- 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
Objective: To study the effects of gatifloxacin on blood glucose in order to provide scientific basis for clinical safe use of the drug. Methods: Four hundred and seventyfive inpatients receiving gatifloxacin or levofloxacin from 13 hospitals between May 2007 and October 2007 were enrolled in a follow-up study. The gatifloxacin group were 230 cases and the levofloxacin group were 245 cases. All patients were administered with an IV infusion of a dose of 400 mg daily for 7 days. Blood glucose levels were measured before drug administration, on day 4 after drug administration, and after drug discontinuation. Results: The incidence of high blood glucose and elevated blood glucose after drug discontinuation were greater in the gatifloxacin group than in the levofloxacin group (13.91% vs 6.53% and 18.70% vs 9.80%, respectively). The differences were statistically significant (P<0.01). The incidence of reduced blood glucose after drug discontinuation were greater in the levofloxacin group than the gatifloxacin group (36.73% vs 22.17%). The differences were statistically significant (P<0.01). The incidence of high blood glucose, elevated blood glucose, and reduced blood glucose after drug discontinuation to the gatifloxacin group were 12.90%, 17.74%, and 22.58% in diabetic patients, and 14.29%, 19.05%, and 24.40% in non-diabetic patients, respectively. The differences were no statistically significant (all P>0.05). Conclusion: Gatifloxacin can elevate or reduce blood glucose levels. Therefore, care should be taken and blood glucose levels should be monitored in clinical gatifloxacin use.
Albumin, the major protein involved in maintaining colloid osmotic pressure in the blood, has been used in conditions such as burns, severe acute loss of albumin, and acute hypovolaemic shock. However, a variety of inappropriate use of albumin has been widely present in clinical practice recently, such as supplying nutrition, enhancing immunity, promoting wound healing, and expanding or maintaining blood volume in the routine treatment of fluid depletion. Actually, despite of the increase in serum albumin level, the use of albumin can not improve the therapeutic effects for original disease, reduce the incidence rate of complications, and improve clinical prognosis. One study reported that the increased deaths were 6 cases for each 100 critically ill patients using albumin, and it might be linked to increased mortality. In addition, there was no evidence that albumin administration reduces mortality in critically ill patients with hypovolaemia, burns, or hypoproteinemia. At present, the generally acknowledged indications of albumin in clinical practice are as follows: 24 hours after large area burns, acute traumatic shock, acute respiratory distress syndrome, blood replacement therapy, renal dialysis, severe hypoproteinemia and ascites, acute liver failure with hepatic coma.
A 40yearold woman with acute pyelonephritis received an intravenous infusion of cefotaxime sodium 2 g dissolved in 250 ml of sodium chloride 0.9%. No adverse reactions were found. Later, fleroxacin 0.4 g dissolved in 500 ml of glucose 5% was infused intravenously. She developed chill after receiving about 250 ml of the infusion. Her BP was 100/70 mmHg, and HR was 84 beats/min. The infusion was stopped. She was given IM promethazine and IV dexamethasone. Approximately 17 minutes later, convulsion of her extremities, undetectable blood pressure, heart arrest, and respiratory arrest occurred in the woman. Despite continuous resuscitation efforts, she died.
A 5monthold girl with infectious diarrhea accompanied by mild dehydration was administered with an IV infusion of 250 ml of glucose 10% mixed with 8 ml of sodium chloride 10% and 3 ml of potassium chloride 10%. Five minutes later, the girl developed chill, fever and dyspnea. The infusion was discontinued. Her condition improved after treatment with dexamethasone. The next day, the girl was given the same fluid again, then anaphylactic reaction reappeared. On day 3, potassium chloride was stopped and other drugs was unchanged. The fluid therapy was continued and anaphylactic reaction did not occur.
A 35yearold man with chronic hepatitis B took adefovir 10 mg/day. Three months later, his liver function returned to normal; fifteen months later, his HBV DNA level was ＜1×103 copies/ml. However, his HBeAg was still positive. After two years of treatment, adefovir was withdrawn by himself. After forty days of adefovir discontinuation, the man developed fatigue and anorexia. Laboratory testing showed the following results: ALT 1 884.9 U/L, AST 1 135.4 U/L, TBil 42.8 μmol/L, DBil 16.8 μmol/L, HBV DNA 1.27×107 copies/ml. Viral rebound due to adefovir withdrawal was suspected. Subsequently he was admitted to hospital and given oral entecavir 1 mg/day and liverprotective and symptomatic therapy. However, the patient's symptoms became aggravated gradually, and deepening jaundice occurred. Laboratory investigations revealed the following values: TBil 428 μmol/L, PTA 13.8%, INR 5.8. He was diagnosed with hepatic failure. Despite treatment with nonbiotype artificial liver and plasmapheresis, his condition deteriorated further, and hepatic encephalopathy occurred. Finally he died of hepatic failure.
