2016 Volume 18 Issue 4 Published: 28 August 2016
  

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  • Sun Shiguang, Fan Wei, Qi Dongmei, Liu Jian, Tian Yuejie, Xie Yanjun, Sun Rong
    2016, 18(4): 243.
    Abstract ( ) PDF ( )
    ObjectiveTo explore the clinical characteristics and the warning signals of Danshen lyophilized powder injection (DLPI).MethodsThe adverse drug reaction (ADR) reports of DLPI from the ADR Spontaneous Reporting Database of Shandong Province from January 1, 2005 to December 31, 2015 were collected. The clinical characteristics of ADR were analzed by descriptive statistical method. The conceptual data and the data for each year from 2005 to 2015 were analyzed to find out the warning signals of ADR induced by DLPI by the methods of proportional reporting ratio (PRR), reporting odds ratio (ROR), and bayesian confidence propagation neural network (BCPNN).ResultsA total of 887 reports and 887 patients which comprised 460 males and 427 females with the average age of (57.7±16.6) years (3 d to 91 years) were enrolled into the analysis. The patients  whose age ≥45 years accounted for 79.59% (706/887). There were 1 281 times of ADR in 887 patients which involved mainly in skin and cardio-cerebrovascular system. Top ten in turn were erythra, pruritus, dyspnea, shiver, nausea, headache, fever, palpitation, dizziness, and injection site reactions, totally 1 152 times of ADR which accounted for 65.89% (1 152/1 281). The patients stopped to use DLPI when the ADR appeared. Of the 887 patients, 557 cases were recovered and 330 had improvement after receiving the symptomatic treatments. The results of analysis on conceptual data and the data for each year by methods of PRR, TOR, and BCPNN showed that erythra (PRR method: conceptual data, from 2008 to 2015; ROR method: conceptual data, from 2008 to 2014; BCPNN method: conceptual data), pruritus (PRR method: conceptual data, 2012, 2013, 2015; ROR method: conceptual data, 2012, 2013), dyspnea (PRR method: conceptual data, from 2008 to 2014; ROR method: conceptual data, from 2008 to 2014; BCPNN method: conceptual data, 2014), shiver (PRR method: conceptual data, from 2007 to 2009; ROR method: conceptual data, from 2011 to 2013; BCPNN method:conceptual data, 2012 and 2013) could be  warning signals of ADR induced by DLPI.ConclusionsADRs due to DLPI involve mainly skin and cardio-cerebrovascular system. Erythra, pruritus, dyspnea, and shiver can be the warning signals of ADR induced by DLPI.
  • An Xiang, Gao Jingfei, Ding Xuansheng
    2016, 18(4): 249.
    Abstract ( ) PDF ( )
    ObjectiveTo compare the "dose-time-toxicity" relationship of acute liver injury in mice induced by a single-dose of Chaiqin Qingning capsule or Ganmaoling capsule.Methods"Time-toxicity" study: the mice were divided into 19 subgroups (10 mice in each subgroup), including 9 Chaiqin Qingning capsule subgroups, 9 Ganmaoling capsule subgroups, and 1 normal control group (treated with distilled water). The mice in the Chaiqin Qingning capsule group were treated with a single intragastric administration with 1.65 times of clinically equivalent dose (ED) (equal to 95.42 times of 70 kg normal adult daily dose) of the drug suspension. The mice in the Ganmaoling capsule group were treated with a single intragastric administration with 1.554 times of ED (equal to 52.53 times of 70 kg normal adult daily dose) of the drug suspension. The mice in the Chaiqin Qingning capsule group and Ganmaoling capsule group were divided into 1 h, 2 h, 4 h, 8 h, 12 h, 24 h, 48 h, 72 h and 96 h subgroups after administration, respectively. "Dose-toxicity" study: the mice were divided into 13 subgroups (10 mice in each subgroup), including 6 Chaiqin Qingning capsule subgroups (according to dose, the mice were divided into ED, 1.6ED, 1.62ED, 1.63ED, 1.64ED and 1.65ED subgroups; 351.00, 561.60, 898.56, 1 437.70, 2 300.31 and 3 680.50 mg/kg, respectively), 6 Chaiqin Qingning capsule subgroups (according to dose, the mice were divided into ED, 1.55ED, 1.552ED, 1.553ED, 1.554ED and 1.555ED subgroups; 390.00, 604.50, 936.98, 1 452.31, 2 251.08 and 3 489.18 mg/kg, respectively), and 1 normal control group (treated with distilled water). "Time-toxicity" was studied at different times after the drugs administration and "dose