Лекарственно-индуцированная гипокальциемия

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.

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