A 55yearold woman with lung adenocarcinoma started receiving erlotinib 150 mg once daily after stopping paclitaxel, carboplatin, and gefitinib. Two weeks later, the woman developed skin eruption on her forehead and back. She also had paronychia on both hands and feet. A subungual abscess occurred on her great toes. The patient underwent partial excision of nail root, the dosage of erlotinib was reduced to 120 mg once daily, and epidermal growth factor gel was given for external use. Approximaly 3 weeks later, her paronychia resolved, but skin eruption on her forehead and trunk still remained.
Objective: To study the efficacy and safety of carvedilol for preventing recurrence of paroxysmal atrial fibrillation (PAF) in order to benefit rational and safe use of carvedilol. Methods: Fiftythree patients with PAF were enrolled in a prospective, randomized, parallel, controlled study, and assigned to two groups: the carvedilol (CAV) group (27 cases) and the metoprolol（MET）group (26 cases). The patients in both groups received carvedilol 25 mg daily or metoprolol 50 mg daily, respectively. Duration of treatment was 1 year. MMP2 and MMP9 expressions in peripheral blood monouclear cells, silent heart rate (SHR), left atrial diameter (LAD), left ventricular enddiastolic diameter (LVEDd), and left ventricular ejection fraction (LVEF) were measured before and after treatment. Atrial fibrillation (AF) recurrence parameters including AF recurrence rate, occurrence frenquency (OF), occurrence sustain time (OST) and occurrence ventricular rate (OVR) were all recorded during one year of therapy. Results: ⑴ In comparison of after treatment with before treatment, LVEDd and LVEF found no change in the two groups (all P>0.05); SHR was (68±12) beats/min and (61±9) beats/min in the CAV group, and (69±11) beats/min and (61±11) beats/min in the MET group, respectively, SHR was significantly slower after treatment than before treatment (all P<0.05); there was no significant change in LAD in the CAV group (P>0.05), but LAD in the MET group was markedly greater (P<0.01); MMP2 and MMP9 expressions before and after teatment were (138.5±56.4) ng/dl, (103.7±49.5) ng/dl and (19.6±11.1) ng/dl, (11.3±9.4) ng/dl in the CAV group, MMP2 and MMP9 expressions were markedly lower after treatment than before treatment (P<0.05, P<0.01), MMP2 and MMP9 expressions showed no significant decrease in the MET group (P>0.05). OF decreased significantly in the CAV group (P<0.01), but there was no marked difference in the MET group (P>0.05). ⑵ In comparison of both groups after treatment, LAD was marked lower in the CAV group than in the MET group (P<0.01), but there was no statistically difference in other parameters of heart morphology and function (all P>0.05); MMP2 and MMP9 expressions, OF and OST of AF were lower in the CAV group than in the MET group (P<0.01, P<0.05); and there was no significant difference for AF recurrence rate and OVR in both groups (all P>0.05). ⑶ A positive correlation was observed between OF and LAD (r=0.826, P<0.01), and the expressions of MMP2 and MMP9 (r=0.773, r=0.819, all P<0.01). ⑷ No severe AV block was found in both groups. The two drugs did not influence on the blood glucose levels. Conclusion: Carvedilol could be safely and effectively used for preventing recurrence of paroxysmal atrial fibrillation.
