대장내시경 전처치로 Picosulfate Sodium/Magnesium Citrate 사용 후 발생한 혼수를 동반한 급성 저나트륨혈증 1예
Severe Hyponatremia with Mental Change after Ingestion of Picosulfate Sodium/Magnesium Citrate for Bowel Preparation
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초록
결론적으로, PS/MC는 효과적인 대장내시경 전처치제이나장점막에 미세한 염증반응을 일으키거나, 삼투 효과에 의한장점막에서의 수분과 전해질의 이동, 메스꺼움 등 비삼투성자극을 통한 ADH 과분비를 유발함으로써 저나트륨혈증 등의 전해질 불균형이 발생할 수 있다. 따라서 고령, 갑상선기능저하증, 기저 심장/신장/간질환이 있는 환자에게 처방시 특별한 주의가 요구되며, 갑작스러운 혈장량의 감소가 발생하지 않도록 전처치시 적절한 수분섭취를 교육하는 것이 중요하다. 그러나 비교적 맛과 용량 면에서 순응도가 높은 하제임에도 PS/MC가 위팽만이나 구역, 구토를 유발할 수 있고 항진된 장운동 자체도 비삼투성 자극체로서 ADH를 상당 수준과발현시켜 의식 소실이나 신경학적 이상을 유발할 정도의심각한 저나트륨혈증이 발생할 수 있으며, 이것이 탈수나 기타 위험 인자가 없는 상황에서도 충분히 합병될 수 있음을의료진이 인지하여, 3% 고장성 식염수나 항경련제 등의 치료가 시기적절하게 진행될 수 있도록 하는 것이 중요하겠다.
Abstract
Picosulfate sodium/Magnesium citrate (PS/MC) is a common bowel cleansing agent for colonoscopy. It is equally effective and better tolerated by patients with regard to taste and volume than polyethylene glycol. However, because of its osmotically active characteristics, PS/MC can cause plasma volume depletion and electrolyte disturbances, such as hyponatremia. Here, we report a case of severe hyponatremia combined with loss of consciousness in a 59-year-old woman following ingestion of PS/MC as bowel preparation for a screening colonoscopy. Upon arrival, serum sodium level was 109 mEq/L and urine osmolality and sodium levels were 393 mOms/Kg and 99 mmol/L, respectively. She was euvolemic and showed normal kidney, thyroid, and adrenal function. Based on these findings, inappropriate anti-diuretic hormone syndrome (SIADH) was diagnosed. She was treated with 3% hypertonic saline and completely recovered without any neurologic sequelae. This case shows that SIADH can be caused by PS/MC (not accompanied by dehydration), even in patients without any underlying renal, heart, or liver diseases. (Korean J Med 2016;91:206-210)
참고문헌 (10)
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