利妥昔单抗致肾病综合征患者急性低钾血症

Acute hypokalemia caused by rituximab in a patient with nephrotic syndrome

1例17岁男性患者因肾病综合征接受利妥昔单抗治疗,第1次治疗(500 mg静脉滴注)时未出现明显不适,半年后给予第2次治疗(300 mg静脉滴注)时患者出现四肢乏力、双下肢不能抬起等症状,实验室检查示血钾2.37 mmol/L。治疗前患者血钾4.16 mmol/L,其他实验室检查指标基本正常。考虑为利妥昔单抗导致的急性低钾血症。给予氯化钾口服治疗,第2天患者诉症状有所缓解,无力感消失,血钾3.06 mmol/L;第3天血钾4.34 mmol/L,共补钾3 d。停止补钾次日血钾4.70 mmol/L,患者四肢无力及不适症状消失。之后患者未再应用利妥昔单抗,亦未再出现低钾血症。

A 17-year-old male patient received rituximab due to nephrotic syndrome.No obvious discomfort occurred during the first treatment(500 mg by intravenous infusion).After half a year,when the second treatment(300 mg by intravenous infusion)was given,the patient developed symptoms such as fatigue of limbs and inability to lift both lower limbs.Laboratory test showed blood potassium 2.37 mmol/L.Before treatment,the serum potassium was 4.16 mmol/l,and other laboratory test indicators were basically normal.Acute hypokalemia caused by rituximab was considered.Oral potassium chloride was given.On the 2nd day,the symptoms in the patient were relieved,the feeling of powerlessness disappeared,and the blood potassium was 3.06 mmol/L.On the 3rd day,the blood potassium was 4.34 mmol/L.the potassium supplement was stopped after 3 days of medication.The next day,the blood potassium was 4.70 mmol/l,and the patient′s limb weakness and discomfort symptoms disappeared.After that,the patient did not use rituximab again,and no hypokalemia recurred.