泮托拉唑钠肠溶胶囊致双下肢水肿1例

One case of edema of both lower extremities induced by pantoprazole sodium enteric-coated capsules

1例68岁男性患者,因14 d前进食大量柿子后出现间断上腹部疼痛入院。入院诊断为胃溃疡、胃结石。初始治疗给予注射用泮托拉唑钠(80 mg,qd,ivgtt)抑制胃酸分泌,葡萄糖氯化钠注射液(500 m L,qd,ivgtt)补液,碳酸氢钠片(0.6 g,tid)等对症治疗。入院第2天行无痛胃镜碎石治疗,治疗5 d后无腹痛、反酸、烧心等症状,无双下肢水肿,办理出院。出院时嘱患者继续口服碳酸氢钠片(0.6 g,tid),泮托拉唑钠肠溶胶囊(40 mg,1次/晨),胶体果胶铋(0.15 g,qid),阿莫西林胶囊(1.0 g,bid),克拉霉素片(0.5 g,bid),5 d后复诊。患者出院第6天为进一步碎石再次入院、入院体格检查发现其双下肢水肿,水肿区域包括足背、脚踝、小腿,手指按压局部后有凹陷,体质量增加2.3 kg,经检查,排除心源性、肾源性、肝源性及营养不良性水肿,考虑因连续服用泮托拉唑钠肠溶胶囊所致。二次入院第2天停用泮托拉唑钠肠溶胶囊,予以呋塞米片(20 mg,qd),同时抬高肢体,予自下而上按摩小腿后患者水肿逐渐减轻,次日水肿完全消退,体质量恢复正常,且后期住院期间再未见双下肢水肿。

A 68-year-old male patient was admitted to hospital because of abdominal pain for eating a lot of persimmons 14 days before.The patient was diagnosed as gastric ulcer and gastric calculi.After admission,the patient was treated with pantoprazole for injection（80 mg,qd,ivgtt） for inhibiting gastric acid secretion,glucose and sodium chloride injection（500 mL,qd,ivgtt） for fluid supplementation and sodium bicarbonate tablets（0.6 g,tid）,etc.On the second day after admission,painless gastroscopy lithotripsy was performed.The abdominal pain,acid reflux,heartburn disappeared after five days treatment,and the patient did not have edema of both lower extremities,and then the patient was released from the hospital.At the time of discharge,the patient was given sodium bicarbonate tablets（0.6 g,tid）,pantoprazole sodium enteric-coated capsules（40 mg,qd）,colloidal bismuth pectin（0.15 g,qid）,amoxicillin capsules（1.0 g,bid）,clarithromycin tablets（0.5 g,bid）,and enjoined to return visit five days later.The patient was re-admitted for further lithotripsy on the 6 th day after discharge,the patient was found to have mild edema of the both lower extremities and weight gain（2.3 kg） during the physical examination,and edema area included the dorsum of feet,ankle and calves,simultaneously there was a pitting on the finger press part.After examination,cardiogenic,renal,liver and malnutrition edema were excluded.Subsequently,we related it to the continuous intake of pantoprazole sodium enteric-coated capsules,and stopped the drug.On the second day,the patient was treated with furosemide（20 mg,qd）,raised the limbs and massaged calves from bottom to top.Gradually,edema reduced,and completely subsided on the next day,weight was back to normal.Furthermore,edema of both lower extremities did not appear again in the hospital.