toxicity" was studied at 12 h after administration. General state and body weight of mice were observed. The changes of the levels of ALT, AST, and ALP in serum and organ index of liver, spleen, and thymus were tested.ResultsThe difference of serum levels of ALT, AST, and ALP and liver, spleen, and thymus organ index of mice between the 9 different time subgroups and the 6 different dose subgroups in Chaiqin Qingning capsule group and the normal control group were not statistically significant (all P>0.05). The ALT, AST, and ALP levels in the 2 h, 4 h, 8 h, 12 h, and 24 h subgroups and the 1.553ED, 1.554ED, and 1.555ED subgroups, the serum levels of ALT in the 48 h subgroup, the serum levels of ALT and AST in the 1.552ED subgroup, and liver organ index in mice in the 8 h and 12 h subgroups and the 1.553ED, 1.554ED, 1.555ED subgroups in the Ganmaoling capsule group were significantly higher than those in the normal control group (P<0.05, P<0.01). The serum levels of ALT, AST, ALP, and liver organ index in the 12 h subgroup were the highest in the "time-toxicity" study [(1 017.0±342.6) U/L, (281.3±60.1) U/L, (171.8±43.5) U/L, (6.76±0.60) g/100 g], and the serum levels of ALT, AST, ALP, and liver organ index in the 1.555ED subgroup were the highest in the "dose-toxicity" study [(2 930.6±661.5) U/L, (888.8±180.6) U/L, (392.7±42.4) U/L, (7.21±1.12) g/100 g].ConclusionsA single large dose of Chaiqin Qingning capsule did not induce significant hepatotoxicity in mice. A single large dose of Ganmaoling capsule could induce acute liver injury in mice and showed a significant "dose-time-toxicity" relationship.
  • Chen Xintong, Zhuang Wei, Wang Yawei, Zhou Jingyan, Lin Xiaolan
    2016, 18(4): 255.
    Abstract ( ) PDF ( )
    ObjectiveTo investigate the status and influencing factors of medication error (ME) in traditional Chinese medicine.MethodsME reports in Xuanwu Hospital of Capital Medical University from January 1st, 2014 to November 31st, 2014 were collected from International Network for the Rational Use of Drugs (INRUD).Of them, ME reports of traditional Chinese medicine were selected. Category, content, persons who triggered the ME, triggering factor, persons who found the ME were analyzed descriptively.ResultsA total of 863 ME reports were collected and 477 reports (55.27%) related to traditional Chinese medicine were selected. Of the 477 ME reports, 180 reports(37.74%) were related to Chinese patent drugs and 297 reports (62.26%) were related to Chinese herbal drugs. Four hundred and seventy-seven patients were reported in the 477 ME reports. Of the 477 patients, 218 patients (45.70%) were male, 221(46.33%) were female, and in 38 (7.97%) the sex was not clear. Their ages were from 4 to 92 years and 113 patients(23.69%) were ≥66 years old. Of the 477 MEs, 83 cases (17.40%) belonged to category A, 389 cases(81.55%) belonged to category B, 5 cases(1.05%) belonged to category C, and none of the patients were hurt. The dosage errors in content of MEs ranked the first and accounted for 31.03% (148/477), errors of drug category ranked the second and accounted for 12.16% (58/477). In persons who triggered the ME, doctors accounted for 68.13% (325/477), pharmacists accounted for 23.06% (110/477). Four hundred and sixty-seven cases of the 477 MEs were caused by a factor, 28 cases were caused by 2 kinds of factors, 10 cases were caused by 3 kinds of factors, and a total of 525 person-time MEs were reported. Lack of professional knowledge of traditional Chinese medicine was the first triggering factor and accounted for 24.57%(129/525), fatigue was the second triggering factor and accounted for 17.72%(93/525). The main persons who found the MEs were pharmacists with primary and medium professional titles and accounted for 61.49% (289/470) and 36.81% (173/470), respectively. ConclusionsMEs related to traditional Chinese medicine accounted for half of all MEs and most of them were related to Chinese herbal drugs. The main persons who triggered the MEs were doctors and pharmacists. The main triggered factors were lack of professional knowledge of traditional Chinese medicine and fatigue. Pharmacists play an important role to find and correct ME related to traditional Chinese medicine in time for protecting the patient′s medication safety.
