2017 Volume 19 Issue 2 Published: 28 April 2017
  

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  • Xia Peiyuan
    2017, 19(2): 81-83.
    Abstract ( ) PDF ( )
  • Sun Lu, Zhao Huanyu
    2017, 19(2): 84-88.
    Abstract ( ) PDF ( )
  • Zheng Junfu, Dang Yan, Yu Yanhua, Li Lei, Lou Jinli, Ding Huiguo
    2017, 19(2): 89-95.
    Abstract ( ) PDF ( )
    ObjectiveTo investigate the strain distribution of ascitic pathogens in patients with spontaneous bacterial peritonitis (SBP) and the changes of sensitiveness to antibacterials from 2009 to 2016. MethodsThe medical records of SBP patients who were hospitalized in Beijing Youan Hospital from 2009 to 2016 were collected. The results of ascites bacterial culture of SBP patients were all positive. The results of ascites culture, pathogen identification, and the drug sensitivity test were recorded. The changes of distribution of ascitic pathogens and the sensitiveness to antibacterials were analyzed according to the time interval of every two years.ResultsA total of 1 107 SBP patients were enrolled in the study. Of them, 816 patients were male with average age (54±10) years, 291 patients were female with average age (57±13) years. There were 1 042(94.1%) patients with positive bacterial culture of ascites and 65 patients (5.9%) with positive fungal culture of ascites among the 1 107 patients, respectively. There were 920(83.11%) patients with end-stage liver disease, 113 (10.2%) with biliary tract disease, and 74(6.68%) with other diseases in the 1 107 patients. A total of 1 441 strains of pathogenic bacteria were identified, comprised of gram negative (G-) bacteria 637 (44.2%) strains, gram positive (G+) bacteria 739(51.3%) strains, and fungi 65(4.5%) strains. During 2009 to 2016, the top four number of strains of G-bacteria in SBP patients′ascites from high to low were Escherichia coli [213(14.8%)], Klebsiella pneumoniae [146 (10.1%)], Pseudomonas aeruginosa[52(3.6%)] and Enterobacter cloacae[38(2.6%)]; the top four strains of G(+) bacteria were Enterococcus faecium[176(12.2%)], Staphylococcus epidermidis[132(9.1%)], Staphylococcus haemolyticus [130(9.0%)] and Enterococcus faecalis [75(5.2%)] ; and the top 2 of fungi in SBP patients′ ascites were Candida albicans[36(2.5%)] and Candida glabrata[12(0.8%)].  Compared with the time interval of 2009-2010, the constituent ratio of G(-) bacteria in 2015-2016 was decreased significantly [49.3%(73/148)vs. 39.4% (196/498), P=0.031 ] , the constituent rate of fungi was increased significantly [6.4%(32/498) vs. 2.0% 3/148), P=0.038]. There were no statistical significance in G(+) bacteria′s constituent ratio among different time intervals . The constituent rate of extended spectrum beta-lactamases (ESBL) in Escherichia coli was higher in the time interval of 2015-2016 than that in the time interval of 2009-2010 [57.4% (35/61) vs. 32% (8/25), P=0.033]. The drug resistance of Escherichia coli to imipenem and meropenem were increased significantly during the same period (P=0.026, P=0.025). The results of drug sensitivity tests showed that G(-) bacteria was sensitive to imipenem, meropenem, amikacin and piperacillin/tazobactam; G(+) bacteria was sensitive to linezolid, teicoplanin and vancomycin. ConclusionsThe distribution of ascitic pathogens in SBP patients who were hospitalized in Beijing Youan Hospital from 2009 to 2016 present the tendency of decreasing of G(-) bacteria and increasing of fungi. The main pathogenic bacteria of SBP are drug-resistant. The resistance rates of Escherichia coli to imipenem, meropenem and cefotaxime have increased year by year.
  • Yang Zhiyun, Li Shanshan, Chen Jie, Chen Xiao
    2017, 19(2): 96-102.
