2016 Volume 18 Issue 3 Published: 28 June 2016
  

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  • Clinical manifestations of elderly and non-elderly patients with drug induced liver injury
    Pang Lili, Yang Wanna, Hou Fengqin
    2016, 18(3): 163.
    Abstract ( ) PDF ( )
    ObjectiveTo compare and analyze the clinical characteristics of elderly and non-elderly patients with drug-induced liver injury (DILI).MethodsThe clinical characteristics of elderly (≥60 years old) and non-elderly (<60 years old) patients with DILI who sought medical advice in section for outpatients or hospitalized in Department of Infectious Diseases, Peking University First Hospital from January 1997 to September 2015 were analyzed retrospectively.ResultsThe elderly group comprised 193 patients ［female:121(62.7%)］ with average age of (69±7)years. The non-elderly group comprised 286 patients ［female: 192(67.1%)］ with average age of (43±12)years. The time from medication to the appearance of liver injury in the elderly group was 14-60 days (the median time 30 days) and the non-elderly group was 10-60 days (the median time was 30 days)(Z=-1.267, P=0.205). There were 132 cases (68.4%) with the symptoms of weakness, 121 cases (62.7%) with yellow urine, 118 cases (61.1%) of jaundice, 33 cases (17.1%) had fever in the elderly group, respectively. There were 189 cases (66.1%) with the symptoms of weakness, 182 cases (63.6%) had yellow urine, 179 cases (62.6%) had jaundice, 46 cases (16.1%) had fever in the elderly group, respectively. There were no significant differences in incidence of the symptoms mentioned above between the two groups (all P＞0.05). The differences of peak values of alanine aminotransferase, alkaline phosphatase, and total bilirubin between the two groups were not statistically significant (all P>0.05). The case number of antinuclear antibody-positive in the elderly group were more than those in the non-elderly group［27(9.4%)］(P<0.001). There were 221 kinds of suspected drugs which ［47(24.4%)］ may cause DILI in the elderly group. The top three were traditional Chinese medicine (107, 48.4%)，cardiovascular agents (31,14.0%) and antimicrobial agents (18, 8.2%). There were 316 kinds of suspected drugs which might cause DILI in the non-elderly group. The top three were traditional Chinese medicine (154, 48.7%), antimicrobial (50, 15.8%), and non-steroidal anti-inflammatory drug (23, 7.3%). The number of  cases with DILI types of hepatocellular, cholestatic, and mixed in the elderly group and the non-elderly group were 157(81.4%), 13(6.7%), 23(11.9%) and 238(83.2%), 25(8.7%), 23 (8.1%), respectively. The differences were not statistically significant. The cases number of DILI classification of 1, 2, 3, 4, and 5 in the elderly group and the non-elderly group were 56(29.0%), 31(16.1%), 99(51.3%), 5(2.6%), 2(1.0%) and 65(22.7%), 37(12.9%), 174(60.9%), 4(1.4%), 6(2.1%), respectively. The differences were not statistically significant. The suspicious drugs were withdrawn and all the patients with DILI received the anti-inflammatory and hepatoprotection therapy after the appearance of clinical symptom. There were 14 cases in the elderly group and 34 cases in the non-elderly group received steroid therapy additionally. The course of disease in the elderly group were 27-78 days, the median time was 47 days. The course of disease in the non-elderly group were 30-87 days, the media time was 54 days (P=0.07). Of 193 patients in the elderly group, 176 cases (91.2%) were cured and improved, 14 cases (7.2%) developed chronic DILI, and 3 cases (1.6%) died. Of 286 patients in the non-elderly group, 254 cases (88.8%) were cured and improved, 24 cases (8.4%) developed chronic DILI, 7 cases (2.4%) died, and 1 case received liver transplantation. The difference of prognosis between the two groups were not statistically significant (P=0.856).ConclusionsThe traditional Chinese medicines and cardiovascular agents are the main drugs which due to DILI in elderly patients, the traditional Chinese medicines and antimicrobial are main drugs which due to DILI in non-elderly patients. In addition to the cases of accompanying with autoimmune phenomena in the elderly group are more than those in the non-elderly group, the clinical manifestations, treatment, and prognosis are similar in the elderly and non-elderly patients.
  • Investigation and risk factors analysis on potentially inappropriate medications in elderly inpatients
    Wan Liyan, Yuan Liping, Wei Jianying, Wu Yang, Ning Ming, Xu Dan, Dong Moran
    2016, 18(3): 170.
