2015 Volume 17 Issue 1 Published: 28 February 2015
  

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  • Attention to adverse reactions of longterm proton pump inhibitors therapy
    Wang Shujun;Qian Jiaming
    2015, 17(1): 1-2.
    Abstract ( ) PDF ( )
  • Efficacy and safety of pantoprazole sodium and omeprazole treatments in patients with duodenal ulcer: a Meta-analysis
    Zhang Jiaxing;Wang Zhongyuan;Xie Juan;Chen Qi;Gao Ling;Luo Lei;Li Lianhua;Xiong Shijuan;Sheng Changcheng
    2015, 17(1): 3-9.
    Abstract ( ) PDF ( )
    ObjectiveTo systematically evaluate the effectiveness and safety of pantoprazole sodium(PAN) and omeprazole(OME) treatments in patients with duodenal ulcer.Methods"Panto-prazole sodium", "omeprazole", "ulcer", and "randomized controlled trial" were selected as key words and PubMed, Embase, the Cochrane Library, VIP, CNKI, and Wanfang databases from the inception to September 2014 were searched. Randomized controlled trials (RCT) on comparison of PAN and OME treatments in patients with duodenal ulcer were selected. According to the intervention measures, the subjects were divided into the PAN group and the OME group. The medication comprised oral and intravenous administration. The Meta-analysis was performed using RevMan 5.2 software. The outcomes included the ulcer healing rate, the pain relief rate and time, the incidence of adverse drug reactions, and the recurrence rate at six months. ResultsA total of 17 RCTs involving 1 847 patients were entered, including 1 008 in the PAN group and 839 in the OME group. The patients in 12 RCTs received drugs by mouth and the patients in other 5 RCTs received intravenously and the Meta-analysis was performed respectively. The ulcer healing rates in patients with 2 or 4 weeks of oral PAN treatment, the pain relief rates in patients with 1, 2 or 4 weeks of oral PAN treatment were compared with those in patients with oral OME treatment at the same period and the differences were not significant. The pain relief rates in patients with 3 days of oral PAN treatment were higher than those in patients with 3 days of oral OME treatment ［relative risk (RR)=1.27, 95% confidence interval(CI): 1.03-1.57, P=0.03］. The differences of the pain relief time, the incidence of adverse drug reactions, and the recurrence rates of six months between the patients with oral PAN treatment and the patients with OME treatment were not significant. The differences of the ulcer healing rates, the pain relief rates, the incidence of adverse drug reactions, and the recurrence rates of six months between the patients with intravenous PAN treatment and the patients with intravenous OME treatment were not significant.ConclusionBoth PAN and OME are safe and effective drugs for duodenal ulcer treatment.
  • Efficacy and safety of pantoprazole sodium versus rabeprazole sodium in prevention of gastrointestinal hemorrhage after percutaneous coronary intervention
    Zhang Lixin;Fan Rong;Ren Tianshu;Ren Liuli;Dang Dasheng;Shi Guobing
    2015, 17(1): 11-4.
    Abstract ( ) PDF ( )
    ObjectiveTo explore the short-term efficacy and safety of the proton pump inhibitor (PPI) pantoprazole sodium versus rabeprazole sodium for preventing gastrointestinal hemorrhage after percutaneous coronary intervention (PCI) which used aspirin and clopidogrel dual antiplatelet therapy.MethodsThe clinical data of patients who were hospitalized in the General Hospital of Shenyang Military Command during February to April 2014 and were diagnosed as coronary heart disease (CHD) and received PCI were collected and analyzed retrospectively. The patients were divided into pantoprazole group (an IV infusion of pantoprazole sodium 40 mg in 0.9% 100 ml sodium chloride, once daily) and rabeprazole group (oral rabeprazole sodium 10 mg once daily). Three days before PCI, the two groups received dual antiplatelet therapy with clopidogrel and aspirin. The occurrence of gastrointestinal hemorrhage and major cardiovascular events and incidence of adverse reactions within two months after PCI were compared.ResultsA total of 84 patients were enrolled in this study, each group had 42 cases. Pantoprazole sodium group comprised 23 males and 19 females with an average age of (65±8) years; rabeprazole sodium group comprised 22 males and 20 females with an average age of (66±8) years. During follow-up, none of the two groups of patients developed gastrointestinal hemorrhage, no cardiovascular events including myocardial infarction, recurrent angina, stent thrombosis, revascularization occurred. The incidence of gastrointestinal reaction in the pantoprazole sodium group and rabeprazole sodium group were 9.5%(4/42) and 11.9%(5/42), respectively. The results of liver function, kidney function and blood routine tests were within normal range in two groups before and after treatment. Before treatment, pantoprazole sodium group serum aspartate aminotransferase ［(47±28)U/L］ was higher than that of rabeprazole sodium group ［(24±13)U/L］, the difference was significant (P=0.020). After treatment, pantoprazole sodium group serum aspartate amino-transferase (28±15) U/L was significantly lower than that before treatment (P=0.026).ConclusionsIn patients underwent PCI and dual antiplatelet therapy, combined treatment with pantoprazole sodium or rabeprazole sodium may be effective in preventing gastrointestinal hemorrhage and do not increase the risk of cardiovascular events within short time. There was no significant difference in efficacy and safety for preventing gastrointestinal hemorrhage in short-term between intravenous pantoprazole sodium and oral rabeprazole sodium.
