背景:米多君广泛用于低血压状态的治疗,在慢性肾脏病低血压患者中,尚无与使用米多君相关的肌阵挛症的报道.
方法:我们报告了一名58岁的慢性肾病(CKD)女性患者,在服用米多君2小时后出现不自主震颤,在6小时后变得更加频繁。脑部CT和神经系统检查没有产生值得注意的发现。血化学显示血清白蛋白为3.1g/L,ALT为19U/L,AST为22U/L,SCr为273.9μmol/L,K为2.94mmol/L,Ca为1.63mmol/L,Mg为0.46mmol/L她的血压维持在83-110/56-75mmHg。她的尿量是600-1000mL/d,她的心率在90-100次/分钟的范围内。
方法:慢性肾脏病(CKD),低血压,代谢性酸中毒,低钙血症,低钾血症,和低镁血症.
方法:停止米多君治疗,患者接受血管内补液和呋塞米治疗。米多君戒断后一天,肌阵鸣停止。
结论:口服米多君广泛用于治疗直立性低血压,复发性反射性晕厥和透析相关性低血压,不良反应大多轻微.然而,临床医生应该警惕米多君引起的肌阵挛症,尤其是CKD患者。
BACKGROUND: Midodrine is widely used in the treatment of hypotensive states, there have been no
reports of myoclonus associated with midodrine use in hypotension with chronic kidney disease.
METHODS: We report a 58-year-old female patient with chronic kidney disease (CKD) presenting with involuntary tremor 2 h after taking midodrine, which became more frequent after 6 h. Brain CT and neurological examination did not yield findings of note. Blood chemistry showed serum albumin of 3.1 g/L, ALT of 19 U/L, AST of 22 U/L, SCr of 273.9 μmol/L, K of 2.94 mmol/L, Ca of 1.63 mmol/L, and Mg of 0.46 mmol/L. Her BP was maintained at 83-110/56-75 mmHg. Her urine volume was 600-1000 mL/d, and her heart rate was within a range of 90-100 beats/min.
METHODS: Chronic kidney disease (CKD), hypotension, metabolic acidosis, hypocalcemia, hypokalemia, and hypomagnesemia.
METHODS: Midodrine treatment was stopped and the patient was treated with intravascular rehydration and furosemide. Myoclonus ceased one day after midodrine withdrawal.
CONCLUSIONS: Oral midodrine is widely used in the treatment of orthostatic hypotension, recurrent reflex syncope and dialysis-associated hypotension and the adverse effects are mostly mild. However, clinicians should be alert for midodrine-induced myoclonus, especially in patients with CKD.