文章摘要
武润苗,吴桦,陈瑞琳,等.复方磺胺甲 唑联合伏立康唑致高钾并低钠血症 3例报告及分析[J].安徽医药,2024,28(6):1269-1272.
复方磺胺甲 唑联合伏立康唑致高钾并低钠血症 3例报告及分析
Hyperkalemia with hyponatremia induced by the compound sulfamethoxazole combined with voriconazole: 3 case reports and analysis
  
DOI:10.3969/j.issn.1009-6469.2024.06.045
中文关键词: 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
英文关键词: Drug-related side effects and adverse reactions  Trimethoprim, sulfamethoxazole drug combination  Voriconazole  Drug combination  Drug-induced hyperkalemia  Sodium zirconium cyclosilicate
基金项目: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)
作者单位E-mail
武润苗 陕西省人民医院呼吸与危重症科陕西西安 710068  
吴桦 陕西省人民医院呼吸与危重症科陕西西安 710068  
陈瑞琳 陕西省人民医院呼吸与危重症科陕西西安 710068  
赵亚利 陕西省人民医院呼吸与危重症科陕西西安 710068  
柴春艳 陕西省人民医院老年医学科陕西西安 710068 syyhxnyk@163.com 
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中文摘要:
      目的探讨复方磺胺甲唑(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。
英文摘要:
      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 withSMZ 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 withoral zirconium cyclosilicate sodium and sodium supplementation, the three patients' blood potassium recovered to 4.9, 5.1, and 4.5mmol/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 potassiumexcretion, leading to hyponatremia and hyperkalemia. Combination with Voriconazole may lead to an increased risk of hyperkalemiadue to abnormally high serum voriconazole levels. In case of drug-induced hyperkalemia, timely withdrawal of suspected drugs and oralSodium zirconium cyclosilicate can effectively reduce potassium. Hyponatremia can be corrected by oral and intravenous supplementation of hypertonic salt.
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