2017 Volume 19 Issue 6 Published: 28 December 2017
  

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  • Automatic monitoring of liver and kidney injury due to roxatidine acetate hydrochloride for injection
    Wang Xiaoyu, Jia Wangping, Guo Daihong, Kou Wei, Hu Pengzhou, Zhao Boyu, Pang Ning
    2017, 19(6): 414.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the effects of  roxatidine acetate hydrochloride for injection (roxatidine) on liver and kidney function and analyze the related risk factors.MethodsThe electric medical records of the hospitalized patients who received roxatidine during January 1st, 2016 to December 31st, 2016 in Chinese PLA General Hospital were monitored by the autonomic monitoring system which was researched and developed by ourselves. The adverse drug reactions (ADR) were re-evaluated for the alarmed cases from the autonomic monitoring system by clinical pharmacists. The incidence rates of liver and kidney injury were calculated. The risk factors and the independent risk factors of liver and kidney injury due to roxatidine were confirmed by univariate and multivariate logistic regression analysis.ResultsData of a total of 9 284 patients who come from 34 clinical departments (Department of Urinary Surgery, Orthopedics, and Cardiac Surgery, etc.) were collected. Of the 9 284 patients, 5 308 (57.2%) were male, 3 976 (42.8%) were female. The dosage of roxatidine was 75 mg twice daily and the route of medication was intravenous infusion. The time of medication was 1-39 days and the median time was 3 (1, 5) days. Totally 8 268 patients were enrolled into the monitoring for roxatidine related liver injury. Eighty-six patients (1.0%) were judged to have liver injury, all the relevant evaluations were "possible", the degrees of liver injuries were mild. The 86 patients′ average age was (59±13) years, average body mass index (BMI) was (24.6±3.3) kg/m2, average time of medication was (8.1±4.1) days. Of 86 patients, 52 (60.5%) were combined with ceftriaxone sodium. The results of univariate logistic regression analysis showed that age, time of medication, and combination with ceftriaxone sodium were the risk factors of liver injury due to roxatidine. The results of multivariate logistic regression analysis showed that ＞65 years (OR=1.57, 95%CI: 0.99-2.43), ＞3 days of medication time (OR=14.14, 95%CI: 6.99-33.81), and combination use of ceftriaxone sodium (OR=2.31, 95%CI: 1.50-3.60) were the independent risk factors of liver injury due to roxatidine. Nine thousand two hundred and eighty-four patients enrolled into the monitoring of roxatidine related kidney injury. Twenty-six patients (0.3%) were judged as kidney injury, all the relevance evaluations were "possible", the degrees of kidney injuries were mild. The 26 patients′ average age was (59±15) years, average BMI was (22.0±6.2) kg/m2, average time of medication was (7.5±6.1) days. Of26 patients, 8 patients (30.8%) suffered from hepatobiliary diseases meanwhile. The results of univariate logistic regression analysis showed that the time of medication and suffering from hepatobiliary diseases were the risk factors of kidney injury due to roxatidine. The result of multivariate logistic regression analysis showed that ＞3 days of medication time (OR=3.57, 95%CI: 1.56-9.16) was the independent risk factor of kidney injury due to roxatidine. ConclusionsThe incidence rates of liver and kidney injuries due to roxatidine are lower. Roxatidine is safe in clinical medication. ＞65 years, ＞3 days of medication time, and combination use of ceftriaxone sodium are the independent risk factors of liver injury due to roxatidine. ＞3 days of medication time is the independent risk factor of kidney injury due to roxatidine.
  • Analysis on risk and related factors of acute renal injury in patients with compound diclofenac sodium injection treatment after surgeries
    2017, 19(6): 420.
