2013 Volume 15 Issue 4 Published: 28 August 2013
  

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  • Rational drug use of antibiotics in perioperative period of retroauricular expander implantation
    ZHU Xiao-li; WANG Zhen; WANG Pu;CHEN Xiao-wei
    2013, 15(4): 183-4. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.002
    Abstract ( ) PDF ( )
    ObjectiveTo investigate the rational use of antibiotics for infection prophylaxis in retroauricular expander implantation during perioperative period.MethodsThe subjects were 63 consecutive patients, who received retroauricular expander implantations in Peking Union Medical College Hospital from February 4th, 2013 to July 10th, 2013. The surgical patients hospitalized from February 4th to June 9th received IV infusion of sodium cefmetazole 1-2 g twice daily from 30 min before the operation to 2 days after the operation in 3 consecutive days (the 3-day medication group); the surgical patients hospitalized from June 13th to July 10th received only one time of IV infusion of cefuroxime 0.75-1.50 g 30 min before the operation and the infusion must be finished within 30 min (the one-time medication group). There were 32 patients in the 3-day medication group. Of them, 26 patients were men and 6 were women with ages from 6 to 38 years and an average age of (11.5±6.5) years; 26 patients were <14 years, 3 were 14-17 years, and 3 were ≥18 years. There were 31 patients in the one-time medication group. Of them, 26 patients were men and 5 were women with ages from 6 to 32 years and an average age of (12.3±6.3) years; 22 patients were <14 years, 5 were 14-17 years, and 4 were ≥18 years. There was no significant difference in ages between the 2 groups (P=0.73). All patients were implanted with 50 ml reniform expander. Negative pressure drainage tubes were placed in all surgical patients and could not be pulled out until the liquid became serum-like fluid with light-yellow color and less than 5 ml. The situation of surgical site infections and adverse reactions during perioperative period were observed. ResultsThe drainage time was 4-5 days with an average of 4.4 days in the 3-day medication group and 3.5-4.5 days with an average of 4.2 days in the one-time medication group. There was no significant difference in the drainage time between the 2 groups (P=0.07). The incisions in all patients healed well and no infections or hematoma occurred. Eczema or herpetiform changes on skin behind ear appeared in one patient in the three-day medication group and in one patient in the one-time medication group, respectively. One patient developed rashes on the neck and chest in the one-time medication group. The rashes disappeared after symptomatic treatments.ConclusionsPreoperative one-time treatment with bactericidal antibiotics is enough for postoperative infection prophylaxis in retroauricular expander implantation. It′s a rational regimen of antibiotic use and worthy of clinical popularization.
  • Influence of drug safety environment on pharmacists′drug safety practice
    SHEN Qun-hong;TANG Li-yang;ZHANG Xiao-le;SHENG Ying
    2013, 15(4): 187-5. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.003
    Abstract ( ) PDF ( )

    ObjectiveTo explore the influence of drug safety environment on pharmacists′drug safety practice.MethodsThe subjects of the investigation were 1959 pharmacists (1763 from 3A hospitals and 196 from 2A hospitals), who were selected from 112 hospitals of 26 provincial administrative regions in China using stratified sampling method. Baseline survey questionnaire about patient safety and medication errors was designed by the research group and the survey was performed by filling out an online questionnaire and paper questionnaires. In this questionnaire, 4 dimensions, including drug safety knowledge, attitude, environment, and practice, and 6, 3, 8, and 6 sub-dimensions corresponding to above 4 dimensions were designed. There were 102 questions altogether. Five-point scale was used for each question and higher scores represented good performance. Specified ordinary least squares regression models were used to analyze dataset from this survey.ResultsThe scores of drug safety knowledge, attitude, environment, and practice in 1959 pharmacists were (3.45±0.23), (3.72±0.45), (3.35±0.50), and (3.68±0.48), respectively. The results showed that drug safety knowledge, attitude, and environment had significant positive influences on drug safety practice and among them the influence of drug safety environment was the largest. Among the 8 sub-dimensions of drug safety environment, hospital regulation and drug safety culture of work team had the largest influence on pharmacist′s drug safety practice. The pharmacist′s drug safety knowledge had the largest influence on basic drug safety practice, while drug safety environment had the largest influence on pharmacists′advanced drug safety practice.ConclusionsThe drug safety environment is the most important factor to influence pharmacists′drug safety practice in China. The most effective way to increase the levels of pharmacists′drug safety practice is to improve pharmacists′drug safety knowledge levels and improvement of the drug safety environment is the most effective way to increase the levels of drug safety practice.