  • Huang Wenhui, Zhang Yakun, Hou Xingyun, Lin Xiaofeng
    2016, 18(4): 261.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the risk of  arthralgia due to dipeptidyl peptidase-4 (DPP-4) inhibitors.MethodsThe documents involving arthralgia due to DPP-4 inhibitors ending in February 2016 were searched from correlative data base and online library. DPP-4 inhibitors was used in the test group while placebo was used in the control group. The relevant data were collected from enrolled documents and the  quality of RCTs was assessed. The software Review Manager 5.3 was used for Meta-analysis and the results were expressed  in RR and 95%CI.ResultsA total of 22 RCTs were enrolled into the Meta-analysis and 9 927 patients [6 760 cases in the test group (T) and 3 167 cases in the control group(T)]  were treated 12 to 206 weeks. The number of patients who were enrolled into the study on sitagliptin,  saxagliptin, vildagliptin,  linagliptin, and  alogliptin were 954 (T: 545, C: 409), 4 246 (T: 2 923, C:1 323) , 899 (T: 528, C: 371), 2 624 (T: 1 893, C: 731), and 1 204 (T: 871, C: 333), respectively.  The results of quality evaluation to all literatures showed  13 for Grade A and 8 for Grade B. The results of Meta analysis showed that the risk of arthralgia induced by saxagliptin and vildagliptin was higher than that by placebo (RR=1.35, 95%CI: 1.01-1.81, P=0.04 and RR=2.80, 95%CI: 1.29-6.08, P<0.01).The results of subgroup analysis showed that the risk of arthralgia induced by saxagliptin 2.5 mg/d added to metformin or TZDs, saxagliptin 10 mg/d monotherapy or added to metformin,  and vildagliptin 50 mg/d was higher than that by placebo (RR=1.74, 95%CI: 1.06-2.88, P=0.03; RR=1.97, 95%CI: 1.01-3.82, P=0.05;  RR=1.86, 95%CI: 1.06-3.28, P=0.03; RR=2.55, 95%CI: 1.15-5.64, P=0.02). The risk of arthralgiadue induced by itagliptin, linagliptin, and alogliptin were similar with that by placebo(all P>0.05). ConclusionsSaxagliptin and vildagliptin  may increase the risk of arthralgia. The patients with type 2 diabetes and joint disease should choose sitagliptin, linagliptin or alogliptin when they were using DPP-4 inhibitors.
  • Wang Zixin, Liu Lijie, Meng Qingling, Chen Wei, Zhang Jing, Zheng Hui, Ji Congying
    2016, 18(4): 273.
    Abstract ( ) PDF ( )
    ObjectiveTo explore the safety of salbutamol and doxofylline treatments with different orders.MethodsThe subjects were inpatients who need to be treated with salbutamol and doxofylline in Department of Respiratory and Critical Care Medicine Ward, Beijing Hospital during September 2012 to December 2014. Firstly, the nurses were divided into A, B, and C groups and the admitted patients in accordance with inclusion criteria were entered into the  on-duty nurses′ group. The patients in the group A received intravenous injection of doxofylline after salbutamol inhalation, the patients in the group B received salbutamol inhalation and intravenous injection of doxofylline at the same time, and  the patients in the group C received salbutamol inhalation after intravenous injection of doxofylline (a total of 1 to 2 treatment cycles, the treatment was stopped if adverse reactions occurred). The adverse reactions in the 3 groups were observed.ResultsEach group comprised 100 patients. There were 63 males in the group A and average age was (71±13) years; 58 males in the group B and average age was (71±12) years; 64 males in the group C and average age was (73±12) years.  The diseases in patients in the 3 groups included chronic obstructive pulmonary disease, pneumonia, lung cancer, lung infection, bronchiectasis, and bronchial asthma, etc. The differences of age, gender distribution, and percentages of different diseases among the three groups were not statistically significant (all P>0.05). Totally 24 cases of adverse reactions appeared in 16 patients in the 3 groups, including 12 cases of palpitations, 10 cases of shortness of breath, and 1 case of finger tremor. The incidence of adverse reactions in the 3 groups were 2% (2/100), 10% (10/100), and 5% (5/100), respectively. The difference between the group A and the group B was statistically significant (P=0.045).ConclusionsSalbutamol inhalation and intravenous injection of doxofylline with different order had an marked impact on medication safety. The incidence of adverse reactions was the lowest when the patients were given intravenous injection of doxofylline after salbutamol inhalation.