    Abstract ( ) PDF ( )
    ObjectiveTo establish a regression model for predicting the resistance rate of Acinetobacter baumannii (Ab) to anti-bacterial agents.MethodsThe monitoring data of resistance rate of 1 249 Ab strains to 10 frequently used anti-bacterial agents and drug consumption data [the main indicators for the frequency of medication (DDDs) and antimicrobial use intensity (AUD)] of these agents from January 2014 to December 2016 in the First Affiliated Hospital of Sun Yat-sen University were collected. Pearson correlation analysis was performed to analyze the correlation between Ab resistance and AUD. A linear regression model was established for the anti-bacterial agents with correlation between drug resistance and AUD. Then the regression model was used to predict the resistance rate of Ab in January 2017 and February 2017.ResultsDuring the 3 years from 2014 to 2016, the resistance rate of Ab to tigecycline was the lowest (<7% for the 3 years), the resistance rate of Ab to ciprofloxacin was the highest (the average resistance rate was 82.1% for 3 years), there were 3 kinds of drugs whose average resistance rates were <70% and 7 kinds of drugs whose average resistance rates were >70% during the 3 years. The AUD of cefoperazone sodium sulbactam sodium, levofloxacin, tigecycline, panipenem/betamipron, and cefepime were increased. Pearson correlation analysis showed that the resistance rates of Ab to cefoperazone sodium sulbactam sodium and levofloxacin were correlated with their AUD (r=0.681, P=0.015; r=0.694, P=0.012). The data related to Ab resistance rates and AUD of cefoperazone sodium sulbactam sodium and levofloxacin were brought into the one variable linear regression equation. The variance analysis showed that the 2 regression equations fitted well(F=8.634, P= 0.015; F=9.285, P=0.012). The AUD of cefoperazone sodium sulbactam sodium and levofloxacin in January and February, 2017 were respectively brought into the regression equation and the resistance rates of Ab were predicted. The results showed that the actual resistance rates were evenly distributed around the predictive values and within 95% of the predicted range.ConclusionIn our hospital, AUD of cefoperazone sodium sulbactam sodium and levofloxacin were related to resistance rates of Ab and the linear regression model could predict the resistance rate of Ab by AUD.
  • Zhang Ruiqin, Kang Jianbang, Li Xiaoxia, Yin Donghong, Gao Yating, Zhang Zhiqi, Duan Jinju, Hou Ruigang
    2017, 19(2): 103-108.
    Abstract ( ) PDF ( )
    ObjectiveTo observe and compare the resistance changes of ciprofloxacin (CIP), levofloxacin (LEV), norfloxacin (NOR) to Pseudomonas aeruginosa (PA), and choose the drug which had the best curative effect for PA from the drugs mentioned above.MethodsSeven strain of non-repetitive PA which had sensitiveness to ciprofloxacin (CIP), levofloxacin (LEV), norfloxacin (NOR) and the same minimal inhibitory concentration (MIC) of the three drugs were co-cultured with CIP, LEV, NOR in concentrations of 0.5, 1.0, 2.0, and 4.0 times of MIC for evoked drug resistance, respectively. The MIC of CIP, LEV, and NOR to PA which evoked drug resistance by 3 kinds of concentration were detected by the methods of Epsilometer Test and Two-fold Agar Dilution.ResultsThe MIC value of CIP to PA after evoking by 3 concentrations increased from 0.09 μg/ml before evoking to 0.25-16.00 μg/ml. The MIC after evoking was 3 to 178 times that before evoking. The MIC value of NOR to PA after evoking increased from 0.50 μg/ml before evoking to 2.00-64.00 μg/ml. The MIC after evoking was 4 to 128 times that before evoking. The MIC value of LEV to PA after evoking by 3 concentrations increased from 0.50 μg/ml before evoking to 2.00-32.00 μg/ml. The MIC after evoking was 2 to 64 times that before evoking.The differences of MIC of CIP to PA after evoking by different concentrations of CIP, NOR and LEV were not statistically significant (all P>0.05). The MIC value of NOR to PA after evoking by 4.0×MIC CIP was higher than that of evoking by 0.5×MIC CIP (P=0.006). The MIC value of NOR to PA after evoking by 4.0×MIC LEV was higher than that evoked by 1.0×MIC LEP (P=0.006).The MIC value of LEV to PA after evoking by 4.0×MIC CIP was higher than that of evoking by 0.5×MIC CIP (P=0.006). The MIC value of LEV to PA after evoking by 4.0×MIC NOR and LEV were higher than those evoked by 0.5×MIC NOR and LEV (all P=0.007).ConclusionPA can be evoked to develop resistance to different degrees after co-culturing with different concentrations of CIP, LEV, and NOR. The change of resistance of CIP to PA is the least among the three drugs mentioned above. It is suggested that CIP is still one of the best fluoroquinolones for the treatment of PA infection.