    Abstract ( ) PDF ( )
    ObjectiveTo understand the risk of acute renal injury (AKI) in patients using compound diclofenac sodium injection after surgeries and analyze the influencing factors.MethodsData of patients who had normal renal function before receiving compound diclofenac sodium injection treatment after surgeries in 2015 in the Second Xiangya Hospital of Central South University were collected and studied retrospectively (unmatched case-control study). The patients with AKI after treatment were included in the case group and the patients without AKI were included in the control group. The general condition, postoperative medication, and renal function before and after medication in the 2 groups were compared. The risk and related factors of AKI using compound diclofenac sodium injection were analyzed.ResultsA total of 821 patients were enrolled into this study, including 63 cases in the case group ［43 males and 20 females, average age(51±13)years］ and 758 cases in the control group ［425 males and 33 females, average age(50±14)years］. The proportion of patients with hypertension and liver cirrhosis in the case group was higher than that in the control group ［25.4% (16/63) vs. 13.1% (99/758), P=0.009; 9.5%(6/63) vs. 2.8% (21/758), P=0.013］, the proportion of patients with general surgeries in the case group was higher than that in the control group ［42.9%(27/63) vs. 26.9% (204/758), P=0.007］, the proportion of patients with neurosurgery in the case group was lower than that in the control group ［15.9%(10/63) vs. 33.5% (254/758), P=0.004］，the proportion of patients using compound sodium diclofenac injection within 24 h after operation in the case group was higher than that in the control group ［20.6%(13/63) vs. 10.7%(81/758), P=0.017］. The results of binary logistic regression analysis showed that the risk of AKI in patients with hypertension was significantly higher than the other patients with other diseases(OR=2.847, 95%CI: 1.498-5.410, P=0.001); the risk of AKI in patients with compound diclofenac sodium injection treatment within 24 h after operation was significantly higher than that in patients with compound diclofenac sodium injection treatment 24 h after the surgery(OR=1.956, 95%CI: 1.154-3.315, P=0.013).ConclusionThe patients with compound diclofenac sodium injection treatment after surgeries could develop AKI, the combination of hypertension and the use of the drug within 24 hours postoperatively could significantly increase the risk of AKI.
  • Risk factors of acute-phase reaction following the first-dose administration of zoledronic acid in osteoporotic patients: a Meta-analysis
    Li Ping, Li Xiaoxiao, Zhao Rongsheng
    2017, 19(6): 425.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the risk factors of acute-phase reaction (APR) following the first-dose administration of zoledronic acid in osteoporotic patients.MethodsThe documents of the observational studies about risk factors of APR following the first-dose administration of zoledronic acid in osteoporotic patients were searched from correlative data base until July, 2017. The quality of the literature enrolled into the Meta-analysis was evaluated by Newcastle-Ottawa Scale (NOS), and then Meta-analysis was conducted using RevMan 5.3 software. The effective measurements were expressed as adds ratio (OR) or difference in means (MD) and 95% confidence interval (CI).ResultsA total of 17 studies involving 1 981 patients with osteoporotic and having the first-dose administration of zoledronic acid were enrolled into the Meta-analysis.  Nine hundred and seventy-nine patients had APR (APR+group) and 1 002 patients without APR (APR-group).The scores of NOS in 17 articles were all greater than or equal to 6. The results of Meta-analysis showed that the patients in the APR(+) group were significantly younger then those in the APR(-) group (MD=-3.27, 95%CI: -4.54--2.01, P<0.000 01). The incidence rate of APR in the patients who had the history of administration of nitrogenous bisphosphonates (NBP) were lower than those without history of administration of NBP, and the difference was statistically significant (OR=0.27, 95%CI: 0.17-0.41, P<0.000 01). The incidence rate of APR in the patients having the history of fracture were higher than those without history of fracture, and the difference was statistically significant (OR=2.31, 95%CI: 1.29-4.13, P=0.005). The incidence rate of APR in the patients who had analgesic-antipyretic preventability treatment were lower than those who had no analgesic-antipyretic preventability treatment, and the difference was statistically significant (OR=0.14, 95%CI: 0.05-0.37, P<0.000 1). There were no statistical correlation between the patients′ body mass index, creatinine clearance, prior calcium usage, prior calcitriol usage, sex and APR.ConclusionLow age and the history of fracture are risk factors of APR, while the histories of administration of NBP and analgesic-antipyretic preventability are the protective factors of decreasing APR.