    Abstract ( ) PDF ( )
    ObjectiveTo investigate the potentially inappropriate medications (PIM) and their risk factors in elderly inpatients.MethodsThe medical record data of patients≥65 years, who were discharged from the Department of Geriatrics in Tsinghua University First Hospital between October 2013 and May 2014, were collected and retrospectively studied. The PIM and PIM related to certain diseases were evaluated according to the 2012 Beers criteria. Multivariate logistic regression were performed to analyze the risk factors of PIM.ResultsA total of 217 patients were enrolled in this study. Of them, 120 (55.3%) were males and 97 (44.7%) were females with age from 65 to 97 years and their average age was (80±6) years. In the 217 patients, the disease categories were 3 to 14 in each patient, 3-5 in 52 patients (24.0%), 6-10 in 141 patients (65.0%), 11-14 in 24 patients (11.1%), and the average category was 7±3. The hospitalization time was 4-57 days with average time of (17±10) days in each patient. In the 217 patients, the categories of drugs were 2-49 each day in each patient, 2-5 kinds in 33 patients (15.2%)，6-10 in 84 patients (38.7%), ＞10 kinds in 100 patients (46.1%), and the average category was 12±8. In the 217 patients, 79 patients (36.4%) received PIM listed in the 2012 Beers criteria, 16 kinds of drugs were involved and cumulative 76 PIMs were found. Of them, the most wildly used drugs were sedatives and hypnotics ［51.3% (39/76)］. In the 79 patients with PIM, 42 patients were given PIMs related to certain diseases in the 2012 Beers criteria, 18 kinds of drugs were involved and cumulative 62 PIM involving disease status such as fracture, dementia, insomnia, constipation, heart failure, prostatic hyperplasia, delirium, chronic kidney disease, and Parkinson′s disease. Logistic regression analysis showed that the risk factors of PIM were hospitalization time (OR=1.06, 95%CI: 1.022-1.094, P=0.001), disease categories (OR=1.15, 95%CI: 1.014-1.302, P=0.03), and daily used drug categories (OR=1.05, 95%CI: 1.005-1.104, P= 0.03).ConclusionThe incidence of PIMs in elderly inpatients was high and its risk factors are hospitalization time, disease categories and daily used drug categories.
  • Analysis of medication situation of Alzheimer′s disease on hospitals of six cities in China
    Wang Hailian, Chen Lianzhen, Jin Yan
    2016, 18(3): 175.
    Abstract ( ) PDF ( )
    ObjectiveTo understand the medication situation of Alzheimer′s disease(AD) of six cities in ChinaMethodsThe data were from 50 hospitals of six cities (including Beijing, Tianjin, Shanghai, Guangzhou, Chengdu and Hangzhou) in China which involved in the Hospital Prescription Analysis Cooperative Project. Prescriptions from Department of Outpatient and Emergency, doctor′s orders of inpatients in 40 days in each hospital in each year from 2012 to 2014 were selected randomly. The information of medication use about AD was extracted and analyzed using software of Visual FoxPro 8.0 and SPSS 22.0.ResultsThere were 59 891 AD patients in six cities. The patients′ prevalence peak was in 75 to 89 years, accounted for 66.9% of the total cases of AD patients (40 096 patients). Application of cholinesterase inhibitors (ChEI) and N-methyl-D-aspartate (NMDA) receptor antagonist accounted for 46.5% of the total cases of AD patients (27 827/59 891), behavioral and psychological symptoms of dementia (BPSD) accounted for 26.4% (15 811/59 891), neural nutrition agent accounted for 15.1% (9 043/59 891), prevention of AD accounted for 11.7% (7 007/59 891). There were no significant differences in constituent ratios of ChEI use alone, NMDA receptor antagonist use alone, or ChEI combined with NMDA receptor antagonist treatment in AD patients in the 3 years (P>0.05). The compound annual growth rate was 69.6% of ChEI combined with NMDA receptor antagonist treatment. The top 3 drugs in AD patients were donepezil (14 254 patients), memantine (12 278 patients), and olanzapine (4 612 patients). Total amount of AD patients′ prescriptions was 20.124 million yuan, of the top 15 drugs according to the cost for AD treatment, the cost of first-line therapy was 9.129 million yuan (45.4%), the cost of BPSD was 1.538 million yuan(7.6%), the cost of neural nutrition agent was 1.278 million yuan (6.4%), and the cost of prevention of AD was 0.433 million yuan (2.2%).ConclusionsChinese doctors in six cities could follow European and Chinese AD treatment guidelines and implement multi-target drug combination regimen for AD patients. The use of drugs in this AD patients was basically reasonable. But there were some problems in which doctors prescribed ineffective drugs, leading to heavy economic burden in AD patients.
  • Comparative study on medication errors between elderly and non-elderly patients in China based on data from monitoring network of clinical medication safety
    Wang Yawei, Li Xiaoling, Yan Suying, Wang Yuqin
    2016, 18(3): 181.