  • Analysis of changes of hepatic function in opioid addicts during rehabilitation
    LI Xiao-xiao;LIANG Jun-cheng;SUN Li;HAO Wei;LI Jing;DENG Yan-ping
    2013, 15(4): 192-6. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.004
    Abstract ( ) PDF ( )
    ObjectiveTo investigate the hepatic function condition and influencing factors in opioid addicts during rehabilitation after detoxification.MethodsOpioid addicts abstained from opioid in duration of rehabilitation were recruited from Shanghai, Sichuan and Henan Compulsory Isolated Detoxification Center. The subjects′demographics, drug abuse histories, and withdrawal symptoms were recorded. The protracted withdrawal symptoms scale, Hamilton Anxiety scale (HAMA), and Hamilton Depression scale (HAMD) were used to assess withdrawal symptoms. Hepatic function tests including alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) were performed at baseline (the 15th day after detoxification), 4th, 12th, 18th, and 24th weeks of rehabilitation.ResultsA total of 130 subjects were enrolled into the study, comprising 106 (81.5%) male and 24 (18.5%) female with average age of (43.8±15.3) years. Their duration of drug abuse was (83.2±4.9) months ranging from 1 to 242 months and average daily dose taken during the last week before abstinence was (1.02±0.09) g ranging from 0.10 to 6.00 g. At the beginning of rehabilitation, the protracted withdrawal symptoms scale averaged (20.2±0.9) ranging from 10 to 52, HAMD averaged (13.7±0.6) ranging from 4 to 41, and HADA averaged (12.3±0.5) ranging from 4 to 31. The initial percentage of abnormal ALT, AST, and TBil in the subjects were 22.3% (29 cases), 9.9% (8 cases), and 2.3% (3 cases), respectively. Compared with the baseline, the percentage of cases with abnormal ALT increased to 36.8% at the 4th week of rehabilitation (P<0.01) and then fluctuated and dropped to 16.7% at the 24th week. The change between the 4th and the 24th weeks was statistically significant (P<0.01). The percentage of cases with abnormal AST showed a trend of increase at the 4th week and then fluctuated and reduced to 4.9% at the 24th week. The percentage of cases with abnormal TBil at the 12th week was 8.4%, which was much higher than that at the baseline and the 4th week of rehabilitation (all P<0.05), and rapidly decreased to zero at the 24th week. The number of subjects who had clinically significant decrease in ALT levels increased from 7 cases (5.6%) at the 4th week to 10 cases (16.7%) at the 24th week, while the number of subjects who had clinically significant increase in ALT levels was decreased from 16 cases (12.8%) to 2 cases (3.3%) at the same time. The risk for abnormal ALT levels in the patients with graver withdrawal symptoms at the beginning of rehabilitation was 0.907 times higher than that with lighter withdrawal symptoms. The risk of abnormal ALT levels in the female patients was 4.51 times higher than that in the male patients. The risk of abnormal ALT levels in patients with severe depression was 1.12 times higher than that with lighter depression during 24 weeks of rehabilitation (OR were 4.51 and 1.12, respectively).ConclusionsThe levels of hepatic function parameters in opioid addicts may be abnormally increased during initial rehabilitation and may improve gradually with prolongation of rehabilitation. Continuous monitoring of hepatic function of opioid addicts should be performed and it is a good strategy for both rehabilitation and prevention of relapse.
