2013 Volume 15 Issue 2 Published: 28 April 2013

  

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论著

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  论著

  Analysis of 1165 cases of medication errors in 22 hospitals in Beijing

  LI Xiao-ling;YAN Su-ying;WANG Yu-qin;ZHANG Qing-xia;WANG Ya-wei;SHEN Jiang-hua;LIU Chen

  2013, 15(2): 64-5.

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  ObjectiveTo understand the current status of medication errors (ME) report in Beijing area and improve the ME monitor and report system.MethodsME cases which were reported by pharmacy departments of 22 hospitals in Beijing in 2012 were collected and analyzed. Analysis projects included category, classification, and triggering factor of ME and the number and proportion of persons who triggered or detected ME. Category A is potential error. Category B, C, and D are mild ME which did not harm patients. Category E, F, G, H, and I are severe ME which cause harm to patients even death.ResultsOne thousand one hundred and sixty-five cases of ME were totally reported by 22 hospitals in Beijing. Proportion of ME of category A, B, C, D, E, and F were respectively 5.9% (69 cases), 71.9% (837 cases), 19.3% (225 cases), 2.2% (26 cases), 0.5% (6 cases), and 02% (2 cases). ME of category G, H, and I have not been reported. In 1165 reports of ME, 1220 errors of classification were noted. Therein, the error of kinds of medications was the highest proportion which reached 27.2% (332 errors). The errors of administration route, dosage, and time respectively accounted for 12.0% (147 errors), 14.3% (175 errors), and 7.1% (86 errors). The content of unreasonable drug use was contained in the errors of kinds of medications, administration route and time. In 1165 reports of ME, 1183 triggering factors were noted. The top three factors were sound alike, prescribing errors, and look alike, whose proportions were 19.1% (226 errors), 14.0% (166 errors), and 8.3% (98 errors), respectively. In terms of the persons that triggered ME, the proportions of doctors, pharmacists, nurses, and patients or families were respectively 66.0%, 30.6%, 1.1%, and 2.3%. In terms of the persons who detected ME, doctors, pharmacists, nurses, and patients or family members respectively accounted for 14%, 88.8%, 4.6%, and 5.2%.ConclusionsThe report system of ME in Beijing had tended to be mature gradually. The operation model could be used for reference for national systems of ME monitor and report.

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  论著

  Analysis of drug resistance in 20 chronic hepatitis B patients receiving antiviral therapy during pregnancy

  CAO Yan-jun;FANG Fang;LIU Min;CAI Hao-dong

  2013, 15(2): 69-4.

