Trong b\u00e0i vi\u1ebft n\u00e0y, c\u00e1c t\u00e1c gi\u1ea3 b\u00e1o c\u00e1o m\u1ed9t tr\u01b0\u1eddng h\u1ee3p ti\u00eau c\u01a1 v\u00e2n c\u1ea5p v\u00e0 suy th\u1eadn c\u1ea5p do s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi simvastatin v\u00e0 danazol.<\/p>\n
M\u1ed9t ph\u1ee5 n\u1eef 65 tu\u1ed5i v\u1edbi b\u1ec7nh n\u1ec1n l\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2, t\u0103ng lipid m\u00e1u v\u00e0 gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch m\u1ea1n t\u00ednh \u0111\u1ebfn g\u1eb7p b\u00e1c s\u0129 v\u00ec 2 tu\u1ea7n tr\u01b0\u1edbc \u0111\u00f3 c\u1ea3m th\u1ea5y kh\u00f3 ch\u1ecbu to\u00e0n th\u00e2n v\u00e0 \u0111au c\u01a1. Kh\u00f4ng ghi nh\u1eadn ch\u1ea5n th\u01b0\u01a1ng m\u1edbi, ban ngo\u00e0i da hay lo\u00e9t ni\u00eam m\u1ea1c. Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o cho th\u1ea5y nhi\u1ec5m tr\u00f9ng trong th\u1eddi gian g\u1ea7n \u0111\u00f3. R\u1ea5t nhanh sau khi kh\u1edfi ph\u00e1t \u0111au c\u01a1, b\u1ec7nh nh\u00e2n gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u v\u00e0 m\u00e0u s\u1eafc n\u01b0\u1edbc ti\u1ec3u r\u1ea5t s\u1eadm. Kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng n\u00e0o kh\u00e1c \u1edf \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u. C\u00e1c thu\u1ed1c b\u1ec7nh nh\u00e2n th\u01b0\u1eddng d\u00f9ng bao g\u1ed3m prednisolone 5 mg\/ng\u00e0y, danazol 200 mg 2 l\u1ea7n\/ng\u00e0y, simvastatin 40 mg v\u00e0o bu\u1ed5i t\u1ed1i, metformin 1,000 mg 3 l\u1ea7n\/ng\u00e0y, v\u00e0 insulin ngu\u1ed3n g\u1ed1c t\u1eeb ng\u01b0\u1eddi (30 insulin h\u00f2a tan : 70 percent insulin isophane) 34 \u0111\u01a1n v\u1ecb v\u00e0o bu\u1ed5i s\u00e1ng v\u00e0 10 \u0111\u01a1n v\u1ecb v\u00e0o bu\u1ed5i t\u1ed1i.<\/p>\n
Th\u0103m kh\u00e1m th\u1ea5y m\u1ea5t n\u01b0\u1edbc nh\u1eb9. B\u1ec7nh nh\u00e2n kh\u00f4ng s\u1ed1t, m\u1ea1ch 110 l\u1ea7n\/ph\u00fat, huy\u1ebft \u00e1p 120\/60 mmHg. Kh\u00e1m tim m\u1ea1ch, h\u00f4 h\u1ea5p, b\u1ee5ng kh\u00f4ng ph\u00e1t hi\u1ec7n g\u00ec \u0111\u1eb7c bi\u1ec7t. T\u1ee9c nh\u1eb9 \u0111\u00f9i 2 b\u00ean, kh\u00f4ng c\u00f3 ban ngo\u00e0i da ho\u1eb7c s\u01b0ng kh\u1edbp. X\u00e9t nghi\u1ec7m m\u00e1u l\u00fac v\u00e0o vi\u1ec7n: ure 23,6 mmol\/L, creatinine 465 \u00b5mol\/L, kali 7,0 mmol\/L, calci 2,05 mmol\/L, phosphate 2,9 mmol\/L, alanine transaminase (ALT) 538 IU\/L, v\u00e0 creatine phosphokinase (CK) 131,000 IU\/L. S\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u l\u00e0 78 x 10^9\/L (t\u01b0\u01a1ng t\u1ef1 m\u1ee9c \u0111\u1ed9 b\u00ecnh th\u01b0\u1eddng c\u1ee7a b\u1ec7nh nh\u00e2n). N\u1ed3ng \u0111\u1ed9 hemoglobin, s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u, x\u00e9t nghi\u1ec7m \u0111\u00f4ng m\u00e1u, n\u1ed3ng \u0111\u1ed9 phosphatase ki\u1ec1m v\u00e0 bilirubin \u0111\u1ec1u b\u00ecnh th\u01b0\u1eddng. T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u th\u1ea5y h\u1ed3ng c\u1ea7u ni\u1ec7u d\u01b0\u01a1ng t\u00ednh m\u1ea1nh, trong khi soi t\u01b0\u01a1i n\u01b0\u1edbc ti\u1ec3u l\u1ea1i kh\u00f4ng th\u1ea5y h\u1ed3ng c\u1ea7u. Ch\u1ea9n \u0111o\u00e1n suy th\u1eadn c\u1ea5p th\u1ee9 ph\u00e1t do ti\u00eau c\u01a1 v\u00e2n n\u1eb7ng \u0111\u01b0\u1ee3c \u0111\u1eb7t ra. L\u1ecdc m\u00e1u c\u1ea5p c\u1ee9u \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh do kali m\u00e1u t\u0103ng cao.