  • Yu Jianliang, Kang Ming, Chen Xiaoyan
    2016, 18(4): 277.
    Abstract ( ) PDF ( )
    ObjectiveTo understand the clinical characteristics and outcomes of electrocardiogram (ECG) abnormalities induced by risperidone.MethodsMedical records of patients, who had hospitalized in Department of Psychiatry, Hangzhou Fuyang Third People′s Hospital and treated with risperidone for the first time from June 2013 to June 2014, were collected and retrospectively analyzed. The incidences [including the total incidence of ECG abnormalities, incidence in the low dose (<4 mg/d) group and the high dose (4-6 mg/d) group, incidence at different time of treatment (1, 2, 3 months of treatment)], characteristics, treatments, and outcomes of ECG abnormalities were analyzed.ResultsA total of 293 patients were enrolled into this study. Of them, 135 patients (70 males and 65 females with age from 22 to 68) were in the low dose group and 158 patients (77 males and 81 females with age from 24 to 63) were in the high dose group. The total incidence of ECG abnormalities was 39.60% (116/293) and the difference between the low dose and the high dose groups was not statistically significant [37.78%(51/135) vs. 41.14%(65/158),  χ2=0.344, P=0.502]. All ECG abnormalities appeared within 3 months of treatment, the incidences in the 1, 2, and 3 months were 16.72%(49/293), 14.75%(36/244), and 14.90%(31/208), respectively. The incidences in the 1, 2, and 3 months were 16.30% (22/135), 14.16% (16/113), 13.40% (13/97) in the low dose group and 17.09% (27/158), 15.27% (20/131), 16.22% (18/111) in the high dose group, respectively. There were no statistical significance between the 2 groups (all P>0.017) . The incidence of ECG abnormalities was the highest in the first month of treatment in the 2 groups. The main characteristics of abnormal ECG induced by risperidone were sinus tachycardia, sinus tachycardia, sinus arrhythmia, ST-T changes, atrioventricular block, QT interval prolongation, etc. Of the 116 patients with ECG abnormalities, 7 patients′ risperidone treatments were not stopped and no any other treatments were given, 31 patients′ risperidone treatments were not stopped and symptomatic treatments were given, 3 patients were given a lower dosage of risperidone, and 75 patients′ risperidone treatments were stopped. All patients′ ECG returned to normal.ConclusionsSinus arrhythmia was more common in the ECG abnormalities caused by risperidone. ECG abnormalities appeared mostly in the early stage of risperidone treatment, had no significant relationship with the dosage, and could return entirely to normal.
  • Li Dandan, Li Hongwei, Shen Su
    2016, 18(4): 282.
    Abstract ( ) PDF ( )
    Ticagrelor, a P2Y12 receptor reversible antagonist, plays the role of anti-platelet through inhibiting platelet aggregation medicated by adenosine diphosphate.Dyspnea is the most common adverse reaction of ticagrelor, and the possible mechanisms include adenosine accumulation theory: ticagrelor can lead to dyspnea by inhibiting the reuptake of adenosine through red blood cells, inducing ATP release from red blood cells, and then accumulate and degradate to adenosine or directly metabolize into adenosine analogs. Inhibition of neuronal P2Y12 receptor: ticagrelor can inhibit P2Y12 receptor, increase cAMP production, improve prostaglandin E2 (PGE2) activity, increase vagal C fibers excitability, and then cause dyspnea. Similar reaction to transfusion-related acute lung injury (TRALI): the reversible combination of ticagrelor and P2Y12 receptor could accumulate aged, exhausted, and destroyed platelets, initiate apoptotic program, lead to the similar reaction of TRALI, and finally cause dyspnea. Reducing the dose of ticagrelor or intravenous injection of theophylline (5 mg/kg) can effectively alleviate ticagrelor-related dyspnea.
  • Liang Huayu, Wang Yuqin
    2016, 18(4): 286.
