2020 Volume 22 Issue 9 Published: 28 September 2020
  

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  • Health worker safety：a priority for patient safety
    Adverse Drug Reactions Journal Agency
    2020, 22(9): 497-498. https://doi.org/10.3760/cma.j.cn114015-20200911-00953
    Abstract ( ) PDF ( )
  • Annual report on clinical medication safety of National Monitoring Network #br# for Clinical Safe Medication (2019)
    Zhang Qingxia, Wang Yawei, Li Xiaoling, Wang Yuqin, Medication Safety Panel in China Core Group of International Network for the Rational Use of Drugs, Chinese Pharmacological Society Professional Com
    2020, 22(9): 499-504. https://doi.org/10.3760/cma.j.cn114015-20200728-00818
    Abstract ( ) PDF ( )

    In 2019, a total of 15 056 cases of medication error (ME) from 234 hospitals in 24 provincial administrative regions were collected in the National Monitoring Network for Clinical Safe Medication. The number of hospitals reporting ME increased by 32.20% compared with that in 2018 (177 hospitals), and the number of reported cases increased by 28.02% compared with that in 2018 (11 761 cases). In 15 056 cases of ME reports, 52 (0.35%) were classified as grade A, 11 175 (74.22%) as grade B, 3 351 (22.26%) as grade C, 350 (2.32%) as grade D, 79 (0.52%) as grade E, 44 (0.29%) as grade F, 0 as grade G, 4 (0.03%) as grade H, and 1 (0.01%) as grade I. Among the 15 004 patients involved in ME of grade B‑I, 8 801 (58.66%)were male and 6 203 (41.34%) were female; the age of these patients ranged from 1 day to 103 years, 2 027 patients (13.51%) were <18 years old, 7 377 patients (49.17%) were ≥18 to <60 years old, and 5 600 patients (37.32%) were ≥60 years old. Serious MEs (grade E‑I) involved 128 patients, of whom 65 (50.78%) were aged over 60 years. The top 3 drugs involved in serious MEs were insulin glargine, methotrexate tablets, and warfarin tablets. The 52 cases of grade A MEs did not involve person who triggered the MEs and places where MEs occurred. In the 15 004 cases of grade B‑I MEs, 9 821 (65.46%) were triggered by physicians, 3 561 (23.73%) by pharmacists, 634 (4.23%) by nurses, 306 (2.04%) by patients and their family members, and 2.04% (4.54%) by other persons; the proportion of MEs triggered by physicians and patients and their family members were higher than those in 2018 (60.89% and 1.06%), respectively; 5 662 (37.74%) occurred in the clinics, 4 001 (26.67%) in hospital wards, 3 721 (24.80%) in the pharmacies, 1 084 (7.22%) in pharmacy intravenous admixture services, 224 (1.49%) in the nurse stations, 133 (0.89%) in patients′ houses, 4 (0.03%) in the community health service stations, and 175 (1.17%) in other places; the proportion of MEs in pharmacy intravenous admixture services and patients′ houses were higher than those in 2018 (5.52% and 0.41%), respectively. The top 3 contents of MEs were wrong drug class, wrong usage, and wrong single dose. The top 3 persons who discovered the MEs were pharmacists, nurses, and physicians. The top 3 factors cau- sing MEs were lack of related pharmacologic knowledge, tiredness, and insufficient training of medical workers.

  • Literature case analysis of perioperative euglycemic diabetic ketoacidosis induced by sodium‑glucose cotransporter 2 inhibitors
    Cai Jun, Cui Wenxia, Gao Lei, Shi Xiaoting, Pan Fenghui, Hu Yun
    2020, 22(9): 505-510. https://doi.org/10.3760/cma.j.cn114015-20191120-00928
    Abstract ( ) PDF ( )

    To explore the clinical characteristics of perioperative euglycemic diabetic ketoacidosis (euDKA) induced by sodium‑glucose cotransporter 2 (SGLT2) inhibitors.　Methods The case reports of perioperative euDKA caused by SGLT2 inhibitors published up to June 30, 2019 were collected by searching the relevant databases and the following information of patients including demographic characteristics, types of diabetes, use of SGLT2 inhibitors, onset time and clinical manifestation of euDKA, the blood glucose and pH, serum bicarbonate and anion gap, β-hydroxybutyric acid and ketone body concentration in urine when diagnosing euDKA, predisposing factors of euDKA, as well as the treatments and outcomes were collected. The clinical characteristics of perioperative euDKA induced by SGLT2 inhibitors were analyzed descriptively.　Results A total of 27 patients (from 20 articles) were collected, including 13 males and 14 females with an age of (58±12) years; 26 patients were with type 2 diabetes mellitus and 1 with type 1 diabetes mellitus. Of them, 15 cases were treated with canagliflozin, 6 cases were treated with dapagliflozin, and 6 cases were treated with empagliflozin; the onset time of euDKA was 10 hours to 10 days after operation and within 3 days after operation in 21 cases (77.8%); 24 cases had similar symptoms as ketoacidosis and 3 cases had no obvious symptoms; the blood glucose was (9.5±2.2) mmol/L when diagnosing euDKA and the other laboratory test results were similar to those of ketoacidosis. The main factors inducing euDKA were operation and low carbohydrate diet. After the occurrence of euDKA, all patients received insulin and rehydration the- rapy, and then 26 cases (96.3%) got better and 1 (3.7%) died.　Conclusions The perioperative euDKA mainly occurred within 3 days after operation. The main inducing factors of euDKA were operation and low carbohydrate diet. After insulin and rehydration therapy, most patients had a good prognosis.