  • Sun Jiyun, Ma Xiaoyan, Cai Haodong
    2017, 19(2): 109-112.
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    ObjectiveEffects of long-term use of tenofovir on kidney and skeletal muscle related laboratory indexes in patients with chronic hepatitis B.MethodsThe medical record data of patients with chronic hepatitis B in Beijing Ditan Hospital, Capital Medical University from January 1, 2014 to December 31, 2014 were collected and retrospectively analyzed. All patients were given tenofovir 300 mg once daily and lasted for 24 months. The levels of serum creatinine, phosphorus, alkaline phosphates (ALP) and creatine kinase (CK) were tested before medication and 3, 6, 9, 12, 15, 18, and 24 months after medication. The laboratory tests suggestive of adverse events included the following: values of serum creatinine exceeding the baseline value by 44.2 μmol/L, blood phosphorus<0.8 mmol/L for 2 consecutive times (every 3 months), serum ALP>2 times more than the upper limit of normal (ULN) and,serum CK>3 times more than ULN or CK>500 U/L for 2 consecutive times (every 3 months).ResultsA total of 40 patients were enrolled in this study, including 31 males and 9 females, with a mean age of 34±11 years (19-59 years). After medication, the serum creatinine levels of all patients gradually increased, but only the trend of male patients was statistically significant (P=0.03). There was no statistically significant difference in serum phosphorus and CK levels between male and female patients before and after medication (P>0.05). Of the 40 patients, 1(2.5%) case was identified as a laboratory adverse event since serum phosphorus <0.80 mmol/L for 3 consecutive times. No other laboratory test results suggesting adverse events were found. ConclusionsChronic hepatitis B patients taking tenofovir for two consecutive years might cause increase of serum creatinine and decrease of blood phosphorus, therefore monitoring should be strengthened. The medication had no significant impact on serum CK levels.
  • Li Huibo, Tang Huilin, Ding Shigang, Zhao Rongsheng
    2017, 19(2): 113-120.
