2013 Volume 15 Issue 5 Published: 28 October 2013
  

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  • Organ toxicity of Yuhong Ointment(玉红膏) after repeated transdermal administration in rats
    HU Xiao-jing;SUN Xin-min;HUANG Wen;QIU Heng;MU Ji-zheng;WANG Li-xia;WANG Qi
    2013, 15(5): 248-6.
    Abstract ( ) PDF ( )
    ObjectiveTo observe the effects of Yuhong Ointment on rat′s liver and kidney functions and histomorphology of heart, brain, liver, kidney and spleen after transdermal administration repeatedly, in order to provide experimental evidences for safe use of Yuhong Ointment in clinical practice.MethodsA total of 100 SPF SD rats of equal number of both genders, weighting 200 g, were divided into 5 groups: matrix control group, 1 time concentration of Yuhong Ointment group (containing 0.4% calomel), 2 times concentration of Yuhong Ointment group (containing 0.8% calomel), 4 times concentration of Yuhong Ointment group (containing 1.6% calomel) and calomel group (containing 1.6% calomel) by drawn lots randomly, each group comprised 20 rats. The model of rat′s skin injury was prepared. Yuhong Ointment in different concentrations were applied on the skin-impaired once daily for 28 days. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), creatinine (Cr) and N-acetyl beta-D glucosaminidase (NAG) of rats in different groups were measured before treatment, 14 and 28 days after treatment, and 28 days after drug withdrawal, respectively. Ten rats in every group were sacrificed on 28 days after treatment and 28 days after drug withdrawal, respectively. The heart, brain, liver, kidney, and spleen of rats in different groups were taken and weighed up. The organ coefficients were calculated and the histomorphological changes of liver, kidney and spleen were examined.ResultsThere were no statistically significant differences in levels of serum ALT、AST、BUN、Cr and NAG in rats among the different concentrations of Yuhong Ointment groups, 1.6% calomel group and matrix control group (all P＞0.05) . The level of serum Cr in rat of 1.6% calomel group was significantly higher than that of matrix control group 28 days after drug withdrawal (P<0.05). The kidney coefficients of rats in 2 times and 4 times concentration of Yuhong Ointment group and 1.6% calomel group were significantly higher than that in the matrix control group (P<0.05) on 28 days after treatment and 28 days after drug withdrawal. The differences of coefficients of heart, brain, liver, and spleen of rats in different groups were not statistically significant (all P＞0.05). There were no obvious morphological changes in liver, kidney and spleen in different groups 28 days after treatment.ConclusionsNo obvious toxic reactions were observed in rats after transdermal administration of Yuhong Ointment repeatedly. The high concentrations of Yuhong Ointment maybe bring reversible kidney injury. The kidney function of patient who received large volume of Yuhong Ointment for long-term should be monitored.
  • Hepatic veno-occlusive disease induced by senecio chrysanthemoides (Tusanqi) in 81 patients: analysis of literature
    LING Mei;WU Qian-Hu
    2013, 15(5): 254-4.
    Abstract ( ) PDF ( )
    ObjectiveTo explore the clinical characteristics and risk factors of hepatic veno-occlusive disease (HVOD) induced by senecio chrysanthemoides and provide reference for its rational drug use in clinical practice.MethodsThe CHKD database and Wanfang medicine database were searched using “senecio chrysanthemoides”, “herba gynurae segeti”, and “hepatic veno-occlusive disease” as key words and literature related to HVOD induced by senecio chrysanthemoides were collected and analyzed.ResultsA total of 81 patients with HVOD induced by senecio chrysanthemoides were selected. Of them, 50 were males (61.7%) and 31 females (38.3%) aged from 17 to 81 and with an average of (51±1) years. There were 73 patients (90.1%) aged ≥45 years. Of the 81 patients, 60 patients′primary diseases were orthopedic problems and 11 patients had chronic hepatic diseases. All patients took the drugs by themselves. The time of onset was 1 week to 2 years after taking the drugs. The higher the daily dose was, the earlier the time of onset was; if daily dose was low but medication time was long, the time of onset was late relatively. Thirty-six patients had chronic onset and 45 were subacute onset. The main clinical manifestations were gastrointestinal symptoms and water-sodium retention. Laboratory examination showed abnormal coagulation function and liver function. Liver biopsies in 46 patients showed endothelial damage and luminal stenosis in veins of the hepatic lobule. After the drugs withdrawal and supportive treatments, 14 patients were cured, 32 were improved, and 15 died. Twenty patients′ treatments were given up and their outcomes were unknown. ConclusionsHVOD induced by senecio chrysanthemoides is related to dosage and the mortality is high. Prevention is more important for HVOD induced by senecio chrysanthemoides. Education should be enhanced and the correct methods of taking herbal medicines should be taught.
