Severe hypokalemia,rhabdomyolysis,and acute renal injury due to compound glycyrrhizin
10.3760/cma.j.issn.1008-5734.2015.03.016
- VernacularTitle:复方甘草酸苷致严重低血钾、横纹肌溶解和肾功能损伤
- Author:
Changqing LI
1
;
Si HA
1
;
Donghua LIU
1
;
Zhongchao CAO
1
Author Information
1. 内蒙古医科大学附属医院保健中心, 呼和浩特,010050
- Publication Type:Journal Article
- Keywords:
Glycyrrhizic acid;
Hypokalemia;
Rhabdomyolysis;
Acute kidney injury
- From:
Adverse Drug Reactions Journal
2015;(3):225-226
- CountryChina
- Language:Chinese
-
Abstract:
A 55-year-old man with hypertension,type 2 diabetes,abnormal liver function[ alanine aminotransferase(ALT)74 U/L,γ-glutamytransferase(γ-GT)712 U/L)]and hypokalemia(3. 40 mmol/L)received extended release nifedipine 30 mg once daily,benazepril 10 mg once daily,acarbose 25 mg three times a day before each meal,potassium chloride tablets 1. 0 g three time daily,and an IV infusion of compound glycyrrhizin 60 ml(120 mg)once daily. On day 14 after administration the patient developed lower legs weakness and myalgia. The result of examination of animal force of limbs wasⅣlevel. The serum potassium was 1. 1 mmol/L. Compound glycyrrhizin and benazepril were stopped. The patient was given potassium chloride tablets 2. 0 g orally and an IV infusion of 10% potassium chloride 40 ml dissolved in more than 1 000 ml of 0. 9% sodium chloride. The speed of IV infusion was 1. 0 g potassium chloride/hour. The serum potassium was 1. 5 mmol/L four hours after drug withdrawal. The spirolactone 40 mg three times daily was added. Twenty four hours later,the patient′s serum potassium increased to 2. 9 mmol/L,his symptom of myasthenia of limbs improved. Forty eight hours later,his serum potassium was 3. 1 mmol/L,but he developed whole body myalgia,distending pain in both lower extremities and choking sensation in chest. Laboratory test showed creatine kinase( CK)50 940 U/L,CK-MB 441 U/L,lactate dehydrogenase( LDH) 1 992 U/L,aspartate aminotransferase( AST)441 U/L,T( cTnT)0. 20 ng/ml,serum creatinine( SCr) 317 μmol/L,blood urine nitrogen( BUN)18. 2 mmol/L,uric acid( UA)533 mol/L,and carban dioxide-combining Power(CO2-CP)35. 5 mmol/L. Myoglobins in blood and urine did not tested. The color of urine was dark brown. The patient was diagnosed severe hypokalemic,rhabdomyolysis,and renal injury. He received the symptomatic treatments of potassium supplement, fluid infusion, nutritional support, and protection of renal function. On day 5 of compound glycyrrhizin withdrawal,the laboratory test showed the following values:serum potassium 3. 3 mmol/L,CK 10 292 U/L,Cr 252 μmo/L,BUN 16. 3 mmol/L,UA 472 μmo/L;on day 10 of compound glycyrrhizin withdrawal,the laboratory test showed the following values:serum potassium 4. 6 mmol/L,CK 107 U/L,Cr 116 μmo/L,BUN 6. 4 mmol/L,UA 189 μmol/L. His blood pressure was maintained at 130-160/70-90 mmHg,and the symptoms of myasthenia of limbs,myalgia in whole body disappeared completely.