  • Analysis of literature on HBV reactivation in HCV/HBV coinfection after treatment with direct-acting antiviral drugs
    Song Rui, Chen Fengxin, Cai Haodong, Yan Jie
    2017, 19(6): 432.
    Abstract ( ) PDF ( )
    ObjectiveTo understand the clinical features and outcome of hepatitis B virus (HBV) reactivation after the direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) in HCV/HBV coinfection.MethodsStudies on HBV reactivation after DAA treatment for HCV in HCV/HBV coinfections which were reported in PubMed from Jan 1, 2011 to 31st Aug, 2017 were searched and retrieved. After document screening, data extraction and quality evaluation, the data of the cases with HBV reactivation after treatment with DAA drugs for the HCV/HBV coinfection were collected. A descriptive statistical analysis was performed.ResultsData of a total of 17 cases were collected, which were from 13 case-reports. There were 10 males and 7 females, the age ranged from 46 to 83 years with the mean of 62 years. There were 3 HBsAg-positive, 7 HBsAg-negative, and 7 HBsAg-unreported cases. Five of them had low level HBV DNA replication (230-2 300 IU/ml); in 11 cases HBV DNA was not detected and in 1 case it was not reported. Fourteen patients were planned to take DAA drugs for 12 weeks, 3 cases were 24 weeks. Reactivation of HBV occurred in 12 patients during the course of DAA treatment (4 to 21 weeks after starting), in 5 cases occurred 4 to 28 weeks after the end of treatment. Twelve of the 17 patients experienced severe reactivation of HBV and significant symptoms of exacerbation of liver disease. The levels of alanine aminotransferase, aspartate aminotransferase and HBV DNA were significantly higher than before, of which 4 of them developed liver failure. After HBV reactivation, 13 were treated with anti-HBV drugs, 11 of them improved, while 2 of them had liver failure and underwent liver transplantation. Four cases got spontaneous cure. Three of the 4 liver failure patients had cirrhosis before DAA treatment.ConclusionsDAA drugs may lead to HBV reactivation in HCV/HBV coinfected patients. HBV reactivation occurs not only in the course of drug treatment, but also in the months after the withdrawal of medication. Anti-HBV drugs in the reactivated cases generally got good prognosis. The presence of cirrhosis before DAA treatment is a risk factor for liver failure after HBV reactivation. The status of HBV infection should be assessed and HBV DNA levels and liver function should be monitored during the DAA drugs treatments.
  • Effects and the risk prevention and control of drugs commonly used in pregnancy on fetus
    Lin Xiaofeng, Wang Fangfang, Fei Yan
    2017, 19(6): 438.
    Abstract ( ) PDF ( )
    Medication treatment during pregnancy has both pros and cons on the fetus. The drugs commonly used in pregnancy include: (1) Blood and hematopoietic system drugs, which are folic acid and iron-containing drugs mainly. Folic acid can reduce fetal neural tube deformity and multiple risks in early pregnancy, but it may also affect fetal bone formation. Iron supplement can effectively reduce the risk of maternal anemia, low birth weight and premature birth. (2) Digestive and metabolic system agents, which include antemetic, antacids, magnesium, calcium and other minerals, insulin and antidiabetic drugs. Vitamin B6, H1-receptor antagonists, trimethobenzamide and metoclopramide are safe and effective on morning sickness, but phenothiazine has the risk of teratogenic effects on fetus. (3) Systemic anti-infection agents, which include penicillin G, ampicillin, piperacillin, mezlocillin etc. Roxithromycin, erythromycin and azithromycin are commonly used because the macrolides are difficult to cross the placental barrier. Clarithromycin and spiramycin should be used with caution because of the toxicity to the fetus. (4) Skin disease agents are mainly for local application, including calamine lotion, antifungal agents, antibiotic ointment and corticosteroid ointment, which have less effect on the fetus. The measures for risk prevention in pregnancy drugs use include improving education on safe medication during pregnancy, strengthening the communication between the pregnant women and the medical staff, providing the counseling of safe medication and the individual administration.