    Abstract ( ) PDF ( )
    ObjectiveTo know the situation of ME in the present and explore the characteristics of ME between the elderly and non-elderly patients in China.MethodsME reports from September 22, 2012 to June 30, 2015 in the Monitoring Network of Medication Safety in China Core Group of International Network for the Rational Use of Drugs (INRUD) were taken. The patients with age  65 years were entered into the elderly patient group and other patients were entered into the non-elderly patient group. The ME category, the persons that triggered ME, ME content, and drugs related to ME in the 2 groups were analyzed and compared.ResultsWithin A total of 8 421 cases of ME were reported and involved 8 421 patients. Of them, 2 503 patients (29.72%) were in the elderly patient group and 5 918 (70.28%) in the non-elderly patient group. The most errors ［98.41%(8 287/8 421)］ belonged to the second level of ME which did not induce injury to patients. The difference of distribution of ME with different categories between the elderly and non-elderly patient groups were not statistically significant (P>0.05). The errors that triggered by doctors and pharmacists were 5 599 cases (66.49%) and 2 567 cases (30.48%), respectively. The errors that triggered by doctors in the elderly patient group were higher than those in the non-elderly patient group ［69.64%(1 743/2 503) vs. 65.16%(3 856/5 918)］, the errors that triggered by pharmacists in the elderly patient group was lower than those in the non-elderly patient group ［27.21%(681/2 503) vs. 31.87%(1 886/5 918)］, and the differences between the 2 groups were statistically significant (all P<0.05). The top 5 errors that triggered by doctors were drug dosage ［27.56%(1 543/5 599)］, administration frequency ［12.40%(694/5 599)］, indication ［9.09%(509/5 599)］, route of administration ［8.64%(484/5 599)］, and solvent ［7.89%(442/5 599)］. The errors about administration frequency, contraindication, and interaction in the elderly patient group were higher than those in the non-elderly patient group (all P<0.05). The top 5 errors that triggered by pharmacists were variety of drugs ［51.69%(1 327/2 567)］, number of drugs ［14.57%(374/2 567)］, specification ［12.23%(314/2 567)］, others ［6.31%(162/2 567)］, and dosage form ［4.25%(109/2 567)］. The errors about number of drugs, administration time, administration frequency, and solvent in the elderly patient group were higher than those in the non-elderly patient group (all P<0.05). There were 6 742 drugs involved in ME, the top 5 drugs were anti-infective agents (1 309 cases, 19.42%), cardiovascular drugs (848 cases, 12.58%), digestive system drugs (649 cases, 9.63%), nervous system drugs (584 cases, 8.66%), and respiratory system drugs (543 cases, 8.05%). The proportions of respiratory system drugs, urinary and reproductive system drugs, allergy and immune system drugs, biological products/vaccines, rheumatoid arthritis and arthritis drugs, and ear/mouth/throat drugs used in the elderly patient group were higher than those in the non-elderly patient group (all P<0.05).Conclusion The most MEs in China belong to the second level which occurred but did not cause injury to the patients, doctors and pharmacists are key personnel that trigger the ME. The doctors or pharmacists that trigger the ME, ME contents, the composition of drugs related to ME are different between the elderly patients and the non-elderly patients. Doctors should pay more attention to frequency of administration, contraindication, and interaction of drugs during prescribing for elderly patients, pharmacists should pay more attention to the number of drugs, administration time, frequency of administration, and solvent during allocating drugs for elderly patients.
  • A review on safety of metoclopramide in children
    Zhang Zhihui, Zhang Lingli, Zhang Yongjun, Wan Chaomin, Liang Yi, Huang Liang, Quan Shuyan, Hu Zhiqiang
    2016, 18(3): 188.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the safety of metoclopramide in children.MethodsReports on clinical studies involving metoclopramide treament in children were searched at PubMed, Embase, Cochrane Library, CNKI, VIP, and Wanfang Database from inception to September 2014. Adverse drug reaction information bulletins and pharmacovigilance information related to metoclopramide were searched from China Food and Drug Administration (CFDA), US FDA, Health Canada, and European Medicines Agency (EMA). The relationship between the adverse reactions and metoclopramide were evaluated using evaluation criteria of WHO and the characteristics of adverse reactions were descriptively analyzed.ResultsA total of 54 articles in accordance with inclusion criteria were entered in this study. No RCT was included. A total of 646 cases of adverse reactions were reported in the 54 articles. Of them, 42 cases of adverse reactions in the 29 case reports were reported and 604 cases in the 25 case series reports were reported. In the 646 children, 352 cases were males and 284 were females with ages from 2 months to 18 years old, of them, 174 cases (26.9%) were <1 year, 367 cases (56.8%) were 1-6 years old, 85 cases (13.2%) were 6 to 14 years old, and 20 cases (0.03%) were >14 years. Among the 42 cases of adverse reactions, 29 cases had extrapyramidal reactions; 4 cases had gynecomastia; 2 cases had nausea syndrome and apnoea, respectively; 1 case had hyperaldosteronism, skin rashes, blood pressure increase, and circulatory failure, respectively; 39 cases were cured, 2 cases were improved but sequelae remained, and 1 case was transferred to other hospital for treatment. All adverse reactions among the 604 cases of adverse drug reactions in the 25 case series reports were extrapyramidal reactions, all patients were cured without sequela. It was reported that 16 cases of 58 cases with adverse reactions in 2008 CFDA Bulletins were children. In 2011 and 2009, the FDA and Health Canada warned that long-term or large doses of metoclopramide could cause tardive dyskinesia. In 2013, the EMA recommended that metoclopramide was limited to short-term use (≤5 d), should not be applied to children under 1 year of age and only as second-line drugs for the prevention of nausea and vomiting in chemotherapy and postoperative treatments in children >1 year of age.ConclusionThe risks of extrapyramidal reactions and other serious adverse reactions existed in children with conventional dose of metoclopramide.