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  ObjectiveTo explore the cause of drug resistance in patients with chronic hepatitis B during pregnancy and the management policy.MethodsThe clinical data of 20 pregnant women with chronic hepatitis B received lamivudine (LAM) or telbivudine (LdT), developed drug resistance during pregnancy, and delivered full-term newborns from January 1,2007 to December 31,2012 in Beijing Ditan Hospital were collected and analyzed retrospectively. The main indicators of analysis included the situation of antiviral drug use before and after pregnancy, the occurrence time of drug resistance and the restriction measures during pregnancy, HBV-DNA load, liver function, maternal and neonatal outcomes.ResultsLAM group comprised 12 patients with age of 26 to 38 (31±3) years, received LAM 100 mg/d for 15 to 8 years before pregnancy. Of them, 3 patients had received entecavir for 2 years and then changed to LAM. LdT group comprised 8 patients with age of 27 to 34 (31±2) years, received LdT 600 mg/d for 2.0 to 4.5 years. Of them, a patient had received entecavir for 2 years and then changed to LdT. The drug resistance occurred during 0-12, 13-27, and 28-40 weeks of pregnancy in LAM group in 1, 2, and 9 cases, in LdT group in 1, 1, and 6 cases, respectively. A total of 15 (75%) patients developed drug resistance during 28-40 weeks of pregnancy. Of 12 patients in LAM group, 4 substituted tenofovir (TDF) 300 mg/d for LAM, 3 received LAM and added adefovir dipivoxil after 28 weeks of pregnancy, 4 received LAM continually and added adefovir dipivoxil after childbirth, another one substituted telbivudine for LAM but was not effective and added adefovir dipivoxil after childbirth. Of 8 patients in LdT group, 2 substituted TDF 300 mg/d for LdT, 6 received LdT continually and combined with adefovir dipivoxil 10 mg/d after childbirth. Twenty pregnant women were all singleton and had full-term natural labor. In LAM group, a newborn′s venous HBV DNA load was 1.56×106 copies/ml and diagnosed as intrauterine infection associated with mother′s drug resistance. In LdT group, a newborn developed annexal ear on the right side, another newborn had intracranial bleeding and anemia, both were not correlated with drug and mothers′drug resistance. Twenty newborns were followed-up for 2 to 57 months, all had normal growth and development.ConclusionsDrug resistance monitoring during pregnancy should be applied for chronic hepatitis B women receiving antiviral therapy, especially for the patients receiving antiviral therapy for a long time before pregnancy. The drug resistance may lead to liver disease aggravation and increase the risk degree of hepatitis B virus mother-to-infant transmission. When drug resistance occurred, the liver funcion should be monitored regularly and the therapy should be changed in the following circumstances: fully informed the risk, weighed the advantage and disadvantage, and signed informed consent. TDF is the best choice for LAM or LdT-resistant patients during pregnancy.
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  论著

  Analysis of adverse events following immunization from 2009 to 2011 in Guangling District, Yangzhou City, Jiangsu Province

  QIAN Ying

  2013, 15(2): 73-6.

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  ObjectiveTo evaluate the monitoring quality of adverse events following immunization (AEFI) from 2009 to 2011 in Guangling District, Yangzhou City, Jiangsu Province preliminarily. Methods
  The data of AEFI in Guangling District from 2009 to 2011 were collected through the AEFI information system of China and analyzed by descriptive epidemiological method.ResultsA total of 24 kinds of va-ccine were inoculated from 2009 to 2012 in Guangling District, the accumulative total inoculation doses were 732 005, the accumulative total AEFI cases were 388, the reporting rate was 53.7 per 100 000 doses. In seven state indicators of AEFI monitoring system, reporting rate within 48 hours, investigation rate within 48 hours, and classification rate were 100.0%. The input rate of questionnaire within 3 days, upload rate of investigation report within 7 days, integrity rate of key project in questionnaire, and report coverage rate in districts were not up to the standard of AEFI during 2009. The input rate of questionnaire within 3 days and upload rate of investigation report within 7 days were increased greatly during 2010, but were not up to the standard of AEFI yet. The completion rate of all indicators of AEFI monitoring system reached 100.0% since 2011. Of 388 cases of AEFI, the common adverse reactions were found in 330 cases (850%), the main clinical manifestations were fever, red swelling and induration in injection area. The abnormal reactions were found in 50 cases (12.9%), the clinical manifestations were allergic skin rashes (40 cases, 80.0%), angioedema (3 cases, 6.0%), BCG abscess (2 cases, 4.0%), morbilliform rash (2 cases, 4.0%), allergic purpura (1 case, 2.0%), febrile convulsion (1 case, 2.0%), and diarrhea (1 case, 20%). The coincidental events occurred in 8 cases (2.1%). The top five vaccines associated with reporting rate of AEFI were pneumococcal 7-valent conjugate vaccine(PCV-7，507.9/100 000), 23-valent pneumococcal polysaccharide vaccine (343.2/100 000), poliomyelitis vaccine (monkey kidney cell) oral (166.7/100 000), hemophilus influenzae type b conjugate vaccine(163.8/100 000)and measles and rubella combined vaccine, live (MR，147.1/100 000). The top five vaccines associated with abnormal reactions reporting rate were MR(88.3/100 000), PCV-7(63.5/100 000), influenza vaccine (split virion), inactivated(17.0/100 000), MR(16.9/100 000)and measles vaccine, live(13.7/100 000).ConclusionsThe operation quality of AEFI surveillance system in Guangling District, Yangzhou City improves year by year from 2009 to 2012. The completeness and sensitiveness are well.
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  Significance of early measurement of plasma-paraquat concentrations in patients with acute paraquat poisoning

  CUI Wen-hua;QIU Ze-wu;SUN Cheng-wen;WANG Zhe;PENG Xiao-bo

  2013, 15(2): 79-4.