    Abstract ( ) PDF ( )
    Benzbromarone is a potent uricosuric drug by inhibiting the re-absorption of uric acid salt in renal proximal convoluted tubules and widely used for gout and hyperuricemia. The common adverse reactions of  benzbromarone are gastrointestinal symptoms (including diarrhea, stomach discomfort, and nausea),  skin  allergies (including rash and itching), and  abnormal liver function with the increase of  aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase. Hepatotoxicity induced by benzbro-marone is mainly associated with the  suppression of β-oxidation and respiratory chain, reducing the synthesis of ATP, increasing the generation of reactive oxygen species, promoting the opening of mitochondrial permeability transition pore and leading to apoptosis induced by the release of cytochrome C. In addition, the synthesis of  adjacent benzene ortho-quinone intermediate and the decrease of glutathione, level could exacerbate hepatotoxicity. Cytochrome P450(CYP) oxidase is important for metabolism of benzbromarone and increase of the activity of CYP2C9/CYP3A4 and  CYP2C9*3 mutation are likely to increase the hepa-totoxicity of benzbromarone.
  • Wang Nana, Zhou Guiqin
    2016, 18(4): 290.
    Abstract ( ) PDF ( )
    Tamoxifen is widely used in the treatment of patients with estrogen receptor positive breast cancer. Tamoxifen can lead to fatty liver. Risk factors of tamoxifen induced fatty liver were obesity, hyperlipidemia, and hyperglycemia. The mechanism of tamoxifen induced fatty liver includes drugs estrogen antagonism, influence on fatty acid metabolism enzyme expression and activity, promoting fatty acid synthesis, and influencing lipid metabolism related nuclear receptors. The above factors interfering with fatty acid metabolism cause fat accumulation in the liver. Obeticholic acid can improve the prognosis of patients with fatty liver induced by tamoxifen.
  • Yao Yao, Ge Weihong
    2016, 18(4): 293.
    Abstract ( ) PDF ( )
    A 48-year-old female patient was hospitalized 2 times for pseudotrichinosis. She received an IV infusion of methylprednisolone 60 mg once daily (changed to oral prednisone acetate 20 mg once daily after discharging) and oral methotrexate 10 mg once a week. After 107 days of treatments with the above-mentioned drugs, thalidomide 50 mg once daily by mouth was added because of recurrent erythra in her face and trunk. One hundred and thirty-six days later, methotrexate was withdrawn for the liver injury. Forty-eight days after receiving thalidomide, her skin rash was aggravated and accompanied by desquamation and erosion. Thalidomide was stopped. Anti-infective and anti-allergic treatments, skin protective treatments were given. Fourteen days later, her skin rash was ameliorated.
  • Han Mei, Ge Ming, Li Wei
    2016, 18(4): 295.
    Abstract ( ) PDF ( )
    A 62-year-old male patient with gastric cancer was treated with an IV infusion of oxaliplatin (0.2 g, the first day) combined with oral tegafur, gimeracil and oteracil potassium (60 mg twice daily, the first day to the 14th day), the chemotherapy cycle was 21 days. On day 8 of the second cycle, the patient presented with massive erythema on face, neck and chest, accompanied by itching and pain. Hand-food syndrome induced by tegafur, gimeracil and oteracil potassium was considered. The patient and family refused to replace the chemotherapy regimens. On day 3 of the third cycle, the patient presented with new erythema and blisters on his face, truck and limbs. The patient was diagnosed as Stevens-Johnson syndrome. He was treated with intramuscular injection of diphenhydramine 20 mg once daily and topical application of Binghuang Fule ointment (冰黄肤乐软膏) twice daily. After eight cycles of chemotherapy, the skin lesions were significantly improved and regenerated skin was observed.
  • Hu Xinling, Zhang Wen, Sha Dan, Yang Xiaolin
    2016, 18(4): 297.
    Abstract ( ) PDF ( )
    A 23-year-old male patient was given the chemotherapy regimen consisting of IV infusion of oxaliplatin (225 mg, the first day) and oral capecitabine (1.5 g in the morning, 2.0 g in the evening, the first day to the 14th day) after resection of colon cancer. The chemotherapy cycle was 21 days. Six hours after the first infusion of oxaliplatin, the patient began to have blurred vision, upper quadrant visual field defect and amaurosis when sitting. The symptoms occurred as intermittent episodes 5-6 times, about 10 seconds each time. On day 2, eye examination showed no abnormality, and he had a clear vision than the day before. On day 3, the visual field returned to normal. The chemotherapy regimen of the second cycle was changed to single drug capecitabine. Abnormal visual field did not recur.
