复方甘草酸苷片致假性醛固酮增多症

Pseudohyperaldosteronism caused by compound glycyrrhizin tablets

1例51岁男性患者,因银屑病性关节炎口服甲氨蝶呤片,治疗过程中出现AST、ALT轻度升高,考虑药物性肝损害,给予复方甘草酸苷片2片,tid。1周后患者出现下肢乏力、行走费力,2周时出现颜面及下肢水肿,BP 160/90 mm Hg,3周时出现上肢乏力、发抖,BP 160/90 mm Hg。停药1周后乏力、行走费力、上肢发抖症状缓解,BP 130/76 mm Hg,血钾1.76 mmol·L-1、代谢性碱中毒。期间无联合用药,查甲功、肾上腺功能等未见异常。经补钾治疗5 d后患者血钾恢复至4.22 mmol·L-1,代谢性碱中毒纠正。

One 51-year-old male patient with psoriasis arthritis developed elevation of AST and ALT and received compound glycyrrhizin tablets （2 tablets, tid） for the treatment of drug-induced hepatitis, which caused by methotrexate. After a week of the treatment, the patient developed weakness in lower legs and hard walking. After 2 weeks, he appeared edema in the face and lower extremity, and the blood pressure increased to 160/90 mm Hg. He suffered from upper limbs weakness and shivering, and the blood pressure was 160/90 mm Hg after 3 weeks of the treatment. After stopping use of compound glycyrrhizin for one week, the symptoms of weakness, hard walking and upper limb shaking relieved, the blood pressure returned to 130/76 mmHg, while the patient appeared hypokalemia with blood potassium 1.76 mmol·L^-1 and metabolic alkalosis. The combination use of medication was not found. The fimctions of thyroid and adrenal were normal. After the treatment of potassium supplementation for 5 days, blood potassium recovered to 4.22 mmol·L^-1, metabolic alkalosis was corrected.