  • Analysis on lansoprazole-induced microscopic colitis in 62 patients
    an Guobao;Lei Zhaobao
    2015, 17(1): 15-4.
    Abstract ( ) PDF ( )

    ObjectiveTo analyze the clinical characteristics and risk factors of lansoprazole-induced microscopic colitis (MC).MethodsPubMed, Da-Yi medical search, CHKD and Wanfang databases were searched and articles related to MC induced by lansoprazole were collected. The patients′primary diseases, coexisting diseases, the dosage, the way of administration, combination drugs, latent period, clinical manifestations, colonoscopic findings, the treatment measures, and the outcomes were recorded and the clinical characteristics, the risk factors of MC induced by lansoprazole were analyzed.ResultsA total of 30 articles and 62 patients with MC induced by lansoprazole were retrieved. All articles were case reports and no randomized controlled trials were found. Of all the 62 patients, 22 were male (35.5%) and 40 were female (64.5%) with age from 36 to 92 years and the average age was (69±12) years; 57 patients (91.9%) were >50 years; 43 patients were with collagenous colitis (CC) (69.4%) , 18 patients (29%) were with lymphocytic colitis (LC), and one patient with LC changed into CC (1.6%). All patients were treated with oral lansoprazole. The latent period of MC induced by lansoprazole were 5d-6 years and within 1-6 months in 31 patients (60.8%) . The most common clinical manifestations were non-bloody watery diarrhea (3-10 times daily in 59 patients, >10 times daily in 3 patients). Intestinal mucosal screening was performed for all the patients and mild abnormalities or edema were observed in 37 patients, mucosal defect and mucosal laceration in 11 patients, epithelial collagen layer thickening, inflammatory cells infiltration in lamina propria, increased lymphocytes in intraepithelial spaces in 18 patients. High-risk drugs for drug-induced MC were combined use in 20 patients and the combination drugs in 13 patients were non steroidal anti-inflammatory drugs. Fifty-eight patients with mild or moderate drug-induced MC returned to normal after withdrawl of lansoprazole and treatment with omeprazole or rabeprazole sodium and 4 patients with severe drug-induced MC recovered after withdrawl of lansoprazole and treatment with glucocorticoids.ConclusionsThe clinical characteristics in patients with MC induced by lansoprazole are watery diarrhea, mild abnormality or edema of colon mucosa, and thickening in the epithelium of colonic mucosa in histopathology. Age, gender, and combined use of drugs may be related to occurrence of MC induced by lansoprazole.

  • Development of a list of potentially inappropriate medication for the Chinese aged people
    Yan Yan;Wang Yuqin;Shen Qian;Jiang Dechun;Li Xiaoling;Liu Chen;Li Xingwei
    2015, 17(1): 19-8.
    Abstract ( ) PDF ( )
    ObjectiveTo develop a list of potentially inappropriate medication (PIM) for the Chinese aged people and provide reference for prevention and reduce the medication risk of the aged people.MethodsBased on the PIM lists of the United States, Canada, Japan, France, Norway, Germany, South Korea and Austria, and combined with the data of serious adverse drug reactions (ADR) in the aged people collected from China National Center for ADR Monitoring, ADR monitoring center in the People′s Liberation Army, Beijing Center for ADR Monitoring and ADR data from Beijing 22 hospitals, we created a preliminary PIM list for the Chinese aged people. Using Delphi technique experts consultation was made for the initial list. Round 1 consultantation invited 32 experts, according to the expert advice to adjust the initial list, and form a revised list. Round 2 consultantation invited 38 experts, according to the expert advice to adjust revised list, and the final version of the PIM list formed. ResultsA total of 13-class 72 medications or medication classes were selected as the Chinese aged people PIM list, each medicine had 1-6 risk points. The list was divided according to the result of expert evaluation into 35 kinds of high risk medications and 37 kinds of low risk medications. In addition, according to the frequency of drug use, the medications were divided into A and B two categories, including 24 medications or medication classes as the preferred alert medications (A), 48 medications or medication classes as routinely alert medications (B).ConclusionPIM list for the Chinese aged people have been developed, which can be taken as reference to intervention and evaluation of China′s elderly medication.
  • Analysis for risk factors of adverse drug reactions related to iodinated contrast medium
    Gao Ruya;Ji Liwei;Zhu Kongcai;Hu Xin;Cao Guoying
    2015, 17(1): 27-9.
