临床药师参与1例肺部感染伴咯血患者合并电解质紊乱的治疗
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摘要
目的 :分析电解质紊乱与药物不良反应的相关性,优化药物治疗方案。方法 :通过对1例肺部感染伴咯血患者的药学监护及干预,分析在治疗过程中出现电解质紊乱的原因,探讨低钠血症、低钾血症与卡泊芬净、垂体后叶素、复方甘草酸苷之间的关系,综合评估给予合理建议。结果 :经过补钠、补钾治疗后,患者低钠血症得到纠正,但血钾仍持续下降;停用复方甘草酸苷后,低钾血症纠正。结论 :临床工作中要重视药物引起的电解质紊乱,如复方甘草酸苷引起的难以纠正低钾血症、垂体后叶素引起的低钠血症,密切监测电解质,及时发现药物不良反应,综合分析评估给予针对性的处理措施。
Objective: To analyze the correlation between electrolyte disturbance and adverse drug reactions and to optimize drug treatment regimen. Methods: The causes of electrolyte disturbance in the course of treatment were analyzed by pharmaceutical care and intervention of a patient with pulmonary infection and hemoptysis and the relationship between hyponatremia, hypokalemia and caspofungin, vasopressin or compound glycyrrhizin was discussed. The reasonable advice was given after comprehensive assessment. Results: After sodium and potassium supplementation, the patient's hyponatremia was corrected, but the serum potassium still continued to decline, while hypokalemia was corrected after the withdrawal of the compound glycyrrhizin. Conclusions: In clinical practice, it is necessary to pay attention to the electrolytes disorder caused by drugs, such as hyponatremia caused by vasopressin and hypokalemia by compound glycyrrhizin, which is difficult to be corrected. The electrolytes should be closely monitored to reduce the occurrence of adverse drug reactions. The counter measures should be adopted after comprehensive analysis and evaluation.
Objective: To analyze the correlation between electrolyte disturbance and adverse drug reactions and to optimize drug treatment regimen. Methods: The causes of electrolyte disturbance in the course of treatment were analyzed by pharmaceutical care and intervention of a patient with pulmonary infection and hemoptysis and the relationship between hyponatremia, hypokalemia and caspofungin, vasopressin or compound glycyrrhizin was discussed. The reasonable advice was given after comprehensive assessment. Results: After sodium and potassium supplementation, the patient's hyponatremia was corrected, but the serum potassium still continued to decline, while hypokalemia was corrected after the withdrawal of the compound glycyrrhizin. Conclusions: In clinical practice, it is necessary to pay attention to the electrolytes disorder caused by drugs, such as hyponatremia caused by vasopressin and hypokalemia by compound glycyrrhizin, which is difficult to be corrected. The electrolytes should be closely monitored to reduce the occurrence of adverse drug reactions. The counter measures should be adopted after comprehensive analysis and evaluation.
引文
[1]蔡柏蔷,李龙芸.协和呼吸病学[M].2版.北京:中国协和医科大学出版社,2010:127-128.
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[3]吴晓平,阿依古丽·玉努斯,刘军.108例药源性低钾血症文献分析[J].临床合理用药,2014,7(1):91.
[4]雷招宝.药源性低钠血症及其防治[J].药物不良反应杂志,2002(4):233-234.
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[6]赵慧瑾,钱樱,陈丽,等.卡泊芬净经验性治疗血液疾病合并真菌感染32例临床观察[J].内科理论与实践,2011,6(6):435-438.
[7]杨华,黄文荣,王书红,等.卡泊芬净治疗恶性血液病患者化疗或移植过程中肺真菌感染临床研究[J].军医进修学院学报,2010,31(11):1063-1064.
[8]郑海燕,安冬月,金文姬.卡泊芬净治疗危重病人侵袭性真菌感染的疗效与护理[J].海峡药学,2009,21(6):170-171.
[9]席楠,郭梦园,崔向丽,等.733例咯血患者垂体后叶素致低钠血症文献分析[J].临床药物治疗杂志,2017,15(4):61-64.
[10]江苔,杨仁辉,冯元凤,等.垂体后叶素治疗大咯血致电解质紊乱20例临床分析[J].中国实用内科杂志,2015,35(増1):44-45.
[11]宋亚红,蒋剑敏.复方甘草酸苷致假性醛固酮增多症的防范与措施[J].北方药学,2015,12(11):24-25.
[12]姜霞.复方甘草酸苷致低钾血症1例[J].实用医药杂志,2011,28(11):1051.
[2]陈慧君,朱齐兵.60例药源性低钾血症文献分析[J].中国医院药学杂志,2009,29(10):862-863.
[3]吴晓平,阿依古丽·玉努斯,刘军.108例药源性低钾血症文献分析[J].临床合理用药,2014,7(1):91.
[4]雷招宝.药源性低钠血症及其防治[J].药物不良反应杂志,2002(4):233-234.
[5]斯威曼SC.马丁代尔药物大典[M].李大魁,金有豫,汤光,等译.2版.北京:化学工业出版社,2013,9:503.
[6]赵慧瑾,钱樱,陈丽,等.卡泊芬净经验性治疗血液疾病合并真菌感染32例临床观察[J].内科理论与实践,2011,6(6):435-438.
[7]杨华,黄文荣,王书红,等.卡泊芬净治疗恶性血液病患者化疗或移植过程中肺真菌感染临床研究[J].军医进修学院学报,2010,31(11):1063-1064.
[8]郑海燕,安冬月,金文姬.卡泊芬净治疗危重病人侵袭性真菌感染的疗效与护理[J].海峡药学,2009,21(6):170-171.
[9]席楠,郭梦园,崔向丽,等.733例咯血患者垂体后叶素致低钠血症文献分析[J].临床药物治疗杂志,2017,15(4):61-64.
[10]江苔,杨仁辉,冯元凤,等.垂体后叶素治疗大咯血致电解质紊乱20例临床分析[J].中国实用内科杂志,2015,35(増1):44-45.
[11]宋亚红,蒋剑敏.复方甘草酸苷致假性醛固酮增多症的防范与措施[J].北方药学,2015,12(11):24-25.
[12]姜霞.复方甘草酸苷致低钾血症1例[J].实用医药杂志,2011,28(11):1051.