1例垂体后叶素诱发重度低钠血症、精神异常的药学监护

Pharmaceutical care on a case of severe hyponatremia and mental disorder induced by pituitrin

1例36岁男性患者,主因“咳嗽、咳痰4个月,咯血5 d”入院。入院后给予止血、抗感染、祛痰治疗。入院第2天加用垂体后叶注射液持续静脉泵入(6 U·h^(-1)),当日累计用量36 U。患者咯血逐渐控制,但出现恶心、呕吐。入院第5天突然出现幻觉、幻听、明显烦躁,血生化示Na^(+)116.7 mmol·L^(-1)。药师考虑存在垂体后叶素诱发低钠血症、精神异常的可能,且患者咯血已基本控制、垂体后叶素已减量2 d,建议停用垂体后叶注射液、纠正低钠血症,医生采纳。遂于入院第6天停用垂体后叶注射液,并在药师协助下给予规范补钠治疗,后患者咯血控制,精神异常消失,血钠恢复至正常水平,共住院治疗10 d出院。

A 36-year-old male patient was admitted to hospital mainly due to cough and expectoration for 4 months,hemoptysis for 5 days.After admission,treatment of hemostasis,anti-infection and expectorant were given to him.On the second day after admission,pituitrin injection was given to him by continuously intravenous pumping(6 U·h^(-1)),and the total amount of pituitrin on that day was 36 U.Hemoptysis was gradually controlled,but he developed nausea and vomiting.On the 5^(th) day of admission,he suddenly developed hallucination,auditory hallucination and obvious irritability.Results of blood biochemistry showed the level of blood Na^(+)was 116.7 mmol·L^(-1).Considering that hyponatremia and mental abnormality of the patient was possibly induced by pituitrin,the hemoptysis has been basically controlled,and the amount of pituitrin has been reduced for 2 days,the pharmacists suggested stopping the pituitrin injection and correcting hyponatremia,which was accepted by physician.On the 6th day after admission,the pituitrin injection was stopped and standardized sodium supplement therapy was given to him with the assistance of pharmacists.Thereafter,the hemoptysis was controlled,the symptoms of mental disorder disappeared,and the level of blood sodium increased to the normal range.The patient was hospitalized for 10 days and discharged.