  • Correlation between HLA-B*5801 allele and allopurinol-induced severe cutaneous adverse reaction in Han ethnic group patients in Jiangsu province
    GAO Jie;ZHANG Jing-jing;WANG Jin;ZHANG Wen-wen;YU Di;QIAN Yu-lan;ZHENG Xiao-xian;DING Xiao-liang;MIAO Li-yan
    2013, 15(5): 258-5.
    Abstract ( ) PDF ( )
    ObjectiveTo explore the correlation between HLA-B*5801 allele and allopurinol-induced severe cutaneous adverse reaction (SCAR) in Han ethnic group patients in Jiangsu province.MethodsThe patients who developed SCAR after receiving allopurinol were enrolled in SCAR group (36 cases), the patients without any adverse reaction receiving allopurinol over 6 months were enrolled in allopurinol control group (50 cases) and 167 healthy volunteers were enrolled in healthy control group. The subjects′peripheral blood samples were taken to detect the HLA-B*5801 allele by sequence-specific primer polymerase chain reaction and polymerase chain reaction-sequencing based typing, in order to analyze the correlation between HLA-B*5801 allele and allopurinol-induced SCAR.ResultsThere were 36 cases in SCAR group comprised 22 males and 14 females with median age of 61 years (21 to 87 years). There were 50 cases in allopurinol control group comprised 42 males and 8 females with median age of 74 years (49 to 93 years). The difference of sexual distribution between 2 groups was statistically significant (P＝0.02). The dose of allopurinol in two groups was 0.1-0.3 g everyday and the median dose was 0.2 daily. The subjects in SCAR group developed SCAR 5 to 47 days after receiving allopurinol. The case number of cases with drug hypersensitivity syndrome, Stevens-Johnson syndrome(SJS), toxic epidermal necrolysis (TEN) and SJS/TEN were 20, 10, 3 and 3, respectively. The positive rate of HLA-B*5801 allele was 97.2% (35/36) in SCAR group, 8.0% (4/50) in allopurinol control group, and 12.0%(20/167)in healthy control group. The risk of developing SCAR was significantly higher in subjects with positive HLA-B*5801 allele than those with negative HLA-B*5801 allele (OR=403, 95%CI: 43-3761, P=0.000). The sensitivity and specificity of the HLA-B*5801 allele for prediction of allopurinol-induced SCAR were 97.2% and 92.0%, respectively.ConclusionsThe HLA-B*5801 allele in Han ethnic group in Jiangsu province is highly correlated with allopurinol-induced SCAR. The patients should be received genetic screening before administration of allopurinol, which may decrease the incidence of SCAR induced by allopurinol.