    Abstract ( ) PDF ( )
    ObjectiveTo analyze the risk factors of adverse drug reactions related to iodinated contrast medium.MethodsAll the hospitalized patients, who underwent coronary angiography (CAG) or percutaneous coronary intervention (PCI) from April 20th 2013 to July 20th 2013 in Beijing Hospital, were investigated using a questionnaire on usage of iodinated contrast medium designed by the research group. The investigation included patients′ basic information, main discharge diagnosis, information on surgery, combined drugs, the results of laboratory tests before and after using iodinated contrast medium, and information on adverse drug reactions and adverse events. The questionnaire was filled in by the research group according to the patient′s subjective feelings one day after surgery and on discharge and the medical records. Using the patient′s sex, age, body mass index (BMI), CAG or PCI, usage of iodinated contrast medium, allergic history, history of drinking, coexisting diseases, kinds of iodinated contrast medium used this time, and combined drugs as independent variables, the whole iodinated contrast medium-related adverse reactions and adverse reactions of single system were studied by the single-factor analysis. The significant statistical variables were selected and the logistic regression analysis including odds ratio (OR) and 95% confidence interval (CI) was performed. ResultsTotally 581 patients were enrolled into this study; 364 were men (62.7%) and 217 women (38.3%) with an average age of (65±12) years (29-90). The patients′ levels of BMI were 15.8-41.0 kg/m2 with an average level of (25.5±3.4) kg/m2. Of them, 338 patients (58.2%) underwent CAG and 243 patients (41.8%) underwent PCI. The number of patients receiving iohexol injection (Shuangbei), iohexol injection (Omnipaque), iodixanol injection (Visipaque), and iopromide injection (Ultravist) were 173 (29.8%), 160 (27.5%), 164 (28.2%), and 84 (14.5%), respectively. And the dosage of iodinated contrast medium was 23-500 ml with an average dose of (136±77) ml. Of the 581 patients, 69 patients (11.9%) developed iodinated contrast medium-related adverse reactions. The incidences of Shuangbei, Omnipaque, Visipaque, and Ultravist were respectively 12.7% (22/173), 7.5% (12/160), 18.3% (30/164), and 6.0% (5/84) and there were no statistically significant differences among the different kinds (P＜0.05, P＜0.01). The 69 patients experienced 88 adverse reactions in total including 60 mild reactions and 28 moderate reactions. These reactions involved skin and accessories (23 reactions, 26.1%), central and peripheral nervous system (17 reactions, 19.4%), gastro-intestinal system (14 reactions, 15.9%), autonomic nervous system (12 reactions, 13.6%), urinary system (12 reactions, 13.6%), systemic disorders (8 reactions, 9.1%), and musculoskeletal system (2 reactions, 2.3%). The logistic regression analysis showed that the risk factors of skin and accessories disorders were duration of hospital stay (OR=1.083, 95%CI: 1.024-1.146, P=0.005), history of liver disease (OR=4.483, 95%CI: 1.815-11.072, P=0.001), and allergic history (OR=5.686, 95%CI: 2.136-15.135, P=0.001); the risk factors of gastro-intestinal system disorders were history of liver disease (OR=3.879, 95%CI: 1.110-13.552, P=0.034) and insulin use (OR=3.764, 95%CI: 1.087-12.027, P=0.036); the risk factors of central and peripheral nervous system disorders was allergic history (OR=6.778, 95%CI: 1.187-38.685, P=0.031); the risk factors of urinary system disorders was anti-infective drug use (OR=6.918, 95%CI: 1.425-33.589, P=0.016); the risk factors of musculoskeletal system disorders was BMI (OR=0.608, 95%CI: 0.376-0.984, P=0.043); the risk factors of the systemic reactions were history of liver disease (OR=2.925, 95%CI: 1.412-6.061, P=0.004), having PCI (OR=2.546, 95%CI: 1.071-6.054, P=0.034), underweight (OR=10.743, 95%CI: 2.040-56.572, P=0.005), and allergic history (OR=2.925, 95%CI: 1.191-7.183, P=0.019).ConclusionsThe main risk factors of adverse drug reactions related to iodinated contrast medium to different system were different. The main systemic risk factors of the iodinated contrast medium-related adverse reactions were history of liver disease, underweight, and allergic history.
  • Efficacy and safety of dinoprostone suppositories in treatment for promoting cervical ripening:a randomized controlled trial
    Liu Da;Wei Jun
    2015, 17(1): 36-4.
    Abstract ( ) PDF ( )
    ObjectiveTo investigate the efficacy and safety of dinoprostone suppositories in treatment for promoting cervical ripening.MethodsA randomized controlled clinical trial was conducted. The full-term pregnant women whose cervical conditions were not ripe in Shengjing Hospital of China Medical University from September 2011 to September 2013 were randomly divided into the dinoprostone suppositories group (one dinoprostone suppository was placed in the posterior vaginal fornix and removed 12 hours later) and the oxytocin group (an intravenous infusion of 2.5 U oxytocin in 0.9% sodium chloride solution for injection 500 ml was infused slowly) by envelope sortition method. The efficacy was evaluated by Bishop score before and 6 and 12 hours after drug administration, the first, second, and third stage labor and total labor time, and the rate of vaginal delivery. Safety evaluation index included the incidence of drug adverse reaction in the pregnant women, fetal distress, and neonatal asphyxia.ResultsThe Bishop scores 6 and 12 hours after drug administration in the dinoprostone suppositories group［(6.5±0.8) and (8.3±0.9)］ were higher than the Bishop scores before drug administration in the dinoprostone suppositories group (4.2±0.6) and the Bishop scores 6 and 12 hours after giving the drug in the oxytocin group ［(4.2±0.6) and (4.5±0.3)］, the differences were statistically significant (all P＜0.05). The total effective rate to promote cervical ripening in the dinoprostone suppositories group ［85.0% (221/260) ］ was significantly higher than that in the oxytocin group ［23.1% (60/260) ］(P=0.01). The first and second stage labor and total labor time in the dinoprostone suppositories group were significantly shorter than that in the oxytocin group (all P<0.05). The rate of vaginal delivery in the dinoprostone suppositories group ［90.8% (236/260)］ was significantly higher than that in the oxytocin group［46.9% (122/260)］ (P=0.01). The incidence of drug adverse reaction in the pregnant women, fetal distress, and neonatal asphyxia were respectively 7.0% (18/260), 4.7% (12/256), and 3.9% (10/256) in the dinoprostone suppositories group and were respectively 6.2% (16/260), 4.8% (14/253), and 4.3% (11/253) in the oxytocin group, there were no statistically significant differences between the two groups (all P>0.05).ConclusionThe efficacy of dinoprostone suppositories for promoting cervical ripening was better than oxytocin and dinoprostone suppository showed a good safety profile.
