2014 Volume 16 Issue 5 Published: 28 October 2014
  

  • Select all
    |
  • Effects of pharmaceutical intervention based on genotype detection on curative effect and safety in hospitalized patients receiving warfarin
    Xiang Qian;Mu Guangyan;Zhao Nan;Zhou Ying;Cui Yimin
    2014, 16(5): 259-5.
    Abstract ( )

    Objective To explore the effects of pharmaceutical intervention based on genotype detection on curative effect and safety in hospitalized patients receiving warfarin.MethodsThe medical records of patients hospitalized in the Department of Cardiology, First Hospital of Peking University whose dosages of warfarin were adjusted according to the results of CYP2C9*2, CYP2C9*3, vitamin K epoxide reductase complex subunit (VKORC1)G-1639A genotype testing from June 2013 to March 2014 (experimental group) and the patients received warfarin but did not carry the genotype testing (control group) from June to December 2012 were collected and analyzed retrospectively. The length of hospital stay, administration time of warfarin, proportion of patients whose international normalized ratio (INR) ≥3.0 had happened, incidence of bleeding associated with warfarin, INR values and warfarin dosage on discharging were compared between the patients in the two groups. The correlation of warfarin dosage on discharging and the suggested dosage proposed by clinical pharmacist, the above-mentioned parameters and the genotype in the experimental group were analyzed.ResultsThere were 102 patients in the experimental group comprised 62 male and 40 female with average age of (63±16) years (14-88). There were 140 patients in the control group comprised 89 male and 51 female with average age of (64±13) years (21-85). The patients′ primary diseases included auricular fibrillation, deep vein thrombosis, pulmonary embolism and renal vein thrombus, etc. There were no statistically significant difference between age and sexual distinction in the 2 groups. The average length of hospital stay and average administration time of warfarin in patients in the experimental group were obviously longer than those in the control group ［(16.7±8.4) d vs. (12.6±6.0) d， (13.2±8.2) d vs. (9.9±6.1) d, all P<0.001］. There were no statistically significant difference of the proportion of INR≥3.0, incidence of bleeding associated with warfarin, and INR values on discharging between the 2 groups. The warfarin dosage on discharging in patients carried CYP2C9*1/*3 (7 cases) were lower than those in the patients carried CYP2C9*1/*1 (95 cases) in the experimental group ［(1.79±0.57)mg/d vs. (3.12±1.13)mg/d，P＝0.003］. The warfarin dosage on discharging in patients carried VKORC1-1639 GG (1 case) and VKORC1-1639GA (20 cases) were more than those in the patients carried VKORC1-1639AA (81 cases) in the experimental group ［6.00,(3.55±1.63)mg/d vs. (2.87±0.92)mg/d，P＝0.002］. The length of hospital stay and administration time of warfarin in patients who INR≥3.0 were longer than those in the patients who INR＜3.0 ［(24.7±10.9)d vs. (15.2±6.9)d，(21.8±10.9)d vs. (11. 6±6.4)d，all P＜0.001］ and the dosages of warfarin on discharging was lower than that in the patients who INR＜3.0 in the experimental group ［(2.50±1.02) mg/d vs. (3.13±1.15) mg/d，P=0.042］. In the control group, the difference of length of hospital stay between the patients who INR ≥3.0 and ＜3.0 was no statistically significant, the administration time of warfarin in patients who INR≥3.0 was longer that in the patients who INR ＜3.0 ［(12.6±6.5)d vs. (9.3±5.8)d，P=0.015］，and the warfarin dosages on discharging was lower than that in the in the patients who INR ＜3.0 ［(2.49±1.17)mg/d vs.(3.11±0.99) mg/d，P＝0.007］. The cases of fecal occult blood positive, slightly higher of red blood cell in the urine, and gingival bleeding were 8 and 14 in the experimental group and the control group, respectively. No severe bleeding was appeared in both groups. The bleeding was significantly correlated with the length of hospital stay and the administration time of warfarin in the control group(P=0.001, P=0.008). There was no correlation between bleeding and warfarin curative indexes in the experimental group.ConclusionsThe pharmaceutical intervention based on genotype detection can eliminate the effect of genetic factors on warfarin curative effect, avoid prolonging hospitalization caused by adjusting the dose repeatedly, and have a positive role in determination of warfarin maintenance dose. The pharmaceutical intervention has no effect on safety. It is suggested that the patient who receives warfarin anticoagulant therapy should do the genotype detection.

    • 论著

  • 论著
    Comparison of efficacy and safety between valproic acid monotherapy and valproic acid in combination with oxcarbazepine for treatment of children with epilepsy
    Zhang Ti;Zhou Jingkai;Liu Mei;Li Shuang;Zhao Limei;Chen Yu
    2014, 16(5): 264-5.