  • Efficacy and safety of beclometasone dipropionate aqueous nasal spray in the treatment of allergic rhinitis: a multicenter, randomized, double-blind, and controlled trial
    ZHU Rong-fei;LIU Guang-hui;HUA Qing-quan;MA Jian;DONG Pin;TAN Guo-lin;FENG Yong
    2013, 15(5): 263-6.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the efficacy and safety of beclometasone dipropionate aqueous nasal spray in the treatment of allergic rhinitis.MethodsThis is a multicenter, randomized, double-blind, and positive drug parallel controlled clinical trial. The patients with allergic rhinitis and who met the eligibility criteria were enrolled and divided into the test group and the control group. The patients in the test group received beclometasone dipropionate aqueous nasal spray and the patients in the control group received beclometasone dipropionate nasal spray. All patients in the 2 groups were administered two inhalations of beclomethasone dipropionate into each nostril twice daily (each inhalation contains beclometasone dipropionate 50 μg) for 14 days. The efficacy of these two drugs was evaluated according to the total scores of symptoms of rhinitis, scores of signs and quality of life and percentage changes of patients in three scores mentioned above when the treatment was over. The safety of these two drugs was evaluated according to the incidence of adverse events/adverse reactions, the results of laboratory tests, and ECG when the treatment was over.ResultsA total of 239 patients were included into the efficacy analysis. Of them, 120 patients were in the test group and 119 were in the control group. There was no significant differences in gender, age, rhinitis symptoms, and signs before the drug administration between the 2 groups (P＞0.05). The total scores of symptoms of rhinitis, scores of signs and quality of life on days 7 and 14 of treatment decreased significantly as compared with those obtained before the treatment in the both groups (P＜0.05), but there was no significant difference in the extent of decrease between the 2 groups (P＞0.05). When the treatments were over, the differences in the percentage changes of patients of rhinitis symptoms, signs and quality of life scores before and after treatments in the both 2 groups were statistically significant (P＜0.05), but there was no significant difference between the 2 groups (P＞0.05). A total of 241 patients were included into the safety analysis. Of them, 121 patients were in the test group and 120 were in the control group. There were 12 adverse events in 10 patients in the test group. Of them, 2 events in the 2 patients were adverse drug reactions, including 1 case with throat discomfort and another case with nose bleeding. There were 20 adverse events in the 13 patients in the control group. Of them, 11 events in 7 patients were adverse drug reactions and nose bleeding and dry nose were their major manifestations. There was no significant difference in the incidence of adverse events between the 2 groups (P>0.05). No severe adverse events occurred during the clinical trial.ConclusionBeclometasone dipropionate aqueous nasal spray could effectively control the symptoms of allergic rhinitis and its efficacy and safety were similar to those of beclometasone dipropionate nasal spray.
  • Retrospective analysis of kidney injury induced by cinepazide maleate injection in elderly patients
    LI Sheng-nan;MA Qing;CHEN Hai-ping
    2013, 15(5): 269-4.
    Abstract ( ) PDF ( )
    ObjectiveTo preliminarily evaluate the kidney′s safety of cinepazide maleate injection.MethodsThe clinical data of patients who were hospitalized in Medical Care Center of Beijing Friendship Hospital during August 2011 to July 2012 and had complete medical records, aged ≥60 years and received cinepazide maleate injection for cardiovascular and cerebrovascular diseases were collected and analyzed retrospectively. The serum creatinine elevated ≥26.4 μmol/L, or increased 1.5 times of baseline, or urine volume＜0.5 ml/(kg·h) were the diagnostic criteria of kidney injury after received cinepazide maleate injection.ResultsData of a total of 489 patients were collected. They comprised 377 male with average age of (83±7) years (60 to 106 years), and 112 female with average age of (81±8) years (63 to 100 years). There were 160 cases (32.7%) aged between 60 to 80 years and 329 cases (67.3%) over 80 years. There were 265 (54.2%) infections, 223 (45.6%) chronic kidney diseases, 125 (25.6%) diabetes, 32 (6.5%) cancers, and 24 (4.9%) with critical illness in 489 patients. One hundred and fifty cases received combined treatment with angiotensin-converting enzyme inhibitors/angiotensin Ⅱ receptor blockers (ACEI/ARB) at the same time. The treatment method of cinepazide maleate injection was 320 mg, IV infusion once daily and the average time of administration was 12 days (2 to 68 days) for all patients. Fourteen (2.9%) patients developed kidney injury, they comprised 12 male(3.2%) and 2 female (1.8%), one case aged between 60 to 80 years (0.6%), 13 cases aged over 80 years (4.0%). The level of serum creatinine was 54-217 μmol/L ［(105±48) μmol/L］ before treatment and increased to 86-276 μmol/L ［(142±57) μmol/L］ 2 to 15 days (mean of 6 days) after receiving cinepazide maleate injection. The incidence of kidney injury in patients who were over 80 years was higher than that in patients aged between 60 to 80 years (P＝0.043). The incidence of kidney injury in patients with chronic renal insufficiency was higher than that in the patients without chronic renal insufficiency (P＝0.002). No cases developed the symptoms of oliguria or anuria in 14 patients. Nine patients (64.3%) had the records of dynamic monitoring of kidney function. Of them, cinepazide maleate injection was withdrawn immediately in 6 patients after developing renal damage and three patients continued to receive cinepazide maleate injection until the end of therapeutic course. The result of dynamic monitoring of kidney function showed that the levels of serum creatinine in above-mentioned 9 patients returned to the baseline level 3-12 (an average of 6 d) days after drug withdrawal. Five patients (35.7%) did not undergo the dynamic monitoring of kidney function. Of them, one patient stopped cinepazide maleate injection and four patients continued the medication. All the patients who developed kidney injury did not receive any drug treatment, did not develop irreversible kidney injury and did not bring adverse effects on the primary diseases.ConclusionsCinepazide maleate injection may cause kidney injury in elderly patients. Dynamic monitoring of kidney function should be given in patients at advanced age with chronic kidney disease.