Objective: To study the effects of insulin aspart and human regular insulin on blood glucose in elderly type 2 diabetic patients with irregular food intake. Methods: Thirtythree elderly patients with type 2 diabetes mellitus \[18 men, 15 women, average age (65.82±2.85) years\] were enrolled in a clinical study from February 2006 to April 2007. They initially received regimen A (SC human regular insulin 30 minutes before each meal and SC human isophane insulin at bedtime for 4 months), followed by regimen B (SC insulin aspart 1015 minutes after meals and SC human isophane insulin at bedtime for 4 months). The fasting and 2hour postprandial (after breakfast, midday meal, and evening meal) blood glucose levels were measured twice a week. The frequency and severity of hypoglycemia as well as the changes in glycosylated haemoglobin (HbAlc) levels were observed comparatively between the two regimens. Results: The fasting and 2hour postprandial (after breakfast, midday meal, and evening meal) blood glucose levels were (7.37±4.22) mmol/L, (9.73±3.38) mmol/L, (10.23±3.96) mmol/L, and (10.85±3.36) mmol/L for regimen A, and (701±1.74) mmol/L, (9.23±1.58) mmol/L, (9.22±1.28) mmol/L, and (9.76±1.32) mmol/L for regimen B, respectively. The differences were statistically significant (all P＜0.01). The fluctuations of postprandial blood glucose were lower for regimen B than for regimen A. The difference values of HbAlc before and after treatment was (3.08±0.96)% for regimen A and (3.37±0.47)% for regimen B (P＜0.01), respectively. The frequency of hypoglycemia and the incidence of moderate-to-severe hypoglycemia were 68 cases and 36.70% for regimen A, and 21 cases and 19.05% for regimen B, respectively. The differences were statistically significant (P＜0.001). Conclusion: In elderly type 2 diabetic patients, subcutaneous injection of insulin aspart after meals can effectively decrease the blood glucose levels, reduce the fluctuation of postprandial blood glucose levels, and diminish the frequency and severity of hypoglycemia. It is a safe and effective regimen for elderly type 2 diabetic patients with irregular food intake.
A 48yearold woman who had a history of penicilin hypersensitivity was administered with an IV infusion of levofloxacin 0.2 g for upper respiratory infection. After 2 minutes of this infusion, the woman developed dizziness, nausea and vomiting. Subsequently unconsciousness and cardiorespiratory arrest occurred. She was given cardiopulmonary resuscitation and IV dexamethasone 10 mg immediately. Thirty seconds later, her breath and heartbeat recovered. Thirty minutes later, her respiration, heart rate, and blood pressure returned to normal limits. The medication was switched to azithromycin and the similar reactions did not reappear.
A 64yearold man was hospitalized with hypertension and chronic renal failure complicated by superficial abscess of left ankle. The man was infused with cefazolin sodium pentahydrate 2 g dissolved in 100 ml of sodium chloride injection 0.9% every 12 hours intravenously for treating infection. Three days later, the man developed mental disorder, consciousness disturbance and convulsion. Water and electrolyte disturbances, uremic encephalopathy, cerebrovascular accident and viral encephalitis were excluded by CT examination and blood biochemical analysis. Cefazolin sodium pentahydrate was stopped and other medications were unchanged. The patient’s encephalopathic symptoms resolved gradually.
Objective: To analyze the related risk factors for drug-induced epileptiform seizures. Methods: The data of 148 patients with drug-induced epileptiform seizures were collected from CNKI and CMB between 1997 and 2007. The risk factors for drug-induced epileptiform seizures were analyzed retrospectively, including age, sex, and primary diseases of patients; causative drugs, dosage, and drug combination; type, onset time, duration, and prognosis of seizures. Results: Of the 148 patients, 82 were men, 66 were women. Their average age was (40.16±24.08) years. Fifteen patients of them had history of epilepsy .The first three kinds of drugs that may induce epileptiform seizures were antimicrobial drugs, drugs acting on the central nervous system, and anesthetics. Eighty-two cases (55.41%) of epileptiform seizure were caused by antimicrobial drugs, and quinolones accounted for 39 of 82 cases. Thirtyfour cases (22.97%) were caused by drugs acting on the central nervous system, and antipsychotic accounted for 20 of 34 cases. Eight cases (5.41%) caused by anesthetics, and ketamine accounted for 6 of 8 cases. The most common type of epileptiform seizures was generalized tonicclonic seizure (120 cases, 81.08%), followed by complex partial seizure (15 cases, 10.14%). The patients < 19 years of age were 32 cases (21.6%), and the patients ≥60 years of age were 52 cases (35.14%). The patients receiving drug overdose were 21 cases (14.19%). Of 45 patients receiving drug combination, 10 patients developed epileptiform seizures. The time of seizure onset was 3 minutes to 6 months after the first administration of the drug, lasting from 4 seconds to 20 minutes. After drug withdrawal or symptomatic therapy, 147 patients with epileptiform seizures improved or recovered, and one patient died from pulmonary infections and circulatory failure. Conclusion: The risk factors for drug-induced factors include the effects of drugs on the central nervous system, patient's age (older or younger age), history of epilepsy, primary diseases, overdose, and drug combination.
