铂类化疗药致小儿低血钠性癫痫发作5例临床分析

Hyponatremia Epilepsy Caused by Platinum Based Chemotherapy Medicine in Children: A Report of Five Cases

目的:报道并分析铂类化疗药引起小儿低血钠性癫痫发作的不良反应,促进临床安全用药。方法:回顾分析5例使用卡铂或顺铂化疗后导致低血钠性癫痫发作的病例,记录其年龄、性别、癫痫既往史、诊断、给药方式、发作时间、发作形式、血钠水平、处理措施。结果:5例病例年龄2-5岁;男孩3例,女孩2例;既往均无癫痫病史;视网膜母细胞瘤2例、横纹肌肉瘤1例、神经母细胞瘤2例;均为静脉输注给药,卡铂按560mg/m2给药,顺铂按90mg/m2给药;发作出现在给药后2-4d;均表现为癫痫大发作;血钠浓度(118-123)mmol/L;采取安定止抽、速尿及甘露醇利尿、高张盐水输注纠正低钠血症后缓解。结论:铂类化疗药可致小儿低血钠性癫痫发作,临床应用时应严密监测血钠水平。

Objective： To report and analyze the adverse drug reaction of platinum based chemotherapy medicine which may cause hyponatremia epilepsy in children.Methods： The clinical data of five cases of hyponatremia epilepsy caused by platinum based chemotherapy medicine were studied,and the age,gender,epilepsy history,diagnosis,dosage and route of administration,time and form of epilepsy,serum sodium concentration and therapy were discussed.Results： The age of these 5 cases ranged from 2 to 5 years old.There were 3 boys and 2 girls.All cases had no epilepsy history.Two cases were complicated with retinoblastoma,1 case had rhabdomyosarcoma,and 2 cases had neuroblastoma.The route of administration were all intravenous injection.The dosage of carboplatin was 560 mg/m2,while the dosage of cisplatin was 90 mg/m2.Epilepsy happened in 2 to 4 days after carboplatin or cisplatin was administered.The form was grand mal.Serum sodium concentration was from 118 to 123 mmol/L.All cases were given diazepam,furosemide,mannitol and hypertonic sodium chloride after epilepsy happened.Conclusion： Platinum based chemotherapy medicine can cause hyponatremia epilepsy,and doctors should monitor serum sodium concentration closely.