    Abstract ( ) PDF ( )
    ObjectiveTo investigate the efficacy, safety and compliance of valproic acid (VPA) monotherapy and VPA in combination with oxcarbazepine (OXC) in children with epilepsy.MethodsA retrospective analysis of clinical data of children with epilepsy, treated in Shengjing Hospital of China Medical University from October 2012 to October 2013 was performed. The patients were treated with VPA (VPA group) or VPA in combination with OXC (VPA+OXC group) continuously for more than 2 months and were followed up for 1 year. The situation of drug use ［VPA daily dose, OXC daily dose, concentration dose ratio (CDR) of VPA, medication compliance(evaluated by retention raty)］, situation of epilepsy control and occurrence of adverse reactions were recorded and compared.ResultsA total of 208 children were included in the study, 105 children were in the VPA group, 62 male cases and 43 female cases, aged 1 to 15 years, mean (6.8±3.4) years; 103 children were in the VPA+OXC group, 60 male cases and 43 female cases, aged 1 to 15 years, mean (7.4±3.5) years. There was no significant difference in VPA daily dose, CDR, and the retention rate ［(507±207) mg vs.(498±164) mg, (4.2±2.3) (μg·kg)/(ml·mg) vs. (4.3±1.6) (μg·kg)/(ml·mg), 81.9% vs. 79.6%, respectively, P>0.05)］. At one year follow-up, the efficacy rate in the VPA+OXC group ［82.5% (85/103)］ was significantly higher than that in the VPA group ［61.9% (65/105)］ (P<0.05). During one year of follow-up, there was no significant difference in liver function abnormalities and adverse reactions in the VPA and VPA+OXC groups ［13.3%(14/105) vs. 15.5%(16/103), 4.8%(5/105) vs. 6.8%(7/103), respectively, P>0.05］. But the incidence of adverse reactions in the 2 groups and the liver function abnormalities in the VPA+OXC group in children aged from 1 to 10 years were higher than that aged from 11 to 15 years (P<0.05); the incidence of adverse reactions and liver function abnormalities in children with CDR of 5-13 (μg·kg)/(ml·mg) was higher than that in children with CDR of 1-5 (μg·kg)/(ml·mg) (P<0.05).ConclusionsThe efficacy, safety and compliance of VPA in combination with OXC treatment is better than that of VPA monotherapy in children with epilepsy. Age and the plasma concentration maybe the risk factors of adverse reactions and liver function abnormalities.
  • 论著
    Comparison of clinical characteristics between the children and adults patients with drug-induced liver injury
    Wang Shuzhen;Liu Hui;Zheng Junfu;Zhang Xin;Li Bing;Li Lei;Ding Huiguo
    2014, 16(5): 269-5.
    Abstract ( ) PDF ( )

    Objective To compare the clinical characteristics between the children and adults patients with drug-induced liver injury (DILI).Methods"Drug-induced liver injury" was selected as the key word and all the medical records in Beijing You′an Hospital Medical Records Management Center from February 2002 to June 2011 were collected. The patients who were ≤14 years were enrolled into the child group. The patients who were ≥15 years were enrolled into the adult group. The medical records of patients in the two groups were collected and analyzed retrospectively. The main analysis parameters included use of medication, clinical manifestation, and clinical pathological classification of DILI.ResultsThe main drugs which can cause DILI in child group were antibacterial drugs (13 cases, 42%), traditional Chinese medicines (9 cases, 29%), and antipyretic analgesics (6 cases, 19%). The main drugs which can cause DILI in the adult group were traditional Chinese medicines (79 cases, 69%), antipyretic analgesics (12 cases, 11%), and antibacterial drugs (8 cases, 7%) . Twenty-six patients (84%) in the child group and 114 patients (100%) in the adult group developed weak, loss of appetite, aversion to fats, nausea, vomiting and yellow urine 3 to 90 days［mean(18±15)days］and 5 to 90 days［mean(30±20)days］ after drug admission, respectively. Part of patients developed fever, erythema and increased eosinophils. There were no significant differences in the levels of serum alanine transaminase (ALT), aspartate aminotransferase (AST), and glutamyltranspetidase between the two groups. But the level of serum alkaline phosphatase (ALP) in the child group was higher than that in the adult group (P＜0.05). The number of mixed DILI, hepatocellular DILI and cholestasis DILI were 15 (48.4%), 8 (25%) and 8 (25%) cases in 31 patients in the child group, respectively. The number of hepatocellular DILI, mixed DILI, and cholestasis DILI were 69 (60.5%), 26 (22.8%) and 19 (16.7%) cases in 114 patients in the adult group, respectively. The proportion of mixed DILI in child group was significantly higher than that in the adult group (P＜0.01). The proportion of hepatocellular DILI in the child group was significantly lower than that in the adult group (P＜0.01). The drugs were withdrawn immediately after the symptoms of DILI appeared in the patient in the two groups. All the patientsion the adult group and 27 children in the child group were improved and discharged. There were 2 cases with depravation of primary diseases, 1 case discharged himself and 1 case died due to hepatic failure in the child groupConclusionsThe main drugs causing DILI are different in children and adult; in children, antibacterial drugs , while in adults traditional Chinese medicine mainly. The mainly liver injury type in children is mixed DILI. The mainly liver injury type in adults is hepatocellular DILI. It should be vigilant towards DILI when the child or adult treated with antibiotics or traditional Chinese medicine.

