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1例62岁男性患者,因日光性皮炎,给予复方甘草酸苷注射液20ml/d(含甘草酸苷40mg)静脉滴注,并口服依巴斯汀、西替利嗪等药物治疗4d,其后改用蒙药(具体成分不详)治疗10d。因皮肤症状无明显改善,再次给予复方甘草酸苷片2片(含甘草酸苷50mg),口服2次/d。1周后,患者出现眼睑及双下肢水肿,血压180/100mm Hg(1mm Hg=0.133kPa),立即停药。实验室检查:血钾3.1mmol/L,血钠151mmol/L,血肌酐(SCr)82μmol/L,肾素0.40pg/L,血管紧张素Ⅱ98ng/L,醛固酮164ng/L。给予氨苯蝶啶50mg,2次/d口服,硝苯地平20mg,2次/d口服。治疗1d后患者水肿消退,血压控制在140～160/90～100mm Hg。实验室复查示血钾4.7mmol/L,血钠141mmol/L,但SCr升至129μmol/L,最高达144μmol/L。停用氨苯蝶啶2d后,实验室检查示:SCr 86μmol/L,血钾3.7mmol/L,血钠141mmol/L,肾素、血管紧张素Ⅱ、醛固酮水平正常。诊断为假性醛固酮增多症,考虑与甘草酸有关。
A 62-year-old male patient was given intravenous drip of compound glycyrrhizin injection 20ml / d (including glycyrrhizin 40mg) due to solar dermatitis and oral administration of ebastine and cetirizine for 4 days. After switching to Mongolian medicine (specific composition is unknown) treatment 10d. Because no significant improvement in skin symptoms, once again given compound glycyrrhizin tablets 2 (containing glycyrrhizin 50mg), orally 2 times / d. One week later, the patient developed eyelid and lower extremity edema. Blood pressure was 180/100 mm Hg (1 mm Hg = 0.133 kPa). Immediate withdrawal was performed. Laboratory tests: serum potassium 3.1mmol / L, serum sodium 151mmol / L, serum creatinine (SCr) 82μmol / L, renin 0.40pg / L, angiotensin Ⅱ 98ng / L, aldosterone 164ng / L. Give triamterene 50mg, 2 times / d orally, nifedipine 20mg, 2 times / d orally. After 1 day of treatment, the edema subsided and the blood pressure was controlled at 140 ~ 160/90 ~ 100mm Hg. Laboratory review showed potassium 4.7mmol / L, serum sodium 141mmol / L, but SCr rose to 129μmol / L, up to 144μmol / L. After the withdrawal of triamterene 2d, laboratory tests showed: SCr 86μmol / L, serum potassium 3.7mmol / L, serum sodium 141mmol / L, renin, angiotensin Ⅱ, aldosterone levels were normal. Diagnosis of pseudo-aldosteronism, consider glycyrrhizic acid-related.