental illness, symptoms of panic and eating disorders, and a history of overdosing on over-the-counter medications, was referred to our hospital for birth control. She presented with vomiting following bulimia nervosa and hypokalemia. Her baby was delivered vaginally at 36 weeks and 4 days of gestation. The baby's blood gas analysis on day 0 revealed metabolic alkalosis (pH > 7.42, HCO > 28 mmHg). Up to 16 h after birth, mild polyuria and a urine output of 3.3 mL/kg/h were observed without the administration of diuretics. We suspected diuretic intake by the mother before delivery, because she had a history of taking torasemide before being referred to the hospital. As expected, torasemide was detected in the baby's serum. The serum concentration on the first day after delivery (4.80 ng/mL) gradually decreased to 0.45 ng/mL on day 5, whereas torasemide was not detected in the maternal serum. Neonatal metabolic alkalosis improved by day 3 following birth.
This case suggests close counseling and monitoring of pregnant women before childbirth regarding their past and present use of drugs, particularly in those with mental illness.
托拉塞米是一种袢利尿剂，由于循环血浆量减少会导致胎盘血流减少，因此很少用于孕妇。我们遇到了一例患有代谢性碱中毒和轻度多尿的新生儿病例。由于我们通过液相色谱-串联质谱法在新生儿血清中检测到托拉塞米，怀疑其母亲进行了自我用药。
一名20多岁的日本孕妇，患有精神疾病、惊恐和饮食失调症状，并有过量服用非处方药的病史，因节育问题被转诊至我院。她因神经性贪食症和低钾血症出现呕吐症状。她的婴儿在妊娠36周零4天时经阴道分娩。出生第0天婴儿的血气分析显示代谢性碱中毒（pH>7.42，HCO>28 mmHg）。出生后长达16小时，未使用利尿剂的情况下观察到轻度多尿，尿量为3.3 mL/kg/h。我们怀疑母亲在分娩前摄入了利尿剂，因为她在转诊至我院之前有服用托拉塞米的病史。不出所料，在婴儿血清中检测到了托拉塞米。出生后第一天的血清浓度（4.80 ng/mL）在第5天逐渐降至0.45 ng/mL，而在母亲血清中未检测到托拉塞米。出生后第3天新生儿代谢性碱中毒有所改善。
该病例表明，在分娩前应对孕妇过去和现在使用药物的情况进行密切咨询和监测，尤其是对于患有精神疾病的孕妇。