  • 论著
    Effects of dapagliflozin　on cardiovascular safety in patients with type 2 diabetes mellitus: a Meta-analysis
    Fang Zhenwei;Shi Jia;Tang Huilin;Lin Yang
    2014, 16(5): 274-7.
    Abstract ( ) PDF ( )
    Objective To evaluate the effects of dapagliflozin on cardiovascular safety in patients with type 2 diabetes mellitus.MethodsPubMed (up to November 2013) and Cochrane Library, Embase, CNKI, and Wanfang Database (up to October 2013) were searched using "dapagliflozin", "sodium-glucose cotransporter 2 inhibitor*", "SGLT2 inhibitor*", and "BMS 512148" as keywords. Randomized controlled trials (RCT) concerning the effects on cardiovascular safety of dapagliflozin in patients with type 2 diabetes mellitus were filterted. The intervening measures included dapagliflozin in comparison with placebo or other hypoglycemic agent and combination therapy of dapagliflozin and other hypoglycemic agent in comparison with concomitant use of the same hypoglycemic agent and placebo or another hypoglycemic agent. The primary endpoint was major adverse cardiovascular event (MACE) and the secondary endpoints included myocardial infarction, stroke, all-cause mortality, and cardiovascular mortality. Meta-analysis was conducted using RevMan 5.2 software. The dichotomous outcomes were tested by Mantel-Haenszel and odds ratios (OR) and 95% confidence interval (CI) were calculated.ResultsA total of 11 RCT papers were enrolled in this Meta-analysis. There was no statistically significant difference in the incidence of MACE between the dapagliflozin group (0.39%, 5/1 271) and the placebo group (0.54%, 3/551) (OR=0.65, 95%CI:-0.16-2.65, P=0.55), and also between the dapagliflozin group (0.24%, 1/422) and the metformin group (0.24%, 1/409) (OR=0.97, 95%CI:-0.14-6.88, P=0.98). There was no statistically significant difference in the incidence of stroke between the dapagliflozin group (0.28%, 3/1 060) and the placebo group ( 0.29%, 1/343) (OR=0.76, 95%CI:-0.11-5.14, P=0.77). There was no statistically significant difference in the incidence of all-cause fatalities between the dapagliflozin group (0.26%, 6/2 278) and the placebo group (0.18%, 2/1 082) (OR=0.91, 95%CI:-0.30-2.75, P=0.86), and also between the dapagliflozin group (0.24%, 1/422) and the metformin group (0.24%, 1/409) (OR=0.97, 95%CI:-0.14-6.88, P=0.98). There was no statistically significant difference in the cardiovascular fatalities between the dapagliflozin group (0.24%, 3/1 271) and the placebo group (0.18%, 1/551) (OR=0.81, 95%CI:-0.16-4.27, P=0.81), and also between the dapagliflozin group (0.24%, 1/422) and the metformin group (0.24%, 1/409) (OR=0.97, 95%CI:-0.14-6.88, P=0.98).ConclusionDapagliflozin did not increase the risk of MACE in patients with type 2 diabetes mellitus.
  • 论著
    Analysis of irrational drug use in adverse reaction reports of Chinese patent medicines
    Wu Xiaoling;Zhou Minhua;Deng Jianxiong
    2014, 16(5): 281-5.
    Abstract ( ) PDF ( )
    Objective To understand the effect of rational use of traditional Chinese patent medicines on medication safety.MethodsBy using cluster sampling method, the adverse drug reaction (ADR) reports about traditional Chinese patent medicines (including traditional Chinese medicine for injections) derived from the Center for ADR Monitoring of Guangdong from January 1st, 2011 to December 31st, 2011, were collected and retrospectively analyzed. The information of the patients′ gender, ages, primary diseases, the suspected drugs causing ADR, drug combination, and the situation of ADR occurrence were collected. The situation of irrational drug use in these reports at 7 aspects such as indications, syndrome differentiation treatment, medication methods, dosage, combination of traditional Chinese patent medicines, concomitant use of the traditional Chinese medicines and the Western medicines, and suitability of medication were analyzed according to the protocol of evaluation standards of traditional Chinese patent medicine prescription and the rate of irrational drug use were calculated.ResultsA total of 283 reports in accordance with the inclusion criteria were collected, which comprised 283 patients. Of them, 150 were male and 133 were female with ages from 2 months to 88 years and an average age was (44±23) years. The primary diseases ranking at the top three were respiratory system disease (71 patients), nervous system disease (45 patients), and musculoskeletal system disease (42 patients). The traditional Chinese patent medicines involved in these reports were mainly antipyretic-detoxicating agents, blood activating and stasis removing agents, and reinforcing agents. The rates of irrational drug use associated with indications, medication methods, dosage, combination of traditional Chinese patent medicines, concomitant use of the traditional Chinese medicines and the Western medicines, and suitability of medication were 27.2% (77/283), 6.0% (17/283), 7.1% (20/283), 5.3% (15/283), 6.7% (19/283), 0.7% (2/283), respectively. Fifteen patients′ medication (46.8%)did not fit the syndrome differentiation classification among the 32 reports whose differentiation of syndromes could be identified.ConclusionsThe irrational drug use has marked effect on medication safety of traditional Chinese patent medicines and maybe one of the important factors in relation to adverse reactions induced by traditional Chinese patent medicines. In clinical use of traditional Chinese patent medicines, syndrome differentiation treatment should be the primary principle, medication beyond the indications should be avoided, more attention should be paid to usage and dosage of the drugs, and combination of function-similar traditional Chinese patent medicines and pharmacological action-similar traditional Chinese and Western medicines should be used cautiously.