Objective: To investigate the amoxicillininduced renal damage and its clinical characteristics. Methods: The case reports of amoxicillininduced renal damage were collected from medical literature between 1979 and 2007. The dosage and administration of amoxicillin and onset time and clinical characteristics of adverse reactions were analyzed. Results: The patients with amoxicillininduced renal damage were 32 cases [11 men, 21 women, average age (38.95±23.53) years]. Of the 32 patients, 16 received amoxicillin alone, 9 received amoxicillin combination with other drugs, 7 received amoxicillin/clavulanate potassium; 21 was administered by intravenous infusion, 9 was administered by mouth, and two patients’route of administration was not stated. Of the 32 patients, 20 patients' dosage exceeded the common dosage limits, and one patient’s dosage was not stated. The renal damages caused by amoxicillin were acute renal failure, acute interstitial nephritis, and hematuria. The average onset time of renal damage was (8.57±3.10) days in usual dosage and (1.05±1.57) days in overdose. Conclusion: Amoxicillin can cause severe renal damage, especially in overdose.
Objective: To compare the frequency and intensity of nephropathy of isosmolar contrast media with lowosmolar contrast media in patients with renal insufficiency undergoing coronary angiography (CAG) or precutaneous coronary intervention (PCI). Methods: Four hundred and sixtyone inpatients with renal insufficiency in our hospital from March 1, 2003 to September 1, 2007 were divided into two groups: the isosmolar contrast media group (131 cases) and the lowosmolar contrast media group (330 cases). All the patients underwent CAG or PCI. The serum creatinine levels on the day before CAG or PCI and on day 1,3, and 7 after CAG or PCI were measured. And the adverse reactions in the two groups were observed. Results: On the day1, 3, and 7 after CAG or PCI, incidence of nephropathy was 6.9%, 19.1%, and 19.8% in the isosmolar contrast media group, and 23.9%, 36.4%, and 39.4% in the lowosmolar contrast media group, respectively. The deferences between the two groups were statistically significant（all P＜0.05）. On the day 1 and 3 after CAG or PCI, the increased serum creatinine levels were (15.8±55.5) μmol/L and (123±58.0) μmol/L in the isosmolar contrast media group, and (20.1±53.7) μmol/L and (38.3±62.4) μmol/L in the lowosmolar contrast media group, respectively. The deferences between the two groups were statistically significant (all P<0.05). Conclusion: Isosmolar contrast media is less nephrotoxic than lowosmolar contrast media used in the patients with renal insufficiency. And it is safer for the patient with renal insufficiency undergoing CAG or PCI.
A 50yearold woman was scheduled to receive chemotherapy comprising vinorelbine 40 mg/d on day 1 and 8 in combination with cisplatin 40 mg/d on day 2～4 after undergoing right upper lobectomy for mucinous adenocarcinoma. On day 2 after vinorelbine therapy (before starting cisplatin therapy), the patient developed constipation. After symptomatic treatment, her constipation improved. However, on day 7 after the first cycle of chemotherapy her symptoms aggravated, and abdominal pain and distension, nausea, and vomiting occurred. An abdominal X-ray showed intestinal obstruction. Her neutrophil count decreased to 0×109/L. Vinorelbine therapy was discontinued, and recombinant human granulocyte colony stimulating factor was given. Her constipation did not recur and her neutrophil count increased to 16.48×109/L.
34-year-old woman with bronchitis was infused with 200 ml (0.4 g) of azithromycin sodium chloride injection intravenously. The patient presented with tongue tip numbness after receiving 80 ml of the infusion. A tongue examination did not reveal any abnormalities. Two hours after the infusion, her tongue tip numbness disappeared. The next day, her tongue tip numbness recurred after the second infusion of azithromycin. On day 3, azithromycin was replaced with ceftriaxone and the symptom did not recur.
A 64-year-old man was hospitalized with coronary heart disease accompanied by unstable angina pectoris. On hospital day 3, he was infused with sodium ferulate 0.6 g dissolved in 250 ml of glucose 5% at a rate of 3 ml/min. After receiving about 30 ml of the infusion, the man developed persistent angina pectoris, pale face, and fatigue. His BP was 80/50 mmHg; his ECG showed myocardial ischemic change. Sodium ferulate was discontinued. His condition improved after the patient was given with oxygen therapy and placed in the horizontal position. His myocardium enzymogram was within normal ranges. Acute myocardial infarction was excluded. And his angina pectoris was considered to be related to sodium ferulate.
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