An 18-year-old man with epilepsy received carbamazepine treatment for 3 months, but no effects were observed, then carbamazepine was changed to sodium valproate 0.2 g daily for 40 days and more. Subsequently, the patient suddenly developed convulsion on limbs with unconsciousness, then he was hospitalized. His consciousness recovered after management. He presented with dizziness, diplopia, nausea, vomiting, and tinnitus. Examination revealed dysarthria, nystagmus and ataxia. On day four after admission, his blood ammonia level was 117.6 μmol/L. Routine blood testing and liver and renal function examination were normal. A brain MRI found no marked abnormalities. His symptoms improved after discontinuation of sodium valproate and his dizziness recurred after readministration of sodium valproate. Sodium valproate was stopped immediately and switched to clonazepam. His symptoms disappeared. His blood ammonia level decreased to 66 μmol/L.
Three patients with diabetes mellitus (1 man and 2 women aged 42~65 years) received repaglinide 0.5~2 mg thrice daily. Their liver functions were normal before repaglinide administration. About 12 months of therapy, the patients presented with yellowish skin and sclera. Liver function tests revealed the following values: ALT 205~1 350 U/L, AST 183~835 U/L, γ-GT 155~585 U/L, TBil 52.8~158.8 μmol/L. Repaglinide was stopped and liver-protective treatment was given. Their symptoms subsequently improved.
An 84-year-old woman was hospitalized with marked emaciation and anorexia. On admission, her liver function examination revealed the following values: ALT 10.0 U/L, AST 20.2 U/L, and γ-GT 16.3 U/L. An IV infusion of alany1 glutamine 20 g plus compound amino acid (18AA-Ⅱ) 500 ml was given. Three days later, her ALT level was 98.7 U/L, her AST level was 172.3 U/L, and her γ-GT level was 16.0 U/L. On day 5 after admission, the infusion was stopped; and on day 16, her liver function normalized. An IV infusion of alany1 glutamine plus compound amino acid (18AA-Ⅱ) was readministered. Four days after administration, her ALT and AST levels increased to 149.8 U/L and 129.5 U/L, respectively. The infusion was stopped again and her liver function normalized gradually.
A 48-year-old woman with fatty liver and mild increase in liver enzyme level (ALT 54.2 U/L) was treated with tiopronin 02 g thrice daily. Eight days later, the patient developed asthenia, anorexia, and yellowish urine. Laboratory testing revealed the following values: ALT 562.1 U/L, AST 253.9 U/L, DBil 26.2 μmol/L, TBil 38.3 μmol/L. Serology tests for hepatitis A, C, D, E viruses were negative. Tiopronin was withdrawn immediately and an IV infusion of magnesium isoglycyrrhizinate and sodium deoxyribonucleotide was given. Subsequently, her liver function improved gradually. Eighteen days after discharge, her ALT was 27.1 U/L and her AST was 19.1 U/L.
A 40-year-old man with hypertension received captopril 6.25 mg three times daily. One week later, the dosage of captopril was increased to 12.5 mg three times daily. After one month, his TBil increased from 13.6 μmol/L to 37.3 μmol/L. Captopril was discontinued. His TBil was 28.7 μmol/L one week later and 15.6 μmol/L one month later. Routine urine and blood investigations were normal, and viral serology was negative for hepatitis virus markers. Increased bilirubin was considered to be captopril-associated. Subsequently, captopril was changed to nifedipine sustained-release tablets and above-mentioned symptoms did not recur.
A 41-year-old male patient was hospitalized with peptic ulcer bleeding. After admission, the patient was treated with an IV infusion of pantoprazole 40 mg twice daily, an IV infusion of pazufloxacin 0.3 g once daily, etamsylate, aminomethylbenzoic acid, and hydroxyethyl starch. On day 3 of therapy, his WBC count decreased from 11.8×109/L to 1.7×109/L. Leukopenia was considered to be possibly pazufloxacinassociated. Pazufloxacin was stopped and switched to ceftezole, and pantoprazole was continued. His WBC count was 2.7×109/L two days later and 4.1×109/L one week later.