  • Analysis of severe medication errors in the Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University from 2010 to 2013
    Chen Zhidong
    2015, 17(1): 40-4.
    Abstract ( ) PDF ( )
    ObjectiveTo understand occurrence and causes of severe medication errors (SME) in hospital and provide a basis for formulating preventive measures.MethodsAdverse drug reactions or adverse events cases which were reported by the Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University from 2010 to 2013 were collected. And the ME cases of category E to I (Categories E through I were respectively errors occurred that may have contributed to or resulted in temporary harm to the patient ［E］, hospitalization or prolonged hospitalization ［F］, permanent patient harm ［G］, required intervention necessary to sustain life ［H］, and the patient′s death ［I］. SME contained ME of category E to I.) were selected and analyzed retrospectively. Main analysis indexes included category, clinical manifestation, triggering factor, and involved drug and department. ResultsA total of 511 adverse drug reactions or adverse events cases were collected. Of them, 80 SME cases (15.66%) were selected. Proportion of SME cases in 2010 to 2013 were respectively 22.52%(59/262), 16.67%(10/60), 3.95%(3/76), and 7.08%(8/113) to all the adverse drug reactions or adverse events cases in that year. Of the 80 SME cases, the proportion in 2010, 2011, 2012, and 2013 were respectively 73.75% (59 cases) , 12.50% (10 cases), 3.75% (3 cases), and 10.00% (8 cases) and the proportion of category E, H, and I were respectively 95.00% (76 cases), 3.75% (3 cases), and 1.25% (1 case). The most manifestation of ME of category E was skin rash and all the symptoms of ME of category H were anaphylactic shock. ME of category I caused the patient′s death. In 80 SME cases, there were 81 records including 78 records (96.30%) of excessive doses for one time and 1 record each of excessive doses for a day, insufficient solvent, and contraindication. The 80 SME cases were related to 18 kinds of drugs and, of them, 76 records (93.83%) were related to 14 kinds of antibacterial agents. The 80 SME cases were associated with 14 departments and the top three were respectively the department of emergency(46.25%, 37/80), osteology(15.00%, 12/80), and general surgery(11.25%, 9/80).ConclusionsThe ME of category E was primary SME in our hospital and the main triggering factor was excessive doses for one time. However, there was 1 ME case of category I which resulted in the patient′s death. So some effective preventive measures should be carried out to strengthen prevention.
  • Progress in studies on embryo toxicity of nano drug delivery system
    Tang Hongbo;Zhou Zhimin;Yan Suying;Liang Xinyun;Li Yifan;Dai Yinmei;Feng Xin
    2015, 17(1): 44-5.
    Abstract ( ) PDF ( )
    Nano drug delivery system (NDDS) is a kind of drug delivery system which are made up of drugs and drug carriers and their particle sizes are less than 1 000 nm. In general, polymeric micelles, liposome, nano capsule, microemulsion, and organic or inorganic nanoparticles are used as carriers in NDDS, pharmacodynamic substance and carriers are combined into new type of controlled/slow release preparations or the drugs are directly processed into nanoparticles. Embryo toxicity is an important index for non-clinic safety evaluation of NDDS. The in vitro studies showed that embryo toxicity of NDDS is related to physical and chemical properties of nanoparticles, such as size and modification materials on surface, exposure time of nanoparticles, and dosage. It has been shown that zinc oxide nanoparticles have embryo toxicity, titanium dioxide, silica, magnesium oxide, and quantum dots have different degrees of embryo toxicity, and polystyrene based nanoparticles have no embryo toxicity. The in vivo studies showed that zinc oxide nanoparticles, quantum dots containing cadmium or selenium, and high concentrations of nano silver have embryo toxicity in one or several animal models, such as rat, mouse, zebrafish, Paracentrotus lividus, Xenopus laevis, and Mytilus Galloprovincialis. Silica, titanium dioxide, chitosan nanoparticles and single-walled carbon nanotubes at different dose and size showed different effects on embryonic development of different animal models. Embryotoxic or teratogenic effects of NDDS include stagnation, miscarriage, and deformity, and the mechanism of toxicity is mainly related to oxidative stress and inflammation. Though embryo toxicity of NDDS in models, methods and content need further exploration and research, studies which have been carried out provide important references for further research.
  • Research progress in correlation between genetic polymorphism and adverse drug reactions
    Zhou Ting;Wang Chunjiang;Su Qunfang
    2015, 17(1): 49-5.