    Abstract ( ) PDF ( )
    ObjectiveTo systematically evaluate the relationship between proton pump inhibitors (PPI) and the risk of fractures.MethodsThe related databases were electronically searched for the cohort studies and the case-control studies about the relationship between proton pump inhibitors and the risk of fractures from inception to July 12, 2016. Meta-analysis were conducted using RevMan 5.3 softwear. The results were presented as odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI). The evidence quality of the enrolled literatures were evaluated by Grades of Recommendation, Assessment, Development, and Evaluation.ResultsA total of 20 reports which were related to 21 studies involving 9 cohort studies, 12 case-control studies and 2 076 154 subjects were enrolled in the study. There were 262 298 cases who used PPI and 1 813 856 cases who did not use PPI in the 2 076 154 subjects. The pooled results of Meta-analysis of cohort studies showed that compared with the subjects who had not used PPI, the risk of fracture increased 85% in the subjects who used PPI (OR=1.85, 95%CI: 1.55-2.21, P<0.000 01); the risk of hip fracture increased 58% (OR=1.58, 95%CI: 1.07-2.33, P<0.000 01);the risk of fracture in the subjects who were ≥50 years old increased 58% (OR=1.58, 95%CI: 1.47-1.70, P<0.000 01). The pooled results of Meta-analysis after combination of case control studies showed that compared with the subjects who had not used PPI, the risk of fracture increased 39% in the subjects who used PPI (OR=1.39, 95%CI: 1.26-1.52,  P<0.000 01); the risk of hip fracture increased 45% (OR=1.45, 95%CI: 1.23-1.69, P<0.000 01); the risk of fracture in the subjects who were ≥50 years old increased 43% (OR=1.43, 95%CI: 1.14-1.79, P=0.002). There were no explicit dose-effect relation and time-effect relation between PPI and hip fracture. The risk of fracture in female and male patients who used PPI increased 110% and 88% as compared with those in female and male patients who never used PPI (OR=2.10, 95%CI: 1.50-2.92, P=0.000 1; OR=1.88, 95%CI: 1.14-3.11, P=0.01), respectively. The result of quality evaluation by GRADE showed that the risk factors (including fracture, hip fracture, female, male, and the patient’s age 50-years or older) which increased the degree of fracture after PPI use were all very low quality evidences.ConclusionPPI use modestly could increase the degree of risk of all kinds of fracture and hip fracture, especially in females.
  • Li Ying, Du Liping, Li Lingling, Mei Dan
    2017, 19(2): 121-125.
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    A variety of medications can lead to weight change. Overweight are risk factors for cardiovascular diseases. Weight gain was associated with the use of glucocorticoids, insulinsecretagogues, thiazolidinediones, atypical antipsychotics, valproate, lamotrigine, antidepressants and H1-receptor antagonist. Weight loss was associated with the use of metformin, glucagon-like peptide-1 receptor agonist, alpha-glucosidase inhibitors, zonisamide, topiramate, fluoxetine and bupropion. Weight change reduces medication adherence and influences the treatment of primary disease. Clinicians should balance the advantages and disadvantages and strengthen the patients′ medical education to reduce the drug adverse effect on the body weight.
  • Shi Yingqin, Lin Jie
    2017, 19(2): 126-127.
    Abstract ( ) PDF ( )
    A 52-year-old female patient received compound acetate gossypol tablets 1 pill daily (each one contains acetic acid gossypol 20 mg, vitamin B1 10 mg, vitamin B6 10 mg, potassium chloride 250 mg) for 21 months due to uterine fibroid. The patient developed weakness after 18 months of treatment, muscle soreness and fatigue after about 21 months of treatment. Laboratory tests showed the levels of serum potassium, magnesium, creatine kinase, and myoglobin were 2.0 mmol/L, 0.57 mmol/L, 8 830 U/L, and 977 μg/L, respectively. The compound acetate gossypol tablet was stopped and potassium, magnesium, and other treatments were given. Eight days later, her physical strength recovered, muscle soreness disappeared, and the levels of serum potassium, magnesium, creatine kinase, and myoglobin were 3.6 mmol/L, 0.78 mmol/L, 6 097 U/L, and 113 μg/L, respectively. Treatments of potassium and magnesium supplement continued. Ten days later, her serum potassium was 3.7 mmol/L, magnesium 0.82 mmol/L, creatine kinase 101 U/L, and myoglobin 40 μg/L.
  • Ma Zetong, Gong Rui, Fu Nansi, Gao Hua
    2017, 19(2): 127-129.