  • Anaesthetic effect and safety of lumbar anesthesia combined with intravenous dexmedetomidine in elderly patients
    CHU Jing;LI Hong;ZHANG Qiang
    2013, 15(5): 273-4.
    Abstract ( ) PDF ( )

    ObjectiveTo evaluate anesthetic effect and safety of lumbar anesthesia combined with intravenous dexmedetomidine (DMT) in elderly patients.MethodsThe elderly patients (aged 65 to 75 years) undergoing prostate electrocision through urethra from January 2012 to May 2013 in Logistics College Hospital of Chinese People′s Armed Police Forces were enrolled into this study and were divided into DMT group and control group using a random number table. The patients in the two groups received bupivacaine (5.0 mg/ml) 2.0 ml for lumbar anesthesia. The patients in the DMT group received a slow intravenous bolus of DMT (0.5 μg/kg) before anesthesia and pumped DMT continuously at a rate of 0.5 μg/(kg·h) until the end of operation. The patients in the control group received the same volume of 0.9% sodium chloride solution for injection at the same rate. The anesthetic effects (maximal sensory block plane and regression time, sedation score), adverse reactions and the residence time in post anesthesia care uint were compared between the two groups.ResultsA total of 86 patients were enrolled into this study. DMT group comprised 43 cases with the average age of (69±5) years and the control group comprised 43 cases with the average age of (71±6) years. There were no significant differences in the systolic pressure, diastolic pressure, heart rate, pulse oxygen saturation (SpO2) and maximal sensory block plane of patients during the operation between the two groups. The differences of regression time of maximal sensory block plane, sedation score during operation, incidence of hypotension, incidence of bradycardia, and the residence time in post anesthesia care unit between DMT group and the control group were (223±38)min vs. (155±26) min, (4.2±1.9) vs. (2.1±1.3), 20.9%(9 cases) vs. 2.3%(1 case), 44.2%(19 cases) vs. 4.7%(2 cases), and (245±43)min vs.(195±38) min, respectively. The differences were statistically significant (all P＜0.05). The difference in incidence of excessive sedation between DMT group and the control group ［9.3%(4 cases)vs. 0］ was not statistically significant, the incidence of low pulse oxygen saturation［14.0%(6 cases)vs 0］ was statistically significant (P＜0.05). The patients who developed hypotension, bradycardia and low pulse oxygen saturation received ephedrine, atropine and oxygen, respectively. The patients′ above-mentioned symptoms were improved after the treatment.ConclusionsLumbar anesthesia combined with intravenously DMT may enhance the effects of analgesia and sedation, and is relatively safe for elderly patients. The clinician should pay attention to the adverse reactions such as hypotension, bradycardia and low pulse oxygen saturation. The monitoring of adverse reactions should be intensified. Once adverse reactions develop, the symptomatic treatment should be given.

  • Research progress in safety evaluation of toxic traditional Chinese medicine
    JIN Meng-ya;WU Jia-rui;DONG Ling;ZHANG Xiao-meng
    2013, 15(5): 277-3.