    • 用药错误

  • 用药错误
    Application of root cause analysis in inadequate communication in adjusting rate of intravenous infusion pump
    Zhang Mengmeng;Zhang Ting;Wang Shuang;Zhao Juan;Zhai Suodi
    2014, 16(5): 286-4.
    Abstract ( ) PDF ( )
    Objective To reduce the occurrence of medication error (ME) by analyzing a case of inadequate communication about the rate adjustment of intravenous infusion pump and making improvable plans and carrying out.MethodsAn ME case of category D was analyzed using root cause analysis (RCA). The steps were as follows: forming an RCA team, collecting and analyzing relevant information on this ME event, drawing flowcharts to mine the direct causes, drawing fishbone diagram to confirm the root causes, and making improvable plans.ResultsThe event was identified as "inadequate communication about the rate adjustment of intravenous infusion pump". The direct causes included inadequate communication between doctors and nurses, lack of record about the rate adjustment of intravenous infusion pump, and nurses′heavy workload. The root cause was lack of a mechanism of carrying out and recording of the rate adjustment of intravenous infusion pump. The improvable plans contained establishing and standardizing the mechanism of carrying out and recording of the rate adjustment of intravenous infusion pump, introducing intelligent intravenous infusion pump or designing an appropriate record sheet of the rate adjustment of intravenous infusion pump to note the process of rate adjustment, reinforcing learning and training of medical staff on norm and standard procedure. The implement achievements were as follows. Standard procedure and regulatory framework were established, the appropriate record sheet of the rate adjustment of intravenous infusion pump were designed, doctors were asked to implement written statement of the rate adjustment and explain when shift exchange, and the charge nurses were asked to implement signature confirmation after the rate adjustment. Meanwhile, the learning and training of medical staff were carried on to clarify about the roles. After a follow-up observation of pharmacist, the kind of the event did not recur in the wards.ConclusionME event could be reduced by establishing standardized flow and regulatory framework, introducing advanced technology, and reinforcing learning and training of medical staff.

    • 综述

  • 综述
    Long-term endocrine therapy-related adverse drug reactions in patients after breast cancer surgery and treatment strategies
    Wang Tao;Ye Qinong;Jiang Zefei
    2014, 16(5): 290-4.
    Abstract ( ) PDF ( )
    Endocrine therapy is an important treatment method for patients after breast cancer surgery. At the present, selective estrogen receptor modulator (such as tamoxifen) and aromatase inhibitors (such as anastrozole, letrozole, and exemestane) are main treatment drugs for patients after breast cancer surgery. The patients receiving adjuvant endocrine therapy need usually about 5 years and some patients need 10 years. The adverse reactions induced by tamoxifen were symptoms related to gynecology and cardiovascular system. The treatment measures include regular detection of the patients′ endometrium, pressure, and blood lipid, etc. and symptomatic treatments. The adverse reactions induced by aromatase inhibitors are as follows. (1) Adverse reactions related to bone. The treatment measures are supplement of vitamin D and calcium, and bisphosphonates maybe given. (2) Joint and muscle symptoms. The patients with mild symptoms are given vitamin D, calcium, and appropriate physical exercise. The patients in marked symptoms are given non steroidal anti-inflammatory drugs or the treatment drugs are stopped for 3-4 weeks. (3) Adverse reactions in cardiovascular system. The patients are given symptomatic treatments.
  • 综述
    Drug-induced rabbit syndrome
    Sun Zhenxiao;Yu Xiangfen
    2014, 16(5): 294-3.
