2015 Volume 17 Issue 3 Published: 28 June 2015
  

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  • Adverse reactions and risk factors of zoledronic acid in the treatment of osteoporosis combined with rheumatic diseases
    Wu Rui; Zhao Yi' Li Xiaoxia
    2015, 17(3): 170.
    Abstract ( ) PDF ( )
    ObjectiveTo observe the adverse reactions of zoledronic acid in the treatment of osteoporosis combined with rheumatic diseases and analyze the potential risk factors.MethodsMedical record data of patients with rheumatic diseases and osteoporosis who were treated with zoledronic acid during hospitalization in Xuanwu Hospital of Capital Medical University from January 2011 to December 2014 were collected and a retrospective analysis was conducted. The patients were grouped according to the occurrence of adverse reactions and their demographic characteristics, types of rheumatic diseases and medication regimen of zoledronic acid were compared. The screened risk factors for adverse reactions were analyzed by multivariate logistic regression. The results were expressed by odds ratio (OR) and 95% confidence intervals (CI).ResultsA total of 120 patients were enrolled into the study. There were 41 males and 79 females. Their ages ranged from 23 to 85 years. Of 120 patients, 64 cases (53.3%) received first infusion of zoledronic acid, 66 cases (55.0%) received the treatment with corticosteroids during hospitalization, 58 cases (48.3%) were given antipyretic analgesics before infusion of zoledronic acid and 64 cases (53.3%) received sufficient hydration before and after the infusion; 49 (40.8%) of the 120 patients were reported to have adverse reactions. All adverse reactions were of acute phase responses, including fever in 32 (65.3%), flu-like symptoms in 21 (42.9%), headache in 17 (34.7%), fatigue in 12 (24.5%), myalgia in 10 (20.4%), arthralgia in 8 (16.3%), chills in 6 (12.2%), nausea in 5 (10.2%), vomiting in 4 (8.2%), and dry cough in 1 (2.0%). No severe adverse events occurred. The incidence of adverse reactions in initial infusion patients was significantly higher than that in non-initial infusion patients［51.6% (33/64) vs. 28.6% (16/56), P=0.011］. The incidence of adverse reactions in patients with  corticosteroid therapy was significantly lower than that in patients with no corticosteroid therapy［24.2% (16/66) vs. 61.1% (33/54), P<0.001］. The patients who were given sufficient hydration before and after the infusion also had significantly lower incidence of adverse reactions than those without sufficient hydration treatments［31.2% (20/64) vs. 51.8% (29/56), P=0.023］. Multivariate logistic regression analysis suggested that initial infusion was a risk factor for adverse reactions (OR=2.631, 95%CI: 1.132-6.116, P=0.025). However, oral corticosteroid and sufficient hydration treatments before and after the infusion were protective factors (OR=0.232, 95%CI: 0.102-0.526, P<0.001; OR=0.379, 95%CI: 0.164-0.874, P=0.023).ConclusionsAcute phase responses related to zoledronic acid are common in the treatment of patients with rheumatic diseases and osteoporosis. Iniaial infusion is closely associated with adverse reactions of zoledronic acid, but oral corticosteroid and sufficient hydration treatments before and after the infusion might decrease the incidence of adverse reactions.
  • Analysis on adverse drug reactions caused by cyclosporine in patients with rheumatic diseases
    Wu Liyao, Sheng Xiaoyan, Ma Lingyue, Zhao Xia，Zhou Ying，Cui Yimin
    2015, 17(3): 181.
