复方甘草酸苷相关横纹肌溶解合并低钾血症

1例37岁男性患者因慢性乙型肝炎病毒感染再活动单独应用复方甘草酸苷注射液60 ml（含甘草酸苷120 mg）静脉滴注。治疗12 d，症状明显改善，改为口服复方甘草酸苷片（含甘草酸苷150 mg，2片/次，3次/d）和水飞蓟素（140 mg，3次/d）。服药2周，患者出现下肢无力，症状逐渐加重。服药25 d，双下肢肌力3级、肌张力减低，肌酸激酶（ CK）8378 U/L，血钾2.2 mmol/L。当日停用复方甘草酸苷片和水飞蓟素，结合腓肠肌活检，诊断为横纹肌溶解合并低钾血症。予氯化钾、还原型谷胱甘肽和螺内酯。治疗10 d，肌力恢复至5级，肌张力正常，CK 459 U/L，血钾5.1mmol/L。3个月后，体格检查示双下肢正常，CK 156 U/L，血钾4.8 mmol/L。

Rhabdomyolysis and hypokalemia related to compound glycyrrhizin

A 37-year-old male patient received an intravenous infusion of compound glycyrrhizin injection 60 ml（ containing 120 mg of glycyrrhizin）for reactivation of chronic hepatitis B. His symptoms improved markedly after 12-day treatment and the regimen was changed to oral compound glycyrrhizin tablets （containing 150 mg of glycyrrhizin,two tablets every time,thrice daily）and silymarin（140 mg,thrice daily）. After 2 weeks of taking the medicines,the patient developed weakness of lower extremities and the symptom worsened gradually. After 25 days of taking the medicines,he presented with grade 3 muscle strength,hypomyotonia,a level of creatine kinase（CK）8 378 U/L,and a level of potassium 2. 2 mmol/L. Compound glycyrrhizin tablets and silymarin were discontinued,combined with the biopsy of musculus gastrocnemius, rhabdomyolysis and hypokalemia were diagnosed, and potassium chloride, reduced glutathione,and spirolactone were given. After 10-day treatment,he returned to grade 5 muscle strength, normal muscular tension,a level of CK 459 U/L,and a level of potassium 5. 1 mmol/L. Three months later,the physical examination showed normal lower extremities and the levels of CK and potassium were respectively 156 U/L and 4. 8 mmol/L.