    Abstract ( ) PDF ( )
    PubMed, Nature database, ScienceDirect database and China National Knowledge Infrastructure(from year 2009 to 2013)were searched. The journal articles on correlation between gene polymorphism and adverse drug reactions were collected and analyzed. This article reviews the articles on correlation between adverse drug reactions and pleomorphic gene of metabolic enzymes, transporters, immune molecule and receptors. The metabolic enzymes mainly included cytochrome P450 2C9, N-acetyltransferase 2, uridine diphosphate glucuronosyl transferase 1A6, methylenetetrahydrofolate reductase, matrix metalloproteinase-9 and dihydropyrimidine dehydrogenase. The transporters mainly included solute carrier family 22 member 2, calcium channel, voltage-dependent, gamma subunit 6, solute carrier family 6 member 12, and ATP-binding cassette B1. The immune molecules mainly included human lymphocyte antigen (HLA) for instance HLA-B, HLA-A and HLA-C. The receptors mainly included dopamine 2 receptors/ankyrin repeat and kinase domain containing 1 Taq IA, chemokine receptor 3, orphan nuclear receptor NR4A1, pregnane X receptor and interleukin-4-receptor alpha. Understanding the relationship between gene polymorphism and adverse drug reactions is helpful to facilitate individualized drug administration and avoid or reduce the occurrence of adverse reactions.
  • Peripheral neuropathy induced by lamivudine
    hao Xiaowei;Chen Hongli;Xu Canli
    2015, 17(1): 54-1.
    Abstract ( ) PDF ( )
    A 56-year-old female patient with chronic hepatitis B was treated with lamivudine 100 mg once daily. Three years later, the patient developed numbness of extremities. Electromyography showed slower sensory nerve conduction velocity. She was given treatment with vitamin B1 and mecobalamin for two months, but her symptoms was not improved. Lamivudine was discontinued and therefore switched to adefovir dipivoxil 100 mg once daily. Two months later, her symptom of numbness improved significantly.
  • Epileptic seizures induced by cefoperazone sodium and sulbactam sodium
    Xiao Changqian;Han Qi
    2015, 17(1): 55-2.
    Abstract ( ) PDF ( )
    A 79-year-old man received an intravenous (IV) infusion of cefoperazone sodium and sulbactam sodium 1.5 g every 12 hours with concomitant use of levofloxacin 0.5 g once daily，doxofylline injection 0.2 g via pump twice daily, and an IV push of 45 mg ambroxol injection twice daily for acute exacerbation of chronic obstructive pulmonary disease. Levofloxacin was discontinued after 7 days of treatments ambroxol and doxofylline were discontinued after 13 days of treatments. Just after completion of the infusion of cefoperazone sodium and sulbactam sodium on day 16 of treatment, the patient suddenly experienced unconsciousness, convulsion of extremities, gnathospasmus, and eyes gazing rightwards, which lasted about one minute. An IV injection of methylprednisolone sodium succinate 40 mg was given immediately and 1 minute later, his consciousness restored and symptoms relieved. And then an IV injection of sodium valproate 400 mg and sodium valproate 30 mg/h via a pump were given. On day 17, 2 hours after completion of the infusion of cefoperazone sodium and sulbactam sodium, the symptoms mentioned above appeared again. An IV push of diazepam 5 mg and sodium valproate 80 mg/h were given and 2 minutes later, the symptoms alleviated gradually. Subsequently, cefoperazone sodium and sulbactam sodium was discontinued, an IV push of sodium valproate 400 mg once daily and an oral sodium valproate 0.5 g twice daily were given. After that, he didn′t experience epilepsy seizure again.
  • Torsades de pointes after receiving an intravenous infusion of levofloxacin lactate
    Lyu Shichen;Liu Lingling
    2015, 17(1): 57-2.
    Abstract ( ) PDF ( )
    A 87-year-old female patient received an intravenous infusion of levofloxacin lactate (300 mg/100 ml) and vitamin C 1.0 g for community-acquired pneumonia. Fourteen hours later, about 40 minutes after the second levofloxacin lactate infusion start, the patient presented with chill, shortness of breath, and vomiting and the infusion was stopped immediately. And then she developed respiratory and cardiac arrest. After 1 minute of cardiopulmonary resuscitation, she returned to normal breath and heartbeat and experienced atrial fibrillation with a heart rate of 150 beats/min. About 30 minutes of nitroglycerin infusion via pump start, the patient developed suddenly unconsciousness and ventricular tachycardia and returned to sinus rhythm after undergoing electroversion. Fifteen minutes later, the electrocardiogram showed torsades de pointes with a heart rate-adjusted QT interval of 557 ms. Nitroglycerin was withdrawn and amiodarone was given. Torsades de pointes did not recur. At the next night, her electrocardiograph monitoring revealed frequent torsades de pointes. Amiodarone was given immediately and, about 15 seconds later, she returned to sinus rhythm. Hereafter, the patient did not developed torsades de pointes again.
  • Anaphylactic shock and cardiac arrest induced by iobitridol injection
    Liu Xianjun
    2015, 17(1): 58-2.