    Abstract ( ) PDF ( )
    ObjectiveTo explore adverse reactions induced by cyclosporine in patients with rheumatic diseases.MethodsClinical data of patients diagnosed with rheumatic diseases and treated with cyclosporine ( 3 d) in Peking University First Hospital from January 2013 to December 2014 were collected and analyzed retrospectively.ResultsData of a total of 46 patients in accordance with inclusion criteria were collected. Of them, 20 patients were diagnosed with systemic lupus erythematosus, 8 with dermatomyositis, 6 with sicca syndrome, and 4 with undifferentiated connective tissue diseases and etc. There were 2-13 kinds of combination drugs in this 46 patients. In addition to cyclosporine treatment, all of them were treated with glucocorticoid, 39 with non-steroidal antiinflammatory drugs, 12 with other immune suppressants, 20 with antibiotics, 15 with hypoglycemic drugs, 14 with antihypertensive drugs, and 8 with proton pump inhibitors at the same time. Of the 46 patients, 21 developed 33 patient-time adverse drug reactions and the incidence was 45.7%. Of the 21 patients, 14 patients developed 1 kind of adverse reaction, 3 patients developed 2 kinds of adverse reactions, 3 patients developed 3 kinds of adverse reactions, and 1 patients developed 4 kinds of adverse reactions. The incidence of different adverse reactions were as follow: infection 21.7%(10/46), urea nitrogen increase 10.9%(5/46), gastrointestinal reactions 10.9%(5/46), blood glucose increase 8.7%(4/46), blood pressure increase 8.7%(4/46), and liver injury 6.5%(3/46), dizziness and headache 2.2%(1/46), and hypoleucocytosis 2.2%(1/46). Severe adverse reactions occurred in 5 patients and in 4 of them improved after treatments with drug withdrawal or symptomatic therapy, including recurrence of pulmonary tuberculosis in 2 patients, aggravation of original interstitial lung disease in 1 patient, and peptic ulcer in 1 patient; the fifth patient with repetitive infection died of primary disease after drug withdrawal. Moderate adverse reactions in 8 patients improved after symptomatic treatments. Mild adverse reactions in 7 patients were self-relieved and not clear in 1 patient because of discharge.ConclusionsThe incidence of adverse reactions induced by cyclosporine is high. The incidence of infection is higher and more severe. During the treatments, infection, blood glucose, blood pressure, and liver and renal function should be monitored to ensure medication safety.
  • Risk of dyspepsia and anorexia due to glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes mellitus: a Network Meta-analysis
    Li Zhixia, Zeng Xiantao, Chai Sanbao, Quan Xiaochi, Wu Shanshan, Yang Zhirong, Zhan Siyan, Sun Feng
    2015, 17(3): 185.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the risk of dyspepsia and anorexia due to glucagon-like peptide-1 receptor agonist (GLP-1 RA) in patients with type 2 diabetes mellitus (T2DM).MethodsThe electronic database of Chinese BioMedical Literature Database(CBMdisc), Chinese Medical Current Contents(CMCC), Medline, EMbase, the Cochrane Library and web site of ClinicalTrials.gov were searched from inception to May 1st 2014. Those randomized controlled trials whose inclusion criteria including patients with T2DM as the research object, comparisons of GLP-1 RA and placebo or other conventional anti-diabetic drugs as the intervention measures, and dyspepsia and anorexia as the outcomes were collected. A traditional Meta-analysis and a Network Meta-analysis were used and relational graph and rank ordering figure of all the intervention measures were drawn. ResultsA total of 42 randomized controlled trials were enrolled into this study involving 20 916 patients with T2DM and 13 kinds of intervention measures comprised 7 kinds of GLP-1 RAs (exenatide, exenatide release agent, liraglutide, lixisenatide, taspoglutide, albiglutide, and dulaglutide), 5 kinds of conventional anti-diabetic drugs (insulin, metformin, sulfonylureas, sitagliptin, and thiazolidinediones ketones), and placebo. The traditional Meta-analysis showed that, compared with placebo, the whole of GLP-1 RAs could increase the risks of dyspepsia ［odds ratio(OR)=3.04, 95% confidence interval (CI): 1.79-5.16］ and anorexia (OR=2.57, 95%CI: 1.69-3.91) and there were statistically significant differences (P<0.05). The Network Meta-analysis showed that, compared with placebo, albiglutide, exenatide, exenatide release agent, liraglutide, lixisenatide, and taspoglutide could increase the risks of dyspepsia with statistically