  • Analysis of 36 cases of bleeding caused by ticagrelor
    Wang Peng, Hu Yong
    2016, 18(3): 194.
    Abstract ( ) PDF ( )
    ObjectiveTo analyze the characteristics of bleeding caused by ticagrelor and provide reference for clinical medication safety.MethodsNational Adverse Drug Reaction Monitoring System was searched and adverse drug reaction reports on bleeding induced by ticagrelor from January 2013 to December 2014 were collected. The patients′ sex, age, primary disease, manifestations of bleeding, evaluation of causality were analyzed. Ttreatment and outcome were recorded.ResultsA total of 36 patients with bleeding were entered in this study. Of them, 26 patients were males, 7 were females, and sex of 3 were not clear; their ages were 40-113 years. The primary diseases of bleeding were acute coronary syndrome (ACS) in 20 patients, ACS combined with coronary heart disease in 5 patients, coronary heart disease and coronary heart disease combined with other diseases in 7 patients, and other diseases in 4 patients. The percentages of patients with gastrointestinal bleeding and intracranial hemorrhage induced by ticagrelor were 54.6% (20/36) and 19.4% (7/36), respectively. Of the 25 patients who were treated with ticagrelor and aspirin, 18 patients developed gastrointestinal bleeding and 7 patients developed intracranial hemorrhage. Of the 36 patients with bleeding, 17 patients were cured, 8 were improved, 2 were not improved, 3 died, and 6 were not clear.ConclusionsFatal/life-threatening bleeding (gastrointestinal bleeding, intracranial hemorrhage) induced by ticagrelor accounted for large proportion and was mainly serious bleeding. However, most patients with bleeding induced by ticagrelor could recover or improve after treatments.
  • An analysis of subacute cutaneous lupus erythematosus due to proton pump inhibitor in 26 cases
    Cheng Jun
    2016, 18(3): 197.
    Abstract ( ) PDF ( )
    ObjectiveTo summarize the clinical characteristics of subacute cutaneous lupus erythematosus (SCLE) due to proton pump inhibitor (PPI).MethodsThe database of China National Knowledge Infrastructure, VIP, Wanfang and PubMed were searched. The reports in literature about SCLE related to PPI were collected. The patients′ sexuality, age, history of past illness, medications, the time from medication to appearance of SCLE symptoms, clinical characteristics of SCLE, results of laboratory examination, treatment and prognosis. The clinical characteristics of SCLE related to PPI were analyzed.ResultsA total of 10 cases were reported to have SCLE due to PPI overseas and 26 patients were enrolled in this study. They comprised 4 males (15.4%) and 22 females (84.6%) with the average age of (63±14) years. Of them, 23 cases (88.5%) were over 50 year-old, six patients had the history of autoimmune disease. All the patients received PPI orally. Twenty seven case-times of SCLE occurred. Of them, numbers of cases caused by lansoprazole, omeprazole, esomeprazole and pantoprazole were 9, 8, 5 and 5 case-times, respectively. The time from medication to appearance of SCLE symptoms were from 8 days to 5 years, median time was 3 months. The clinical characteristics of SCLE due to PPI were multiple annular erythema or scale plaque on body, limbs and face. One patient was accompanied by arthralgia. The results of laboratory examination showed the positive rates of anti dry syndrome antigen A antibody (SSA), antinuclear antibodies (ANA), anti dry syndrome antigen B antibody (SSB), anti-histone antibody (AHA), and direct immuno fluorescence test were 81.8% (18/22), 76.9% (20/26), 17.6% (3/17), 6.3% (1/16), and 30.0% (6/20), respectively. There were 21 patients who stopped PPI after appearance of SCLE. Of them, 14 patients′erythema disappeared without any treatment, 6 patients′erythema disappeared after receiving symptomatic treatment, and one died after switching to other kind of PPI. There were 5 patients who continued to use PPI after appearance of SCLE. Of them, 2 patients′erythra persisted, 3 patients died.ConclusionsThe characteristics of patients with SCLE due to PPI included the following: most of the patients were more than 50 years old, female, and having history of autoimmune diseases. The key action of improving the prognosis after appearance of SCLE is to stop the medicine immediately.
  • afe use of new oral anticoagulants in elderly patients with non-valvular atrial fibrillation
    Ding Zheng, Wang Ranran, Feng Shoujun, Zheng Yingli
    2016, 18(3): 201.
    Abstract ( ) PDF ( )
    New oral anticoagulants(NOAC) including dabigatran, rivaroxaban, apixaban and edoxaban have been widely used clinically. These drugs are the direct coagulation factor inhibitor. They have the stable pharmacokinetics so that patients don′t require routine coagulation monitoring. They can be administrated in fixed doses and have few drug interactions. NOAC have been recommended in 2014 guideline for the management of patients with atrial fibrillation by American Heart Association, American College of Cardiology and Heart Rhythm Society. NOAC can be a replacement in patients who have contraindications for warfarin. The dose-adjustment of NOAC is based on the particular pharmacokinetic characteristics and kidney function of the elderly. Pharmaceutical care plan is helpful to increase the safety and efficacy of the medication in the elderly.
