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급성 신부전이 합병된 심한 횡문근융해증을 유발한 Doxylamine 중독증
김성열 ( Seong Ryol Kim ),이해운 ( Hae Woon Lee ),이정연 ( Jeong Yeon Lee ),안해련 ( Hae Lyun Ahn ),조영일 ( Young Il Jo ),송종오 ( Jong Oh Song ) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.6
Doxylamine succinate is an over-the-counter drug widely used for treating. We experienced a case of severe rhabdomyolysis complicating acute renal failure after doxylamine overdose in a 24-year-old male. The maximum values of creatine kinase and creatinine level during hospitalization were 264,141 IU/L and 8.4 ㎎/dL, respectively. Oliguria on the sixth hospital day and sere treated with hemodialysis. Then, he recovered without any sequelae. To the best of our knowledge, the maximum creatine kinase level of 264,141 IU/L in the present case is the highest value anong the case reports on doxylamine-induced rhabdomyolysis and this is the first case report in Korea of doxylamine-induced severe rhabdomyolysis accompanying oliguric acute renal failure and requiring treatment with hemodialysis.
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김성렬,조영일,이해운,이정연,안해련,송종오,명승운 건국대학교 의과학연구소 2002 건국의과학학술지 Vol.12 No.-
Gitelman's syndrome is a rare disorder with a characteristic set of metabolic abnormalities. These include hypokalemia, metabolic alkalosis, hypocalciuria and hypomagnesemia. The clinical manifestations of Gitelman's syndrome are very similar with those of Bartter's syndrome and diuretic abuse. Gitelman' syndrome and Bartter's syndrome can be distinguished by renal clearance study after administration of furosemide and thiazide, since the primary defect in each of these disorders is an impairment in sodium reabsorption in the distal tubule and loop of Henle, respectively. Pseudo-Bartter's syndrome due to diuretic abuse can be distinguished by history of diuretic use and a positive urine assay for diuretics. We have experienced a case of pseudo-Gitelman's syndrome in 56-year old woman with unexplained hypokalemic metabolic alkalosis, hypocalciuria, and hypomagnesemia. The patient denied ingestion of diuretic medication. The results of renal clearance study using furosemide and thiazide in this case suggested the presence of the primary defect of sodium reabsorption in the distal tubule rather than in the loop of Henle. These clinical and laboratory findings were consistent with those of Gitelman's syndrome. But, this case was confirmed as pseudo-Gitelman's syndrome since diuretics were detected by a urine assay for diuretics. Furosemide and hydrochlorothiazide were contained in the pill that she had been taking due to constipation. Herein, we report the case of pseudo-Gitelman's syndrome by abuse of cathartics containig diuretics presented as Gitelman's syndrome in renal clearance study.
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