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    A 68-year-old female with infection after left knee replacement received an IV infusion of cefoperazone sodium and sulbactam sodium 2.0 g twice daily. It was about to the ending of the second time of IV infusion, the patient developed anhelation, dyspnea, sweating profusely, and fever. The IV infusion was stopped immediately. Three days after drug withdrawal, the patient presented with millet to soya bean size red rash on her trunk which had clear ambit and faded after pressing. It was considered as erythema morbilliforme and needed to be investigated by a dermatologist. The patient received loratadine granules 10 mg once daily and topical application of calamine lotion. Eight days after drug withdrawal, the patient developed skin ulceration on her waist, back, right scapular, and paravertebrae. There were blisters on the left elbow ulnar side and skin peelings on her her waist and back. She was diagnosed as toxic epidermal necrolysis due to cefoperazone sodium and sulbactam sodium by the Department of Dermatology consultation. The patient received IV infusion of calcium gluconate; calglucon; glucal 20 ml, methylprednisolone 80 mg, and human immuno-globulin 2.5 g once daily; intravenous injection of diphenhydramine hydrochloride 20 mg every 12 hours; and topical application of nanoparticulate silver antibacterial gel. The patient developed pulmonary infection and the symptoms of skin peeling off had no improvement. On day 14 of drug withdrawal, her family members decided to give up treatment because of economic reason. It was told that the patient died on the third day after discharge by telephone follow-up.
  • Li Maosheng, Wu Zhimei
    2017, 19(2): 130-131.
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    A 32-year-old female patient with schizophrenia received amisulpride 0.8g twice daily. The results of her routine blood test were normal before taking medicine. On day 26 of administration, the results of routine blood test showed white blood cell count (WBC) 2.3×109/L,  neutrophil count (NEUT) 1.4×109/L. She was given batilol tablet 100 mg and leucogen tablet 20 mg three times daily. On day 32 of administration, the results of routine blood test showed WBC 3.7×109/L,NEUT 2.2×109/L, platelet count (PLT) 65×109/L. The patient received hypodermic injection of recombinant human interleukin-11 for injection 1.50 mg once daily for 7 days. The result of reexamination 7 days later showed WBC 3.9×109/L,NEUT 2.5×109/L,and PLT 113×109/L. She needed to take amisulpride sequentially for treatment. On day 51 of administration, she developed weak, dizziness and headache occasionally. The result of laboratary test showed WBC 2.7×109/L, NEUT 1.4×109/L. The dosage of amisulpride was decreased gradually and then withdrawn. She was given olanzapine 20 mg daily. The result of reexamination on day 18 and 33 of drug withdrawal showed WBC 4.1×109/L, NEUT 2.4×109/L, PLT 100×109/L and WBC 4.2×109/L, NEUT 2.4×109/L, PLT 110×109/L, respectively.
  • Wu Zeyang, Zhou Xiaoming, Gu Xiu, Chen Yu, Zhao Limei, Zhao Li
    2017, 19(2): 132-133.
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    A 60-year-old man with septicemia received an IV infusion of tigecycline (first 100 mg, then 50 mg every 12 hours). The patient developed abdominal distension, pain, and tenderness at left lower abdomen on the tenth day of cumulative medication. Laboratory tests showed the following values: white blood cell (WBC) 18.4×109/L, neutrophile granulocyte 0.90, serum amylase 432 U/L, lipase 432 U/L, urinea amylase 389 U/L. The result of abdominal CT showed effusion in abdominal pelvis, exudation around duodenum and stomach. The patient was diagnosed as acute pancreatitis induced by tigecycline. The patient was told to fast. He accepted gastrointestinal decompression by indwelling gastric tube. Tigecycline was withdrawn. He received symptomatic treatments including acid suppression, inhibition of pancreatic secretion, and intravenous infusion. Six days after symptomatic treatment, the patient′s abdominal symptoms were disappeared. Laboratory test showed the following values: serum amylase 95 U/L, lipase 222 U/L, urinea amylase 93 U/L.
  • Chen Jing
    2017, 19(2): 134-135.
