- ISSN 1008-5734
- CN 11-4015/R
- 1999年创刊
- 主管: 中国科学技术协会
- 主办: 中华医学会
A 63yearold woman with a 4month history of diabetes took glipizide and acarbose without adverse reactions occurring. Later, the woman received oral famciclovir 0.25 g thrice daily for herpes simplex. Two hours after the first administration, she experienced dizziness, nausea, vomiting, abdominal pain, and diarrhea. Intestinal infection was excluded by stool examination. Famciclovir was withdrawn and switched to an IV infusion of aciclovir 0.5 g once daily. Glipizide and acarbose were continued. Meanwhile, fluid replacement and symptomatic therapy were given. The following day, her dizziness and gastrointestinal symptoms disappeared completely. The patient continuously received IV infusion of aciclovir for four days. Her herpes simplex was entirely crusted and she was fully cured and discharged.
A 41-year-old woman with adhesive ileus underwent terminal ileum resection. The woman was given intravenous injection of hemocoagulase 1 KU dissolved in 20 ml of sodium chloride 0.9% after surgery, once every two hours for three times. No adverse reactions occurred after receiving the first and second dose of the medication. However, during the third infusion, the patient abruptly developed unconsciousness, sighing respiration, cyanosis of lips, pale face, bilateral mydriasis, and cardiac arrest. The infusion was stopped immediately. She underwent closed-chest cardiac message and oxygen with assisted mask ventilation. Lidocaine, adrenaline, and atropine were given intravenously. Thirty minutes later, her heart beat and respiration recovered.
A 1year and 9monthold girl with Kawasaki disease took dipyridamole 25 mg for treatment of thrombocytosis (684×109/L). About 15 minutes after taking the first dose, the girl developed vomiting, drenching sweats, pallor, perioral cyanosis, swelling of her lips, and dyspnea. She had a temperature of 36.3℃, a HR of 130 beats/min, a respiration rate of 32 breaths/min, and a BP of 97/54 mmHg. Dipyridamoleinduced anaphylaxis was diagnosed. Intramuscular adrenalin was administered immediately. Her symptoms resolved 5 minutes later. Cetirizine and methylprednisolone were given 30 minutes later. She recovered completely one hour later.
A 46-year-old woman was hospitalized with tuberculous pleurisy. She was treated orally with rifampicin 450 mg once daily, isoniazid 300 mg once daily, pyrazinamide 500 mg thrice daily, and ethambutol 750 mg once daily. Her platelet count was 335×109/L before treatment. After 14 days of therapy, her platelet count decreased to 1.8×109/L, and the dense bleeding points and ecchymoses occurred on her skin of extremities and abdomen. Rifampicin was withdrawn, and platelet transfusion and methylprednisolone treatment was given. The other therapy remained unchanged. One week later, her platelet count increased to 1642×109/L.
A 48yearold woman was given an IV infusion of cefoperazone/sulbactam 3 g dissolved in 0.9% sodium chloride injection 250 ml for treatment of bronchitis. The patient developed difficulty breathing, agitation, lips cyanosis, and unconsciousness with an unrecordable BP about 10 minutes after starting the infusion. Cefoperazone/sulbactam was discontinued immediately. Despite treatment with oxygen inhalation, adrenaline, dexamethasone, and hydrocortisone, she died.
Two patients receiving succinylated gelatin injection during surgery developed anaphylactic shock.Patient 1, a 16-year-old woman received an IV infusion of succinylated gelatin during undergoing malignant schwannoma resection. After infusion of 20-30 ml, her BP suddenly fell to 26/20 mmHg with a HR of 150 beats/min, and her generalized skin had an ‘orange peel’ appearance. The surgery was stopped immediately. Her condition improved after antianaphylactic and anti-shock treatment. Three days later, she underwent surgery again. The anesthesia remained the same and no adverse reactions occurred.Patient 2, a 46-year-old woman underwent an exploratory laparotomy for recurrence of postoperative ovarian cancer. She received an IV infusion of succinylated gelatin during surgery. After infusion of about 100 ml, her BP abruptly fell to 40/20 mmHg, and her chemosis occurred. The medication was withdrawn at once and her condition improved after antianaphylactic and antishock treatment. Her surgery was continued.
Strychni semen is the dried ripe seed of Strychnos nuxvomica L. The crude drug contains alkaloids, of which the main alkaloids are strychnine and brucine. Strychnine is the main toxic component of strychni semen. Generally, the oral intoxicating dose of strychnine in adults is 5～10 mg, and the oral lethal dose is 30 mg. Strychnine can cause excitation of all parts of the central nervous system. Early signs of intoxication are headache, dizziness, nausea, vomiting, anxiety, restlessness, and slight twitching. Generalized convulsion, increasing sensitivity of sense organs, trismus, risus sardonicus, opisthotonus, dysphagia, and dyspnea follow. The patients often die from respiratory arrest. The principle of therapy in strychni semen poisoning is the prevention or control of convulsions and asphyxia. Management includes gastric lavage, the administration of activated charcoal, sedation with diazepam or phenobarbital, respiration support, and symptomatic treatment. The following precautions should be taken for safe use of strychni semen: crude drug should not be used, and the dosage should conform to the dosage limit in Chinese Pharmacopoeia; strychni semen should not combine with some drugs such as spirit, poppy capsule, musk, and so on; strychni semen is contraindicated in pregnant women; strychni semen should be used with caution in patients with liver and renal function insufficiency, neurological disorders, hypertension, and heart disease; overuse and prolonged use of strychni semen should be avoided, otherwise careful monitoring should be performed; the dosage should be adjusted when using strychni semen from different producing area.
A 35-year-old woman was hospitalized with worsening of generalized rash. Before admission, she had taken Baixuanxiatare tablets for one year. After hospitalisation, she received monoammonium glycyrrhizinate, chlorphenamine, diphenhydramine, and acitretin. Four days after admission, because of bloody stools, she underwent enteroscopy, which revealed a dark brown colic mucous membrane. Colon biopsies showed the presence of pigmentladen mononuclear phagocytes within the lamina propria. Melanosis coli was diagnosed. Baixuanxiatare tablets were discontinued and other drugs were continued. One year later, a repeated enteroscopy revealed normal mucosa in the colon. Melanosis coli might be associated with anthraquinonecontaining aloe in Baixuanxiatare tablets.
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