  • Efficacy and safety of danazol in treatment of hereditary angioedema
    TANG Rui;ZHANG Hong-yu
    2013, 15(4): 198-4. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.006
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the efficacy and safety of danazol in treatment of hereditary angioedema (HAE).MethodsThe clinical data of patients with HAE in Department of Allergy, Peking Union Medical College Hospital during the period of 1985-2010 were collected and analyzed retrospectively. The patients were required to have received danazol over one year, the follow-up time was required to be longer than or equal to one year or the follow-up times were more than or equal to 5, and all the subjects should have complete follow-up data. The efficacy of danazol was evaluated according to the changes of frequency of hydroderma, abdominal pain and laryngeal edema, the changes of C1 and C4 inhibitor levels and the function of C1 inhibitor before and after treatment. The safety of danazol was evaluated according to the changes of liver function, body weight, and female′s menstruation before and after treatment.ResultsA total of 24 patients were enrolled in the study. They comprised 12 males and 12 females with an average age of (36±15) years and an average course of disease of (14.7±8.5) years. The initial dose of danazol was 200 mg twirce or thrice daily orally. One to 4 weeks later, the dosage was decreased to maintenance level gradually. The maintenance dose for male and female were (169±94) mg/d and (130±56) mg/d, respectively. The median time and the four quartile range of receiving danazol in 24 patients were 5 (1.1-10.3) years. The incidences of hydroderma, abdominal pain, and laryngeal edema before treatment were present in 100% (24 cases), 70.8% (17 cases), and 62.5% (15 cases), respectively. After the treatment, the variables mentioned above decreased to 41.6% (10 cases), 12.5% (3 cases), and 8.3% (2 cases), respectively. The differences were statistically significant (all P＜0.01). One to 4 weeks after treatment, the level and function of C1 inhibitor in 24 patients increased from (0.08±0.06) g/L and (0.14±0.04) U/ml to (0.12±0.07) g/L (P＝0.05) and (0.26±0.05) U/ml（P<0.001), respectively. But the level and function of C1 inhibitor did not returned to the normal yet. There were 22 patients whose C4 levels detection results were recorded. Of them, 17 patients presented to hospital before 2004 and 5 after 2004. Their levels of C4 were (23.5±12.6) mg/L, (56.9±30.0) mg/L and (0.06±0.01) g/L, (0.08±0.01) g/L before and after treatment, respectively. The differences were statistically significant (all P＜0.05). Thirty and 45 days after treatment, two patients′ serum ALT levels increased from 25 and 20 U/L to 138 and 74 U/L, as well as developed alopecia, seborrhea, and dysthesia at the same time. The ALT levels in the two patients with abnormal liver function decreased to normal level after liver protective treatment. Six patients gained weight. Six females developed menelipsis or dysmenorrhea. The females′ symptoms of menstrual disorder were improved when the dosage of danazol was decreased to 200 mg/d daily or every other day.ConclusionsDanazol is effective and safe in treatment of HAE. It is suggested that C4 level may be an important monitoring indicator of danazol in HAE treatment.
  • Severe adverse reactions induced by cisplatin in cancer patients: analysis of 228 reports
    LIU Chen;WANG Yu-qin;SHEN Qian;LI Xiao-ling;JIANG De-chun;LI Xing-wei.
    2013, 15(4): 202-5. https://doi.org/Cisplatin;Elderly;Neoplasms
    Abstract ( ) PDF ( )
    ObjectiveTo analyze the clinical manifestations of severe adverse reactions induced by cisplatin in cancer patients and discuss the influencing factors.MethodsThe reports of severe adverse reactions induced by cisplatin in National Center for ADR Monitoring from January 1, 2009 to December 31, 2010 were collected and analyzed retrospectively. The patients were divided into two groups: elderly group (≥60 years old) and non-elderly group (18-59 years old). The gender and age distribution, tumor location, appearance time for severe adverse reactions after treatment, clinical manifestation, cisplatin′s formulation and dosage, drug combination, and patients′outcome were compared between the two groups. The elderly group was further divided into two subgroups, 60-69 years old and 70-79 years old. Subgroup analysis of statistically significant factors were conducted.ResultsA total of 228 reports of severe adverse reaction induced by cisplatin including 228 patients were collected. There were 103 patients in the elderly group comprising 72(69.9%) males and 31(30.1%) females with an average age of (67±5)years. There were 125 patients in the non-elderly group comprising 59(47.2%) males and 66(52.8%) females with an average age of (48±9)years. Percentage of male in the elderly group was higher than that in the non-elderly group(χ2=11.907, P＝0.001). The