A 63-year-old man was hospitalized with angina pectoris. On admission, his blood pressure was 130/80 mm Hg. After hospitalization, he received oral administration of aspirin, simvastatin, and Tongxinluo, followed by an IV infusion of nitroglycerin 10 mg dissolved in 250 ml of glucose 5%. The patient developed increased blood pressure (150/90 mm Hg), headache, and chest distress half an hour after the first infusion start. The next day, headache, chest distress, and increased blood pressure (170/100 mm Hg) recurred 5 minutes after the second infusion start. Subsequently, nitroglycerin was stopped; all his other medications were continued. His blood pressure normalized.
An 87yearold man was hospitalized with lung metastasis of renal cancer complicated by lung infection. After admission, his ECG showed atrial premature beats with occasional ventricular premature beats. The patient was treatment with ceftizoxime and levofloxacin. On day 5 of hospitalization, he received an IV infusion of recombinant human interleukin-2 21 million units in 0.9% sodium chloride 100 ml. The next day, the patient developed paroxysmal atrial fibrillation. Initially, 2-3 episodes occurred every day and each episode lasted for 1-2 minutes. Four days later, multiple episodes occurred and each episode sometimes lasted for 10 minutes and more. Propafenone 100 mg thrice daily was given by mouth, but this had no obvious effect. Atrial fibrillation was considered to be possibly recombinant human interleukin-2-associated. Recombinant human interleukin-2 was stopped immediately. Subsequently, his ECG did not reveal any atrial fibrillation.
A 69-year-old woman with coronary heart disease and hypertension received captopril, atenolol, isosorbide dinitrate, and nifedipine for two years and more. After admission, enteric-coated aspirin 0.1 g once daily and SC low molecular weight heparin calaium 5 000 U once every 12 hours were added to her regimen due to unstable angina. The next day, her enteric-coated aspirin dosage was increased to 0.3 g once daily, and low molecular weight heparin calcium was changed to heparin sodium 800-1 500 U/h, which was administered via an intraveous infusion pump. Forty-eight hours later, heparin sodium was switched to SC low molecular weight heparin calcium 6 000 U once every 12 hours again. On day 5, the patient developed retroperitoneal hematoma, and the amount of bleeding was 1 000-1 200 ml. Entericcoated aspirin and low molecular weight heparin calcium were withdrawn. RBC suspension, batroxobin, and fluid expansion were given. On day 28 after hospitalization, a CT scan revealed that his hematoma was absorbed in some degree and she was discharged two days later. Two months after discharge, repeated CT scan showed that a greater part of hematoma was absorbed.
A 54-year-old male renal transplant recipient received allopurinol, prednisone, and sodium bicarbonate for gout in the past three years. In recent one month, his gout symptoms were exacerbated, then he was hospitalized and celecoxib 0.2 g twice daily was added to his regimen. The patient's renal function was normal and his urine protein was negative before treatment. After three days of therapy, he developed a 1+ urine protein and increased foamy urine. Celecoxib was stopped. After 3 further days, his foamy urine decreased and his urine protein became negative.
Two man with coronary artery disease or myocardial ischemia developed priapism after receiving alginic sodium diester (dosage not stated).Patient 1, a 35-year-old man with coronary artery disease, received an IV infusion of alginic sodium diester. On day 7, the patient developed priapism, and then he was hospitalized with an erection of 32 hours duration. The man underwent blood aspiration from the corpora cavernosa and received corpora cavernosa irrigation with phenylephrine, low molecular weight heparin, and normal saline. Three days later, his priapism resolved.Patient 2, a 41-year-old man with myocardial ischemia, received an IV infusion of alginic sodium diester. On day 3, the patient developed priapism, and then he was hospitalised with an erection of 72 hours duration. Corpora cavernosa irrigation and cavernosal-glandular shunt were not successful in relieving the priapism. Subsequently, cavernosalglandular shunt plus cavernous dilation were performed again. The next day, his priapism subsided completely.
A 23-year-old man with acute purulent tonsillitis received 1 aspirin 0.5 g effervescent tablet for a fever. About thirty minutes after administration, the patient developed facial swelling, mild skin flushing over his entire body, pruritus, chest distress, short of breath, dyspnea, and cyanosis. After admission, an examination revealed a BP of 70/40 mm Hg, a heart rate of 125 beats/min, a respiratory rate of 36 breaths/min. He had popular eruption of different sizes on his entire body and wheezing over both lungs. ECG showed sinus tachycardia. Oxygen inhalation, dexamethasone, promethazine, and fluid expansion were given immediately. Half an hour later, his symptoms improved gradually.