  • Research progress in pathogenesis, prevention and treatment of drug-induced dry eye disorders
    Bai Fang, Tao Hai, Wang Peng
    2016, 18(3): 205.
    Abstract ( ) PDF ( )
    Drug-induced  dry eye disorders may cause potential damage to the ocular surface which can seriously decrease the quality of life of patients. The main clinical manifestations include eye dryness, burning-like feeling, foreign body sensation, itching, redness, photophobia, and blurred vision. The common drugs causing drug-induced dry eye disorders include systemic anticholinergic drugs such as psychotropic drugs, antihistamines and decongestant,  steroids, chemotherapeutic drugs, antiviral drug, anti-malarial, antirheumatic agents, chelating agent, and neurotoxin. The drug for local application around the eye include eye drops and botox with or without preservative. The main mechanisms of drug-induced  dry eye disorders may involve decrease of glandular secretion, affecting the aqueous layer and mucin layer; disturbing the stabilization of tear lipid layer and decreasing the lipid secretory volume; inducing the inflammatory reaction which damages the conjunctival goblet cells, eyelid glands, conjunctiva and cornea; reducing the degree of corneal sensation, the reduction of afferent nerve impulse, and tear production. Unnecessary drugs application in multiple systemic or topical use of drugs around the eye should be avoided. If the diagnosis of drug-induced dry eye was confirmed, the above-mentioned drugs should be withdrawn or replace the drugs which those having a low level of adverse drug reactions.
  • Severe neuropsychiatric symptoms induced by intravenous ertapenem: report of 2 cases
    Wang Jie, Zhang Fubin, Zhang Fang, Ma Shuai, Du Tiekuan
    2016, 18(3): 209.
    Abstract ( ) PDF ( )
    Two male patients (aged 73 and 62 years, respectively) received an intravenous infusion of ertapenem 0.5 g once daily and 1.0 g once daily for perianal abscess and intestinal obstruction. On day 5 and 9, the two patients developed neuropsychiatric symptoms, such as seizures, hallucination and sleep-walking. Ertapenem was withdrawn, the neuropsychiatric symptoms did not recur.
  • Ataxia and orofacial involuntary movement due to compound phenytoin sodium
    hang Shuyi, Wu Liyong, Yin Na, Liu Jia, Jia Jianping
    2016, 18(3): 211.
    Abstract ( ) PDF ( )
    A 63-year-old woman with chronic obstructive pulmonary disease for 10 years received compound phenytoin sodium (2 tablets, three times daily) from January 2013 to January 2015. The patient developed a paroxysmal dysbasia and facial involuntary movement in April 2014 (16 months after medication) and 4 times outbreaking from April 2014 to January 2015. She was considered the dystaxia due to compound phenytoin sodium. Compound phenytoin sodium was stopped immediately and an IV infusion of coenzyme complex injection 400 U once daily was given. Twelve days later, the patient could walk alone without obvious involuntary movement in her face. Then she was discharged. The result of follow-up 2 months after discharge showed that the symptoms had no recurrence, and the patient could walk alone. Her daily life returned to normal.
  • cute interstitial pneumonia induced by gefitinib
    Mei Dan, Ni Meixin, Gao Jie
    2016, 18(3): 213.
    Abstract ( ) PDF ( )
    An 88-year-old female with pulmonary adenocarcinoma received gefitinib 250 mg once daily. Four days after gefitinib treatment, the patient presented with aggravated chest distress and short of breath in resting state. Seven days later, she still had the above-mentioned symptoms and gefitinib was withdrawn. The pulmonary CT scan showed diffusive exudation in her bilateral pulmonary and acute interstitial pneumonia was considered. After treatments with methylprednisolone and anti-infective drugs, the patient′symptoms relieved for a while, but she died from pulmonary infection combined with respiratory failure finally.
  • Acute pancreatitis due to application of vildagliptin and metformin
    Huang Nianxu, Lu Jin
    2016, 18(3): 215.
    Abstract ( ) PDF ( )
    A 59-year-old female patient with type 2 diabetes mellitus was treated with metformin 0.5 g thrice daily. Vildagliptin 50 mg twice daily was added to her regimen due to poor control of her diseases. Four weeks later, the patient developed acute abdominal pain. Laboratory tests showed the following values: serum amylase 588 U/L, lipase 1 226 U/L. Abdominal ultrasound showed a small amount of peritoneal fluid around the pancreas. Acute pancreatitis was diagnosed. Vildagliptin and metformin were stopped. Fluid infusion, anti-infection therapy, acid suppression therapy, and nutritional support therapy were given. On day 9, the abdominal pain disappeared, the serum amylase was 64 U/L, and the lipase was 102 U/L.
  • Thrombocytopenia and hypofibrinogenemia induced by sodium valproate
    Guo Chenyu, Zheng Wenwen, Li Kaimin, Lu Congxiao
    2016, 18(3): 216.