    Abstract ( ) PDF ( )
    Rabbit syndrome(RS) is a tardive extrapyramidal syndrome associated with prolonged use of drugs, especially antipsychotics. The incidence of RS induced by antipsychotics ranged from 1.5% to 4.4%. The clinical characteristics of RS is fast and rhythmic involuntary movement of oral and masticatory muscles. The mechanism of RS may be associated with imbalance of the cholinergic and dopaminergic neurotransmission in the basal ganglia. RS should be distinguished from tardive dyskinesia. About treatment of RS, anticholinergic agents is the first choice. Some patients switching to an atypical antipsychotic with high anti-cholinergic properties is another treatment strategy.
  • 综述
    Study advances for efficacy and safety of polymyxins
    Gao Ruya;Zhu Kongcai;Hu Xin;Cao Guoying
    2014, 16(5): 297-3.
    Abstract ( ) PDF ( )
    Polymyxin E and polymyxin B were the polypeptide antibiotic which were obtained from the Bacillus polymyxa medium. They were used to treat the resistant bacterial infection with Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumonia. The adverse reactions of polymyxin E were renal toxicity and nervous system toxicity. Age, dose and the combination with other drugs are the risk factors of renal toxicity. Combination with antioxidant, free radical scavenger and some Chinese medicine with protective effect on the kidney may reduce the renal toxicity of polymyxin E and improve the curative effect. Patients with renal insufficiency do not need to adjust the dose when they used polymyxin E and polymyxin B. Novel derivatives of polymyxin had lower renal toxicity.

    • 病例报告

  • 病例报告
    Leukopenia and neutropenia caused by cefmetazole sodium
    Hu Yang;Qiu Lulu;Wang Lan;Zhang Bo
    2014, 16(5): 300-2.
    Abstract ( ) PDF ( )
    A 17-year-old woman with infectious endocarditis received an IV infusion of cefmetazole sodium 2 g three times daily and amikacin 0.4 g once daily. On day 6 of treatment, blood routine examination revealed the following levels: leucocyte count 23.4×109/L, neutrophile granulocyte 0.92，neutrophil granulocyte absolute value 21.6×109/L. On day 13 of treatment, blood routine examination revealed the following levels: leucocyte count 6.6×109/L, neutrophile granulocyte 0.70, neutrophil granulocyte absolute value 4.6×109/L. On day 14, amikacin was withdrawn and IV infusion of cefmetazole sodium was given at the original dose sequentially. On day 28 of treatment, blood routine examination revealed the following values: leucocyte count 2.6×109/L, neutrophile granulocyte 0.37，neutrophil granulocyte absolute value 1.0×109/L. Cefmetazole sodium was withdrawn and changed to an IV infusion of vancomycin 0.5 g every 8 hours. Seven days after replacement of drug, blood routine examination revealed the following: leucocyte count 6.1×109/L, neutrophile granulocyte 0.60，neutrophil granulocyte absolute value 3.7×109/L.
  • 病例报告
    Rhabdomyolysis due to concomitant use of Zhibituo(脂必妥) and cyclosporin
    Liang Xiangyu;Du Lin; Chai Limin;Xu Yamei
    2014, 16(5): 301-2.
    Abstract ( ) PDF ( )
    A 66-year-old woman received Zhibituo 0.35 g thrice daily by mouth for hypirlipidemia. Four days after the drug administration, the patient developed ache and weakness of deltoid; 25 days later, the patient developed generalized aching pain, weakness, and hard to walk up and down stairs; on 4 weeks of the drug treatment, laboratory testing showed the following values: creatine kinase (CK) >6 400 U/L, creatine kinase isoenzyme (CK-MB) of 150.7 U/L, lactic acid dehydrogenase (LDH) 611 U/L，alanine aminotransferase (ALT) 52 U/L, aspartate aminotransferase (AST) 121 U/L, blood urea nitrogen 10.1 mmol/L, and creatinine 106 μmol/L. Rhabdomyolysis was diagnosed. The patient received cyclosporine for aplastic anemia for a long time. It was considered that the interaction between Zhibituo and cyclosporin induced the rhabdomyolysis. Zhibituo was stopped and fluid replacement, diuretic, and liver-protective drugs were given. Five days later, the symptoms of generalized aching pain and weakness relieved obviously and CK level decreased to 1 170 U/L. Ten days later, the symptoms of generalized aching pain and weakness disappeared completely and the levels of CK, CK-MB, LDH, ALT, and AST were 59 U/L, 6.3 U/L, 173 U/L, 17 U/L, and 16 U/L, respectively.
  • 病例报告
    Numbness of extremities, tremor, and dyspnea induced by montelukast sodium
    Wu Sanlan;Chen Dongsheng
    2014, 16(5): 303-2.
    Abstract ( ) PDF ( )
    A 45-year-old woman received an intravenous injection of levofloxacin (0.4 g, once daily), Suhuangzhike (苏黄止咳) capsules (3 capsules, thrice daily) by mouth, and montelukast sodium (10 mg at bedtime, once daily) by mouth for acute attack of chronic bronchitis. About 30 min after the first administration of montelukast sodium, the patient developed numbness of extremities and tremor, dyspnea, and generalized weakness, followed by nausea and vomiting and the symptoms lasted for about 2 hours without alleviating. Montelukast sodium was discontinued, levofloxacin and Suhuangzhike capsules were applied continuously, and symptomatic treatments were given at the same time. The numbness of extremities and tremor and dyspnea relieved, nausea and vomiting did not recur until 16 ∶ 00 of the following day.