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  ObjectiveTo explore the significance of early measurement of plasma-paraquat concentrations in assessing the severity of liver and kidney injury and predicting the outcome in patients with acute paraquat poisoning (APP).MethodsThe case reports of patients with APP in Department of Gastroenterology, Affiliated Hospital of Academy of Military Medical Science from June 2006 to June 2012 were collected and retrospectively analyzed. The inclusion criteria were as follows: the patients were orally poisoned, without undergoing infusion and hemoperfusion treatment, the time from poisoning to admission ≤ 6 h. According to the plasma-paraquat concentrations measured on admission, the patients were divided into the low-concentration group (<0.5 mg/L), moderate-concentration group (0.5-2.0 mg/L), and high-concentration group (>2.0 mg/L). The highest values of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, blood urea, and serum creatinine levels detected during hospitalization in the 3 groups were compared. The mortalities in the 3 groups were calculated and compared.ResultsData of a total of 87 patients were collected according to the inclusion criteria. Of them, 48 patients were male and 39 were female with age of 9-76 (30±14) years. There were 31, 27, and 29 patients in the low-, moderate-, and high-concentration groups, respectively. The differences in gender, age distribution, and the time from poisoning to admission among the 3 groups were not statistically significant (P>0.05). The median (Q1, Q3) of the highest values of AST, ALT, total bilirubin, blood urea, and serum creatinine levels in the 3 groups were 39(18, 87), 126(92, 249), and 345(108, 666) U/L; 29(25, 37), 120(57, 222), and 233(106, 361) U/L; 24(18, 33), 31(22, 52), and 65(39, 86)μmol/L; 77(59, 136), 243(134, 421), and 295(248, 489) μmol/L; 8(5, 11), 15(13, 21), and 24(19, 27) mmol/L; respectively. The mortalities in the 3 groups were 3.2% (1/31), 44.4% (12/27), and 86.2% (25/29), respectively. Pairwise comparisons among the 3 groups were performed and the differences in all items mentioned above were significant statistically (P<0.05 or P<0.01). Conclusion
  Plasma-paraquat concentrations measured in the early stage of paraquat poisoning could be used to assess the severity of liver and kidney injury and predict the outcome in patients with APP.
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  论著

  Clinical analysis of acute thallium poisoning in fourteen patients

  ZHANG Xiao-ran;QIU Ze-wu;CUI Wen-hua;PENG Xiao-bo

  2013, 15(2): 83-4.