    Abstract ( ) PDF ( )
    A 74-year-old man with old fracture of right femoral neck was planned to undergo CT angiography to determine whether there were both lower extremities arteriosclerosis occlusion. The patient was negative for iodine anaphylactic test. About one minute after an IV injection of iobitridol start, the patient suddenly experienced loss of consciousness, asphygmia, and undetectable blood pressure. Iobitridol was stopped immediately and he was given oxygen inhalation and cardiopulmonary resuscitation immediately. Five minutes later, his heart rate was 121 beats per minute and blood pressure was 86/47 mmHg. An intravenous injection of dexamethasone 10 mg and epinephrine 3 mg were administered. Twenty-three minutes later, his heart rate was 119 beats per minute and blood pressure was 205/140 mmHg. Agitation appeared in the patient. Twenty-nine minutes later, his heart rate was 99 beats per minute and the electrocardiogram showed sinus rhythm. The patient was continuously treated with anti-infection, improvement of cardiac function, and alleviation of pulmonary edema. Seven days later, the patient′s condition was stable.
  • Hematuria due to concomitant use of low dose clopidogrel and aspirin
    Liu Jun;Zhu Yanhong
    2015, 17(1): 60-2.
    Abstract ( ) PDF ( )
    A 76-year-old male patient with acute coronary syndrome received regularly aspirin (0.1 g once daily), clopidogrel (50 mg once daily), atorvastatin calcium (20 mg once daily), and isosorbide mononitrate (10 mg twice daily) by mouth after undergoing percutaneous coronary intervention. He suffered from left lumbago with gross hematuria after 2 months of treatments. Laboratory tests showed the following values：urine occult blood(+++)，235 red blood cells per microlitre and 17 red blood cells per high power field. Urinary system ultrasonography and renal function detection showed no abnormalities. Aspirin and clopidogel were withdrawn and the symptomatic treatments were given. Two days later, the patient′s urine recovered to normal，his left lumbago was alleviated, and the red blood cell in his urine was negative. Gene polymorphism detection of cytochrome P-450(CYP)2C19 showed that the patient carried CYP2C19*17(CT) allele and CYP2C19 enzyme had ultra rapid metabolism. Aspirin was given orally and the hematuria did not appear again.
  • Severe thrombocytopenia induced by sertraline
    He Yanxia;Xue Bing
    2015, 17(1): 61-2.
    Abstract ( ) PDF ( )
    A 75-year-old woman with chronic obstructive pulmonary disease received sertraline 25 mg once daily for anxiety and depression. Her hemoglobin was 140 g/L and platelet count was 175×109/L before taking sertraline. Three days after drug administration, she presented with melena and was stool occult blood positive. Blood routine examination revealed that the hemoglobin was 60 g/L and platelet count was 2×109/L. Sertraline was stopped and two doses of platelet were transfused. Intravenous dexamethasone 5 mg was given. The next day, the platelet count was 15×109/L accompanied with the improvement in hematochezia. The platelet count reached 25×109/L and 85×109/L on the third day and tenth day after sertraline discontinuation respectively. On day 13, her platelet count returned to 105×109/L.
  • Piperacillin sodium and tazobactam sodium-induced acute renal insufficiency
    Shu Wenlin;Su Zhijian
    2015, 17(1): 63-2.
    Abstract ( ) PDF ( )
    An 88-year-old male patient with chronic obstructive pulmonary disease received an IV infusion of piperacillin sodium and tazobactam sodium 4.5 g twice daily for lung infection. His renal function was normal before drug use. On day 2, his serum urea and creatinine were 9.7 mmol/L and 164 μmol/L respectively, and 24 hour urine volume was 100 ml. He was given bladder irrigation but still had anuria. Acute renal insufficiency was considered. On day 3, the patient was treated with continuous renal replacement and piperacillin sodium and tazobactam sodium was stopped. On day 6, the urine volume increased to 2 150 ml. After an interval of 4 days, the patient received piperacillin sodium and tazobactam sodium (the same dosage as before) again for secondary lung infection. On the second day, the patient developed oliguria again and his serum urea and creatinine were 34.9 mmol/L and 382 μmol/L respectively. Piperacillin sodium and tazobactam sodium was withdrawn. Two days later, the urine volume increased obviously. Four days later, his serum urea and creatinine were 12.9 mmol/L and 168 μmol/L respectively.
  • ranulocytopenia in a child with hepatolenticular degeneration induced by a penicillamine provocation test
    Chen Yuan;Geng Jianghui;Yang Shibin;Zhang Huifeng
    2015, 17(1): 64-2.
    Abstract ( ) PDF ( )
    An 8-year-old boy underwent a penicillamine provocation test to confirm the diagnosis of hepatolenticular degeneration. Before the test, the laboratory examination showed the following levels: white blood cell count 8.3×109/L, neutrophil 6.0×109/L, hemoglobin 101 g/L, and platelet count 120×109/L. And 24 hours after oral penicillamine 250 mg once, the levels of his white blood cell count, neutrophil, hemoglobin, and platelet count were 1.6×109/L, 0.6×109/L, 105 g/L, and 92×109/L, respectively. The child was given oral prednisone 10 mg twice daily and two tablets of Diyu Shengbai (地榆升白片) twice daily. Five days later, the re-examination showed his white blood cell count of 3.5×109/L with neutrophil of 1.9×109/L, the hemoglobin level of 108 g/L, and the platelet count of 88×109/L。
  • Acute liver injury induced by alfacalcidol
    Zhang Shengyu;Wang Xia;Jiang Ling;Shi Tianlu
    2015, 17(1): 66-2.