    Abstract ( ) PDF ( )
    The toxic traditional Chinese medicine (TCM) is the drugs that may damage the body′s tissues and organs, disrupt or destroy the normal physiological function, lead to pathologic changes, and even threaten life when the drugs are improperly used. Totally 83 kinds of toxic TCM, including 10 kinds of extremely toxic, 42 kinds of toxic, and 31 kinds of slightly toxic TCM as described in the Chinese Pharmacopoeia (2010). Currently, progresses have been made in the studies on bioactive components, toxicokinetics, and metabonomics of the toxic TCM in our country. But some problems still exist, such as relatively small species members of TCM were entered in the safety evaluation research, limited study methods, and the non-standard management. The effective ways to promote rational use of toxic TCM include some measures such as learning the safety evaluation methods in other counties and formulating the strict quality standards.
  • Injectable imipenem-cilastatin sodium-induced seizures in elderly patient
    WANG He;WANG Chao;HUANG Guang-wei;CHEN Xing-wei;REN Ai-min;WANG Hong
    2013, 15(5): 280-2.
    Abstract ( ) PDF ( )
    A 71-year-old woman received an IV infusion of imipenem-cilastatin sodium 0.5 g every 8 hours for suspicious hospital-acquired infection. On day 3, the patient suddenly developed convulsion, opisthotonos, and trismus complicated within unconsciousness and shortness of breath. The symptoms lasted 2~3 minutes and this attack was relieved spontaneously without any treatment. About 15 minutes later, the above symptoms recurred and, 1~2 minutes later, she returned to normal status spontaneously. About 75 minutes and 2 hours later, the symptoms reappeared respectively lasting for 3-5 minutes and both diazepam and Xingnaojing(醒脑静) were given. About 50 minutes after the fourth seizure, the above-mentioned attack recurred and phenobarbitone was changed to an IV infusion of sodium valproate 400 mg via pump due to poor effect. About one hour later, the patient fell asleep quietly. The next day, imipenem-cilastatin sodium was discontinued and switched to latamoxef sodium and she did not experienced seizure anymore.
  • Pulmonary edema and delayed-onset diarrhea caused by docetaxel
    ZENG Qian;XIE Xue-yuan;LIU Ping;LI Xiao-hui
    2013, 15(5): 282-2.
    Abstract ( ) PDF ( )
    A 52-years-old female patient with breast cancer received chemotherapy regimen(epirubicin and cyclophosphamide for 4 cycles followed by docetaxel for another 4 cycles)after operation. She experienced diarrhea with watery stool around 10 days after each treatment cycle of docetaxel, was treated with montmorillonite powder and her diarrhea disappeared. A chest CT scan revealed no abnormal finding before sequential chemotherapy with docetaxel, while effusion in both lungs after docetaxel chemotherapy. Two months later, effusion in both lungs disappeared.
  • Reversible hypertrophy of interventricular septum induced by tacrolimus
    LIU Li-hui;HU Wen-qing;SHI Bing;YE Li-ping;ZHANG Yong-qing
    2013, 15(5): 284-2.
    Abstract ( ) PDF ( )
    A 52-year-old woman underwent the allogeneic hematopoietic stem cell transplantation because of severe aplastic anemia. She received cyclosporine to prevent graft versus host disease after operation. Two months later, the patient′s therapy was changed to tacrolimus 0.5-1.5 mg twice daily orally because of her renal inadequacy. The trough concentration of tacrolimus was 2.4-7.2 μg/L. The patient developed shortness of breath, fatigue and orthopnea subsequently. The result of echocardiography showed a hypertrophy of interventricular septum (13 mm) 50 days after administration of tacrolimus. Tacrolimus was withdrawn, and her therapy was changed to sirolimus and mycophenolate mofetil capsules. The patient′s symptoms improved gradually. Twenty days later, the echocardiogram showed the thickness of interven-tricular septum was 10 mm.
  • Liver and renal injury associated with nimesulide in a patient with adult-onset Still′s disease
    QU Cai-hong;XIE Xiao-yuan;XIAO Pei-yu
    2013, 15(5): 286-2.
