Severe metabolic alkalosis, hypokalemia, and respiratory acidosis induced by the Chinese herbal medicine yokukansan in an elderly patient with muscle weakness and drowsiness
Severe metabolic alkalosis, hypokalemia, and respiratory acidosis induced by the Chinese herbal medicine yokukansan in an elderly patient with muscle weakness and drowsiness
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DOI：
10.1007/s13730-012-0032-3
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发表时间：
2013-05-01
期刊：
影响因子：
1
通讯作者：
Ooboshi, Hiroaki
中科院分区：
文献类型：
--
作者：
Yamada, Shunsuke;Tokumoto, Masanori;Ooboshi, Hiroaki
Yokukansan是一种含有甘草的中草药，已被证明可以缓解阿尔茨海默病的行为和心理症状，几乎没有副作用。在日本，越来越多的阿尔茨海默病患者正在接受这种药物的治疗。然而，yokukansan应该谨慎使用，因为它有可能通过抑制11- β -羟基类固醇脱氢酶2来诱导假醛固酮症，这种酶能将皮质醇代谢成可的松。我们报告一位有阿尔茨海默病病史的88岁妇女，因嗜睡、厌食症和肌肉无力被转到我们的急诊科。她的血压是168/90毫米汞柱。实验室数据显示血清钾1.9 mmol/l，代谢性碱中毒（pH 7.54, HCO3-, 50.5 mmol/l，氯化物，81 mmol/l，钠，140 mmol/l），呼吸系统疾病(pCO(2), 60.5 mmHg；pO(2), 63.8 mmHg)。血浆肾素活性和醛固酮浓度均受到抑制，尿钾排泄量为22 mmol/l（计算经小管钾梯度12.9）。心电图示平t波和u波伴室性早搏。超声心动图否认容量衰竭。医学采访披露，她曾服用一种含有甘草的中草药（yokukansan）。最终诊断为假性醛固酮增多症及甘草所致呼吸性酸中毒。低钾血症、代谢性碱中毒和呼吸性酸中毒均在停止yokukansan并开始静脉补钾后不久消退。这个病例强调了肾病学家在遇到老年患者低钾血症时，需要考虑包括yokukansan在内的中草药的可能参与。
Yokukansan is a Chinese herbal medicine containing licorice that has been shown to alleviate the behavioral and psychological symptoms of Alzheimer's disease, with few adverse effects. Increasing numbers of patients with Alzheimer's disease in Japan are now being treated with this drug. However, yokukansan should be used with caution because of its potential to induce pseudoaldosteronism through the inhibition of 11-beta-hydroxysteroid dehydrogenase type 2, which metabolizes cortisol into cortisone. We present the case of an 88-year-old woman with a history of Alzheimer's disease who was transferred to our emergency department because of drowsiness, anorexia, and muscle weakness. Her blood pressure was 168/90 mmHg. Laboratory data showed serum potassium of 1.9 mmol/l, metabolic alkalosis (pH 7.54; HCO3-, 50.5 mmol/l; chloride, 81 mmol/l; sodium, 140 mmol/l), and respiratory disorders (pCO(2), 60.5 mmHg; pO(2), 63.8 mmHg). Plasma renin activity and aldosterone concentration were suppressed, and urinary potassium excretion was 22 mmol/l (calculated transtubular potassium gradient 12.9). An electrocardiogram showed flat T-waves and U-waves with ventricular premature contractions. Echocardiography denied volume depletion. Medical interview disclosed that she had been treated with a Chinese herbal medicine (yokukansan) containing licorice. The final diagnosis was pseudoaldosteronism and respiratory acidosis induced by licorice. Hypokalemia, metabolic alkalosis, and respiratory acidosis all subsided shortly after the discontinuation of yokukansan and initiation of intravenous potassium replacement. This case highlights the need for nephrologists to consider the possible involvement of Chinese herbal medicines, including yokukansan, when they encounter hypokalemia in elderly patients.