proportion of respiratory system tumor was the leading ones in the list in both groups. The proportion of respiratory system tumor in the elderly group was higher than that in the non-elderly group (χ2=8.512, P=0.004). The proportion of urogenital tumor in the elderly group was lower than that in the non-elderly group (χ2=8.759, P=0.003). The difference of appearance time for serious adverse reactions after treatment between the 2 groups was statistically significant(χ2=－2.545, P＝0.011). There was no statistically significant difference in applying cisplatin powder or cisplatin solution for injection between the 2 groups. The doses of cisplatin were 10-140 mg/d and 10-420 mg/d in the elderly group and the non-elderly group, respectively. The difference was statistically significant(P=0.011). In the elderly group cisplatin was combined with gemcitabine, etoposide, and docetaxel, the median number of drug combination was 0 (interquartile：0-1). In the non-elderly group cisplatin was combined with paclitaxel, gemcitabine, and docetaxel, the median number of drug combination was 1 (interquartile:1-1), the difference was statistically significant (P=0.032). The main severe adverse reactions induced by cisplatin were myelosuppression and leukopenia. The number of cases who developed myelosuppression and leucopenia was 50(48.5%) and 24(23.3%), 69(55.2%) and 24(19.2%) in the elderly and non-elderly groups, respectively. The differences were no statistically significant. Two patients in the elderly group developed renal impairment. There was no report of renal impairment in the non-elderly group. Two patients in the non-elderly group developed QT prolongation. There was no report of QT prolongation in the elderly group. After discontinuation and symptomatic treatment, the number of cases with recovery, improvement, sequelae, and death in the elderly group were 27(26.2%), 72(69.9%), 3(2.9%), and 1(1.0%), respectively, and in the non-elderly group were 38(30.4%), 83(66.4%), 3(2.4%), and 1(0.8%), respectively. The differences were not statistically significant. Percentage of male in the subgroup of 70-79 years old (87.1%) was higher than that in the subgroup of 60-69 years old (62.5%)(χ2=6.232, P=0.013). Differences in dosage and number of drug combination were not statistically significant between the 2 subgroups.ConclusionsThe severe adverse reactions induced by cisplatin were similar in the elderly group and the non-elderly group. The elderly male, especially aged 70 to 79 years, were the high risk group of severe adverse reactions induced by cisplatin.
  • Analysis of 130 cases of non-punitive drug dispensing errors at outpatient pharmacy
    BAI Yang;DAI Shan-shan;KONG Lei;LI Hong-mei;SUN Rui-fang
    2013, 15(4): 207-4. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.008
    Abstract ( ) PDF ( )
    ObjectiveTo analyze occurrence situation and improvement direction of drug dispensing errors at outpatient pharmacy.MethodsReports in non-punitive medication error reporting system at outpatient pharmacy of Civil Aviation General Hospital from February 2012 to January 2013 were collected. Cases of drug dispensing errors were selected and analyzed according to incidence, category, content, triggering cause, occurrence time, and drug classification of errors and persons who triggered or detected errors.ResultsOne hundred and thirty cases of drug dispensing errors were included. Error cases occurred mainly in February, July, and August and the incidences were 0.037%, 0.022%, and 0.034%, respectively. The incidence of drug dispensing errors in the whole year was 0.009%. Of the 130 cases, errors of category A, B, and C were respectively 4 cases (3.1%), 120 cases (92.3%), and 6 cases (4.6%). The persons who triggered errors of 126 cases of category B and C were respectively elementary pharmacists (108 cases), interns (13 cases), and intermediate pharmacists (5 cases). The persons who detected errors of 126 cases of category B and C were respectively intermediate pharmacists (95 cases), primary pharmacists (30 cases), nurses (2 cases), patients (2 cases), and senior pharmacist (1 case). The most common errors content was errors of drug varieties which accounted for 73.8%. Of the 130 cases, sound-alike drugs caused the most errors which accounted for 34.6%. The errors occurred mainly from 8∶00 to 10∶59 and from 13∶00 to 14∶59. Of 126 cases of category B and C, proportions of western medicine, Chinese patent medicine, high-risk drug, and narcotic drug were respectively 57.9% (73 cases, involving 129 kinds of drugs) , 38.1% (48 cases, involving 74 kinds of drugs), 3.2% (4 cases, involving 3 kinds of drugs) , and 0.8% (1 case, involving 2 kinds of drugs).ConclusionDrug dispensing errors could be prevented by renewing facility, managing drug location, optimizing work norm and procedure, strengthening education and training, and constructing culture of non-punitive drug safety.