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  ObjectiveTo analyze and summarize the clinical manifestations and treatments of acute thallium poisoning.MethodsThe clinical data of patients with acute thallium poisoning, who were hospitalized in Affiliated Hospital of Academy of Military Medical Science from 2009 to 2011 were collected and analyzed retrospectively.ResultsFourteen patients with acute thallium poisoning comprised 8 males and 6 females with an average age of 42 years (rang 9 to 68) were hospitalized from 2009 to 2011. Of them, 1 case complained poisoning by others; 1 case suspected poisoning by accidental mistake; 2 cases lived together with thallium poisoned patients; the other 10 poisoned cases were of unknown aetiology. The early clinical manifestations of thallium poisoning were gastrointestinal symptoms including nausea, vomiting, and abdominal pain (5 cases), and neurological symptoms including acroanesthesia, pain, and memory loss (13 cases). Ten patients developed abnormal hepatic function, 8 patients developed hair loss, and in one patient Mees line appeared. Before treatment, the patients′ serum and urine thallium levels were 3764.0 to 197 μg/L and 29 100.0 to 0.2 μg/L, respectively. After the supportive therapy (1 case), prussian blue therapy (4 cases) and prussian blue combined with hemoperfusion therapy (9 cases), the patients′ serum and urine thallium levels decreased to 68.0 to 2.4 μg/L and 542.0 to 11.3 μg/L, respectively. Thirteen patients with neurological symptoms were markedly improved during the hospitalization period, but the mild acroanesthesia and pain in limbs were still existed after discharge. The gastrointestinal symptoms in five patients were alleviated or disappeared within a week. The liver enzyme levels in ten patients with abnormal hepatic function returned to the normal levels within 2 to 4 weeks. Of the 8 patients with hair loss, 5 were improved during the hospitalization period, the other 3 had no obvious changes. No significant change of sign appeared in the patient with Mees line.ConclusionsIf a patient has gastroenteric symptoms of unknown causes together with neurological symptoms, it should be considered as heavy metal poisoning. Prussian blue combined with hemoperfusion has good efficacy and safety in treatment of thallium poisoning.
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  Effects of cyclophosphamide on embryo-fetal developmental toxicity test with New Zealand rabbits

  ZHOU Li;JIANG Juan;WANG Yong;CHEN Ying;XU Li;CHONG Li-ming;YAN Han;WANG Hua;SUN Zu-yue

  2013, 15(2): 87-6.

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  ObjectiveTo explore the feasibility and the best application regimen of cyclophosphamide as the positive control drug of embryo-fetal developmental toxicity test with rabbits and provide evidences for smoothly developing standardized reproductive toxicity tests.MethodsCommon New Zealand rabbits were used for the experiment and the date of mating success was day 0 of pregnancy (GD 0). Pregnant rabbits were divided into 4 groups including group A using cyclophosphamide (14 rabbits, given intragastric cyclophosphamide 18 mg/kg once daily from GD 6 to 20), group B using cyclophosphamide ( 11 rabbits, given subcutaneous injection of cyclophosphamide 25 mg/kg once daily from GD 10 to 13), group C using cyclophosphamide (12 rabbits, given intramuscular injection of cyclophosphamide 15 mg/kg once daily from GD 6 to 18, and solvent control group (12 rabbits, given intragastric normal saline 2 ml/kg once daily from GD 6 to 18). The general situation of the animals during drug use was observed. The pregnant rabbits were weighed in every group at GD 0, 3, 6, 10, 13, 15, 18, 20, 24, and 28 respectively and extrauterine weight gain was calculated. Serum of rabbits was taken at GD 5 and 28 respectively and the levels of testosterone, progesterone, and estradiol were tested. At GD 28, the rabbits were killed and fetal rabbits were taken. Corpora lutea count, implantation count, live birth rate, absorbed embryo rate, and stillbirth rate were recorded. Fetal rabbits were examined and aberration rates of appearance, internal organs, and bones were calculated.ResultsBody weight of rabbits in group A at GD 10 and 15 and body weight of rabbits in group B and C at GD 15 were all markedly lower than that in solvent control group(P<0.05 or P<0.01). Extrauterine weight gain in group A with use of cyclophosphamide was significantly lower than that in solvent control group［（-0.013±0.163）kg vs.（0208±0194）kg, P<0.01］. The differences of hormone levels at GD 28 and 5 showed the hormone levels changed markedly in group A while using cyclophosphamide and, compared with solvent control group, there were statistically significant difference in change range of estradiol and testosterone (P<0.01 or P<0.05) and there was no significant difference in change range of progesterone (P>0.05). There was no statistical significance in change range of hormone between group B, C using cyclophosphamide and solvent control group. Gross anatomy showed that there was no markedly abnormal manifestation of female rabbits. Live birth rate in group A and B using cyclophosphamide (65.1%, 19.2%) were markedly lower than that in solvent control group (93.1%) (all P<0.01). Absorbed embryo rates (17.4%, 539%) and stillbirth rates (174%, 26.9%) in group A, B using cyclophosphamide were markedly higher than that in solvent control group (4.2%, 2.8%) (all P<0.01). Aberration rates of appearance (60.6%, 93.3%, 16.1%), internal organs (62.9%, 93.3%, 25.9%), and bones (91.4%, 1000%, 61.7%) were markedly higher than that in solvent control group (0, 0, 3.0%) (all P<001).ConclusionIt was feasible that using cyclophosphamide as the positive control drug of embryo-fetal developmental toxicity test with New Zealand rabbit and the best regimen was intragastric cyclophosphamide 18 mg/kg once daily from GD 6 to 20 for 15 days continuously.

