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首页> 外文期刊>CEN Case Reports >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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Severe metabolic alkalosis, hypokalemia, and respiratory acidosis induced by the Chinese herbal medicine yokukansan in an elderly patient with muscle weakness and drowsiness

机译：老年肌无力和嗜睡的中草药五谷kansan引起的严重代谢性碱中毒，低钾血症和呼吸性酸中毒

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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; HCO 3 − , 50.5 mmol/l; chloride, 81 mmol/l; sodium, 140 mmol/l), and respiratory disorders (pCO2, 60.5 mmHg; pO2, 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.
机译：Yokukansan是一种含有甘草的中草药，经证实可缓解阿尔茨海默氏病的行为和心理症状，且几乎没有不良反应。在日本，越来越多的阿尔茨海默氏病患者正在使用这种药物进行治疗。但是，yokukansan应谨慎使用，因为它有可能通过抑制2型11-β-羟基类固醇脱氢酶来诱导假性醛固酮增多，该酶将皮质醇代谢为可的松。我们介绍了一名88岁的女性，该女性有阿尔茨海默氏病病史，由于睡意，厌食和肌肉无力而被转移到我们的急诊科。她的血压为168/90 mmHg。实验室数据显示血清钾为1.9 mmol / l，代谢性碱中毒（pH 7.54; HCO 3 −，50.5 mmol / l;氯为81 mmol / l;钠为140 mmol / l）和呼吸系统疾病（pCO2为60.5 mmHg; pO2，63.8毫米汞柱）。血浆肾素活性和醛固酮浓度得到抑制，尿钾排泄为22 mmol / l（经管肾钾梯度计算为12.9）。心电图显示平坦的T波和U波伴室性早搏。超声心动图否认容量减少。医学采访显示，她曾接受含有甘草的中草药（yokukansan）的治疗。最终诊断为甘草引起的假醛固酮增多症和呼吸性酸中毒。低血钾症，代谢性碱中毒症和呼吸性酸中毒症在停药并开始静脉补钾后不久即消失。该案例凸显了肾脏病医师在老年患者发生低血钾症时需要考虑可能包括中药余育山散在内的中药可能会参与其中。

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