  • Erlotinib-induced interstitial lung disease: characteristics, mechanisms, preventions, and treatment
    LEI Zhao-bao
    2013, 15(4): 211-4. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.009
    Abstract ( ) PDF ( )
    Erlotinib is an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) and has been used clinically in the treatment of non-small cell lung cancer. Interstitial lung disease (ILD) is a serious and rarely adverse reaction induced by erlotinib. The incidence of ILD was 0.1%-4.8% and the mortality rate was 0.8%-2.4%. The median time of erlotinib induced ILD was 22 d after using the drug. The clinical manifestations of ILD were dry cough, low-grade fever, dyspnea and so on. Imaging examination showed diffuse ground-glass shadows in lungs. The laboratory examination showed hypoxemia. The risk factors of ILD induced by erlotinib are male, advanced age, basic lung diseases and smoking. The main mechanisms of erlotinib-induced ILD are immune-mediated reactions and direct drug toxicity. The effective measures to prevent erlotinib-induced ILD should be avoid using in high-risk patient, use low-dose, avoid synchronous use with other chemotherapy and/or radiotherapy, and strengthen the monitoring of respiratory function. Once ILD developed, erlotinib should be discontinued immediately and replaced by other EGFR-TKI. The main aims of treatments of erlotinib-induced ILD are to suppress the inflammatory responses and prevent pulmonary fibrosis. The main measures include oxygen inhalation, using glucocorticoid, prevention of infection, and symptomatic treatment.
  • Toxication due to overdose of digoxin
    LIU Jun;XU Wen-ke
    2013, 15(4): 215-2. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.010
    Abstract ( ) PDF ( )
    A 63-year-old male with asthma received digoxin 0.125 mg once daily for tiredness and short of breath during sleep due to chronic cardiac insufficiency. On day 5 of taking digoxin, his symptoms improved. The dose of digoxin was increased to 0.5 mg twice daily by himself for 7 days and the patient′s asthma symptoms was exacerbated. He could not lie down for sleep at night and had fatigue, poor appetite, disorder of the stomach, nausea, and vomiting. Electroncardiography showed Ⅲ degree atrioventricular block, frequent premature ventricular contractions and bigeminy. The patient′s ventricular rate was 57 beats per minute. Laboratory tests revealed the following levels: serum potassium 2.9 mmol/L, digoxin plasma concentration＞5.0 μg/L. Digoxin was withdrawn immediately. Potassium supplement and other sympto-matic treatment were given. Five days later, his symptom was improved and the electrocardiogram and serum potassium recovered to normal. Digoxin 0.125 mg once daily was given again. Five days later，laboratory tests revealed the following levels: serum potassium 4.3 mmol/L, digoxin plasma concentration 1.78 μg/L. The patient did not present the symptoms of nausea and vomiting again.
  • Stevens-Johnson syndrome caused by cefotiam hydrochloride
    ZHU Zhong-hua;ZHU Hui-ya;LING Yun
    2013, 15(4): 217-2. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.011
    Abstract ( ) PDF ( )
    A 61-year-old woman with acute episodes of chronic cholecystitis received an IV infusion of cefotiam hydrochloride 2.0 g in 0.9% sodium chloride injection 100 ml twice daily, and an IV infusion of pantoprazole 60 mg in 0.9% sodium chloride injection 100 ml twice daily. On day 2, the patient′s body temperature rose, erythematous skin rashes appeared on her face and extremities, accompanied by itching. Cefotiam hydrochloride was stopped. She was treated with IV dexamethasone and IM promethazine. The above symptoms did not markedly improve. On day 3, skin rashes spread over her entire body, accompanied by throat discomfort, facial swelling, palpebral edema, and conjunctival congestion. Stevens-Johnson syndrome was diagnosed. Pantoprazole was stopped, glucocorticoid and antihistamine treatment was continued. On day 5, palpebral edema was relieved. On day 6, rashes on her limbs was significantly improved and facial swelling disappeared. On day 9, her generalized rashes basically subsided.