    Abstract ( ) PDF ( )
    A 22-year-old female patient who was newly diagnosed with adult-onset Still′s disease received an oral nimesulide 100 mg twice daily because her arthralgia and fever were not improved after one week of treatments with anti-inflammatory drug methylprednisolone as well as liver and stomach-protective treatments. Before the nimesulide administration, the patient′s aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were 60 U/L and 50 U/L, respectively and her renal function was normal. After 9 days of nimesulide treatment, her AST and ALT levels were 458 U/L and 450 U/L, respectively. Drug-induced liver injury associated with nimesulide was suspected. Nimesulide was stopped and liver-protective treatments were given. Eleven days later, her AST and ALT levels were 221 U/L and 97 U/L, respectively. Because of the patient′s condition, nimesulide was given again. On the 4th day, she developed dysuria and her levels of serum urea nitrogen, serum creatinine, and uric acid were 11.2 mmol/L, 109 μmol/L, and 435 μmol/L, respectively. On the 5th day of administration, her AST and ALT levels were 542 U/L and 104 U/L, respectively. Drug-induced liver injury as well as renal injury associated with nimesulide was considered. Nimesulide was stopped. Four days later, her renal function returned to normal and 2 weeks later, her AST and ALT levels returned to 47 U/L and 32 U/L, respectively.
  • Liver injury induced by rabeprazole sodium enteric-coated tablets
    LIU Pei;REN Ke-yu;WANG Yan-ting;ZHANG Wei;CAO Bin;WEI Liang-zhou
    2013, 15(5): 288-1.
    Abstract ( ) PDF ( )
    A 45-year-old man received rabeprazole sodium enteric-coated tablets 10 mg once daily for acid regurgitation. Three week later, the symptom worsened, so he self-medicated double dosage. He developed generalized weakness, inappetence, dark yellow urine after 3 days. Rabeprazole sodium enteric-coated tablets was stopped. Laboratory tests showed the following values: alanine aminotransferase 401 U/mL, aspartate aminotransferase 314 U/mL, alkaline phosphatase 143 U/mL, γ-glutamyl transferase 359 U/mL, total bilirubin 22.7 μmol/L. He was given liver protective drugs. One week later, the levels of alanine aminotransferase and aspartate aminotransferase were 40 U/L and 15 U/L, respectively.
  • Delirium caused by oral ornidazole
    YU Jian-liang
    2013, 15(5): 289-2.
    Abstract ( ) PDF ( )
    A 67-year-old male patient with gingivitis received ornidazole orally 1.0 g once daily, cefradine 0.5 g thrice daily, and paracetamol 0.5 g twice daily. Three days later, the pain was relieved, but the patient developed dizziness, headache, and fatigue. Cefradine and paracetamol were stopped and ornidazole was continued. Four days later, the patient developed sudden mental disorder，which was mild during the daytime and severe at night. EEG examination revealed that frequency of α waves became slow and irregular and scattered θ waves appeared. The patient was diagnosed with delirium. Ornidazole was stopped. IM haloperidol 5 mg once daily, IV infusion of vitamin B6 0.2 g, adenosine triphosphate 40 mg, coenzyme A 200 U, and vitamin C 2.0 g in 10% glucose and sodium chloride injection 1000 ml, and oral olanzapine 5 to 10 mg twice daily were given. Three days later, the patient′s consciousness recovered. Then, haloperidol was stopped and the dose of olanzapine was reduced to 0.25 g once daily. On day 6 of treatments, the patient′s dizziness, headache, and fatigue disappeared, physical strength recovered, and EEG examination showed normal results. On day 7 of treatments, antipsychotics were discontinued. After more than 3 months of follow-up, the patient′s mental state was normal.
  • Acute liver damage induced by famotidine
    LI Fang;MA Ping;LAN An-jie;LI Cheng-min;LIU Xiao-hui;TONG Wei-hang
    2013, 15(5): 290-2.