    Abstract ( ) PDF ( )
    A 58-year-old male received a continuous intravenous fusion of sodium valproate 33.6 mg/h for 3 days because of epileptic seizure. Seven days later the patient underwent the the excision of lesion of left temporal lobe. The day after operation his platelet count (PLT) decreased from 242×109/L which was tested on hospitalization to 100×109/L, but he did not receive any treatment for the decreasing PLT. He received the continuous intravenous infusion of sodium valproate according to the primary dose again for 4 days. His PLT decreased to 72×109/L, prothrombin time (PT) prolonged to 20.7s from 13.4 s, and fibrinogen (FIB) decreased from 2.08 to 0.99 g/L. The patient was diagnosed as thrombocytopenia and hypofibrinogenemia induced by sodium valproate. Sodium valproate was  withdrawn and cryoprecipitate 6.0 U was given. One week after drug withdrawal the laboratory tests showed the following values: PLT 294×109/L，PT 13.2 s，and FIB 2.57 g/L.
  • Hypofibrinogenemia caused by hemocoagulase for injection: report of 2 cases
    Guo Yin, Li Yongtao
    2016, 18(3): 218.
    Abstract ( ) PDF ( )
    Two patients (patient 1, 78-year-old female; patient 2, 39-year-old male) received hemocoagulase for injection 4 KU once daily due to bleeding of left lower abdominal mass and traumatic shock, respectively. After 8 or 4 days of hemocoagulase treatments, fibrinogen levels in the 2 patients decreased (1.49 g/L decreased to 0.71 g/L in the patient 1; 2.01 g/L decreased to 0.52 g/L in the patient 2) and active bleeding appeared. It was considered that hypofibrinogenemia was caused by hemocoagulase for injection. Hemocoagulase for injection was stopped and blood plasma cryoprecipitate were given in the 2 patients. Five days later, the fibrinogen level in patient 1 was 2.01 g/L and abdominal ultrasonography showed no active bleeding in the left lower abdomen; the fibrinogen level of patient 2 was 3.44 g/L and the liquid from thoracic drainage tube turned to light red.
  • Leukopenia and neutropenia caused by sertraline
    Zhuang Hongyan, Liu Shanshan, Du Haixia, Cui Yonghua
    2016, 18(3): 220.
    Abstract ( ) PDF ( )
    An 11-year-old female patient was given sertraline 25 mg once daily and quetiapine 25 mg once daily for childhood emotional disorders. The patient′s white blood cells count(WBC) was 4.6×109/L and neutrophil count(NEUT) was 1.8×109/L two days later. The patient was diagnosed as neutropenia. Quetiapine was stopped and sertraline was given continually. At the same time berbamine hydrochloride 84 mg thrice daily and leucogen 20 mg thrice daily were given. Six days later, the dosage of sertraline was increased to 50 mg once daily to improve the symptoms and vitamin B6 10 mg thrice daily was given. On day 13 of sertraline therapy, the WBC was 3.5×109/L and the NEUT was 1.4×109/L. Leukopenia was diagnosed. On day 24 of sertraline therapy, the WBC was 3.3×109/L and the NEUT was 1.4×109/L. Anduolin(安多霖) capsules 0.64 g twice daily were added to her regimen. Sertraline dose was reduced to 25 mg once daily the next day and was stopped 2 days later. Five days later, the patient′s WBC was 4.4×109/L and NEUT was 2.0×109/L. Then, fluvoxamine was given to improve mood. Seven days later, the patient′s WBC was 4.6×109/L and NEUT was 2.3×109/L.
  • Increased of international normalized ratio due to levofloxacin combined with warfarin in a patient with idiopathic pulmonary hypertension
    Wang Ranran, Gu Zhichun
    2016, 18(3): 222.
    Abstract ( ) PDF ( )
    A 25-year-old female patient with idiopathic pulmonary arterial hypertension received warfarin 1.25 mg/d for a long time. Her INR was controlled between 2.0-3.0. She received an IV infusion of levofloxacin 0.4 g once daily for urinary tract infection. Three days later, her INR increased from 2.7 to 3.3. Warfarin was withdrawn temporarily. Five days after warfarin withdrawal, her INR returned to 1.8. Levofloxacin was withdrawn when her urinary tract infection was improved. She received warfarin again and the dosage increased from 0.625 mg/d to 1.25 mg/d generally. On day 3 and 7 of recovery of warfarin′s primary dose, her INR returned to 2.3 and 2.5, respectively.
  • Epidermolysis bullosa type eruption due to iopamidol
    Long Liang, Lei Haibo, Li Ronghui, Li Wei
    2016, 18(3): 224.
    Abstract ( ) PDF ( )
    An 85-year-old female underwent pulmonary CT enhancement scan. Two hours after receiving an IV infusion of iopamidol 54 ml, she presented with unequal size of blisters on trunk,  head and neck. Thirteen hours after receiving iopamidol, she developed fever and vomiting. The patient was diagnosed as epidermolysis bullosa type eruption due to iopamidol by a dermatologist. She received symptomatic treatment including methylprednisolone and sodium thiosulfate for antianaphylaxis and anti-infective agent immediately. Twenty-two days later, the exfoliation occurred, there was rubefaction on the basal surface of  blister. The surface of  wound healed basically.