  • Wang Zhen, Hua Lu
    2016, 18(4): 298.
    Abstract ( ) PDF ( )
    A 65-year-old female patient took warfarin regularly at a dose of 3.75 mg once daily for atrial fibrillation and cerebral infarction and the INR value was maintained between 1.95-2.12. She ate dried red jujube (50-100 g/d) as nutritional supplements. Three weeks later, she found a hematoma on her left forearm, about the size of duck′s egg, and gross hematuria. The INR increased to 3.22. Warfarin was discontinued. The next day, the hematuria disappeared and the hematoma was alleviated. She continued to eat the jujube. Two days later, the hematoma was absorbed with only an ecchymosis left. On day 4 after warfarin withdrawal, the INR was 1.72. The patient was advised to stop eating the jujube and continue warfarin anticoagulation at a dose of 3.75 mg once daily. Six days later, the INR was 1.78 and the ecchymosis disappeared completely.
  • Lin Xiuli, Zeng Huiqing, Cai Xueying
    2016, 18(4): 300.
    Abstract ( ) PDF ( )
    A 68-year-old female patient received icotinib hydrochloride 0.125 mg thrice daily due to lung cancer with systemic multiple bone metastases. On the second day, the patient developed hematochezia with an amount of 20 ml blood in stool. Icotinib hydrochloride was stopped by herself. On the third day, hemafecia disappeared. On the fourth day, she restarted icotinib hydrochloride at the same dosage following the doctor′s advice. On the 5th day, hemafecia three times appeared, which was about 100-150 ml. Laboratory tests showed that platelet was 43×109/L (37×109/L before the drug administration) and hemoglobin was 119 g/L(132 g/L before the drug administration). Icotinib hydrochloride was withdrawn and the hemafecia did not recur for 4 days.
  • Kong Yanling, Zhang Shaobo
    2016, 18(4): 301.
    Abstract ( ) PDF ( )
    A 63-year-old female patient with bronchopneumonia received an IV infusion of  amoxicillin clavulanic acid potassium 1.2 g twice daily. The patient developed nausea and rectal tenesmus about 20 minutes after the start of amoxicillin clavulanic acid potassium treatment each time on the first day. No treatments were given and the symptoms relieved gradually 3 hours after finishing the IV infusion. The patient developed the above-mentioned symptoms again about 20 minutes after the start of amoxicillin clavulanic acid potassium treatment on the second day, and rectal mucosal prolapse appeared at the same time. The amoxicillin clavulanic acid potassium was stopped immediately and an IV infusion of ceftriaxone sodium 2 g once daily was given on the third day. After 3 days of ceftriaxone sodium treatment, the patient′s cough and expectoration were improved and disappeared on the 8th day, and the rectal mucosal prolapse did not recur.
  • Tang Xiaofei, Tan Bing, Zhang Yan, Liu Hongjun, Yang Meng, Chen Lijuan, Yang Zhixiang
    2016, 18(4): 303.