\nMyoglobin ni\u1ec7u sau \u0111\u00f3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn l\u00e0 d\u01b0\u01a1ng t\u00ednh. C\u00e1c kh\u00e1ng th\u1ec3 kh\u00e1ng nh\u00e2n (ANA) v\u00e0 kh\u00e1ng th\u1ec3 kh\u00e1ng kh\u00e1ng nguy\u00ean nh\u00e2n h\u00f2a tan (ENA) \u0111\u1ec1u \u00e2m t\u00ednh. Ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p b\u00ecnh th\u01b0\u1eddng. Kh\u00f4ng ti\u1ebfn h\u00e0nh sinh thi\u1ebft th\u1eadn v\u00ec gi\u1ea3m ti\u1ec3u c\u1ea7u k\u00e9o d\u00e0i. Khi \u0111\u01b0\u1ee3c h\u1ecfi k\u0129 h\u01a1n, b\u1ec7nh nh\u00e2n cho bi\u1ebft m\u00ecnh \u0111\u00e3 tu\u00e2n th\u1ee7 k\u00e9m vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng simvastatin v\u00e0 danazol. Tuy nhi\u00ean, sau khi \u0111\u01b0\u1ee3c gi\u00e1o d\u1ee5c l\u1eb7p l\u1ea1i nhi\u1ec1u l\u1ea7n, kho\u1ea3ng th\u1eddi gian g\u1ea7n \u0111\u00f3 b\u00e0 b\u1eaft \u0111\u1ea7u th\u01b0\u1eddng xuy\u00ean s\u1eed d\u1ee5ng c\u1ea3 2 thu\u1ed1c n\u00e0y.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n ti\u00eau c\u01a1 v\u00e2n do statin, s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi danazol, \u0111\u01b0\u1ee3c \u0111\u1eb7t ra, v\u00e0 c\u1ea3 2 thu\u1ed1c \u0111\u1ec1u \u0111\u01b0\u1ee3c ng\u1eebng ngay l\u1eadp t\u1ee9c. Tri\u1ec7u ch\u1ee9ng \u0111au c\u01a1 tho\u00e1i lui nhanh ch\u00f3ng, nh\u01b0ng b\u1ec7nh nh\u00e2n v\u1eabn ph\u1ea3i l\u1ecdc m\u00e1u trong v\u00f2ng 4 tu\u1ea7n. S\u1ed1 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u v\u00e0 ch\u1ee9c n\u0103ng th\u1eadn d\u1ea7n d\u1ea7n c\u1ea3i thi\u1ec7n, v\u00e0 b\u1ec7nh nh\u00e2n ra vi\u1ec7n 6 tu\u1ea7n sau l\u1ea7n kh\u00e1m \u0111\u1ea7u ti\u00ean. Khi kh\u00e1m l\u1ea1i 8 tu\u1ea7n sau khi ra vi\u1ec7n, b\u1ec7nh nh\u00e2n ho\u00e0n to\u00e0n kh\u1ecfe m\u1ea1nh m\u00e0 kh\u00f4ng c\u00f2n b\u1ea5t k\u00ec c\u01a1n \u0111au c\u01a1 hay y\u1ebfu c\u01a1 t\u1ed3n d\u01b0 n\u00e0o. Gi\u00e1 tr\u1ecb creatinine huy\u1ebft thanh m\u1edbi nh\u1ea5t l\u00e0 120 \u00b5mol\/L.<\/p>\n