  • Elevated serum urea following intravenous infusion of alanyl glutamine
    HU Bin;GE Ting-jie;LOU Yue-fen
    2013, 15(4): 218-2. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.012
    Abstract ( ) PDF ( )
    A 93-year-old woman was hospitalized with repeated vomiting and difficulty in eating. Renal function test showed the following results: creatinine (Cr) 90 μmol/L，blood urea nitrogen (BUN) 10 mmol/L. An IV infusion of amino acid compound injection 500 ml and alanyl glutamine injection 100 ml were given once daily. On day 5 after administration, the renal function test showed the following results: Cr 122 μmol/L，BUN 51 mmol/L. No special treatment was given. On day 12 after administration, laboratory tests revealed the following levels: Cr 120 μmol/L, BUN 62 mmol/L, K+ 6.0 mmol/L，Na+ 157 mmol/L，Cl- 134 mmol/L. The patient developed mental confusion. Amino acid compound injection and alanyl glutamine injection were stopped. The supplement volume of potassium, sodium, and fluid were adjusted at the same time. Four days later, the patient received parenteral-nutrition solution again due to her condition. An IV infusion of only amino acid compound injection 500 ml once daily was given for one week. Laboratory review showed the following results: Cr 126 μmol/L, BUN 29.7 mmol/L. Henceforth, her BUN level did not increase again.

     

  • Tacrolimus-induced glucose metabolic disorder in a patient with membranous nephropathy
    LAO Hai-yan;WAN Bo;YANG Min;LIU Shuang-xin
    2013, 15(4): 220-2. https://doi.org/1008-5734.2013.04.013
    Abstract ( ) PDF ( )
    A 72-year-old man received oral tacrolimus 2 mg twice daily and methylprednisolone 8 mg once daily for atypical membranous nephropathy. About six months later, the patient presented with anepithymia, dry mouth, and asthenia. Laboratory testing showed a fasting blood-glucose level of 23.2 mmol/L and a glycosylated hemoglobin level of 13.1%. The diagnose was considered more likely to be drug-induced secondary diabetes mellitus. Tacrolimus was stopped and changed to oral mycophenolate mofetil 500 mg every 12 hours. And methylprednisolone was continued according to the original dosage and telmisartan and insulin were given at the same time. Four days later, his glucose level became stable relatively.
  • Ceftriaxone sodium associated with bilateral ureteral calculi
    CHEN Rui;YUE Ming;LIU Xiao-yong
    2013, 15(4): 221-2. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.014
    Abstract ( ) PDF ( )
    A 26-year-old female patient received an IV infusion of ceftriaxone 2 g once daily for upper respiratory tract infection. On day 4, the patient developed persistent distending pain in her lower abdomen. Abdominal ultrasonography and CT examinations revealed bilateral ureteral calculi. The patient received symptomatic treatments and supportive therapy. On day 5, little sediment was excreted in the urine. On the same day, the abdominal pain was alleviated and symptoms of urinary frequency and urgency disappeared. On day 6, CT reexamination showed that the bilateral ureteral calculi disappeared.
  • Suspected 5-serotonin syndrome induced by fluoxetine
    MU Wei-jing;REN Xiao-lei;ZHANG Hai-ying;FENG Wan-yu
    2013, 15(4): 223-2. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.015
    Abstract ( ) PDF ( )
    A 72-year-old male received fluoxetine 20 mg daily for 24 months for post-stroke depression (PSD)due to cerebral infarction. After eighteen months of treatment, the patient developed synclonus tremens suddenly but without other complicated syndromes. The patient′s condition improved spontaneously on the next day and did not leave any discomfort. After twenty-three months of treatment, the patient developed similar synclonus tremens two times again.The results of physical and laboratory examinations showed no obvious abnormality. The result of electrocardiogram examination eliminated the seizures and essential tremor. It was considered the suspected 5-serotonin syndrome induced by fluoxetine. Fluoxetine was stopped and the patient had no recurrence of synclonus tremens.