  • 病例报告
    Ketoacidosis in a boy with idiopathic membranous nephropathy during combined therapy with tacrolimus and low-dose prednisone
    Zhang Huijuan;Guo Qingyin;Ren Xianqing;Zhai Wensheng;Ding Ying
    2014, 16(5): 304-2.
    Abstract ( ) PDF ( )
    An 8-year-old boy received concomitant treatment with tacrolimus 1.25 mg every 12 hours and prednisone 12.5 mg once every other day for idiopathic membranous nephropathy. Five weeks later, the boy developed polydipsia, polyuria, vomiting, somnolence, and dehydration. Laboratory tests showed the following values: fasting plasma glucose 22.4 mmol/L, blood pH 7.24, standard bicarbonate 12 mmol/L, and urine ketone bodies (+++). The patient was diagnosed with ketoacidosis. Tacrolimus was stopped and he was treated with fluid supplementation 2 125 ml/d and continuous IV infusion of recombinant human insulin 2.5 U/h. After 10 hours, laboratory results indicated that blood pH was 7.40, fasting plasma glucose was 8.5 mmol/L, and detection of urine ketone was negative for two times in a row. Then, his treatment was switched to subcutaneous injection of recombinant human insulin 6.25 U before three meals. After 3 weeks, the fasting plasma glucose was 5.9 mmol/L.
  • 病例报告
    Ethinylestradiol and cyproterone acetate-induced severe erythema multiforme
    Sun Xin;Zhou Jie;Jiang Sunmin;Yao Ying;Zhang Yan
    2014, 16(5): 306-2.
    Abstract ( ) PDF ( )
    A 43-year-old woman received one tablet of ethinylestradiol and cyproterone acetate (containing cyproterone acetate 2 mg and ethinylestradiol 0.035 mg in one tablet) once daily for dysfunctional uterine bleeding. The patient took the drug regularly. On day 9, she developed generalized iris-like erythema with itching and the drug was stopped. The next day, the area and number of iris-like erythema increased and accompanied by severe itching and pain, the rashes on her face fused into lamella pattern and her face swelled significantly. It was diagnosed as multiform erythema induced by drugs. Mizolastine, loratadine and diammonium glycyrrhizinate were given orally and compound betamethasone was given with a single intramuscular injection. On the day 3, the patient received an IV injection of dexamethasone sodium phosphate 5 mg+5% glucose injection 500 ml and diammonium glycyrrhizinate and sodium chloride injection 150 mg (250 ml) once daily. Topical application of triamcinolone acetonide econazole nitrate cream was given at the same time. Eight days later, her symptoms alleviated and erythema gradually subsided.
  • 病例报告
    Death from hypersensitivity syndrome and acute exacerbation of renal insufficiency due to allopurinol overdose
    Jiang Yuyong;Liu Yang;Hou Yixin
    2014, 16(5): 307-3.
    Abstract ( ) PDF ( )
    A 49-year-old man suffered from gout and received treatment with allopurinol 0.1 g thrice daily. He mistook the drug 0.3 g thrice daily for 5 days and subsequent regimen was changed to 0.1 g thrice daily. The patient developed fever, skin pruritus and maculopapules 25 days after drug administration. Seven days later, erythroderma appeared on his limbs, face and abdomen. He developed ulcers in mouth, and the bilateral tonsils were covered with large white exudate. Laboratory testing showed the following results: white blood cell count 14.1×109/L, eosinophil count 1 100×106/L, alanine aminotransferase 130 U/L, aspartate aminotransferase 93 U/L, total bilirubin 160.5 μmol/L, direct bilirubin 144.3 μmol/L, blood urea nitrogen 39.2 mmol/L, serum creatinine 628 μmol/L, uric acid 508 μmol/L, and prothrombin activity 61%. Allopurinol-induced hypersensitivity syndrome, drug induced liver injury and acute exacerbation of chronic renal insufficiency were diagnosed. Allopurinol was discontinued and he was given IV infusions of compound glycyrrhizin, glutathione, vitamin C, vitamin B6, imipenem and cilastatin sodium, and human albumin. On day 5 after administration, the patient developed fever, cough and gastrointestinal hemorrhage. Then he was transferred into intensive care unit and received methylprednisolone pulse therapy. The patient developed pulmonary infection, typeⅠrespiratory failure, reduced urine and kidney failure successively in the following two weeks. On day 31 of admission, the patient died from liver and renal failure and septic shock.