    Abstract ( ) PDF ( )
    A 3 year-old girl with acute bronchitis received budesonide nebulising suspension 2 ml and terbutaline sulphate solution for nebulization 1 ml twice daily. After 3 days of treatment, the girl′s symptoms of cough and asthma were not improved. The laboratory test showed the following values: fasting blood-glucose 6.2 mmol/L, urine ketone bodies positive. It was told by her parents that the girl ever been used budesonide nebulising suspension and ipratropium bromide solution for inhalation to treat cough with good curative effect with no adverse reactions. It was considered that the increased blood glucose and the positive of urine ketone body were correlated to terbutaline sulfate. Terbutaline sulfate solution for nebulization was stopped, and changed to ipratropium bromide 1.25 ml and budesonide nebulising suspension 2 ml twice daily. Three days later, the gril′s symptoms of cough and shortness of breath disappeared, the laboratory test showed the following values: fasting blood-glucose 6.1 mmol/L, urine ketone bodies positive. The results of reexamination one month later showed fasting blood-glucose 5.1 mmol/L, urine ketone bodies negative.
  • Huang Fangfang, Yan Huan, Deng Muhong, Li Xiuxiu
    2017, 19(2): 135-137.
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    A 29-year-old man with malignant pheochromocytoma was treated with oral apatinib 500 mg once daily. One week later, the apatinib was decreased 375 mg once daily due to increased blood pressure. Thirty-seven days after drug administration, he developed bloody stool 50 ml and apatinib was withdrawn. Four days later, the original dosage of apatinib was given because of disease progression. On day 9, he developed bloody stool 600 ml. On day 10, he developed bloody stool 2 300 ml and vomited coffee-ground-like gastric content about 1 000 ml. He received an IV pumping of octreotide acetate, IV infusions of hydroxyethyl starch 40 sodium chloride, carbazochrome sodium sulfonate, etamsylate and aminomethylbenzoic acid. Laboratory tests revealed the following levels: RBC 1.2×1012/L, Hb 37 g/L, thrombin time 17 s, prothrombin time 22 s, D-dimer 3.3 mg/L, calcium 1.22 mmol/L, potassium 2.5 mmol/L, total protein 26 g/L, albumin 15 g/L, creatinine 12 μmol/L, uric acid 29 μmol/L. Apatinib induced acute gastrointestinal hemorrhage was considered. Apatinib was withdrawn. He was given pressurized by intravenous infusion of suspended red blood cells, IV infusions of carbazochrome sodium sulfonate and glucose gluconate. The next morning, he experienced bloody stool 2 500 ml and vomited coffee-ground-like gastric content about 500 ml. He received oral lyophilized thrombin powder, pressurized by intravenous infusion of suspended red blood cells, IV infusions of dopamine hydrochloride and human albumin, intramuscular injection of vitamin K1, IV infusion of lansoprazole, etamsylate, aminome-thylbenzoic acid, pantoprazole sodium and fat emulsion amino acids (17) and glucose (11%). At the noon of the same day, he experienced melena about 80 g. He was given oral lyophilized thrombin powder. On day 2 after apatinib withdrawal, he experienced melena 30 g. On day 4, laboratory tests revealed the following levels again: RBC 2.6×1012/L, Hb 95 g/L, thrombin time 14 s, prothrombin time 16 s, D-dimer 1.9 mg/L, calcium 2.35 mmol/L, potassium 4.0 mmol/L, total protein 52 g/L, albumin 32 g/L, creatinine 28 μmol/L, uric acid 191 μmol/L. Nutrition supportive, liver and stomach protecting treatments continued, gastrointestinal hemorrhage did not recur.
  • Guo Ruituan, Zhang Gailian, Zhang Liyun, Gao Jinfang, Ma Dan
    2017, 19(2): 138-139.
