摘要
目的 探讨复方磺胺甲噁唑(SMZ co)联合伏立康唑致高钾并低钠血症的原因及其处置措施。方法 收集2023年1-2月因重症肺炎入住陕西省人民医院,联合使用了SMZ co与伏立康唑导致高钾并低钠血症的3例病人的临床资料并分析。结果SMZ co联合伏立康唑可增加高钾并低钠血症风险,3例病人血钾最高分别上升至8.1、6.1、5.6 mmol/L,血钠最低分别下降至128、134、122 mmol/L,经口服环硅酸锆钠及补钠治疗后,3例病人血钾分别恢复至4.9、5.1、4.5 mmol/L,血钠恢复至136、135、137 mmol/L。结论 联合使用SMZ co与伏立康唑可导致高钾血症及低钠血症风险增加,原因可能为SMZ co的甲氧苄啶(TMP)成分竞争性抑制远端肾小管和集合管上皮细胞的阿米洛利样敏感钠通道,阻断钠离子(Na+)-氢离子(H+)和Na+-钾离子(K+)交换,抑制钠的吸收,并减少钾的排泄,从而导致低钠及高钾血症;联合用药可能导致血清伏立康唑水平异常升高而增加高钾血症风险。发生药源性高钾血症时及时停药并口服环硅酸锆钠可有效降钾,低钠血症通过口服及静脉补充高渗盐即可纠正。
Objective To explore the causes of hyperkalemia and hyponatremia caused by the combination of the compound sulfamethoxazole(SMZ)and voriconazole and the associated management measures.Methods The clinical data of 3 patients who were admitted to Shaanxi Provincial People's Hospital with severe pneumonia between January and February 2023 and who were treated with SMZ in combination with voriconazole for hyperkalemia with hyponatremia were collected and analyzed.Results SMZ combined with voriconazole increased the risk of hyperkalemia with hyponatremia.In three patients,the highest blood potassium increased to 8.1,6.1,and 5.6 mmol/L,respectively,and the lowest blood sodium decreased to 128,134,and 122 mmol/L,respectively.After treatment with oral zirconium cyclosilicate sodium and sodium supplementation,the three patients'blood potassium recovered to 4.9,5.1,and 4.5 mmol/L,respectively,and the blood sodium recovered to 136,135 and 137 mmol/L,respectively.Conclusions The combination of SMZ and voriconazole can lead to an increased risk of hyperkalemia and hyponatremia via a mechanism that may be due to the competitive inhibition of amiloride-sensitive sodium channels in distal renal tubular and collecting duct epithelial cells by the methotrexate(TMP)component of SMZ,which blocks Na+-H+ion and Na+-K+ion exchange,inhibiting sodium absorption and decreasing potassium excretion,leading to hyponatremia and hyperkalemia.Combination with Voriconazole may lead to an increased risk of hyperkalemia due to abnormally high serum voriconazole levels.In case of drug-induced hyperkalemia,timely withdrawal of suspected drugs and oral Sodium zirconium cyclosilicate can effectively reduce potassium.Hyponatremia can be corrected by oral and intravenous supplementation of hypertonic salt.
作者
武润苗
吴桦
陈瑞琳
赵亚利
柴春艳
WU Runmiao;WU Hua;CHEN Ruilin;ZHAO Yali;CHAI Chunyan(Department of Respiratory and Critical Care Medicine,Shaanxi Provincial People's Hospital,Xi'an,Shaanxi 710068,China;Department of Geriatric Medicine,Shaanxi Provincial People's Hospital,Xi'an,Shaanxi 710068,China)
出处
《安徽医药》
CAS
2024年第6期1269-1272,共4页
Anhui Medical and Pharmaceutical Journal
基金
陕西省重点研发计划项目(2020SF-100,2024SF-YBXM-086)
陕西省人民医院科技人才支持计划项目(2023JY-20)
陕西省人民医院科技发展孵化基金项目(2023YJY-71)。
关键词
药物相关性副作用和不良反应
甲氧苄氨嘧啶
磺胺甲噁唑复方合剂
伏立康唑
联合用药
药源性高钾血症
环硅酸锆钠
Drug-related side effects and adverse reactions
Trimethoprim,sulfamethoxazole drug combination
Voriconazole
Drug combination
Drug-induced hyperkalemia
Sodium zirconium cyclosilicate