  • 病例报告
    Micafungin induced acute hemolytic reaction and acute kidney failure
    Lin Tianlai;Cai Xiaozhen;Ding Zhirong;Zeng Haiwen
    2014, 16(5): 309-2.
    Abstract ( ) PDF ( )
    A 76-year-old male patient received an IV infusion of micafungin 50 mg in 0.9% sodium chloride 100 ml once daily for pulmonary infection. Ninety minutes after the first infusion, the patient presented with chills, fever and dark brown urine. Laboratory testing showed the following levels: white blood cells count 25.2×109/L, hemoglobin 73 g/L, platelet count 179×109/L, blood urea nitrogen 6.4 mmol/L, serum creatinine 96 μmol/L, procalcitonin 14.13 ng/ml, prothrombin time 17 s, activated partial thromboplastin time 44 s, D-dimer 8.7 mg/L, and routine urine tests showed white blood cells (+++) , urine occult blood test (+++) , urobilinogen (+++) , urine ketones (+++), urine protein (+++) and nitrite positive. The patient was considered as acute hemolysis. Micafungin was stopped. He was given an IV injection of methylprednisolone 40 mg and hydration and urinary alkalinization. However, his urine volume was reduced from 100-150 ml/h to 10-20 ml/h in 4 hours and developed dark urine. The following day, his white blood cells count was 18.6×109/L, red cells count was 1.7×1012/L, hemoglobin was 57 g/L, platelet count was 116×109/L, reticulocytes was 0.05, albumin was 25 g/L, indirect bilirubin was 20.4 μmol/L, aspartate transaminase was 108 U/L, alanine aminotransferase was 42 U/L, blood urea nitrogen was 17.9 mmol/L, serum creatinine was 230 μmol/L, and direct antiglobulin test was positive. He was considered to have acute kidney failure. The patient received anti-infective treatment, continuous renal replacement therapy, and infusion of erythrocyte suspension and plasma. Ten days later, the patient was still anuric and presenting worsening jaundice, family members gave up treatment.
  • 病例报告
    Agranulocytosis associated with carbamazepine combined with nimesulide
    Zhang Ming;Xu Liwen;Gu Xijun
    2014, 16(5): 311-2.
    Abstract ( ) PDF ( )
    A 78-year-old man received intravenous infusion of ceftizoxime sodium 2.25 g once daily, oral carbamazepine 0.2 g twice daily, oral nimesulide 100 mg twice daily, intravenous infusion of dihydroxypropyl theophylline 0.5 g once daily, oral mecobalamin 0.5 mg thrice daily, intravenous infusion of dexamethasone 5 mg for one time, intramuscular injection of meperidine hydrochloride 25 mg for one time, and intramuscular injection of bucinnazine hydrochloride 100 mg for three times for postherpetic neuralgia and chronic obstructive pulmonary diseases with infection. On day 7, ceftizoxime sodium was stopped and changed to intravenous infusion of fosfomycin sodium 8 g once daily. On day 11, his blood routine examination showed the following levels: white blood cell count 1.6×109/L with neutrophils 0.03, neutrophil absolute count 0.1×109/L, and lymphocyte absolute count 0.9×109/L. All the drugs were discontinued and symptomatic and supportive treatment was given. On day 15, the level of white blood cell became 0.9×109/L with neutrophils 0.02, a absolute value of neutrophil and lymphocyte were respectively 0.1×109/L and 0.7×109/L. According to bone marrow smear histology, agranulocytosis was diagnosed. On day 17, the patient developed pneumothorax and atelectasis in the right lung. On day 20, acute respiratory failure and multiple organ failure occurred with infection and the resuscitation was unsuccessful.
  • 病例报告
    Cyclosporine-caused blood glucose elevation
    Sun Min;Cao Kai;Hu Baoxiang;Si Jigang
    2014, 16(5): 313-2.
    Abstract ( ) PDF ( )
    A 27-year-old female patient received oral stanozolol 2 mg thrice daily and 4 Zaizao Shengxue tablets(再造升血片)thrice daily, subcutaneous injection of filgrastim 150 μg once daily, recombinant human interleukin-11 2 mg once daily, and recombinant human erythropoietin 10 000 U thrice weekly, and an intravenous infusion of cefmetazole 2 g twice daily combined with supportive treatment of blood component transfusion for leukopenia and thrombopenia. Her fasting blood glucose was 5.3 mmol/L before the medication. Eighteen days later, aplastic anemia was diagnosed and oral cyclosporine 125 mg twice daily was added to the regimen. On day 28 of adding cyclosporine, the level of fasting plasma glucose increased to 9.8 mmol/L and the patient′s diet restricted. On day 36, the level of fasting plasma glucose was 8.2 mmol/L. On day 45, the level of fasting plasma glucose and 2-hour post-meal blood glucose were respectively 10.7 mmol/L and 18.7 mmol/L. The dose of cyclosporine was adjusted to 100 mg twice daily and diabetic diet was given strictly. On day 47, the level of fasting plasma glucose was 7.3 mmol/L and on day 55, the level of fasting plasma glucose was 5.4 mmol/L and the 2-hour post-meal blood glucose was 11.3 mmol/L.