病例报告

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  病例报告

  Contrast-induced nephropathy caused by iodixanol

  CAI Ran;LIU Xiao-meng

  2013, 15(2): 93-2.

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  碘克沙醇; 急性肾损伤
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  Thiamazole-induced cholestatic liver injury

  2013, 15(2): 96-2.

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  A 51-year-old woman with hyperthyroidism was given thiamazole 5 mg once daily. Ten days later, the patient presented itchiness, nausea, vomiting, and gray excrements. On day 15, the thiamazole was withdrawn. Laboratory examination revealed the following levels: alanine aminotransferase(ALT) 184 U/L, aspartate aminotransferase(AST) 115 U/L, total bilirubin(TBil) 41.6 μmol/L，and direct bilirubin (DBil) 28.6 μmol/L. The patient was considered as cholestatic liver injury. She was given an IV infusion of sodium deoxyribonucleotide injection 150 mg once daily and coenzyme complex for injection 400 U twice daily. On day 7 of liver-protective treatment, laboratory examination showed the following levels: ALT 150 U/L，AST 67 U/L, TBil 28.7 μmol/L, and DBil 19.1 μmol/L. On day 13, the levels of ALT and AST were 93 U/L，and 57 U/L, respectively. On day 28, the levels of ALT, AST,TBil and DBil were 62 U/L, 45 U/L, 11.1 μmol/L, and 5.8 μmol/L, respectively.
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  病例报告

  Iopromide-induced noncardiogenic pulmonary edema

  ZHANG Yun-jian;WANG Xiao-fang;HU Ping;XIA Guo-guang

  2013, 15(2): 98-3.

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  A 68-year-old man with primary hepatic carcinoma received an infusion of iopromide 30 ml for transhepatic arterial chemotherapy. About 20 minutes after completion of the infusion, the patient suddenly developed dyspnea. Physical examination showed a blood pressure of 130/76 mm Hg, a heart rate of 130 beats/min, and a saturation of pulse oximetry of 0.80. Intravenous (IV) dexamethasone 10 mg was given. Arterial blood gas analysis revealed the following levels: pH 7.31, partial pressure of carbon dioxide 34 mm Hg, and partial pressure of oxygen 69 mm Hg. Chest radiograph examination indicated multiple patchy shadows diffusing in bilateral lungs. The diagnosis of iopromide-induced noncardiogenic pulmonary edema was considered. The patient received non-invasive assisted ventilation and IV furosemide 20 mg were administered. About 12 hours later, his dyspnea was improved and oxygenation index (OI) value was 110. Thirty-six hours after therapy, he was treated with oxygen masks and the value of OI was 132. Two days later, he received oxygen inhalation through nasal tube and the value of OI was 175 and, five days later, the value of OI reached 260. About two weeks later, his dyspnea disappeared and arterial blood gas analysis revealed all the measurements were normal.
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  病例报告

  Epidermolysis bullosa after treatment with levofloxacin, cefoperazone sodium and sulbactam sodium, clindamycin

  ZHOU Gan-ping;LU Qi-zhi;LIN Chun-yan;QUAN Xue-mei

  2013, 15(2): 100-2.

