Midodrine
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Myoclonus: case report A 58-year-old woman developed myoclonus while receiving treatment with midodrine for hypotension. The woman, who had chronic kidney disease (CKD) was treated with laser lithotripsy. Her serum creatinine had increased from 200 to 280.2 µmol/L, after 20 days. She was hospitalised. Her serum creatinine continued to increase to 393 µmol/L. Her BP was 106/63mm Hg. She also developed hypocalcaemia and she started receiving IV calcium gluconate. She was also other concomitant drugs. Three days after treatment, she still complained of dizziness and physical weakness. Her BP was maintained at 83–110/56–75mm Hg. Her urine volume and heart rate were 600–1000 mL/d and 90–100 beats/min, respectively. Since she suffered from hypotension, she was started on treatment with oral midodrine (2.5mg three times daily). After taking the first dose of midodrine at 19:00pm, she felt intermittent involuntary tremors 2 hours later. Blood gas analysis indicated a pH of 7.46, with calcium of 0.93 mmol/L. Despite continuous supplementary IV calcium gluconate, the symptoms were not resolved. After taking the second and third dose of midodrine, she developed a generalised myoclonic seizure and paresthesia. Clonus was less painful if she lay down, and she was unable to walk by herself. She was treated with oral diazepam to relieve anxiety, but this was also ineffective. After evaluating her medicines and manifestations, a clinical pharmacist suggested that the myoclonus reflected a rare ADR of midodrine. Midodrine was discontinued immediately. But, the woman’s BP was still low. She was treated with IV rehydration therapy and furosemide. Her symptoms gradually improved. A day after discontinuation of midodrine, myoclonus had resolved; however, her ionised calcium remained abnormal. One month follow-up, she also did not report any further symptoms at the outpatient clinic. Ye X, et al. Case report: severe myoclonus associated with oral midodrine treatment for hypotension. Medicine 99: e21533, No. 40, 2 Oct 2020. Available from: URL: http:// 803514240 doi.org/10.1097/MD.0000000000021533
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Reactions 14 Nov 2020 No. 1830
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