1例唑来膦酸所致严重低磷低钙血症合并肝功能不全患者治疗与营养支持的药学监护

A Case of Zoledronic Acid Caused Severe Hypophosphate and Hypocalcemia Combined with Hepatic Insufficiency in the Treatment and Nutritional Support of Pharmaceutical Care

本文报道临床药师参与1例唑来膦酸致严重低磷低钙血症同时合并肝功能不全患者的治疗,通过保肝治疗,调整支链氨基酸使用,结合肠内营养的个体化营养方案支持,改善了患者肝功能和营养状况。同时通过电解质水平监护和甲状旁腺激素的代偿机制研究,发现了唑来膦酸引起严重低磷低钙血症的可能机制,协助医生使用多倍量钙磷制剂治疗,并提出不良反应的防治建议,提高了患者用药的安全性和有效性。临床药师在整个营养支持过程中的药学监护对于患者的用药安全和医生的治疗策略具有重要意义。

This article reports that a clinical pharmacist participated in the treatment of a liver insufficiency patient with severe hypophosphate and hypocalcemia caused by zoledronic acid, which improved the patient’s liver function and nutritional status through hepatoprotective treatment and adjustment of the use of branched-chain amino acids combined with the support of an individualized nutrition program combined with enteral nutrition. At the same time, through the study of electrolyte level monitoring and the compensation mechanism of parathyroid hormone, the possible mechanism of zoledronic acid causing severe hypophosphate and hypocalcemia was discovered. After assisting doctors to use multiple doses of calcium and phosphorus preparations, they proposed the prevention and treatment recommendations for ADR, which has improved the safety and effectiveness of patients’ medication. The pharmaceutical care of clinical pharmacists in the whole process of nutritional support is of great significance for the safety of drug use of patients and the treatment strategies of doctors.