  • Recent progress in the studies of risk factors on vancomycin-associated acute kidney injury
    Pan Kunming, Ma Lingyun, Zhou Ying, Yang Li, Cui Yimin
    2017, 19(6): 443.
    Abstract ( ) PDF ( )
    Vancomycin (VAN) is an important drug for the treatment of severe Gram-positive bacterial infection. Acute kidney injury (AKI) is main adverse reaction of VAN. However, the mechanism of VAN-associated AKI (VA-AKI) remains unclear and current evidence suggests that it may be associated with renal tubular injury induced by VAN. Elderly population, poor pathophysiological status, accompanied by nephrotoxic drugs, long length of VAN therapy and higher VAN serum trough concentration are risk factors of VA-AKI and obesity shows no association with VA-AKI. The influence of the population of newborns and children, VAN administration method on VA-AKI remains controversial. For the patient concomitant of risk factors, more targeted protection and prevention should be given during clinical treatment.
  • Calcineurin inhibitors induced severe delirium in an allogeneic hematopoietic stem cell transplanted patient
    Hu Rongrong, Zhuang Junling
    2017, 19(6): 459.
    Abstract ( ) PDF ( )
    A 41-year-old male patient with acute myelogenous leukemia and past history of Behcet′s disease received allogenic hematopoietic stem cell transplantation. Tacrolimus 2.5-3.0 mg/24 h was administered through continuous intravenous pump and the serum level was 10.0-15.0 ng/ml. On day 30, the patient experienced severe delirium manifesting as anxiety, color vision defects, irrelevant answer, and losing the ability to calculate and hypoorientation. On day 33, serum tacrolimus level was maintained at  6.0-7.5 ng/ml, but the patient′s mental symptoms was not improved. The next day, tacrolimus was stopped, the delirium was relieved. On day 35, he switched to oral tacrolimus (the initial dose 1 mg twice daily, on day 7, the dose was adjusted to 2 mg twice daily). On day 10 of oral tacrolimus, he developed consciousness disorder again with refusing to eat. Therefore oral tacrolimus was stopped, an IV infusion of cyclosporine 125 mg twice daily was given. On day 2, the symptom of delirium appeared again, accompanied by self harming behavior. On day 5, cyclosporine was withdrawn and he returned to normal consciousness. After that, rapamycin 1 mg twice daily was orally administered. The delirium did not recur.
  • Fanconi syndrome and pathological femoral neck fracture induced by adefovir dipivoxil
    Xu Yong, Li Zhiliang, Feng Jihong, Nie Zhenwang
    2017, 19(6): 461.
    Abstract ( ) PDF ( )
    A 63-year-old female patient received oral adefovir dipivoxil 10 mg once daily for chronic hepatitis B. She developed right knee and left shoulder pain at the 7th year of the treatment, followed by right hip pain and bilateral pain in the ribs, hips, knees and heels. Osteodynia progressed to the lower back and weakness and limited mobility in the 8th year. Laboratory tests showed the following values: serum phosphorus 0.48 mmol/L, calcium 2.28 mmol/L, uric acid 77 μmol/L, urine glucose (+), urinary protein (++), urinary occult blood test (+), urinary β2-microglobulin 2.5 mg/L. Bone mineral density examination revealed osteopenia. Pelvic X-ray examination showed the osteoporosis of the hip and right femoral neck fracture. The patient was diagnosed as adefovir dipivoxil-induced Fanconi syndrome and pathological femoral neck fracture. Adefovir dipivoxil was stopped and her therapy was changed to entecavir 0.5 mg once daily. She was given IV infusion of fructose diphosphate 10 g once daily and 5% sodium bicarbonate injection 125 ml  once daily, oral calcium carbonate 1 500 mg once daily and alfacalcidol soft capsules 0.25 μg thrice daily. One week later, the right femoral head replacement combined with the right femoral shaft fracture plate fixation was performed. The above-mentioned drugs were continued. After 5 weeks of adefovir dipivoxil discontinuation, serum phosphorus was 0.72 mmol/L, uric acid was 136 μmol/L, urinary protein (+) and the osteodynia was significantly alleviated. After 5 months of adefovir dipivoxil withdrawal, laboratory tests showed the following values: serum phosphate 0.87 mmol/L, uric acid 215 μmol/L, urine glucose (-), urinary protein (-). Four months later, the serum phosphate was 1.02 mmol/L, the patient could walk normally.