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  A 62-year-old female patient received an IV infusion of levofloxacin 0.5 g once daily for urinary tract infection, red rash developed on inner side of her upper limbs and back on the same day. The levofloxacin was discontinued and anti-allergic treatments were given. The next day, she received an IV infusion of cefoperazone sodium and sulbactam sodium 4.0 g every 8 hours and clindamycin 0.75 g once daily for pulmonary infection. After six days, she experienced oral mucosal erosion, diffused red swelling and flaccid vesicles appeared on her multiple body regions, and partial exfoliation occurred. Epidermolysis bullosa was diagnosed. Antibiotics were discontinued and an IV infusion of methylprednisolone 80 mg once daily was given. Her skin symptoms relieved after 3 days. The next day, she received an IV infusion of amikacin sulfate 0.4 g every 8 hours for a secondary infection of the skin. The rash appeared again on the same day. Glucocorticoid combined human immunoglobulin and supportive treatments were given. Her symptoms of skin gradually improved.
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  病例报告

  Severe vesicular rash induced by teicoplanin and vancomycin hydrochloride

  ZHAO Jing;KE Hui-xing;ZHANG Ai-ling;WANG Dan-dan;YANG Li-ping

  2013, 15(2): 102-3.

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  A 74-year-old male patient received latamoxef, biapenem, moxifloxacin, teicoplanin, vancomycin hydrochloride, linezolid, and daptomycin in succession for about one month of cough, expectoration, and fever after resection of rectal cancer. Teicoplanin was changed to moxifloxacin after 12 days of teicoplanin treatment. On day 4 of moxifloxacin treatment, the patient developed congestive rash and itching on his limbs and trunk. Moxifloxacin was stopped and changed to vancomycin hydrochloride as well as anti-allergic treatment, and then the rash improved. On day 8 of vancomycin hydrochloride treatment, the patient developed rash again on his limbs. Vancomycin hydrochloride was withdrawn and changed to teicoplanin. On day 5 of teicoplanin treatment, more rash occurred and some of them developed vesicles on the surface and fused into lamella. Linezolid was given and anti-allergic treatment was continued. Old vesicles were absorbed gradually and no new vesicles reoccurred. Teicoplanin-induced delayed-type hypersensitivity was considered. Cross allergies caused by vancomycin hydrochloride and teicoplanin could not be excluded.
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  病例报告

  Eosinophilia with skin rash induced by imipenem and cilastatin sodium combined with vancomycin hydrochloride

  CHU Yan-qi;WANG Wei

  2013, 15(2): 104-2.

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  An 80-year-old female patient was given an IV infusion of imipenem and cilastatin sodium 0.5 g every 8 hours for Enterobacter cloacae detected in fluid drainage of incision after intercondylar fracture of femur open reduction and internal fixation. On day 3, the eosinophil count was increased from 230×106/L before using this medicine to 520×106/L. On day 9, her eosinophil count was 770×106/L. On day 11, an IV infusion of vancomycin hydrochloride 1 g every 12 hours was prescribed for coagulase negative Staphylococcus detected in fluid drainage of incision. On day 18, the eosinophil count was 1810×106/L. Imipenem and cilastatin sodium was stopped. On day 21, the patient developed skin rash with pruritus on both lower extremities. She was given anti-allergic therapy. On day 26, her conditions improved, but the eosinophil count was still 2990×106/L. So vancomycin hydrochloride was stopped. The patient′s rash gradually subsided. On day 48, the eosinophil count decreased to 20×106/L.
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  病例报告

  Abnormal liver function due to intravenous infusion of moxifloxacin

  YANG Rui;HUANG Xin;HAN Yi;SU Le-qun;LI Hong-jian

  2013, 15(2): 105-2.

