medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-14-164-175medsovet-6445Research ArticleПРАКТИКАPRACTICEЛекарственно-индуцированная гипокальциемияDrug-induced hypocalcemiahttps://orcid.org/0000-0002-0401-1132ЛистратовА. И.ListratovA. I.

Листратов Александр Иванович, ординатор 2-го года кафедры терапии и полиморбидной патологии

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Alexander I. Listratov, 2nd Year Resident of the Department of Therapy and Polymorbid Pathology

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

alexanderlistratoff@yandex.ruhttps://orcid.org/0000-0002-0795-8225ОстроумоваО. Д.OstroumovaO. D.

Остроумова Ольга Дмитриевна, д.м.н., профессор, заведующая кафедрой терапии и полиморбидной патологии, профессор кафедры клинической фармакологии и пропедевтики внутренних болезней

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

Olga D. Ostroumova, Dr. Sci. (Med.), Professor, Head of the Department of Therapy and Polymorbid Pathology, Professor of the Department of Clinical Pharmacology and Propedeutics of Internal Diseases

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

8, Bldg. 2, Trubetskaya St., Moscow, 119991

ostroumova.olga@mail.ruhttps://orcid.org/0000-0003-4258-1889КлепиковаМ. В.KlepikovaM. V.

Клепикова Мария Викторовна, к.м.н., доцент кафедры терапии и полиморбидной патологии

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Maria V. Klepikova, Cand. Sci. (Med.), Associate Professor, Department of Therapy and Polymorbid Pathology

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

pelageam@mail.ruhttps://orcid.org/0000-0002-3426-5467АлешковичЕ. В.AleshkovichE. V.

Алешкович Елена Валерьевна, к.м.н., врач-кардиолог, заведующая кардиологическим отделением для больных с острым инфарктом миокарда №4

125284, Москва, 2-й Боткинский проезд, д. 5

Elena V. Aleshkovich, Cand. Sci. (Med.), Cardiologist, Head of the Cardiology Department for Patients with Acute Myocardial Infarction No. 4

5, 2nd Botkinskiy Proezd, Moscow, 125284

elena.aleshckovitch@yandex.ruРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian FederationРоссийская медицинская академия непрерывного профессионального образования; Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияRussian Medical Academy of Continuous Professional Education; Sechenov First Moscow State Medical University (Sechenov University)Russian FederationГородская клиническая больница имени С.П. БоткинаРоссияBotkin City Clinical Hospital; 5, 2nd BotkinskiyRussian Federation202118102021014164175Copyright © Листратов А.И., Остроумова О.Д., Клепикова М.В., Алешкович Е.В., 20212021Листратов А.И., Остроумова О.Д., Клепикова М.В., Алешкович Е.В.Listratov A.I., Ostroumova O.D., Klepikova M.V., Aleshkovich E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6445

Гипокальциемия (ГКа) является одним из основных водно-электролитных нарушений в клинической практике. Острое снижение уровня кальция в  сыворотке может приводить к  судорогам, желудочковым аритмиям, бронхо- и  ларингоспазму. Результатами хронической ГКа могут быть дезориентация, спутанность сознания. Чтобы предотвратить данные осложнения, необходимо тщательно оценивать факторы риска снижения уровня кальция. Одним из таких факторов являются лекарственные средства (ЛС) – в таком случае идет речь о лекарственно-индуцированной (ЛИ) ГКа. Список препаратов-индукторов ЛИ ГКа довольно обширен, но ведущую роль в развитии данного нарушения играют препараты для лечения остеопороза, противоопухолевые, противотуберкулезные и  противоэпилептические препараты. При приеме золендроновой кислоты ЛИ ГКа наблюдается с частотой до 39%. При приеме иматиниба, таргетного противоопухолевого ЛС, снижение уровня кальция наблюдалось в 40% случаев. Патофизиологическими механизмами ЛИ ГКа могут являться снижение костной резорбции, снижение концентрации витамина D, ингибирование действия паратиреоидного гормона и нарушение всасывания кальция. Факторами риска в большинстве случаев ЛИ ГКа являются дефицит витамина D и гипомагниемия. Острое снижение уровня кальция приводит к симптомам нервно-мышечной возбудимости, нарушениям на электрокардиограмме (ЭКГ) и электроэнцефалограмме (ЭЭГ). Основа лечения ЛИ ГКа – отмена препарата-индуктора, назначение кальция и витамина D. Основными методами профилактики ЛИ ГКа являются определение уровня кальция и витамина D перед началом терапии препаратами-индукторами, коррекция их уровня. Также важно назначение дополнительного количества кальция и витамина D во время терапии такими ЛС. Осведомленность лечащих врачей о проблеме ЛИ ГКа, тщательная оценка ее факторов риска и профилактическое назначение препаратов кальция и витамина D будут способствовать эффективному предотвращению тех серьезных осложнений, к которым приводит снижение уровня кальция в клинической практике.

Hypocalcemia (HCa) is one of the main water-electrolyte disturbances in clinical practice. An acute decrease in serum calcium levels can lead to seizures, ventricular arrhythmias, bronchospasm and laryngospasm. Chronic HCa can result in disorientation and confusion. To prevent these complications, the risk factors for low calcium levels must be carefully evaluated. One of these factors is drugs, in which case we are talking about drug-induced (DI) HCa. The list of drugs-inducers of DI HCa is quite extensive, but the leading role in this disorder is played by drugs for the treatment of osteoporosis, antineoplastic and antiepileptic drugs, as well as drugs for anti-tuberculosis therapy. When taking zoledronic acid, DI HCa is observed with a frequency of up to 39%. When taking imatinib, a targeted anticancer drug, a decrease in calcium levels was observed in 40% of cases. The pathophysiological mechanisms of DI HCa can be a decrease in bone resorption, a decrease in the concentration of vitamin D, inhibition of the action of parathyroid hormone and impaired calcium absorption. Risk factors in most cases of DI HCa are vitamin D deficiency and hypomagnesemia. An acute decrease in calcium levels leads to symptoms of neuromuscular excitability, abnormalities on the electrocardiogram (ECG) and electroencephalogram (EEG). The basis for the treatment of DI HCa is the drug withdrawal and the appointment of calcium. It is also necessary to prescribe vitamin D. The main methods of prevention of DI HCa are to determine the level of calcium and vitamin D before starting therapy with culprit medication, and to correct its level. It is also important to prescribe additional amounts of calcium and vitamin D during therapy with such drugs. Awareness of the attending physicians about the problem of DI HCa, a thorough assessment of its risk factors and the prophylactic administration of calcium and vitamin D preparations will help to effectively prevent those serious complications resulting from a decrease in calcium levels in clinical practice.

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The authors declare that there are no conflicts of interest present.