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1例76岁女性患者,因急性脑梗死和原发性高血压应用尼莫地平、氯吡格雷、曲克芦丁及奥拉西坦治疗。入院第3天为控制血压加用厄贝沙坦0.15 g,1次/d。治疗7 d后患者BP 125/60 mm Hg,病情好转出院。出院后继续服用氯吡格雷25 mg、2次/d,尼群地平15 mg、3次/d,尼莫地平40 mg、2次/d,氢氯噻嗪12.5 mg1、次/d,厄贝沙坦0.15 mg1、次/d。出院第5天,门诊复查肾功能示BUN 14.42 mmol/L、SCr 114.0μmol/L、K+6.89 mmol/L,BP 150/70 mm Hg。诊断为高钾血症,再次入院。给予利尿、排钾治疗。考虑血钾升高与降压药有关,停用厄贝沙坦、尼群地平,改服硝苯地平控释片30 mg,1次/d。3天后患者血钾和肾功能恢复正常,出院。追踪病史,患者约1年前曾服用坎地沙坦酯并出现血钾升高。
A 76-year-old female patient was treated with nimodipine, clopidogrel, troxerutin, and oxiracetam for acute cerebral infarction and essential hypertension. Admission on the 3rd day for the control of blood pressure plus irbesartan 0.15 g, 1 / d. After 7 days of treatment BP 125/60 mm Hg, the patient’s condition improved discharge. After discharge from the hospital, we continued taking clopidogrel 25 mg twice daily, nitrendipine 15 mg thrice daily, nimodipine 40 mg twice daily, hydrochlorothiazide 12.5 mg once daily, irbesartan 0.15 mg1, times / d. On the fifth day after discharge, the outpatient renal function tests showed BUN 14.42 mmol / L, SCr 114.0 μmol / L, K + 6.89 mmol / L, BP 150/70 mm Hg. Diagnosis of hyperkalemia, re-admission. Give diuretic, row potassium treatment. Consider the rise in serum potassium and antihypertensive drugs, disable irbesartan, nitrendipine, change service nifedipine 30mg, 1 / d. After 3 days, serum potassium and renal function returned to normal, and discharged. Tracing the medical history, the patient took candesartan cilexetil about 1 year ago and developed hyperkalemia.