• PDF / 174,674 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 15 Downloads / 258 Views

DOWNLOAD

REPORT

---

1

Angelicae-radix/astragalus-propinquus/atractylodes-japonica/cassia/cnidium-officinalemakino/ginseng/radix-glycyrrhizae/rehmannia/paeonia-lactiflora/wolfiporia-extensa

S

Pseudoaldosteronism and rhabdomyolysis: case report A 76-year-old woman developed pseudoaldosteronism and rhabdomyolysis during treatment with angelicae radix/astragalus propinquus/atractylodes japonica/cassia/cnidium officinale makino/ginseng/radix glycyrrhizae/rehmannia/paeonia lactiflora/ wolfiporia extensa for stomach cancer. The woman, who had a surgery for stomach cancer, had been receiving oral granules of angelicae radix/astragalus propinquus/ atractylodes japonica/cassia/cnidium officinale makino/ginseng/radix glycyrrhizae/rehmannia/paeonia lactiflora/wolfiporia extensa [Kracie Juzentaihoto Extract Granules; supplied by Kracie Pharmaceuticals]. The daily dosage of these granules was 6.2gm of a dried extract of the following mixed crude drugs: 3gm of the dried root of Astragalus propinquus, 3gm of the dried bark of cassia [Cinnamomum cassia], 3gm of the dried root of Rehmannia [Rehmannia glutinosa], 3gm of the dried root of Paeonia lactiflora, 3gm of the dried rhizome of Cnidium officinale makino [Cnidium officinale], 3gm of the dried rhizome of Atractylodes japonica, 3gm of the dried root of Angelicae radix [Angelica acutiloba], 3gm of the dried root of Ginseng [Panax ginseng], 3gm of the dried sclerotium of Wolfiporia extensa [Wolfiporia cocos] and 1.5gm of the dried root and stolon of Radix glycyrrhizae [Glycyrrhiza uralensis]. She received the therapy with these granules for 3 years, which included Radix glycyrrhizae [licorice] 1.5gm for 1 year and 2 months, and then 3gm for 1 year and 10 months. Concurrently, she was on prednisolone and voriconazole. She exhibited decreased plasma potassium to around 3 mEq/L. The woman was thus admitted and was treated with potassium gluconate supplementation. She also reported weakness, malaise and difficulty of walking. Further decrease in her plasma potassium (2.1 mEq/L) and increase in creatinine kinase (364 U/L) were noted (day 0). She also exhibited low plasma renin activity and low aldosterone level. The plasma collected on day 0 was analysed to check levels of metabolites of Radix glycyrrhizae, which showed 18β-glycyrrhetyl-3-O-sulfate level of 8.6µM, glycyrrhetinic acid (GA) level of 1.3µM, and 22α-hydroxy-18β-glycyrrhetyl-3-O-sulfate level of 87nM. Based on these findings, she was diagnosed with pseudoaldosteronism with rhabdomyolysis due to Radix glycyrrhizae [exact time to reaction onset not stated]. Therefore, the therapy with angelicae radix/astragalus propinquus/atractylodes japonica/cassia/cnidium officinale makino/ginseng/radix glycyrrhizae/ rehmannia/paeonia lactiflora/wolfiporia extensa was stopped. Simultaneously, potassium supplementation was increased. On day 5, low plasma potassium level persisted. The plasma concentrations of 18β-glycyrrhetyl-3-O-sulfate and GA decreased to 3.6µM and 0.65µM, respectively. On day 14, the plasma potassium level was 3.4 mEq/L, and the concentra