  • Rivaroxaban-caused abnormal liver function and blurred vision
    XIA Zong-ling;HAN Xue-cheng;ZOU Ying
    2013, 15(4): 224-3. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.016
    Abstract ( ) PDF ( )
    A 75-year-old female patient received oral metoprolol (100 mg every morning and 75 mg every night) and rivaroxaban (20 mg every night) for hypertension and atrial fibrillation following the advice of doctor in hospital. One month later, liver function tests showed an alanine aminotransferase(ALT) value of 90 U/L and gamma-glutamyl transpeptidase(γ-GT) value of 133 U/L and the patient developed blurred vision. Rivaroxaban was stopped and, on the next day, her blurred vision disappeared. On day 3, the levels of ALT and γ-GT were 49 U/L and 73 U/L, respectively. On the second day after stopping rivaroxaban, oral warfarin 3 mg every night was given. The next day, the patient presented with hematuria and an emergency test showed an INR level of 0.98. The patient refused to continue using warfarin. Then she took reduced-dose rivaroxaban (10 mg every night and providing for herself) again and the liver function and ocular symptoms were monitored closely. Henceforth, the levels of ALT and γ-GT were normal basically and blurred vision did not recur.
  • Severe thrombocytopenia caused by sodium valproate
    ZHAO Hui;ZHAO Ying;ZHEN Jian-cun;ZHAO Xing-shan
    2013, 15(4): 226-2. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.017
    Abstract ( ) PDF ( )
    An 87-year-old woman with convulsions and bradycardia received a continuous IV infusion of sodium valproate 1200 mg once daily by a pump at a rate of 20 ml per hour. Her platelet count was 214×109/L before treatment. Eight days after treatment, her platelet count decreased to 63×109/L. Sodium valproate injection was withdrawn and her therapy was changed to sustained-release sodium valproate tablets 500 mg/d once daily. Five days later, the patient′s platelet count decreased to 25×109/L. Sustained-release sodium valproate tablets were withdrawn. The patient received platelet transfusion 1 U and amino-polypeptide tablets 1000 mg three times a day. After eight days of symptomatic treatment, the patient′s platelet count increased to 160×109/L.
  • Liver damage due to erlotinib
    BAI Fan;LIU Yang;FENG Lei
    2013, 15(4): 228-2. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.018
    Abstract ( ) PDF ( )
    A 78-year-old man, who was newly diagnosed with epidermal growth factor receptor-positive lung cancer, received treatment with oral erlotinib 150 mg once daily. Laboratory test before the chemotherapy showed the following values: alanine aminotransferase (ALT) 12 U/L, aspartate aminotransferase (AST) 16 U/L, total bilirubin (TBil) 22.0 μmol/L, direct bilirubin (DBil) 7.6 μmol/L. Two weeks after chemotherapy treatment, re-examination revealed the following values: ALT 30 U/L, AST 33 U/L, TBil 20.0 μmol /L, DBil 6.3 μmol/L. Two months after chemotherapy, the patient presented with dark urine and yellowish whole skin and sclera. Seventy-five days after the chemotherapy, laboratory test showed the following values: ALT 368 U/L, TBil 182.1 μmol/L, DBil 155.2 μmol/L. Erlotinib was discontinued and liver-protective treatment was given. On day 4 after erlotinib discontinuation, the levels of ALT, AST, TBil, and DBil were 171 U/L, 177 U/L, 322.0 μmol/L, and 278.2 μmol/L, respectively. On day 6 after erlotinib discontinuation, methylprednisolone was added to his regimen. On day 12 after erlotinib discontinuation, the levels of ALT, AST, TBil, and DBil were 132 U/L, 141 U/L, 172.6 μmol/L, 135.4 μmol/L, respectively. Two months after erlotinib discontinuation, the levels of ALT, AST, TBil, and DBil were 12 U/L, 30 U/L, 19.8 μmol/L, and 13.5 μmol/L, respectively. Then chemotherapy was switched to 6 cycles of gemcitabine and nimotuzumab and abnormal liver function did not recur.
