Kronisk nefropati og polyfarmaci – en potentiel livsfarlig situation

Resumé

En 65-årig comorbid mand med flere dages anamnese af diarré samt nedsat muskelkraft, blev efter en faldepisode indlagt på akutmodtagelsen. Han var i forvejen kendt med blandt andet kronisk nefropati og i behandling med medicin, der vides at kunne påvirke nyrefunktionen samt medføre hyperkaliæmi.

På baggrund af kombinationen af polyfarmaci, bestående nyresygdom og diarré udviklede patienten akut nyresvigt med svær hyperkaliæmi og hjertepåvirkning til følge.

Casen illustrerer, hvordan polyfarmaceutisk behandling af comorbide patienter nemt kan tage en uheldig drejning, og hvor vigtigt det er, at der passes ekstra godt på disse patienter. 

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A 65-year-old comorbid man with a history of diarrhea through several days as well as lowered muscle strength, was admitted to the emergency department after a fall. He had previously been treated for chronic nephropathy among other things and was receiving medical treatment known to affect kidney function and cause hypercalcemia. Due to the combination of polypharmacy, existing kidney disease and diarrhea, the patient developed acute kidney failure with severe hypercalcemia and cardiac distress as a result. The case illustrates how easily polypharmacy treatment of comorbid patients can be fatal and how important it is to take extra care of these patients.