  • 病例报告
    Ventricular tachycardia torsades de pointes due to moxifloxacin
    Jiang Yan;Zhang Lei
    2014, 16(5): 314-3.
    Abstract ( ) PDF ( )
    An 61-year-old woman with fever received an IV infusion of moxifloxacin 0.4 g once daily. Seventy-four minutes after IV infusion, the patient stared at her right side, convulsions over the body, pallor, gnathospasmus, loss of consciousness and incontinentia urinae suddenly. Totally 3 paroxysmal attacks occurred, each persisted for 3-4 seconds in a minute. Electrocardiogram showed frequent ventricular premature beats, short array torsades de pointes ventricular tachycardia and ventricular flutter. Moxifloxacin was withdrawn immediately. She received an IV infusion of 0.9% sodium chloride injection 250 ml plus potassium chloride 0.7 g and magnesium sulfate 1.25 g. Forty-six minutes later the patient regained consciousness, electrocardiographic monitoring showed sinus rhythm and the premature beat disappeared. The patient had a history of 36 years of schizophrenia and took chlorpromazine 400 mg/d for long time. The patient′s fever disappeared after moxifloxacin and chlorpromazine withdrawal and receiving piperacillin sodium and sulbactam sodium, ceftazidime, and olanzapine successively. After that her torsades de pointes did not recur in twenty days of hospitalization.
  • 病例报告
    Rhabdomyolysis and hypokalemia related to compound glycyrrhizin
    Zhu Wenjing;Ma Hong
    2014, 16(5): 316-3.
    Abstract ( ) PDF ( )
    A 37-year-old male patient received an intravenous infusion of compound glycyrrhizin injection 60 ml (containing 120 mg of glycyrrhizin) for reactivation of chronic hepatitis B. His symptoms improved markedly after 12-day treatment and the regimen was changed to oral compound glycyrrhizin tablets (containing 150 mg of glycyrrhizin, two tablets every time, thrice daily) and silymarin (140 mg, thrice daily). After 2 weeks of taking the medicines, the patient developed weakness of lower extremities and the symptom worsened gradually. After 25 days of taking the medicines, he presented with grade 3 muscle strength, hypomyotonia, a level of creatine kinase (CK) 8 378 U/L, and a level of potassium 2.2 mmol/L. Compound glycyrrhizin tablets and silymarin were discontinued, combined with the biopsy of musculus gastrocnemius, rhabdomyolysis and hypokalemia were diagnosed, and potassium chloride, reduced glutathione, and spirolactone were given. After 10-day treatment, he returned to grade 5 muscle strength, normal muscular tension, a level of CK 459 U/L, and a level of potassium 5.1 mmol/L. Three months later, the physical examination showed normal lower extremities and the levels of CK and potassium were respectively 156 U/L and 4.8 mmol/L.

    • 中药不良反应

  • 中药不良反应
    Acute liver failure induced by Runzaozhiyang capsules (润燥止痒胶囊)
    Lin Fang;Li Ke
    2014, 16(5): 319-2.
    Abstract ( ) PDF ( )
    A 25-year-old female patient with eczema and nettle-rash received 4 Runzaozhiyang capsules (润燥止痒胶囊) thrice daily followed the doctor′s advice. She developed fatigue, jaundiced skin and sclera, poor appetite, and dark urine about one month after drug administration. Laboratory tests revealed the following results: alanine aminotransferase 2 211 U/L, aspartate aminotransferase 3 977 U/L, total bilirubin 299.0 μmol/L and direct bilirubin 157.2 μmol/L. The diagnosis on admission was drug-induced acute liver failure. The patient was given liver protecting agents and jaundice relieving therapy. On day 6 of admission, the patient developed fever, vomiting, and abdominal distension. The testing of ascites revealed the following results: total cell count 2 110×106/L, leucocyte count 1 200×106/L, neutrophilic granulocyte 0.80. She was diagnosed as primary peritonitis and treated with anti-bacterial therapy. On day 7 of admission, the patient developed dysphoria and slow in response. The blood ammonia was 107 μmol/L. She was diagnosed as hepatic encephalopathy and treated with blood ammonia-reducing medicine. On day 9 of admission, the patient developed lethargy and dyspnea and treated with tracheal intubation. On day 10 of admission, the patient lost consciousness, had no response to orbital pressing, bilateral mydriasis, and dullness of light reflex. On day 11 of admission, she developed high fever and declined blood pressure. The blood ammonia was 306 μmol/L. She was diagnosed as hepatic encephalopathy (stage IV) and treated with drugs, enema, and continuous hemofiltration. On day 12 of admission, the patient died due to septic shock caused by abdominal infection.
Office
Journal
Download
More...
Link
More...