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    A 58-year-old female patient with systemic lupus erythematosus received an IV infusion of cyclophosphamide for four times (the therapeutic dose of 200, 400, 200, 400 mg, there were 8 days  apart between the first and the second medication, there were 12 days  apart between the second and the third medication, there were 29 days apart between the third and the fourth medication). There were no symptoms after first administration. On day 2 of the second administration, the patient showed limb shaking and sweating. The serum sodium decreased from 127 mmol/L before treatment to 107 mmol/L. Hyponatremia associated with cyclophosphamide was considered. Continuous intravenous pumping of concentrated sodium 2.3 g was given. Four days later, her serum sodium was 133 mmol/L, concentrated sodium was replaced by oral salt capsules one pill thrice daily. The level of serum sodium decreased slightly after the third and the fourth administrations then returned to normal levels after giving salt capsules.
  • Ma Yanli, Zhao Jing
    2017, 19(2): 140-141.
    Abstract ( ) PDF ( )
    A 30-year-old woman was hospitalized because of ectopic pregnancy. She received an intramuscular injection of methotrexate 75 mg and mifepristone tablets 300 mg taking orally in three days. On day 5, the patient developed fever and oral ulcers. On day 7, red rashes appeared on her face and limbs. Laboratory tests showed the following results: C-reactive protein (CRP) 105.3 mg /L, procalcitonin 0.33 μg/L, white blood cell (WBC) 2.5×109/L, neutrophil count 0.85, red blood cell (RBC) 3.3×1012/L, platelet count (PLT) 244×109/L, hemoglobin (Hb)103 g/L. On the 8th day, abdominal pain and diarrhea appeared, her values of WBC, neutrophils, RBC, PLT, and Hb were 0.7×109/L, 0.31, 3.4×1012/L, 202×109/L, 105 g/L. She was diagnosed as myelosuppression due to methotrexate. She received an IV infusion of methylprednisolone 80 mg once daily, subcutaneous injection of recombinant human granulocyte colony stimulating factor 300 μg, and the symptomatic supportive treatments included anti-infection, volume expansion, and intravenous nutrition. However, the patient′s condition did not improve obviously. On day 10, the erythema widely distributed throughout her body. Laboratory tests showed WBC 0.2×109/L, neutrophil count 0.14, RBC 2.7×1012/L, PLT 62×109/L, Hb 84 g/L. On day 11, the patient was transferred to another hospital for treatment. It was told by follow-up that the patient died from respiratory and circulatory failure on the third day after transfer.
  • Zhan Shipeng, Tang Min
    2017, 19(2): 142-143.
    Abstract ( ) PDF ( )

    A 20-year-old male with athetosis received sodium valproate 500 mg twice daily. Twenty days after treatment, the patient developed general erythematous which faded after pressing, increased skin temperature, facial swelling,  and enlargement of superficial lymph node in his head and neck. Laboratory tests showed the following values: white blood cell (WBC) 18.3×109/L, neutrophils 0.392, lymphocytes 0.364, monocytes 0.137, eosinophils 0.097, procalcitonin (PCT) 0.3 μg/L, alanine aminotransferase (ALT) 311 U/L, aspartate aminotransferase (AST) 148 U/L, alkaline phosphatase (ALP) 295 U/L, gamma-glutamyl transferase (γ-GT) 169 U/L. The patient was diagnosed as drug induced hypersensitivity syndrome (DIHS). Valproate was withdrawn. He received the symptomatic treatments which included glucocorticoid, antihistamines, liver protection and topical medication. Twenty days later, his erythematous rash were disappeared mainly. Fifty-five days later, his erythematous rash disappeared completely. Laboratory tests showed the following values: WBC 8.6×109/L, eosinophils 0.005, ALT 32 U/L, AST 22 U/L, ALP 66 U/L, γ-GT 67 U/L.

  • Huang Shan, Song Hongtao, Cui Xiaoping, Xu Haizhen
    2017, 19(2): 144-145.