    Abstract ( ) PDF ( )
    A 79-years-old male patient took carbamazepine 100 mg thrice daily for the trigeminal neuralgia and added the dose of carbamazepine to 200 mg thrice daily by himself because the pain could not be controlled. One month later, the patient developed shortness of breath, heart palpitations, dizziness, and limbs numbness. Laboratory tests showed the following results: white blood cell (WBC) 3.0×109/L, red blood cell (RBC) 3.1×1012/L, hemoglobin (Hb) 100 g/L, serum sodium 127 mmol/L, chloride 95 mmol/L, total thyroxine 58 nmol/L, free thyroxine 10.6 pmol/L, thyroid-stimulating hormone (TSH) 4.5 mU/L. Dynamic electrocardiogram showed average heart rate 59 beats/min and 326 times of cardiac arrest exceeding 2.0 s. He was diagnosed with sick sinus syndrome and hypothyroidism. The patient was discharged after symptomatic treatments. About 3 months later, shortness of breath, dizziness and heart palpitations appeared again, accompanied by syncope 2 times (about 1 minute each time and relieved spontaneously). Laboratory tests showed the following results: WBC3.1×109/L, RBC 3.0×1012/L, Hb 99 g/L, serum sodium 127 mmol/L, chloride 95 mmol/L, total thyroxine 63 nmol/L, free thyroxine 11.8 pmol/L, TSH 7.9 mU/L. Dynamic electrocardiogram showed arrhythmia, atrioventricular block, and R-R interval prolongation. Carbamazepine was stopped. Ten days later, dizziness, heart palpitations, and syncope disappeared. The laboratory revealed the following results: WBC 5.6×109/L, RBC 4.4×1012/L, Hb 120 g/L, serum sodium 139 mmol/L, chloride 102 mmol/L, total thyroxine 67 nmol/L, free thyroxine 15.0 pmol/L, TSH 3.8 mU/L. Dynamic electrocardiogram showed sinus heart rate and heart rate 75 beats/min. Carbamazepine 100 mg thrice daily was administered again for trigeminal neuralgia. The above mentioned symptoms did not recur during a half year of follow-up.
  • Zou Yuzhen, Feng Lei
    2016, 18(4): 305.
    Abstract ( ) PDF ( )
    A 36-year-old female patient received methotrexate/vindesine chemotherapy for mixed acute leukemia. She was treated with intravenous infusion of methotrexate (8 g lasting for 24 hours, on the first day and the 15th day), intravenous infusion of vindesine (4 mg on the first day) and intramuscular injection of pegaspargase (3 750 U, on the 5th day). Her blood concentration of methotrexate was 0.94 μmol/L 20 hours after her first dose. During the second dose, the patient developed epigastric pain. She was treated with intravenous infusion of omeprazole 40 mg once daily. The next day, the patient developed intermittent abdominal pain and mucous stool 5-6 times daily. Her blood concentration of methotrexate was 17.64 μmol/L. Methotrexate intoxication was considered. Intravenous infusion of calcium folinate 1 g every 6 hours and gargling with calcium folinate 30 mg+0.9% sodium chloride 500 ml thrice daily was given immediately. On the third day, the patient developed oral mucosal ulcer and was treated with recombinant basic fibroblast growth factor and lidocaine for external application. On the 4th day, the blood concentration of methotrexate was 1.53 μmol/L, abdominal pain and ulcer was improved. The patient was treated with calcium folinate 36 mg intramuscularly every 6 hours. On the 6th day, the blood concentration of methotrexate dropped to 0.67 μmol/L.
  • Wei Ju, Tong Yin, Gao Yanrong
    2016, 18(4): 307.
    Abstract ( ) PDF ( )
    A 65-year-old female patient with iron-deficiency anemia received conventional ferrous succinate 0.1 g thrice daily by mouth. On the second day of treatment, the patient developed nausea, acid reflux, and diarrhea. On the third day and the 4th day, her alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were 155 U/L and 438 U/L, 470 U/L and 867 U/L, respectively. Acute drug-induced liver injury (DILI) was considered. Ferrous succinate was withdrawn and an IV infusion of polyene phosphatidylcholine 465 mg once daily was given. Her gastrointestinal symptoms relieved and ALT and AST levels returned to 37 U/L and 25 U/L after a week of treatment. Then the patient was given IV infusion of iron sucrose injection 100 mg every other day. Ten days later, hemoglobin level increased to 97 g/L and no gastrointestinal symptoms and liver injury appeared. Then she was discharged. Six months later, the patient was admitted to hospital again because of IDA. Ferrous sulfate and vitamin one pill once daily was given. On the 4th day, the levels of ALT and AST were 98 U/L and 209 U/L, respectively. Ferrous sulfate and vitamin was stopped and liver-protective treatment was given. Three days later, her ALT and AST levels were 36 U/L and 34 U/L. At 3 years of follow-up, it was found that the patient was admitted to hospital many times, IV infusion of iron sucrose injection was given each time, and no liver injury recurred.
  • Li Xinping, Zhang Ping, Li Xiaoyu
    2016, 18(4): 309.