significant differences (all P<0.05) and, of them, liraglutide was at the greatest risk and the risk was 7.69 (1/0.13) times as high as that of the placebo. Compared with insulin, metformin, sulfonylureas, sitagliptin, and thiazolidinediones ketones, GLP-1 RAs could also increase the risks of dyspepsia in the patients with T2DM and, of them, liraglutide was at the greatest risk,which was 13.58, 4.17 (1/0.24), 3.85 (1/0.26), 5.00 (1/0.20), and 3.70 (1/0.27) as high as that of insulin, metformin, sulfonylureas, sitagliptin, and thiazolidinediones ketones, respectively. Compared with placebo, dulaglutide, exenatide, liraglutide, and taspoglutide could increase the risks of anorexia with statistically significant differences (all P<0.05) and, of them, dulaglutide was at the greatest risk, 5.53 times as high as that of the placebo. Compared with insulin, sulfonylureas, thiazolidinediones ketones, and sitagliptin, GLP-1 RAs could also increase the risks of anorexia in the patients with T2DM ( all OR>1.00 except for lixisenatide versus sitagliptin ) and, of them, dulaglutide was at the greatest risk, 48.91, 16.65, 36.24, and 4.75 times as high as that of insulin, sulfonylureas, thiazolidinediones ketones, and sitagliptin, respectively. There was no statistically significant difference between two kinds of GLP-1 RAs for risks of dyspepsia and anorexia (all P>0.05). The risks of dyspepsia and anorexia due to the 13 kinds of intervention measures were ranked by rank ordering figure and liraglutide and dulaglutide were at the greatest risks.ConclusionBoth the traditional Meta-analysis and Network Meta-analysis showed that GLP-1 RAs could increase the risk of dyspepsia and anorexia in patients with T2DM.
  • Safety of pirfenidone in treatment of idiopathic pulmonary fibrosis: a Meta-analysis
    Feng Zhihong, Wei Bing, Teng Guojie, Yu Chunni, Ren Kui, Gao Shang, Nie Xiuhong
    2015, 17(3): 196.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the safety of pirfenidone in treatment of idiopathic pulmonary fibrosis (IPF).MethodsPubMed, the Cochrane library, EMbase, CNKI, and WanFang database were searched using the keywords pirfenidone, idiopathic pulmonary fibrosis, and IPF from January 1999 to January 2015. Randomized controlled trials (RCTs) of pirfenidone in treatment of IPF were selected. The patients in the trial group were given pirfenidone alone while the patients in the control group were given oral placebo. The primary end point event of the outcome was the incidence of pirfenidone′s adverse events. The Meta-analysis was performed using RevMan 5.2.ResultsA total of 4 articles including 5 RCTs were enrolled. There were 945 patients in the trial group and 766 patients in the control group. The incidents of many kinds of adverse events in the trial group were markedly higher than those in the control group, including gastrointestinal discomfort ［12.6% (101/804) vs. 5.2% (40/766), RR= 2.31, 95% CI: 1.63-3.29, P< 0.01］, nausea ［34.6% (241/695) vs. 15.0% (99/659), RR= 2.373, 95% CI:1.92-2.92, P< 0.01］ and vomiting ［13.3% (83/623) vs. 6.3% (39/624), RR= 2.13, 95% CI:1.48-3.06, P< 0.01］, diarrhea ［25.8% (161/623) vs. 20.4% (127/624), RR= 1.27, 95% CI: 1.03-1.56, P=0.02］, anorexia ［15.2% (122/804) vs. 4.7% (36/766), RR= 3.10, 95% CI:2.16-4.46, P<0.01］, abnormal liver function ［6.0% (49/804) vs. 1.7% (13/766), RR= 2.48, 95% CI: 1.46-4.23, P<0.01］, rash ［30.4% (189/623) vs. 10.3% (64/624), RR= 2.95, 95% CI: 2.27-3.83, P< 0.01］, photosensitivity reaction ［24.7% (129/526) vs. 6.1% (30/489), RR= 5.54, 95% CI: 1.78-17.30, P<0.01］, insomnia ［10.4% (65/623) vs. 6.6% (41/624), RR=1.59, 95% CI: 1.09-2.31, P= 0.02］, dizziness ［16.4% (120/732) vs. 9.8% (72/731), RR=1.67, 95% CI: 1.27-2.19, P<0.01］, fatigue ［25.6% (178/695) vs. 16.3% (108/659), RR= 1.60, 95% CI: 1.29-1.98, P< 0.01］, and weight loss ［10.1% (63/623) vs. 5.4% (34/624), RR= 1.85, 95% CI: 1.24-2.77, P= 0.03］. However, there was no statistically significant difference in treatment-related serious events ［26.5% (165/623) vs. 26.4% (165/624), RR= 1.00, 95% CI: 0.83-1.20, P= 0.94］. Compared with the control group, there was a statistical significance in the rate of drug withdrawal in the trial group ［14.6% (117/804) vs. 9.0% (69/766), RR= 1.62, 95% CI: 1.22-2.15, P<0.01). ConclusionThe common adverse events of pirfenidone are gastrointestinal, skin, and neurological system damage and fatigue and loss of weight. The adverse events are mild and mostly recoverable without obvious sequelae. The pirfenidone is safe and well-tolerated.