    Abstract ( ) PDF ( )
    A 25-year-old man with chronic renal insufficiency received oral alfacalcidol 0.5 μg every night, compound α-Ketoacid 2.52 g thrice daily, Shengxuening (生血宁) 0.5 g thrice daily, and subcutaneous injection recombinant human erythropoietin 2500 U once every other day. On day 15, laboratory tests showed the following results: alanine aminotransferase (ALT) 411 U/L，aspartate aminotransferase (AST) 341 U/L. He was given an IV infusion of reduced glutathione 1.2 g once daily. The next day, aminotransferase levels continue to increase, combined with an IV infusion of polyene phosphatidylcholine 465 mg once daily. On day 20, his liver function reexamination showed the following levels: ALT 1 768 U/L, AST 1 164 U/L, alkaline phosphatase 338 U/L, gamma-glutamyl transferase (γ-GT) 210 U/L. The alfacalcidol was stopped at that day and other drugs were continued. Three days after withdrawal, the levels of ALT, AST, and γ-GT were 644 U/L, 206 U/L, and 254 U/L, respectively. Fourteen days later, the level of ALT and AST decreased to 47 U/L and 58 U/L.
  • Neuroleptic malignant syndrome associated with concomitant use of levodopa and benserazide hydrochloride, olanzapine, and chlorpromazine
    Wang Haifei
    2015, 17(1): 67-2.
    Abstract ( ) PDF ( )
    A 71-year-old man with Parkinson′s disease received levodopa and benserazide hydrochloride 0.25 g twice daily for two years. Olanzapine 2.5 mg twice daily was added to his regimen for brain organic mental disorders. On day 3, the patient developed agitation and received an intramuscular injection of chlorpromazine 50 mg. On day 5, he developed temperature of 38.8 ℃, elevated serum creatine kinase (424 U/L), and muscle rigidity. On day 11, he presented with temperature of 39.2 ℃, stupor, and soy-colored urine. Laboratory tests showed the following findings: white blood cell count 9.5×109/L, neutrophile granulocyte 0.9, and creatine kinase 939 U/L. Neuroleptic malignant syndrome was diagnosed. Olanzapine and levodopa and benserazide hydrochloride were withdrawn. Meanwhile symptomatic and supportive treatments such as naloxone, medium and long chain fat emulsion, compound amino acid, enteral nutritional suspension, and dexamethasone were given. On day 13, his body temperature returned to within normal range. On day 15, the creatine kinase level decreased to 109 U/L. On day 17, levodopa and benserazide hydrochloride was resumed.
  • Death attributed to severe myelosuppression caused by the treatment of epirubicin combined with docetaxel
    Cao Kai;Sun Min;Li Jing;Si Jigang
    2015, 17(1): 69-2.
    Abstract ( ) PDF ( )
    A 57-year-old woman with breast cancer received combined chemotherapy of epirubicin (an IV infusion of 50 mg on day 1 and day 2) and docetaxel (an IV infusion of 100 mg on day 1). Her myelogram was normal before chemotherapy. On day 11 of the first period of chemotherapy, she developed fever, hypodynamia, and watery stool. The blood routine examination showed white blood cell count (WBC) 1.7×109/L, red blood cell count (RBC) 3.2×1012/L, hemoglobin (Hb) 101 g/L, platelet count (PLT) 65×109/L. On day 13, the examination showed WBC 0.08×109/L, neutrophil count (NEUT) 0, RBC 3.3×1012/L, Hb 101 g/L, PLT 31×109/L. On day 14, WBC 0.1×109/L, NEUT 0, RBC 2.6×1012/L, Hb 89 g/L, PLT 7×109/L. The patient developed secondary severe pneumonia and acute respiratory distress syndrome. The symptomatic and supportive treatments including anti-infection and stimulating leukocytes production were given. However, the patient′s condition did not improve significantly. On day 14 of the first period of chemotherapy, the patient eventually died due to respiratory and circulatory failure.
  • Severe erythema multiforme caused by sodium ozagrel
    Zhang Fan;Zhang Luming;Zhang Wenzhou
    2015, 17(1): 70-3.
    Abstract ( ) PDF ( )
    A 78-year-old male patient with cerebral infarction received an IV infusion of ozagrel sodium 40 mg twice daily. On day 2, the patient developed purple rash with itching on his feet and left groin. A review of his medical history revealed that he had similar symptoms after taking ozagrel sodium 2 years ago. Ozagrel sodium was withdrawn and anti-allergic therapy was given. On day 3 of ozagrel sodium withdrawal, purple rash occurred on his hands and right groin. He was given an IV infusion of methylprednisolone 40 mg once daily and oral chlorphenamine 4 mg once daily. His symptoms gradually exacerbated, on day 5, the patient presented with blister on the rash and oral-mucosal erosion. It was diagnosed as erythema multiforme induced by drug. Methylprednisolone administration was changed to a 40 mg IV infusion twice daily. Three days later, his erythema was lighter in color than before and no new rashes occurred. Methylprednisolone was stopped. Two days after methylprednisolone withdrawal, the patient experienced aggravated eruption on left foot with pain and a high temperature of 39 ℃. Methylprednisolone 40 mg twice daily was administered again. Three days later, the temperature declined to normal. Eight days later, the rash on the feet, hands, and the groin basically subsided, the pain and itching disappeared, the blister became scabby or exfoliated and the oral mucosa erosion healed. Methylprednisolone was switched to oral prednisone and the dose was reduced each week until the drug stopped. Two weeks after prednisone discontinuation, the rashes disappeared completely.