    Abstract ( ) PDF ( )
    A 25-year-old male patient with upper abdominal pain for 3 hours received combination treatment with famotidine tablets 20 mg twice daily and 2 roter tablets thrice daily. After 2 days of treatment，his upper abdominal pain became worse than before, liver function tests showed the following levels: alanine aminotransferase (ALT)178 U/L. Then he received an IV infusion of famotidine 20 mg and glucurolactone 266 mg twice daily. On day 2 of hospitalization, liver function tests showed the following levels: ALT133 U/L, aspartate aminotransferase (AST) 63 U/L, γ-glutamyl transferase (γ-GT)162 U/L；on day 8 of hospitalization, repeat liver function tests revealed the following levels：ALT 414 U/L, AST 134 U/L, γ-GT 714 U/L, alkaline phosphatase 161 U/L, total bilirubin (TBil) 15.2 μmol/L, direct bilirubin (DBil) 9.7 μmol/L, so it was considered that the liver damage may be associated with famotidine, then famotidine was discontinued immediately and switched to an IV infusion of pantoprazole sodium 40 mg in 0.9% sodium chloride 100 ml twice daily. An IV infusion of reduced glutathione 1.8 g and compound glycyrrhizin 160 mg in 5%glucose 250 ml once daily was given. Five days after famotidine withdrawal, repeat liver function tests revealed the following levels：ALT 62 U/L, γ-GT 315 U/L, TBil 13.1 μmol/L, DBil 6.2 μmol/L. A week later, his liver function tests revealed the following levels：ALT 28 U/L, AST 31 U/L.
  • Rebound hypertension following withdrawal of tizanidine
    DONG Yan
    2013, 15(5): 292-2.
    Abstract ( ) PDF ( )
    A 69-year-old woman with hypertension received oral tizanidine for muscle spasm due to traumatic brain injury. Her blood pressure was 135-174/73-90 mm Hg and heart rate was 60-80 beats/min before using the medicine. The dosage of tizanidine was increased to 4 mg thrice daily and, on day 2, her heart rate decreased to 45 beats/min. Tizanidine was stopped. The next day, her blood pressure was 180/100 mm Hg and heart rate was 120 beats/min. Captopril and nifedipine were given to adjust blood pressure and heart rate, but the effect was not good. Tizanidine 2 mg was given. About an hour later, her blood pressure was 124/69 mm Hg and heart rate was 65 beats/min. Twenty days later, tizanidine 2 mg was given again for hypermyotonia of lower extremity. Half an hour later, her blood pressure decreased to 60/40 mm Hg. Metaraminol was given and then the blood pressure returned to normal. Her blood pressure increased to 180/100 mm Hg again on the following day. The blood pressure tended to be stable gradually by concomitant use of amlodipine besylate, irbesartan, captopril and nifedipine.
  • Polygoni Multiflori Radix Praeparata and Tribuli Fructus-induced acute liver failure
    GAO Yang;JIA Liu;YU Kai-jiang
    2013, 15(5): 294-2.
    Abstract ( ) PDF ( )
    A 14-year-old female patient took Polygoni Multiflori Radix Praeparata and Tribuli Fructus decoction for vitiligo (dose not stated). Thirty-eight days later, she developed yellowish sclera and skin. She appeared disturbance of consciousness after 42 days. Laboratory tests revealed the following results: white blood cell count 13.8×109/L, prothrombin time 27.6 s, prothrombin activity 24%, activated partial thromboplastin time 75.7 s, fibrinogen 1.08 g/L, alanine aminotransferase 510 U/L, aspartate aminotransferase 254 U/L, total bilirubin 395.7 μmol/L, direct bilirubin 319.4 μmol/L, ammonia 65 μmol/L, and urine bilirubin +++. Drug-induced liver injury, acute liver failure, and hepatic encepha-lopathy were diagnosed. She was treated with glutathione, ademetionine 1,4-butanedisulfonate, compound amino acid, naloxone hydrochloride, Xingnaojing (醒脑静), aceglutamide, diisopropylamine dichloroace-tate, polyene phosphatidylcholine, ornithine aspartate, omeprazole sodium and mannitol by intravenous infusion, nasal feeding lactulose oral solution, intermittent infusion of fresh frozen plasma and plasma exchange. On day 5, the patient′s liver function improved and consciousness was restored. On day 16, she recovered well.