  • Hypotonic encephalopathy due to sodium phosphate oral solution
    Wei Fenghua, Liang He
    2016, 18(3): 225.
    Abstract ( ) PDF ( )
    A 41-year-old female with repeated hematochezia for about 10 years prepared to have a colonoscopy in order to clarify a diagnosis. She took  sodium phosphate oral solution (45 ml dissolved in 750 heated water) orally for bowel preparation. Nine hours later she developed the symptoms of nausea, vomiting, dizziness, weakness, and apathy. The results of laboratory test showed K+ 3.0 mmol/L，Na+118 mmol/L，Cl- 92 mmol/L. She was diagnosed as hypotonic encephalopathy due to electrolyte disturbances which was induced by sodium phosphate. She received IV infusion of potassium chloride injection, potassium aspartate and magnesium aspartatse injection, 10% sodium chloride injection, and glycerol and fructose injection. Twenty-one hours later her apathy disappeared. The results of laboratory test showed K+ 4.35 mmol/L，Na+ 130 mmol/L，Cl- 109 mmol/L，Ca2+ 2.15 mmol/L about 27 hours later.
  • Polyuria induced by prednisone
    Cui Yali, Yu Jindong
    2016, 18(3): 227.
    Abstract ( ) PDF ( )
    A 55-year-old male patient with acute peripheral facial paralysis received an IV infusion of Shuxuening(舒血宁) injection 20 ml+0.9% sodium chloride 250 ml once daily; prednisone 15 mg, vitamin B110 mg, and mecobalamin 0.5 mg thrice daily by mouth; and decoction of Traditional Chinese Medicine once daily. Three hours after administration of the medicine, he developed polyuria, 6 times within 5 hours with about 500 ml each time. At the same day, prednisone, vitamin B1, and mecobalamin were stopped by himself and decoction was taken continuously, then his urine output decreased. On the second day morning, prednisone was taken and other drugs were stopped, polyuria reappeared. On the third day, prednisone was stopped and other drugs were taken, the patient′s polyuria disappeared. It was considered that the polyuria was induced by prednisone.
  • Headache induced by carbazochrome sodium sulfonate
    Zhao Jiali，Chen Qiuhong，Zhan Zhihong
    2016, 18(3): 228.
    Abstract ( ) PDF ( )
    A 61-year-old female patient received treatments with cefminox sodium, etimicin, Zhikang Capsules (致康胶囊), hemocoagulase, carbazochrome sodium sulfonate, acetyl cysteine, bromhexine hydrochloride for injection, and spleen aminopeptide oral lyophilized powder for hemoptysis and bronchiectasis with infection. On day 2 of carbazochrome sodium sulfonate treatment for 20 minutes, the patient developed rigidity of the back of her neck and headache. No special treatment was given. On day 3 after carbazochrome sodium sulfonate treatment for 15 minutes, above mentioned symptoms appeared again and aggravated. Carbazochrome sodium sulfonate was stopped at once and rotundine and flunarizine were given. About 45 minutes later, the headache was relieved. It was considered that the headache was caused by carbazochrome sodium sulfonate. After that, other treatments continued and  above mentioned symptoms did not recur.
  • Neuroleptic malignant syndrome due to concomitant use of olanzapine and fluvoxamine
    Sun Zhenxiao, Li Jingjun
    2016, 18(3): 230.
    Abstract ( ) PDF ( )
    A 72-year-old man with depression received oral olanzapine 7.5 mg/d and fluvoxamine 125 mg/d. Two months after the drug administration, the patient developed fever, consciousness, rigidity, sweating, and tachycardia. Blood tests showed that the white blood cell count was 12.3×109/L and creatine kinase (CK) level was 737 U/L. All drugs were stopped and continuous oxygen inhalation, electrocardiographic monitoring and measures for keeping the respiratory tract unobstructed were given. Ice pillows and ice packs were used to lower his temperature. Treatments such as fluid infusion, correction of water-electrolyte balance, infection prevention, intravenous infusion of clonazepam 1 mg once daily, and oral dopamine receptor agonist piribedil 100 mg once daily were also given. Three days later, his temperature returned to normal and his consciousness turned clear. Five days later, his muscle tension, routine blood test, and CK level returned to normal.
  • Respiratory failure caused by misuse of fentanyl transdermal patch
    An Hong, Wu Liyong, Wang Lin, Jia Jianping
    2016, 18(3): 233.