  • Active systemic allergic reaction induced by breviscapine injection in guinea pigs
    Zhou Li, Luo Yongwei, Wang Yong, Jiang Juan, Jia Yuling, Gui Bo, Chong Liming, Sun Zuyue
    2015, 17(3): 204.
    Abstract ( ) PDF ( )
    ObjectiveTo explore the relationships between active systemic allergic reaction induced by breviscapine injection and the drug dose and the sensitization time.MethodsActive systemic allergic reaction in guinea pigs was used as experimental method. Forty-eight guinea pigs were divided into 6 groups according to random number table: breviscapine injection 1, 5, 25 and 50 mg/kg group (the breviscapine injection group 1, 2, 3, 4), 0.9% sodium chloride injection group (the negative control group) and bovine serum albumin (BSA) control group (the positive control group). Each group comprised 8 guinea pigs. Sensitization: the guinea pigs in group 1 to 4 were given the breviscapine injection  at doses of 1, 5, 25 and 50 mg/kg (0.5 ml) by intraperitoneal injection every other day for three times, respectively. The the guinea pigs in the negative control group and the positive control group were given 0.9% sodium chloride injection (0.5 ml) and bovine serum albumin (BSA) 20 mg/kg by intraperitoneal injection every other day for 3 times, respectively. Excitation: the sensitized guinea pigs in each group were divided into 2 subgroups, each subgroup comprised 4 guinea pigs. On the 14 and 21 days after the last sensitization, the guinea pigs in breviscapine 1 to 4 subgroups received 2 times of breviscapine injection intravenously (1.0 ml), respectively. The guinea pigs in the negative and the positive control subgroups  received 2 times of control articles intravenously, respectively. The symptoms of anaphylactic reaction (pilo-erection, shiver, scratching nose, sneeze, cough, vomiturition, cyanosis, dyspnea, urinary and fecal incontinence, instability of gait or tumble, convulsion or hyperspasmia, shock and death) were observed every day during the sensitization phase. The guinea pigs′ reactions which appeared in 30 min after intravenous injections were observed and the occurrence time of allergic symptoms/signs were recorded attentively. The anaphylactic reaction was determined according to the Chinese Pharmacopoeia′s allergic reaction test. ResultsThe guinea pigs in 6 groups did not show any allergic symptoms in the sensitization phase. Within 30 min in fourteenth days′ excitation,  2, 4, 4, 4 guinea pigs developed allergic reactions in the breviscapine 1 to 4 groups, respectively. But none of them were identified as allergic reaction. The 4 guinea pigs in the positive control group were judged to have positive allergic reaction. Within 30 min of 21 days′ excitation, 4、3、4、4 guinea pigs developed allergic reactions in the breviscapine 1 to 4 groups, respectively. Only one guinea pig in the breviscapine 4 group was identified as allergic reaction. The 4 guinea pigs in the positive control group were all judged positive allergic reaction. The guinea pigs in the negative control group did not develop any allergic reactions during the 2 times of excitation. The occurrence time of allergic reactions in the breviscapine groups (within 20 min after excitation) on 21 days′ excitation was shorter than those (within 25 min after excitation) occurred on 14 days′ excitation, but the difference was not statistically significant.ConclusionsThe active systemic allergic reactions induced by breviscapine injection are associated with drug dose and sensitization time. The larger dose and longer sensitization time can increase the risk of allergic reaction and shorten the latency of allergic reaction.
