Metabolic alkalosis caused by tolvaptan
10.3760/cma.j.cn114015-20220901-00802
- VernacularTitle:托伐普坦致代谢性碱中毒
- Author:
Yan HUANG
1
;
Suqin ZHOU
;
Xia SONG
;
Yuan YAO
Author Information
1. 兰州大学第二医院药剂科，兰州 730000
- Publication Type:Journal Article
- Keywords:
Alkalosis;
Heart failure;
Tolvaptan
- From:
Adverse Drug Reactions Journal
2023;25(10):635-637
- CountryChina
- Language:Chinese
-
Abstract:
An 86-year-old male patient with acute exacerbation of chronic heart failure developed diuretic resistance due to long-term use of diuretics, and was added tolvaptan 3.75 mg once daily orally, with significant diuretic effect. The next day, the dose was increased to 7.5 mg once daily orally. After taking medication, the patient′s urine volume increased and the symptoms of heart failure were improved. On the third day, the patient developed frequent dry mouth, thirst, transient restlessness, and convulsion of extremities. Laboratory tests showed pH 7.51, partial pressure of blood oxygen (PaO 2) 67.4 mmHg, standard bicarbonate concentration (SB) 28.4 mmol/L, actual bicarbonate concentration (AB) 28.5 mmol/L, blood potassium 3.0 mmol/L, blood sodium 143 mmol/L, and blood chlorine 104 mmol/L. It was considered that the metabolic alkalosis and respiratory acidosis were caused by tolvaptan. Tolvaptan was stopped and arginine injection, 0.9 % sodium chloride, potassium supplementation, and other symptomatic treatments were given, and the patient′s water drinking was not restricted. On the day of tolvaptan discontinuation, the patient′s dry mouth and thirst were significantly reduced, his mental state was improved, with no convulsion of extremities, and lower limb and facial edema subsided. After 1 day of drug withdrawal, the laboratory tests showed pH 7.49, SB 31.1 mmol/L, AB 31.4 mmol/L, and blood potassium 3.6 mmol/L. After 3 days of drug withdrawal, the patient developed drowsiness, poor mental state, and weakened breathing compared to before, which was considered that the patient suffered from metabolic alkalosis combined with respiratory acidosis and secondary type II respiratory failure. Intravenous pumping of nikethamide was given. After 5 days of drug withdrawal, the patient′s 24-hour urine volume was 3 285 ml, and the levels of AB, SB, and pH slightly decreased. However, the patient′s condition was not improved significantly. After 13 days of drug withdrawal, symptomatic and supportive treatments such as tracheal intubation and ventilation assistance were given, but the patient′s condition continue to worsen.