  • Disulfiram like reaction due to cefaclor
    Wang Huijuan;Cao Tao;Wang Zheng;Li Yalin;Wang Changyuan
    2015, 17(1): 72-2.
    Abstract ( ) PDF ( )
    A 60-year-old male suddenly developed right limb weakness and disturbance of consciousness on process of drinking. One hour later, he was sent to the Emergency Department，Xuanwu Hospital of Capital Medical University. Physical examination showed blood pressure of 70/40 mmHg, heart rate of 112 beats/min, breathing rate of 20 times/min, sluggish light reflex, both upper limbs muscle strength of grade 0, Babinski sign of left side(+)and right side(±). His random blood glucose was 6.4 mmol/L and his cranial CT examination was normal. Electrocardiographic monitoring, oxygen inhalation, and drugs of raising blood pressure were given immediately. Two hours after visiting the emergency department, the patient developed vomiting and received IV naloxone 0.4 mg. About 5 hours after visiting emergency, the doctor was informed from the patient′s family member that the patient might have taken cefaclor. Disulfiram-like reactions due to drinking after administration of cephalosporin antibiotics was considered. Then dexamethasone 5 mg intravenously was given and about 7 hours after visiting the emergency department, the patient′s blood pressure was 90/50 mmHg, light reflex was sensitive, muscle strength was grade 5, and bilateral babinski signs were negative. About 14 hours after visiting emergency department, the patient recovered. Then he said he had taken cefaclor for upper respiratory tract infection.
  • Toxic epidermal necrolysis due to overdose of lamotrigine
    Zhang Xi;Ma Xiaoya
    2015, 17(1): 74-2.
    Abstract ( ) PDF ( )
    A 7-year-old boy with epilepsy received sodium valproate (0.25 g in the morning and 0.5 g at night) for 2 years. Lamotrigine was added because of exacerbation of the illness. The dosage of lamotrigine on the first, second and third weeks were 12.5, 25.0, and 37.5 mg once daily, respectively. On day 15 of taking lamotrigine, he developed erythema on foot, accompanied by pruritus and reddening of the eyes. After that the boy developed erythema on entire body, blister on neck, arms and legs, erosion of oral mucosa occurred accompanied by fever. The boy was hospitalized on day 20 of taking lamotrigine. Laboratory tests showed the following values: white blood cell count 7.6×109/L, red blood cell count 3.9×1012/L, hemoglobin 106 g/L, high-sensitivity C-reactive protein (hs-CRP) 5.5 mg/L, albumin 25 g/L, alanine aminotras nferase (ALT) 66 U/L, and aspartate aminotransferase (AST) 58 U/L. Lamotrigine was withdrawn, and the boy received the symptomatic treatments including anti-inflammation, anti-anaphylaxis, liver protection and fluid infusion. On day 3 of admission, the boy developed high fever, drowsiness and shiver. Laboratory tests showed the following values: ALT 47 U/L, AST 33 U/L, lactate dehydrogenase (LDH) 207 U/L, creatine kinase 322 U/L, creatine kinase isoenzyme (CK-MB) 185 U/L, and alpha-hydroxybutyric dehydrogenase 258 U/L. Meanwhile vesicles appeared on erythematous skin and ulcers occurred. A large area of exfoliation appeared on his neck and face. Ulcers were red with exudates. The purulent secretion was secreted from dental ulcer surface. He was diagnosed as toxic epidermal necrolysis. Then the boy received complex treatments included methylprednisolone, compound glycyrrhizin，gamma globulin, and antimicrobial drug. On day 9 of admission, most liquid in the blister on the trunk and limbs were absorbed. Laboratory test showed the following values: LDH 205 U/L, creatine kinase 247 U/L, CK-MB 31 U/L, ALT 28 U/L，and AST 23 U/L. On day 13 of admission, the boy′s vital sign were stable, erythema on the body disappeared. On day 15, he was discharged. The result of follow-up one year later showed no scars on the boy′s skin.
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    Ma Lin;Fu Xiaoxiu;Hu Aijun
    2015, 17(1): 76-2.
    Abstract ( ) PDF ( )
    A 2 and a half years old boy was considered to have pneumonedema due to his pulse oxygen saturation of 0.78 and exudative lesion in bilateral lungs and received auxiliary treatment of tracheal intubation. During the treatment of tracheal intubation, to ensure the boy calm, he was given a continuous intravenous pumping of dexmedetomidine 200 μg at the rate of 10 μg per hour. Seven hours later, his heart rate deceased to 63 beats/min. Dexmedetomidine was withdrawn immediately. One hour later, the boy′s heart rate increased to 130-140 beats/min.
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