  • Abdominal distension caused by desmopressin acetate tablets
    Chen Zhaoyang, Su Na, Zhu Yanghui, Xu Ting
    2017, 19(6): 464.
    Abstract ( ) PDF ( )
    A 41-year-old male patient with central diabetes insipidus received desmopressin acetate tablet 0.1 mg once per 8 hours. Eight hours after the third medication, he developed obvious abdominal distension. After that, this condition occurred about 30 min after taking the medicine, especially in the afternoon and evening. There was no abdominal distension if no medication. The dose of desmopressin acetate was adjusted to 0.1 mg per night, but the diabetes insipidus could not be controlled. The dose of desmopressin acetate was adjusted to 0.1 mg twice daily (morning and night, respectively), the patient still felt abdominal distension 10 minutes after medication on night. The dose of desmopressin acetate was adjusted to 0.05 mg at the morning and 0.1 mg in the night, the patient′s abdominal distension was gradually alleviated, and disappeared finally.
  • Anaphylactic shock and erythra induced by pemetrexed disodium injection
    Ji Xiaoying, Jin Xuliang
    2017, 19(6): 466.
    Abstract ( ) PDF ( )
    A 68-year-old male patient with lung cancer received the treatment of combination of pemetrexed disodium and bevacizumab. About 20 minutes after finishing the IV infusion of pemetrexed disodium injection, the patient suddenly developed suppression in the chest, dyspnea, hyperhidrosis, pale, and cyanosis of lips. His heart rate was 98 beats/min, breathing rate was 24/min, and blood pressure was 70/40 mmHg. He was diagnosed as anaphylactic shock due to pemetrexed disodium. The patient was given nasal catheter oxygen inhalation and ECG monitoring, intravenous injection of adrenalin (1 mg) and  dexamethasone (20 mg), immediately. Thirty minutes later, his symptoms were relieved. About 2 hours after the end of IV infusion of pemetrexed disodium, skin rashes occurred on the patient′s chest. He received intramuscular injection of phenergan 12.5 mg, immediately. Twenty-six minutes later, the rashes disappeared. About 20 minutes after the subsiding of the rashes, he received IV infusion of bevacizumab. The patient did not develop any symptoms.
  • Anaphylactic shock caused by compound ossotide injection
    Shu Wenlin, Su Zhijian
    2017, 19(6): 467.
    Abstract ( ) PDF ( )
    A 62-year-old female patient with left knee osteoarthritis was treated with an IV infusion of compound ossotide injection 90 mg dissolving in 0.9% sodium chloride injection 250 ml once a day. About 5 minutes after IV infusion on the first day, the patient complained of chest tightness, dyspnea, cold sweat, upper eyelid edema, cyanosis, and vomiting of pale yellow stomach contents. Her blood pressure was 101/72 mmHg, heart rate was 103 beats per minute, breathing rate was 25 times per minute. Compound ossotide injection was discontinued immediately. She was given an intravenous injection of dexamethasone 5 mg and an intramuscular injection of adrenaline 1 mg. About 20 minutes later, her blood pressure decreased to 39/24 mmHg, pulse rate was 59 beats per minute, breathing rate was 24 times per minute. She developed urinary and fecal incontinence and drowsiness. The patient was diagnosed as anaphylactic shock caused by compound ossotide injection. She was given an intramuscular injection of adrenaline 1 mg again, an IV infusion of dopamine 160 mg, and symptomatic treatment. About 40 minutes later, her heart rate was 70 beats per minute, blood pressure was 95/56 mmHg, breathing rate was 12 times per minute. The patient sequentially received an IV infusion of methylprednisolone 40 mg and an intravenous injection of dopamine 10 mg. About 20 minutes later, the patient regained consciousness. Methylepinephrine 10 mg and  dopamine 180 mg were pumped with gradually reduced speed. Twelve hours later, the patient′s symptoms disappeared. Her body temperature was 36.4 ℃, heart rate was 54 beats per minute, breathing rate was 19 times per minute, and blood pressure was 94/57 mmHg.