    Abstract ( ) PDF ( )
    A 71-year-old female patient had an increase in volume of night urine for 2-3 months and her blood calcium level was 3.11 mmol/L by lab tests. It was known by inquiring medical history that the patient took calcium carbonate D3 (containing element calcium 300 mg/pill, 1 pill/d), alfacalcidol (0.5 g/d, increased to 0.75  g/d for 1.5 years), and 2 kinds of health products (variety of vitamins, containing vitamin D3 1000 U and element calcium 500 mg in each tablet, 1 tablet/d; "Joint King", containing vitamin D3 2000 U in each dose, 2 doses/d). In addition, the patient also received losartan potassium and hydrochlorothiazide (containing losartan potassium 50 mg and hydrochlorothiazide 12.5 mg) 1 tablet once daily. Her 25-(OH)D level was >280  g/L. Vitamin D intoxication and hypercalcemia was considered. All drugs and health products were stopped, the patient was adviced to drink more water and increase salt intake, and nifedipine was given for her hypertension. Four days later, the patient′s serum calcium was stable at 2.33-2.41 mmol/L.
  • Zhao Xixi, Wang Haifei
    2016, 18(4): 311.
    Abstract ( ) PDF ( )
    An 80-year old male patient, who had many kinds of diseases, received isosorbide mononitrate, irbesartan and hydrochlorothiazide, furosemide, spironolactone, and acarbose for more than 2 years and was added olanzapine 5 mg once daily because of sleep disorder. One month later, he developed bilateral lower limbs edema and half a month after that he developed right breast pain. Spironolactone was stopped. Four days later, the patient′s symptoms were not improved and color Doppler ultrasound examination of breast showed masculine mastoplasia. Olanzapine was withdrawn and 5 days later, his right breast pain and bilateral lower limbs edema relieved. Spironolactone and the above-mentioned drugs except olanzapine were given again. At 3 weeks of follow-up, the patient′s symptoms did not recur.
  • Xun Zhikun, Qian Jiao, Wu Si
    2016, 18(4): 312.
    Abstract ( ) PDF ( )
    A 60-year-old male patient with hypopharyngeal carcinoma received chemotherapy with docetaxel and nedaplatin. Five minutes after the first treatment with docetaxel (120 mg in 0.9% sodium chloride 500 ml), the patient developed dyspnea, cardiac and breath arrest, and his blood pressure was too low to be measured. The drug was stopped immediately and chest compression, endotracheal intubation, ventilator-assisted breathing, drug therapy such as adrenaline, dexamethasone, and dopamine were given. The patient eventually died after 18.5 hours of rescue.Because the patient did not received any other drugs except docetaxel, it was considered that anaphylactic shock was induced by docetaxel.
  • Shen Qushen, Chen Chibang, Zhou Yongheng, Peng Nanxing, Liu Chunxia
    2016, 18(4): 314.
    Abstract ( ) PDF ( )
    A 24-year-old male patient with viral meningoencephalitis received intravenous infusion of acyclovir 0.5 g thrice daily, Xingnaojing injection (醒脑静注射液) 20 ml once daily, mannitol injection 250 ml thrice daily, creatine phosphate sodium 1 g once daily, insulin injection (6 U+5% glucose injection 500 ml+ potassium chloride injection 10 ml), Xueshuantong injection (血栓通注射液) 500 mg once daily, mecobalamin injection 2 ml once daily, and oral butylphthalide soft capsules 0.2 g thrice daily, ranitidine bismuth citrate capsules 0.2 g twice daily, etc. On day 7, the patient developed visual blurring and could not see distant objects clearly. At the same time, the patient experienced mydriasis with diameter about 5.0 mm and conjunctival congestion. Acyclovir was discontinued and other drugs were continued. Five days after withdrawal, his symptoms of conjunctival congestion, mydriasis, and vision were improved. At 2 months of follow-up, blurred vision did not recur.
  • Yang Zhonghui, Tan Haihong, Shen Dandan
    2016, 18(4): 316.
    Abstract ( ) PDF ( )
    A 37-year-old male patient received nimesulide 0.1 g twice daily because of lower back pain. The platelet count was 155×109/L before the drug use. On day 4 of treatment, petechiae appeared and did not disappear after pressing. Nimesulide was stopped by himself. On day 5, the platelet count was 3×109/L. An IV infusion of gamma globulin and large dose of methylprednisolone were given. Three days later, his platelet count was 108×109/L and petechiae decreased. One month later, his platelet count was 125×109/L and petechiae disappeared.