  • Liver damage induced by compound matrine injection
    CHEN Run-hua;ZHANG Chang;LI Xiao-hong;HAN Hai-xiao;YAO Yu-pu;WANG Zhi-bin;LI Jun-xiang
    2013, 15(5): 296-2.
    Abstract ( ) PDF ( )
    An 80-year-old man with unresectable advanced esophageal cancer who gave up radiotherapy and chemotherapy received an IV infusion of 1 million U interleukin dissolved in 100 ml of 0.9% sodium chloride once daily, 15 ml compound matrine injection dissolved in 250 ml of 0.9% sodium chloride once daily, and 50 ml ranitidine injection into the IV drip bulb twice daily. Before treatment, laboratory tests showed the following values: alanine aminotransferase (ALT) 44 U/L, aspartate aminotransferase (AST) 24 U/L, cholinesterase (CHE) 388 U L, total bilirubin (TBil) 29.2 μmol/L, direct bilirubin (DBil) 7.3 μmol/L, and indirect bilirubin (IBil) 21.9 μmol/L. On day 4 of treatment, laboratory tests showed the following values: ALT 72 U/L, AST 71 U/L, γ-glutamyl transferase (γ-GT) 74 U/L, CHE 3387 U/L, and developed nausea, vomiting and aurigo. On day 29 of treatment, laboratory tests showed the following values: AST 67 U/L, γ-GT 597 U/L, CHE 2734 U/L, alkaline phosphatase (ALP) 151 U/L, TBil 203.0 mol/L, DBil 102.5 mol/L, IBil 100.5 mol/L, albumin (ALB) 32.6 g/L. The compound matrine injection was withdrawn and the liver-protective treatment was given. One month later, his symptoms of nausea, vomiting and aurigo were mitigated and liver function reexamination showed the following values: ALT 15 U/L, AST 21 U/L, γ-GT 59 U/L, ALP 66 U/L, TBil 46.1 mol/L, DBil 16.2 mol/L, IBil 29.9 mol/L.
  • Generalized skin rash due to Xianlinggubao capsules (仙灵骨葆胶囊)
    LIU Cai-hong;HE Yong
    2013, 15(5): 297-2.
    Abstract ( ) PDF ( )
    A 36-year-old female patient with open bone defect received external fixation. She received oral Xianlinggubao capsules 1.5 g twice daily for postoperative recovery. Five hours after taking the first dose, a few red papules appeared on her both knee joints. The medicine was not stopped. The red papules spread all over the body on the next day. Xianlinggubao capsules was stopped and loratadine 10 mg once daily was given. Three days later, the skin rashes became darker in color than before. Loratadine was continued for 2 days. Four weeks later, the skin rashes basically subsided.
  • Hepatic damage and agranulocytosis due to Polygonum multiflorum
    LIU He-ping;WU Xin-rong;YUAN Jin
    2013, 15(5): 298-3.
    Abstract ( ) PDF ( )
    A 20-year-old woman took herbal medicine Polygonum multiflorum powder 15 g/d by herself for blacking hair. Two weeks later, the patient presented with poor appetite and fatigue and, three weeks later, she experienced yellowish urine and liver function tests showed the following values: aspartate transaminase (AST) 878 U/L, alanine aminotransferase (ALT) 1121 U/L, total bilirubin (TBil) 100.8 μmol/L, direct bilirubin (DBil) 77.4 μmol/L. On day 42 of using Polygonum multiflorum powder, laboratory test revealed the following levels: AST 472 U/L，ALT 755 U/L，TBil 102.9 μmol/L，DBil 76.7 μmol/L, WBC count 3.2×109/L, neutrophil count 0.27×109/L. Liver damage and agranulocytosis were considered to be probably produced by the medicine. Polygonum multiflorum was withdrawn and liver-protective medications were used to treat jaundice, and other comprehensive therapy were given. Ten days after treatment, laboratory test revealed the following levels: ALT 62 U/L, AST 73 U/L, DBil 20.5 μmol/L, TBil 30.2 μmol/L, WBC count 6.2×109/L, neutrophil count 3.60×109/L.
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