环孢素联合用药致高钾血症1例及文献分析

One Case of Hyperkalemia Induced by Concomitant Use of Cyclosporine and Other Drugs

目的探讨环孢素联合用药致高钾血症的发生机制和临床特点。方法分析1例应用环孢素联合伏立康唑、沙库巴曲缬沙坦治疗狼疮性肾炎致患者高钾血症的诊疗经过,通过文献分析,探讨上述药物联合使用导致血钾升高可能的机制及处理措施。结果患者联合使用环孢素、沙库巴曲缬沙坦、伏立康唑5 d后出现血钾升高,停用环孢素、沙库巴曲缬沙坦后,5 d内血钾仍未恢复正常,直至停用伏立康唑后血钾完全恢复正常。而再次加用伏立康唑时血钾水平无异常。提示患者联合使用环孢素、伏立康唑、沙库巴曲缬沙坦增加了环孢素发生高血钾不良反应的风险。结论联合使用环孢素、伏立康唑以及作用于肾素-血管紧张素-醛固酮系统的药物时,即使环孢素在相对较低的血药浓度范围内,仍需警惕高钾血症的发生。

Objective To explore the mechanism and clinical features of hyperkalemia induced by concomitant use of cyclosporine and other drugs.Methods The diagnosis and treatment of a patient with hyperkalemia caused by concomitant use of cyclosporine,voriconazole and sacurbatrovalsartan were analyzed.Based on literature review,the possible mechanism by which concomitant use of these drugs led to hyperkalemia was studied.Results After five days of combined administration of these drugs,the serum level of potassium began to exceed the upper limit.After withdrawal of cyclosporine and sulbactam,the serum level of potassium did not return to normal within five days until voriconazole was discontinued.There was no abnormal level of serum potassium when voriconazole was administered a second time.All this suggested that the combination of cyclosporine,voriconazole and sacurbatrovalsartan increased the risk of cyclosporine induced hyperkalemia.Conclusion When cyclosporine,voriconazole,and drugs acting on the renin-angiotensin-aldosterone system are administered in combination,hyperkalemia is likely to occur even if the blood concentration of cyclosporine is at a relatively low level.