  • Application of PDCA cycle method in intravenous infusion speed management in inpatients
    Li Xiaoxiao, Yi Zhanmiao, Zhao Rongsheng, Liu Fang, Huang Runzhou
    2015, 17(3): 209.
    Abstract ( ) PDF ( )
    ObjectiveTo explore application value of PDCA cycle method in intravenous (IV) infusion speed management in inpatients.MethodsPatients hospitalized in the 2nd ward of Department of Neurology, Peking University Third Hospital were selected as subjects and IV infusion speed standards were drown up using a quality improvement management, Plan-Do-Check-Action (PDCA) cycle method. Before and after the management, data related to IV infusion speeds from May 20th to 26th, 2013 (before management) and May 12th to 18th, 2014 (after management) and adverse drug reactions/events (ADR/ADE) evaluated absolutely, probably, or possibly related to drugs from August 2012 to May 2013 (before management) and August 2013 to May 2014 (after management) were collected, the qualified rates of IV infusion speeds and ADR/ADE rates were calculated.ResultsThere were 40 beds of ward of department of Neurology. During May 20th to 26th , 2013, 33 kinds of injections were used in patients (255 person-time), and 11 kinds of injections (belonged to 7 types, 184 person-time) were selected as pilot injections for IV infusion speed management. The qualified rates of IV infusion speed were 82.4%-100.0% and the average IV infusion speed was 94.6%±6.7%. During May 12th to 18th , 2014, 39 injections were used in patients (721 person-time). Among them, 11 pilot injections were used in patients (483 person-time), the qualified rates of IV infusion speed were 85.7%-100.0% and the average IV infusion speed was 96.6%±5.1%. The qualified rate of IV infusion speed after IV infusion speed management increased than that before IV infusion speed management, but difference between them was not statistically significant (P>0.05). A total of 145 cases of ADR/ADE which were evaluated absolutely, probably or possibly related to drugs were collected. Of them, 49 cases of ADR/ADE were related to IV infusion speed, including 22 cases before IV infusion speed management (accounted for 36.1% of 61 cases of ADR/ADE  during the same time) and 27 cases after IV infusion speed management (accounted for 32.1% of 84 cases of ADR/ADE during the same time). As for the ADR/ADE involved in 11 pilot injections, 3 cases occurred before management (accounted for 4.9% of 61 cases of ADR/ADE during the same time) and 4 cases occurred after management (accounted for 4.7% of 84 cases of ADR/ADE during the same time).ConclusionApplication of PDCA cycle method may improve quality of IV infusion speed management in inpatients and increase medication safety management level.
  • Analysis on highly cited papers published in Adverse Drug Reactions Journal during 2009 to 2013
    Meng Yan
    2015, 17(3): 214.