  • Mental disorders attributed to an intravenous infusion of esomeprazole
    LI Ping;CHEN Yu-wen;LIU Hai-yan
    2013, 15(4): 230-2. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.019
    Abstract ( ) PDF ( )
    A 92-year-old male patient with upper gastrointestinal hemorrhage received IV infusions of pantoprazole, compound sodium chloride injection, vitamin K1, water-soluble vitamin, and fat-soluble vitamin (II). Five days later, pantoprazole was withdrawn and changed to an intravenous infusion of esomeprazole 40 mg dissolved in 0.9% sodium chloride 100 ml every 12 hours. Two days later, the patient developed rave, hallucinations, and insomnia. He was given IM diazepam 10 mg. One hour later, the above-mentioned symptoms improved. Esomeprazole was discontinued and other medications remained unchanged. The symptoms of mental disorders did not recur.
  • Liver injury due to allopurinol: two case reports
    LIU Yang;JIANG Yu-yong;DONG Xiao-dong;MENG Pei-pei
    2013, 15(4): 231-3. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.020
    Abstract ( ) PDF ( )
    Two patients, a 32-year-old man and a 27-year-old woman, had normal liver function during antituberculous treatment. Oral allopurinol 0.1 g thrice daily was added to their regimen due to hyperuricemia. They developed fever and rash after 2 weeks. Laboratory tests showed the following values: alanine transaminase (ALT) 1182 U/L, aspartate transaminase (AST) 595 U/L, total bilirubin 25.9 mmol/L in patient 1; ALT 1452 U/L, AST 1942 U/L in patient 2. Allopurinol and the antituberculous drugs were discontinued. Both patients received liver-protective treatment. The results of their liver function tests basically returned to normal on days 14 and 25 of treatment, respectively. In patient 1 antituberculous treatment was continued, he had the normal liver function during 4 months of follow-up. In patient 2 antituberculous treatment was stopped because of the stable condition.
  • Psychosis induced by intravenous infusion of moxifloxacin
    LI Feng-yun; HUANG Ya-qiu; MA Chao; ZHANG Shu-rong
    2013, 15(4): 233-2. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.021
    Abstract ( ) PDF ( )
    A 79-year-old female patient received an IV infusion of moxifloxacin 400 mg once daily for hospital acquired pneumonia. On the night, the patient experienced talking to herself, anxiety, and a blood pressure of 135/85 mm Hg. The anti-infective treatment continued following the doctor′s advice. Hereafter she developed worsened psychic symptoms which included being not able to know families, irrelevant reply, hallucination, mania, and agitation. After infusion of moxifloxacin for 5 days, she presen-ted with a blood pressure of 190/110 mm Hg, a temperature of 39.6 ℃, and a normal electroencepha-logram. Moxifloxacin was stopped and changed to an IV infusion of meropenem 0.5 g once every 8 hours. Meanwhile, irbesartan was added to the regimen for control of blood pressure. Two days later, her psychic symptoms relieved and the blood pressure and temperature returned to within normal range. At a follow-up 2 weeks later, her blood pressure remained normal basically when irbesartan was not taken again after discharge and psychic symptoms did not recur.
  • Severe liver injury induced by Qubai Babuqi tablet (驱白巴布期片)
    ZHANG Kang-huai;WANG Na;CAI Yan
    2013, 15(4): 235-1. https://doi.org/10.3760/cma.j.issn.1008-5734.2013.04.022
    Abstract ( ) PDF ( )
    A 21-year-old male patient received Qubai Babuqi tablet 1.5 g thrice daily for vitiligo. Two months later, he developed jaundice of skin and sclera, and dark urine. Laboratory tests showed the following values: total bilirubin (TBil) 540.7 μmol/L, direct bilirubin (DBil) 365.3 μmol/L, alanine transaminase 390 U/L, aspartate transaminase 553 U/L, γ-glutamyl transferase (γ-GT) 102 U/L, alkaline phosphatase 208 U/L, and alpha-fetoprotein (AFP) 1147 μg/L. Qubai Babuqi tablet was stopped. He was given liver-protective drugs. Ten weeks later, repeat laboratory tests showed the following values: TBil 34.6 μmol/L, DBil 15.7 μmol/L,γ-GT 122 U/L, and AFP 9.4 μg/L.
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