吉非替尼致严重腹泻和低钾血症

Severe diarrhea and hypokalemia caused by gefitinib

1例83岁女性患者因右肺腺癌左肺转移和可疑肝转移口服吉非替尼0.25 g、1次/d。用药27 d后患者出现严重腹泻伴恶心呕吐,实验室检查示血钾2.1 mmol/L,粪培养结果为阴性,排除感染性腹泻。未停用吉非替尼,给予补钾、止泻等治疗4 d,患者痊愈。4 d后患者再次出现上述症状,实验室检查示血钾2.96 mmol/L,考虑腹泻和低钾血症与吉非替尼有关。停用该药,给予补钾、止泻、止吐、护胃等对症治疗。停药9 d后,患者腹泻、恶心呕吐症状减轻,实验室检查示血钾3.52 mmol/L;停药22 d后,患者腹泻、恶心呕吐症状消失,实验室检查示血钾4.69 mmol/L。

An 83⁃year⁃old female patient received gefitinib 0.25 g once daily due to right lung adenocarcinoma with left lung metastasis and suspicious liver metastasis.She developed severe diarrhea with nausea and vomiting 27 days after treatment.Laboratory test showed that blood potassium was 2.1 mmol/L.The results of fecal culture were negative,and infectious diarrhea was excluded.Gefinib was continued.After 4 days of treatments with potassium supplement and antidiarrheal,the patient recovered.Four days later,the patient developed the above symptoms again,and the laboratory test showed that the blood potassium was 2.96 mmol/L.Diarrhea and hypokalemia were considered to be related to gefitinib.The drug was withdrawn and the symptomatic treatments such as potassium supplement,antidiarrheal,antiemetic,and stomach protection were given.Nine days of drug withdrawal,her symptoms of diarrhea,nausea,and vomiting were relieved,and laboratory test showed that blood potassium was 3.52 mmol/L;22 days of drug withdrawal,the diarrhea,nausea,and vomiting disappeared,and the laboratory test showed that blood potassium was 4.69 mmol/L.