    Abstract ( ) PDF ( )
    ObjectiveTo analyze the characteristics of highly cited papers published in Adverse Drug Reactions Journal (our journal) during 2009 to 2013， understand the hot spots of subject development and demands of readers, and improve impact and quality of our journal. MethodsThe citation frequency of papers published in our journal from 2009 to 2013 was searched in China Academic Journal Network Publishing Database (as of April 30, 2015). Price law was used to determine the highly cited papers. The main statistical parameters included total citation frequency of papers published in our journal, average citation frequency of papers, citation frequency of highly cited papers, and average citation frequency of highly cited papers. The distribution of subjects of highly cited papers, regional distribution of authors, distribution of article types, and funding  sources were analyzed descriptively.ResultsA total of 1 052 articles were searched and 736 articles were entered into the study, including 147 original articles, 85 reviews, and 504 case reports. Of the 736 articles, 517 were cited (70.2%) and the total citation frequency was 2 170 times and average citation frequency of papers was 4 times. According to the Price law, the papers which were cited ≥5 times were considered as highly cited papers in our journal during the study period. The citation frequency of 138 highly cited papers was 1 388 times which accounted for 64.0% of total frequency (2  170 times) during the study period and average citation frequency of highly cited papers was 10 times. The subjects of highly cited 138 papers are relatively centered and the top 5 subjects were antimicrobial agents (44 papers, 31.9%), Chinese Medicine (22, 15.9%), cardiovascular system drugs (19, 13.8%), antineoplastic drugs (11, 8.0%), and endocrine system drugs (5, 3.6%); there were 87 papers (63.0%) distributed in Beijing and 51 papers (37.0%) distributed in other 17 provinces or municipality directly under the central government; 33 of the highly cited 138 papers were original articles (23.9%), 29 were reviews (21.0%), and 76 were case reports (55.1%), their citation frequency was 390, 354, and 643, respectively which accounted for 28.1%, 25.5% and 46.3% of total citation frequency 1 388 times, respectively, and the average citation frequency of original articles, reviews, or case reports were 12,12, and 9, respectively. There was 1 paper supported by National funds at top 20 highly cited papers.ConclusionsAs highly cited papers published in our journal, distribution of subjects and regions were relatively centered; distribution of authors were dispersive; reviews and case reports made more contributions; and average citation frequency of original articles and reviews was higher. It is valuable to understand the above mentioned characteristics to make measures for improvement of impact and quality of our journal.
  • Adverse drug reactions induced by long term use of proton pump inhibitors
    Si Xiaobei, Lan Yu
    2015, 17(3): 218.
    Abstract ( ) PDF ( )
    The proton pump inhibitors (PPI) are widely used as the treatment of choice in acid-related diseases in clinic. Long term use of PPI may further induce abnormal absorption of nutrition (vitamin B12, calcium, iron, magnesium and other minerals), abnormal proliferation of gastrointestinal mucosa, infection, and abnormal bone metabolism (osteoporosis and bone fracture), and so on. Most studies on safety of long term use of PPI are retrospective cohorts or case-control studies. More prospective randomized controlled trials should be performed and good clinical evidences should be obtained for reasonable and safe use of PPI.
  • Finger tendon adhesion in a child due to exosmosis of sodium fusidate when Ⅳ infusion
    Wu Ruiqin
    2015, 17(3): 222.
    Abstract ( ) PDF ( )
    A 2-year-old girl with bronchopneumonia received an IV infusion of  sodium fusidate 125 mg in 0.9% sodium chloride 100 ml once daily. On day 5, extravasation of liquid medicine was found on left opisthenar when 80 ml liquid medicine was infused. The swelling area on the back of left hand was about 3.0 cm×3.5 cm. The IV infusion was stopped immediately and magnesium sulphate hydropathic compress and mucopolysaccharide polysulfate cream were given. The swelling on back of left hand was subsided evidently nine days later. There was no symptom of necrosis in local skin. The parents found that tendon adhesion in girl′s third, fourth and fifth fingers 36 days after extravasation. The girl could not do the action of taking object by hand. The girl received the lysis of adhesions of tendon on the third, fourth and fifth fingers. The girl performed physical exercise for three months after operation. The follow-up result showed that the girl′s hand function were well recovered on 6 months after operation.
  • ompound betamethasone injection local blockade caused persistent hiccups
    Jin Xueqin, Ru Jinli, Xie Xiaoxiang, Sun Huiping, Che Guozhu
    2015, 17(3): 223.
    Abstract ( ) PDF ( )
    A 30-year-old male was diagnosed as tenosynovitis for complains of pain and swelling in the right metacarpophalangeal joint of thumb. He received a local blockade injection with 1 ml of compound  betamethasone. He felt immediate relief of the pain and swelling. After 24 hours, he started a persistent hiccups which exerted marked influcence on his sleep and apptite. He tried to treat with omeprazole and metoclopramide, domperidone, but they had no obvious effect. So the patient took herbal medicine by himself. The hicuups continued for about 2 days and gradually disappeared.
  • Severe hypokalemia，rhabdomyolysis，and acute renal injury due to compound glycyrrhizin
    Li Changqing, Ha Si, Liu Donghua,Cao Zhongchao
    2015, 17(3): 225.