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  A 64-year-old man received an IV infusion of moxifloxacin 0.4 g once daily with concomitant use of oral Feilike capsules (肺力咳胶囊)and oral cetirizine for pulmonary infection. On day 2, biochemical tests showed an alanine aminotransferase (ALT) level of 49 U/L and an aspartate aminotransferase (AST) level of 30 U/L. On day 5, the values of ALT and AST rose to 166 U/L and 53 U/L, respectively. On day 9, moxifloxacin was withdrawn and changed to levofloxacin 0.5 g once daily orally. Meanwhile, liver-protective treatment was given and Feilike capsules and cetirizine were continued at original dosage. On day 10, the values of ALT and AST were respectively 111 U/L and 28 U/L, and on day 13, the value of ALT was 77 U/L and the value of AST was 23 U/L. Two months later, hepatic function returned to normal (an ALT level of 28 U/L and an AST level of 21 U/L).
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  病例报告

  Allergic asthma and acute myocardial ischemia induced by rectal administration of indomethacin suppository

  TONG Xue-fei;GUO Hai-jun

  2013, 15(2): 107-2.

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  A 43-year-old male patient received rectal administration of indomethacin suppository 50 mg for fever. About 20 minutes later, the patient developed chest tightness, shortness of breath, dyspnea, cyanosis of face, lips and limbs, orthopnea, and wheeze covering both lungs. Oxygen inhalation, aerosol inhalation of budesonide, intravenous infusion of methylprednisolone and doxofylline were given urgently. Blood gas analysis showed respiratory acidosis and electrocardiogram revealed acute myocardial ischemia. He underwent endotracheal intubation and ventilator support. After 4 days of comprehensive resuscitation, his condition became gradually stable.
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  病例报告

  Elevated liver enzymes levels related to cinepazide maleate

  YANG Fei;QI Xiao-lian

  2013, 15(2): 108-2.

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  A 73-year-old man was hospitalized for acute cerebral infarction accompanied by epilepsy, hypertension, bronchitis, coronary atherosclerotic heart disease, and atrial fibrillation. He received mannitol, glycerol and fructose, valsartan, bisoprolol fumarate, cinepazide maleate, ozagrel sodium, piperacillin sodium and tazobactam sodium, ceftazidime, etimicin, and atorvastatin calcium. Laboratory tests before treatment showed the following levels: alanine aminotransferase (ALT) 18 U/L, aspartate aminotransferase (AST) 25 U/L. On day 13, his ALT and AST levels increased to 243 U/L and 111 U/L. Cinepazide maleate was stopped. Glucurolactone and glutathione were given. On day 7 of cinepazide maleate withdrawal, his ALT and AST levels decreased to 36 U/L and 27 U/L, respectively.
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  病例报告

  Acute hepatic failure and hepatic encephalopathy after receiving a HRZE antitubercular regimen

  ZHENG Xiao-yuan;ZHANG En-juan;ZHANG Zhe

  2013, 15(2): 109-3.

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  A 25-year-old female patient with pulmonary and intestinal tuberculosis received a HRZE antitubercular regimen comprising isoniazid (H) 0.3 g once daily, rifampicin (R) 0.45 g once daily, pyrazinamide (Z) 3 g once every three days, ethambutol (E) 0.75 g once daily. Three days later, she developed hepatic dysfunction. Six days later, she developed acute hepatic failure with hepatic encephalopathy. Laboratory tests showed the following values: alanine aminotransferase (ALT) 519 U/L, aspartate transaminase (AST) 1854 U/L, albumin 29.6 g/L, total bilirubin (TBil) 89.9 μmol/L, direct bilirubin (DBil) 59.2 μmol/L, prothrombin time 113 s, international normalized ratio 918, D-dimer 0.8 mg/L. All antitubercular agents were stopped, polyene phosphatidyl choline, reduced glutathione, ademetionine 1,4-butanedisulfonate, alprostadil, Xiangdan injection (香丹注射液) were given. On day 9, she presented with coma, fructose sodium diphosphate and mannitol were added to her regimen. She received plasma exchange and transfusions of fresh frozen plasma and cryoprecipitate. On day 11, she revived and supportive therapy was continued. One month later, repeat testing showed the following results: ALT 25 U/L, AST 64 U/L, albumin 39.4 g/L, TBil 65.8 μmol/L, DBil 40.2 μmol/L.【
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  病例报告

  Right metatarsophalangeal joints numbness in relation to entecavir

  ZHOU Yan-ping;WU Rong-rong;ZHANG Shi-long;LIU Feng-qun;LING Hai-hui

  2013, 15(2): 111-2.