  • Ataxia and myodystony due to long-term and high-dose use of compound phenytoin sodium, ephedrin hydrochloride and theophylline tablets
    Sun Yang, Pang Dongqing, Liu Linlin, Liu Fang
    2017, 19(6): 469.
    Abstract ( ) PDF ( )
    A 79-year-old female patient with chronic asthmatoid pulmonary disease received compound phenytoin sodium, ephedrin hydrochloride and theophylline tablets 2 tablets twice daily by mouth. The patient developed discontinuous cephalic and facial involuntary movements after 2 months of medication and discontinuous dizziness with weakness of the lower limbs and gait instability after 9 months of medication.After 1 year of medication, the patient changed 2 to 5 tablets twice daily by herself due to the poor curative effect. Two years after high-dose of treatment, the patient developed aggravated involuntary movements and dizziness, body backward and was unable to stand and walk. Ataxia and myodystony due to long-term and high-dose use of compound phenytoin sodium, ephedrin hydrochloride and theophylline tablets was considered. The drug was stopped, an IV infusion of 0.9% sodium chloride injection 500 ml once daily and an intramuscular injection of adenosine cobalamin 1.5 mg once daily were given. Three days later, the patient′s cephalic and facial involuntary movements disappeared and dizziness markedly alleviated. Five days later, the patient could walk with other person′s help. Eight days later, the patient could walk alone.
  • Acute myocardial infarction induced by ultravist solution caused anaphylactoid reaction
    Jiang Zeyu, Cai Shanglang
    2017, 19(6): 471.
    Abstract ( ) PDF ( )
    A 67-year-old female patient underwent the hypersensitivity test of ultravist solution before doing adrenal enhancement CT. Fifteen minutes after intravenous injection of 2 ml of ultravist solution, the patient developed palpitation, chest pain, vomiting, weakness, and hyperhidrosis. Her blood pressure was 90/60 mmHg. She was considered to have contrast agent anaphylactic shock. The patient received intravenous injection of dexamethasone 5 mg and IV infusion of 0.9% sodium chloride injection 500 ml immediately. Two minutes later, her blood pressure elevated to 145/90 mmHg, but the chest pain was not relieved. The results of electrocardiogram showed tilted elevation on ST segment in II, III, aVF leads and declivous depression on ST segment in leads I and aVL. She was diagnosed as acute myocardial infarction. The patient immediately received aspirin enteric-coated tablet 300 mg and clopidogrel hydrogen sulfate 300 mg by chewing, hypodermic injection of low-molecular-weight heparin calcium injection 4 100 U, and continuous intravenous pumping of isosorbide dinitrate injection 50 mg at speed of 2 mg/h. One hour later, the patient′s thoracalgia was remission. She received the treatments of anti-coagulation, stable plaque, anti-hypertension, and expanding coronary artery sequentially. Thirteen days later, the hypersensitive test of ultravist solution was underwent again, the patient did not show any obvious discomfort for 24 hours. It was indicated that the patient′s acute myocardial infarction appeared in the first hypersensitive test was the anaphylactoid reaction induced by ultravist solution.
  • Methimazole caused liver damage, rash and arthritis syndrome
    Li Li, Shi Rui, Lu Shan, Pan Dan
    2017, 19(6): 473.