    Abstract ( ) PDF ( )
    A 55-year-old man with hypertension, type 2 diabetes, abnormal liver function ［alanine aminotransferase (ALT) 74 U/L, γ-glutamytransferase (γ-GT) 712 U/L)］and hypokalemia (3.40 mmol/L) received extended release nifedipine 30 mg once daily, benazepril 10 mg once daily, acarbose 25 mg three times a day before each meal, potassium chloride tablets 1.0 g three time daily, and an IV infusion of compound glycyrrhizin 60 ml (120 mg) once daily. On day 14 after administration the patient developed lower legs weakness and myalgia. The result of examination of animal force of limbs was Ⅳ level. The serum potassium was 1.1 mmol/L. Compound glycyrrhizin and benazepril were stopped. The patient was given potassium chloride tablets 2.0 g orally and an IV infusion of 10% potassium chloride 40 ml dissolved in more than 1 000 ml of 0.9% sodium chloride. The speed of IV infusion was 1.0 g  potassium chloride/hour. The serum potassium was 1.5 mmol/L four hours after drug withdrawal. The spirolactone 40 mg three times daily was added. Twenty four hours later, the patient′s serum potassium increased to 2.9 mmol/L, his symptom of myasthenia of limbs improved. Forty eight hours later, his serum potassium was 3.1 mmol/L, but he developed whole body myalgia, distending pain in both lower extremities and choking sensation in chest. Laboratory test showed creatine kinase(CK)50 940 U/L， CK-MB 441 U/L, lactate dehydrogenase (LDH) 1 992 U/L，aspartate aminotransferase (AST) 441 U/L, T (cTnT) 0.20 ng/ml，serum creatinine (SCr) 317 μmol/L，blood urine nitrogen (BUN) 18.2 mmol/L，uric acid (UA) 533 mol/L，and carban dioxide-combining Power (CO2-CP) 35.5 mmol/L. Myoglobins in blood and urine did not tested. The color of urine was dark brown. The patient was diagnosed severe hypokalemic，rhabdomyolysis，and renal injury. He received the symptomatic treatments of potassium supplement, fluid infusion, nutritional support, and protection of renal function. On day 5 of compound glycyrrhizin withdrawal, the laboratory test showed the following values: serum potassium 3.3 mmol/L, CK 10 292 U/L，Cr 252 μmo/L， BUN 16.3 mmol/L， UA 472 μmo/L；on day 10 of compound glycyrrhizin withdrawal, the laboratory test showed the following values: serum potassium 4.6 mmol/L, CK 107 U/L，Cr 116 μmo/L, BUN 6.4 mmol/L, UA 189 μmol/L. His blood pressure was maintained at 130-160/70-90 mmHg, and the symptoms of myasthenia of limbs, myalgia in whole body disappeared completely.
  • Late-onset diarrhea and severe bone marrow suppression and septicemia induced by combined chemotherapy with irinotecan and lobaplatin: report of two cases
    Ma Xue, Jiang Gang
    2015, 17(3): 227.
    Abstract ( ) PDF ( )
    Two female patients, aged 61 and 48 years old, received a combined chemotherapy of irinotecan 200 mg and lonaplatin 50 mg for cervical cancer. Patient 1 developed diarrhea, grade IV arrest of bone marrow and septicemia, accompanied by septic shock on the ninth day after the second cycle of chemotherapy. Patient 2 developed diarrhea, grade IV arrest of bone marrow, accompanied by fever on the sixth day after the first cycle of chemotherapy, and then developed secondary septicemia. Antidiarrhea, anti-infection, and immune support treatment were given. Five days later, diarrhea was controlled. Ten days later for patient 1 and six days later for patients 2, white blood cell, hemoglobin and platelet count were within normal range. After twenty days for patient 1 and six days later for patients 2, septicemia was controlled.
  • Agranulocytosis (grade Ⅳ) due to topotecan
    Fu Yilan, Yang Liping, Gong Qian, Liu Ni, Zhu Qing, Cao Lizhi
    2015, 17(3): 229.