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  A 36-year-old male patient with chronic hepatitis B received oral adefovir 10 mg once daily. About 6 months later, the treatment was switched to entecavir 0.5 mg once daily due to poor efficacy. Five months later, adefovir 10 mg once daily was added to his regimen. After 5 months of combination therapy, the patient developed a feeling of numbness on the right metatarsophalangeal joints. His creatine kinase level was 800 U/L. On the fourth day after entecavir withdrawal, his creatine kinase was 257 U/L, and the symptom of right metatarsophalangeal joints numbness was improved.
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  病例报告

  Hypodynamia and lethargy caused by spironolactone

  WANG Ke-ke;JIANG Ming-yan;ZHU Peng-li;ZHANG Lin;LI Yan

  2013, 15(2): 113-2.

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  A 24-year-old male patient with secondary hypertension received a therapeutic trial (diagnostic treatment) with spironolactone in order to exclude primary aldosteronism. He was given oral spironolactone 20 mg after lunch, after dinner and the next morning, respectively. About 3 hours after taking the first dose, the patient developed weakness of limbs, dizziness, and headache. The patient underwent bed rest and oxygen inhalation. About 30 minutes later, his symptoms relieved. Three hours after taking the second dose, he developed weakness. About two hours after taking the third dose, the above-mentioned symptoms recurred, accompanied by lethargy. The symptoms relieved spontaneously 2 hours later. Spironolactone was withdrawn. Five days later, the patient was retreated with oral spironolactone 20 mg after supper. Two hours after the drug use and the next morning, dizziness, hypodynamia, and lethargy recurred. Then, the symptoms relieved spontaneously

中药不良反应

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  中药不良反应

  Safflower injection-induced subconjunctival hemorrhage

  HU Yu;CHEN Gang;ZHOU Li-hong

  2013, 15(2): 115-1.

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  A 76-year-old man was administered IV safflower injection 20 ml and IV Shenqi Fuzheng injection (参芪扶正注射液) 60 ml once daily for worsened left foot pain accompanied by arthralgia in his left knee. On day 7, he developed subconjunctival ecchymosis with a diameter of 5 mm on the nasal side of his left eye. Safflower injection was stopped and Shenqi Fuzheng injection was continued. Meanwhile, he was given symptomatic therapy. Six days later, his ecchymosis gradually resolved and, nine days later, disappeared completely.
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  中药不良反应

  Lower extremity numbness, fever, and urinary retention due to misuse of sodium bicarbonate for intrathecal injection

  GUO Min;ZHANG Wen;XI Ya-ming

  2013, 15(2): 116-2.

  Abstract ( ) PDF ( )

  A 61-year-old male patient with acute lymphoblastic leukemia received intrathecal injection of chemotherapy drugs. A doctor in charge took mistakenly the 5% sodium bicarbonate injection as solvent. After intrathecal injection, the patient presented lower limbs numbness, followed by chills, fever (peak temperature 40.1 ℃), sweating, elevated blood pressure (190-210/106-110 mm Hg), increased heart rate (170-180 beats/min), and urinary retention. The patient was given an IV infusion of methyl-prednisolone and mannitol, and at the same time, fluid supplement and urethral catheterization were given. The patient′s temperature, blood pressure, and heart rate returned to normal 4 hours later, numbness of lower limbs disappeared 6 hours later, and urinated on himself 12 hours later. There was no similar symptoms recurrence at one-week follow up.