托伐普坦致高钠血症

Hypernatremia caused by tolvaptan

1例79岁男性糖尿病患者在冠状动脉搭桥术后7年因心力衰竭给予托伐普坦(15 mg口服、1次/d)联合呋塞米、左西孟旦和重组人脑利钠肽治疗,同时给予氯吡格雷、美托洛尔、依折麦布、甘精胰岛素和利拉鲁肽治疗冠状动脉粥样硬化性心脏病和糖尿病。3 d后心力衰竭症状改善,但出现高钠血症,血钠从入院时136 mmol/L升高至152 mmol/L。停用托伐普坦后血钠继续升高,峰值达168 mmol/L。放宽水分入量限制后,血钠逐渐下降至160 mmol/L。停药第4天,加用达格列净5 mg口服、1次/d;第5天,血钠恢复至146 mmol/L。

A 79-year-old male patient with diabetes mellitus was given tolvaptan(15 mg orally once daily)combined with furosemide,levosimendan,and recombinant human brain natriuretic peptide for heart failure 7 years after coronary artery bypass grafting and clopidogrel,metoprolol,ezetimibe,insulin glargine,and liraglutide were given concomitantly for coronary atherosclerotic heart disease and diabetes mellitus.Three days later,his heart failure symptoms were improved,but he developed hypernatremia.His blood sodium rised from 136 mmol/L on admission to 152 mmol/L.After stopping tolvaptan,the serum sodium level continued to rise,with a peak value of 168 mmol/L.After relaxing his water intake restriction,serum sodium gradually decreased to 160 mmol/L.On the 4th day of drug withdrawal,dapagliflozin(5 mg orally once daily)was added;on the 5th day,the blood sodium was 146 mmol/L.