Thiazide에 의한 저칼륨혈증성 횡문근융해증 2예
Two cases of hypokalemic rhabdomyolysis due to thiazide treatment
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초록
결론적으로 thiazide는 임상적으로 심한 부작용이 드물어 임상에서 비교적 흔하게 사용하는 약제이다. Thiazide에 의한 저칼륨혈증은 흔하게 발생하나 대개 경미하지만 고령, 칼륨섭취 저하, 심부전증, 신증후군 등의 저칼륨혈증을 야기할 수 있는 위험인자가 동반되어 있는 경우에는 심한 저칼륨혈증에 의해 횡문근융해증이 발생할 수 있으므로 주의해야 할 것으로 사료된다. 그러므로 이러한 위험인자가 있는 환자들에서 thiazide를 복용시에 전신쇄약, 근육통, 갈색뇨 등의 임상증세가 있을 경우에는 CPK 등의 근효소를 조기에 측정하는 것이 좋을 것으로 사료된다.
Abstract
Hypokalemia is a common metabolic cause of rhabdomyolysis. Although treatment with thiazide causes hypokalemia frequently, hypokalemic rhabdomyolysis after administration with thiazide is very rare. Here we report two cases of hypokalemic rhabdomyolysis due to thiazide treatment. A 50-year-old woman who had been treated with thiazide for hypertension was admitted due to quadriplegia. The patient had a potassium level of 1.5 mEq/L, a creatinine phosphokinase (CPK) level of 21,346 IU/L, and a lactic dehydrogenase level (LDH) of 2,389 IU/L. An 80-year-old man who had been treated with thiazide for hypertension was admitted due to generalized weakness. His potassium level was 1.9 mEq/L, CPK was 29,000 IU/L, and LDH was 2,393 IU/L. There were no any other causes of rhabdomyolysis except hypokalemia due to thiazide treatment for both patients. With adequate hydration and potassium replacement, hypokalemic rhabdomyolysis recovered completely without sequele.(Korean J Med 72:100-104, 2007)
참고문헌 (19)
- Honda N, "Acute renal failure and rhabdomyolysis", Kidney Int, 23, pp.888~898 (1983)
- Gabow PA, "The spectrum of rhabdomyolysis", Medicine, 61, pp.141~152 (1982)
- Zager RA, "Rhabdomyolysis and myohemoglobinuric acute renal failure", Kidney Int, 49, pp.314~326 (1996)
- Knochel JP, "Neuromuscular manifestations of electrolyte disorders", Am J Med, 72, pp.521~535 (1982)
- Greenberg A, "Diuretic complications", Am J Med Sci, 319, pp.10~24 (2000)
- Girola SS, "Hypokalemic rhabdomyolysis and thiazide diuretics: 3 clinical cases", Ann Ital Med Int, 10, pp.134~137 (1995)
- Dal Fabbro S, "2 cases of severe hypokalemia with acute rhabdomyolysis", Recenti Prog Med, 81, pp.576~578 (1990)
- Rizzi D, "Myoglobinuria secondary to hypokalemia during prolonged diuretic therapy", Minerva Med, 75, pp.2843~2846 (1984)
- Antoniadis DJ, "Rhabdomyolysis due to diuretic treatment", Hellenic J Cardiol, 44, pp.80~82 (2003)
- Prat G, "Hypokalemia causing rhabdomyolysis and precordialgia", Intensive Care Med, 27, pp.1096~ (2001)
- 금수미, "과량의 Furosemide에 의한 저칼륨혈증에서 발생한 횡문근융해증 및 급성신부전", 대한신장학회지, 16, pp.385~390 (1997)
- Singhal PC, "Hypokalemia and rhabdomyolysis", Miner Electrolyte Metab, 17, pp.335~339 (1991)
- Bourke E, "Prevention of hypokalemia caused by diuretics", Heart Dis Stroke, 3, pp.63~67 (1994)
- Siegel D, "Diuretics, serum and intracellular electrolyte levels, and ventricular arrhythmias in hypertensive men", JAMA, 267, pp.1083~1089 (1992)
- Schnaper HW, "Potassium restoration in hypertensive patients made hypokalemic by hydrochlorothiazide", Arch Intern Med, 149, pp.2677~2681 (1989)
- Rose BD, "Clinical physiology of acid-base and electrolyte disorders", pp.857~860 (2001), McGraw-Hill
- Barta Z, "Hypokalemic myopathy in a patient with gluten-sensitive enteropathy and dermatitis herpetiformis Duhring: a case report", World J Gastroenterol, 11, pp.2039~2040 (2005)
- Sauret JM, "Rhabdomyolysis", Am Fam Physician, 65, pp.907~912 (2002)
- Bidoli P, "New strategies in the treatment of esophageal cancer", Minerva Chir, 57, pp.717~731 (2002)