    Abstract ( ) PDF ( )
    A 55-year-old male patient self-medicated with 2 fentanyl transdermal patches (8.4 mg/paste) for neck discomfort. After 4 hours, he presented sobbing respiration and disturbance of consciousness. He was comatose without breathing when he was sent to the emergency room. He received electrocardiographic monitoring, tracheal intubation and assisted breathing with ventilator immediately, at the same time, IV injection of nikethamide 0.375 g and lobeline hydrochloride 3 mg were given. Arterial blood gas analysis showed the concentration of hydrogen ions was 6.97, carbon dioxide partial pressure was 97.8 mmHg, oxygen partial pressure was 86.2 mmHg and oxyhemoglobin saturation was 0.90. Six hours later, the patient′s consciousness turned clear. The next day, toxicological tests showed that fentanyl concentration in blood and urine was 70 ng/ml and 92 ng/ml respectively. On the third day, reexamination of arterial blood gas analysis showed that the concentration of hydrogen ions was 7.46, carbondioxide partial pressure was 30.2 mmHg, oxygen partial pressure was 151.0 mmHg and oxyhemoglobin saturation was 1.00, and then the tracheal intubation was removed.
  • Reduced blood cells of three lines on routine blood test induced by overdose of methotrexate in a patient with rheumatoid arthritis
    Yao Yao, Ge Weihong
    2016, 18(3): 234.
    Abstract ( ) PDF ( )
    A 73-year-old female changed the dosage of methotrexate from 5.0 mg once a week to 2.5 mg once daily for 14 days. She developed multiple ulcers in lip and oral mucosa,  severe pain and dry mouth. On day 15 she discontinued methotrexate according to the doctor′s advice of another hospital. The results of laboratory test on 7 days after drug withdrawal showed the following values: WBC 0.6×109/L，Hb 79 g/L，PLT 7×109/L，ALT 169 U/L，AST 96 U/L，γ-GT 72 U/L. The patient was diagnosed as reduced blood cells of three lines induced by overdose of methotrexate. She received IV infusion of methylprednisolone 40 mg once daily, rinsed the mouth by 0.9% sodium chloride injection 100 ml plus lidocaine hydrochloride injection 10-20 ml, hypodermic injection of recombinant human granulocyte colony stimulating factor 300 U, IV infusion of virus inactivated frozen plasma 225 ml and apheresis platelets 1 U successively. At the same time she received the symptomatic treatment including  liver-protection, stomach-protection, iron supplement, and calcium supplement. The results of laboratory test on 12 days after the above-mentioned treatment showed the following values: WBC 8.0×109/L, Hb 81 g/L，PLT 208×109/L, ALT 19 U/L, AST 22 U/L, γ-GT 41 U/L.
  • Torsades de Pointes ventricular tachycardia associated with rapid intravenous infusion of amiodarone
    Wang Min, Zhang Liming, Han Qiang
    2016, 18(3): 236.
    Abstract ( ) PDF ( )
    A 56-year-old male patient with heart failure, atrial fibrillation and hyperthyroidism required hospitalization as a result of acute exacerbation of heart failure. The ventricular rate of the patient was 186 beats/min when he came to the hospital. He received an IV bolus of amiodarone 150 mg and an intravenous infusion of 300 mg for correction of and keeping his ventricular rate. He was given another 300 mg amiodarone later that day. The next day, he became unconscious. Electrocardiographic monitoring showed that his ventricular rate was 92 beats/min, QT interval was 0.40 s on average, premature ventricular beats were frequent, ventricular rate became 256 beats/min, then torsades de Pointes ventricular tachycardia and ventricular fibrillation appeared alternately. Heart rate was turned into ventricular tachycardia after heart thump and electric defibrillation. He was given an IV bolus of lidocaine 50 mg, his heart rate turned into rapid atrial fibrillation and ventricular rate was 140 beats/min. Biochemical examination of the patient showed that potassium concentration was 3.1 mmol/L. An intravenous infusion of 10% potassium chloride 10 ml plus compound balance fluid was given, and amiodarone was stopped. Electrocardiographic monitoring showed no obvious abnormality.
  • Acute kidney injury due to single time overdosage intravenous infusion of  amoxicillin and clavulanate potassium: report of 2 cases
    Li Xinlei, Tang Hongbo, Feng Xin
    2016, 18(3): 238.
    Abstract ( ) PDF ( )
    Two female patients who aged 42 and 33 years with adenomyosis  and hysteromyoma, respectively  were  hospitalized for surgical treatment. They had not history of kidney disease. They developed the symptoms of nausea, vomit, hematuresis, hypourocrinia, and slight puffy swelling after the second and fourth times of IV infusion of amoxicillin and clavulanate potassium 2.4 g, respectively. Laboratory examination showed  the increase of serum creatinine (Scr) and urea nitrogen (BUN)(case 1: Scr 423 μmol/L, BUN 7.2 mmol/L；case 2：Scr 443 μmol/L, BUN 6.8 mmol/L). Amoxicillin and clavulanate potassium were stopped to use in both patients immediately and symptomatic treatments which included those for relieving vomiting, hemostasis, diuresis, and fluid infusion were given to them. The two patients were transferred to another hospital′s   nephrology department for hemodialysis on day 5 and 3 of receiving amoxicillin and clavulanate potassium, respectively. The two patients′ urine volume, levels of Scr and BUN were returned to normal on day 18 and 20 after transferring, respectively (case 1: Scr 49 μmol/L, BUN 4.1 mmol/L；case 2: Scr 55 μmol/L, BUN 5.1mmol/L).
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