    Abstract ( ) PDF ( )
    A 29-year-old female patient with hyperthyroidism received methimazole 20 mg once daily according to the doctor′s advice. Her liver function was normal before drug administration. Fourteen days after medication, the results of laboratory test showed that ALT was 122 U/L, AST 87 U/L. Methimazole was stopped and liver protection treatment was given. Nine days later, her ALT and AST were 42 U/L and 35 U/L, respectively. She received methimazole 10 mg once daily again. On day 9 of remedication, the patient developed rash with pruritus, pain and limitation of activity on the right elbow joint, pain on the bilateral shoulder joints and the knee joints, and laboratory test showed ALT 134 U/L, and AST 109 U/L. She was diagnosed as drug induced liver injury, drug rash, and drug related arthritis syndrome. Methimazole was stopped again. The patient received the treatments of antianaphylaxis, liver protection and analgesic. Ten days later, her rash mostly disappeared. Laboratory test showed ALT 36 U/L and AST 24 U/L. Her arthralgia was improved slightly, could move intentionally, but activity was limitated occasionally.
  • Acute generalized exanthematous pustulosis caused by Xuesaitong for injection(注射用血塞通)
    Wang Haifei，Sun Guoping
    2017, 19(6): 475.
    Abstract ( ) PDF ( )
    A 61-year-old female patient received an IV infusion of Xuesaitong  for injection 400 mg once daily for 6 days after the resection of left popliteal cyst. The next day after the drug withdrawal, She developed systemic rashes with itching and IV infusion of dexamethasone 10 mg once daily and oral chlorpheniramine 4 mg thrice daily were given. The symptoms were not improved after 7 days of treatments. On day 8, dexamethasone and chlorpheniramine were stopped, IV infusion of methylprednisolone 55 mg once daily and oral levocetirizine, cimetidine, potassium chloride sustained-release tablets were given. On day 10，the patient developed new eruption on the back, diffuse edematous erythema on the trunk and limbs, with light yellow pustules on erythema and part of pustules merging into sheet. According to the result of histopathological examination on the rash of the abdomen skin, acute generalized exanthematous pustulosis was considered. After that, the patient′s condition was improved, glucocorticoids was used continuously and the dosage was reduced gradually, while stomach-protective drugs and external use of skin treatment were given at the same time. On day 18, the dose of intravenous infusion of methylprednisolone was reduced to 20 mg once daily and oral methylprednisolone 12 mg once daily was given. On day 32, oral methylprednisolone was stopped. On day 37, new eruption appeared on the patient′s back, intramuscular injection of compound betamethasone injection 1 mg was given at one time, oral compound glycyrrhizin 80 mg and tripterygium glycosides 20 mg were given thrice daily. On day 50, the skin rashes darkened, pustules disappeared basically, no edema and new rash appeared. Methylprednisolone sodium succinate was stopped and changed to oral methylprednisolone tablets 20 mg once daily. Oral methylprednisolone was gradually reduced to 2 mg once daily and about 4.5 months later, the rashes subsided completely, methylprednisolone was stopped.
  • Rhabdomyolysis and acute kidney injury induced by atorvastatin calcium
    Liu Zhiyan, Zhao Rongsheng
    2017, 19(6): 477.
    Abstract ( ) PDF ( )
    An 82-year-old male patient with atrial fibrillation took atorvastatin calcium (20 mg/d) by himself following advise of other person. About one month later, he developed muscular soreness, weakness, and brown urine. The results of laboratory tests showed myoglobin (Mb)＞3 000 μg/L, creatine kinase (CK) ＞16 000 U/L, urea nitrogen 16.0 mmol/L, serum creatinine (Scr) 347 μmol/L, creatinine clearance 15 ml/min. The patient was diagnosed as rhabdomyolysis and acute kidney injury which related to atorvastatin calcium. After the withdrawal of atorvastatin calcium and 13 days of treatments with fluid infusion, alkalizing urine, and diuretic, the patient′s muscular soreness and weakness were improved. The results of laboratory test showed Mb 2 340 μg/L, CK 61 U/L, urea nitrogen 7.1 mmol/L, were Scr 189 μmol/L, and creatinine clearance 30 ml/min. Urine test showed no abnormal results.
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