    Abstract ( ) PDF ( )
    A 50-year-old male with non-Hodgkin lymphoma received topotecan combined with cisplatin (IV infusion of topotecan 2 mg, from the first day to the fourth day; IV infusion of cisplatin from the first day to the third day, a course of treatment was 3 weeks). Blood routine examination before chemotherapy revealed the following levels: white blood cell(WBC) 4.21×109/L, neutrophil counts(NEU) 2.85×109/L. On day 2 after the end of administration of topotecan, the patient developed nausea, obvious weak. Blood routine examination showed WBC 1.88×109/L, NEU 0.99×109/L. On day 3, his body temperature increased to 38.7 ℃, blood routine examination showed WBC 0.38×109/L，NEU 0.10×109/L. The patient was diagnosed as agranulocytosis (Ⅳ degree) accompanied infective fever. He received recombinant human granulocyte colony-stimulating, sulbactam and cefoperazone, fluconazole，moxifloxacin，piperacillin and tazobactam, and isepamicin, successively. Twelve days later, his body temperature returned to normal. Twenty-three days later, blood routine examination showed WBC 5.86×109/L，NEU 4.57×109/L.
  • Rapid-progressive decrease of cognitive and physical functions due to rituximab
    Li Jinfeng, Yan Xiujuan, Zhang Jinbiao, Zhang Yuan
    2015, 17(3): 230.
    Abstract ( ) PDF ( )
    A 63-year-old female with non-Hodgkin's lymphoma was treated with a chemotherapeutic regimen composed of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP). She was given  rituximab 600 mg plus 750 ml of 0.9% sodium chloride injection intravenous drip on the first day, at the same time treatments for hydration, alkalization, protecting visceral function, prevention of adverse reactions were given. On day 2, the patient developed an involuntary shaking limbs, a lower limbs weakness, a slightly slow reaction and an unsteady gait. MRI of the brain did not show any significant finding. On day 3, she had a fever, cognitive impairment and confusion. On day 4, the patient could not have independent feeding and defecation. Methyl prednisolone, drugs for improving microcirculation and rehydration therapy were applied. Two days later, the patient's consciousness restored. He can eat independently, defecate by himself, and his limbs and neuropsychological symptoms were relieved. Five days later, the symptoms were apparently   improved.
  • Mental disorder due to methylprednisolone in patients with systemic lupus erythematosus: report of 4 cases
    Ren Hao, Zhao Jinjun, Lin Jingli, Cui Danyu, Lai Weinan, Huang Qin, Yang Min
    2015, 17(3): 232.
    Abstract ( ) PDF ( )
    Four female patients (aged 17, 14, 25, and 20, respectively) with systemic lupus erythematosus (cases 1 and 2 were complicated with type IV lupus nephritis) received high-dose methylprednisolone pulse therapy, which included an IV infusion of methylprednisolone 0.5 g daily for 3 days, and then instead of prednisone 1-2 mg·kg-1·d-1 orally. Five to eighteen days after administration, the four patients developed the symptoms of mental disorders, such as exciting, garrulous, anxiety, mania, hardly fall asleep, even delusion of persecution and suicidal tendency. The four patients returned to normal completely after 19 days to 2.5 months by decreasing the dosage of the steroid gradually and the treatment with sedatives and antipsychotic drugs.
  • Renal insufficiency associated with adefovir dipivoxil overdose
    Ma Xiaoyan, Cai Haodong
    2015, 17(3): 235.
    Abstract ( ) PDF ( )
    A 69-year-old patient with hepatitis B cirrhosis to join clinical trials of antiviral therapy. His baseline serum creatinine level was 89 μmol/L and creatinine clearance was 56 ml/min. He was given oral lamivudine 100 mg daily. His serum creatinine level was 91 μmol/L and creatinine clearance was 54 ml/min 48 weeks later. Adefovir dipivoxil 10 mg daily was added to the regimen. Three years later, the patient′ s serum creatinine level increased to 113 μmol/L and creatinine clearance was 39 ml/min. He was considered as renal insufficiency due to adefovir dipivoxil. The dosage of adefovir dipivoxil was reduced to 10 mg once every other day and lamivudine was continued according to the original dose. Six months later, the patient′ s serum creatinine level was 88 μmol/L and the creatinine clearance was 50 ml/min.
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