    Abstract ( ) PDF ( )
    A 61-year-old man received oral atorvastatin calcium 20 mg at bedtime for cerebral infarction. Thirty minutes later after the atorvastatin calcium administration for the first time, the patient developed chest tightness, asthma, cough and expectoration. His heart rate was 108 beats/min, respiratory rate was 29 times/min, blood pressure was 98/63 mmHg (1 mmHg=0.133 kPa). Blood gas analysis showed the following levels: oxygen partial pressure 71 mmHg, total carbon dioxide 53 mmol/L. It was considered that atorvastatin calcium induced allergic asthma. He was given oxygen inhalation and IV infusions of dexamethasone 5 mg, ambroxol hydrochloride 30 mg and doxofylline 0.2 g. One hour later, the symptoms were improved. The next day, the patient′s respiratory rate was 18 times/min, the heart rate was 76 beats/min, the blood pressure was 101/66 mmHg. The chest tightness and asthma were obviously improved with oxygen partial pressure of 82 mmHg and total carbon dioxide of 32 mmol/L. Atorvastatin calcium was discontinued and switched to rosuvastatin calcium 10 mg at bedtime, the chest tightness and asthma did not recur.
  • He Yan, Cao Deping, Chen Fen
    2017, 19(2): 145-147.
    Abstract ( ) PDF ( )
    A 26-year-old female patient with excision of left breast fibroma received an IV infusion of lappaconite hydrobromide 8 mg in glucose and sodium chloride 500 ml once daily. No abnormality was found for the first time. About 20 minutes after IV infusion on the next day, the patient developed dry throat, slight dyspnea. Her respiratory rate was 25 times/min, heart rate was 55 beats/min and blood pressure was 70/55 mmHg. Lappaconite hydrobromide was discontinued immediately. She was given oxygen inhalation of 2 L/min, intravenous injection of adrenaline 0.5 mg, intravenous injection of adrenaline 10 mg, intramuscular injection of diphenhydramine 20 mg and IV infusion of dopamine 200 mg. After 5 minutes, the patient lost consciousness, had weak breathing, facial cyanosis and no pulsate. The electrocardiogram monitor displayed isoelectric line. The patient was treated with cardiopulmonary resuscitation, endotracheal intubation and ventilator support, chest compression, intravenous of epinephrine and infusion of hydrocor-tisone. The pathogenetic condition was getting worse progressively. The patient eventually died after 3 hours rescue.
  • Qiu Zhihong, Ma Yinling, He Lien, Dong Zhanjun
    2017, 19(2): 147-148.
    Abstract ( ) PDF ( )
    A 61-year-old female patient with stomach discomfort received omeprazole enteric coated tablet 40 mg once daily. On day 3 of administration of omeprazole, she presented sporadic  erythema and stopped the medicine by herself. Three days after drug withdrawal, her symptom of erythema improved. She received omeprazole enteric coated tablet at the previous dosage again. Two days after taking medicine again, the patient developed rash all over her body, severe diarrhea and vomiting, acute renal injury and allergic shock in succession. She was diagnosed as severe allergic reaction due to omeprazole. The patient received the treatments of antianaphylaxis, maintaining the function of circulatory system, fluid infusion, and continuous veno venous hemodiafiltration. But the therapeutic effect was poor. The patient died on the second day after giving up the treatment which decided by her family members.
  • Wang Shihui, Cui Xiangli
    2017, 19(2): 149-150.
    Abstract ( ) PDF ( )
    An 81-year-old female patient with pulmonary infection was given cefoxitin 2 g by intravenous drip. After 1.5 hours of treatment, the patient self-medicated with compound glycyrrhiza oral solution 10 ml for cough. About 10 minutes later, she experienced chest tightness, dyspnea, facial flushing, hyperhidrosis, weakness of limbs and rash. Disulfiram reaction was considered. Intravenous dexamethasone 10 mg and continuous low flow oxygen were given. About 30 minutes later, the patient′s condition improved. After 2 hours, the symptoms disappeared.