  • Study on the risk signal mining related to letrozole based on the US Food and Drug Administration Adverse Event Reporting System
    Li Li, Li Gen, Chen Li, Wu Liping, Guo Wenmei, Tao Wanjun
    2020, 22(9): 511-517. https://doi.org/10.3760/cma.j.cn114015-20190910-00752
    Abstract ( ) PDF ( )
    To explore the risk signals of letrozole related adverse reactions and provide reference for the clinical safety of letrozole.　Methods The risk signals related to letrozole in the adverse events (AEs) reports from the first quarter of 2009 to the first quarter of 2019 in the US FDA adverse event reporting system (FAERS) were mined using the reporting odds ratio (ROR) method and the proportional reporting odds ratio (PRR) method. An AE with reports>3 and 95% confidence interval (CI) lower limit of ROR and PRR>1 was defined as a positive signal. AEs were counted and classified using the preferred system organ class (SOC) and preferred term (PT) of Medical Dictionary for Regulatory Activities (MedDRA). The PTs of top 50 adverse event reports and signal strength were selected and analyzed.　Results From the first quarter of 2009 to the first quarter of 2019, a total of 31 743 AE reports with letrozole as the primary suspicious drug were reported in the FAERS database. Four hundred and eighty‑three AE risk signals with reports>3 and the 95%CI lower limit of ROR and PRR>1 were detected, involving 16 295 AE reports. After the second screening, PTs with the top 50 AE reports and those with the top 50 PTs ROR values were obtained. After screening out repeated PTs, 93 PTs were included in the analysis, involving 10 138 AE reports. The top 5 system organs in AE reports were neoplasms benign, malignant and unspecified (cysts and polyps) ［24.48%(2 482/10 138)］, musculoskeletal and connective tissue disorders ［21.78%(2 208/10 138)］, general disorders and administration site conditions ［17.04%(1 728/10 138)］, blood and lymphatic system disorders ［17.04%(1 728/10 138)］, and investigations ［5.47%(555/10138)］. There were 32 PTs not labelled in the drug instructions, and PTs with the top 5 signal strength were ovarian fibrosis［ROR=379.63, 95%CI lower limit: 120.87; PRR=278.66, 95%CI lower limit: 120.39］, ret gene mutation［ROR=379.63, 95%CI lower limit: 120.87; PRR=278.66, 95%CI lower limit: 120.39］, antisynthetase syndrome［ROR=208.84, 95%CI lower limit: 190.30）; PRR=174.20, 95%CI lower limit: 101.56］, hashimoto′s encephalopathy［ROR=164.85, 95%CI lower limit: 69.68; PRR=142.51, 95%CI lower limit: 67.74］, and bone marrow oedema syndrome ［ROR=122.82, 95%CI lower limit: 65.47; PRR=110.00, 95%CI lower limit: 64.34］.　Conclusions Through data mining, 32 adverse reaction risk signals were found, which were not labelled in the drug instructions. Of them, ovarian fibrosis, ret gene mutation, antisynthetase syndrome, Hashimoto′s encephalopathy, and bone marrow oedema syndrome had strong signals, which were worthy of clinical attention.
  • Investigation of time limit errors of preparation and delivery for cytotoxic antineoplastic drugs and exploration of improvement strategies
    Ma Zhaochao, Si Yanbin, Qing Xin, Yang Jing, Yang Li, Zhao Zhigang
    2020, 22(9): 518-521. https://doi.org/10.3760/cma.j.cn114015-20200115-00048
    Abstract ( ) PDF ( )
    Objective To explore a method to shorten the time for preparation and delivery of cytotoxic antineoplastic drugs in pharmacy intravenous admixture services (PIVAS), so that patients can use drugs in time according to the drug labels.　Methods The circumstances of prolonged preparation and delivery time of cytotoxic antineoplastic drugs prepared in PIVAS in Beijing Tiantan Hospital from October 8 to December 31, 2018 were investigated by the project team, the causes were analyzed, and the improvement strategies were made. The drug preparation and delivery time after the improvement strategies was counted and compared with that before improvement to evaluate the improvement effect.　Results From 8 October to 31 December 2018, a total of 4 156 bags of cytotoxic antineoplastic drugs were prepared and delivered in PIVAS in our hospital and the delivery time of 951 bags need to be paid attention to. Though the recording time was not accurate, it could be determined that the delivery time of at least 4.7% (45/951) of those bags had been extended. After taking the improvement measures of priority review for prescription of cytotoxic antineoplastic drugs, priority preparation, and delivery by special person from 20 January 2020, the delivery time of drugs was shortened from 2.5-4.5 hours to 0.5-4.0 hours, and the incidence of delivery time prolongation decreased to 0.9% (12/1 281).　Conclusions In hospital PIVAS, there was a phenomenon of delivery time prolongation of cytotoxic antineoplastic drugs when the drugs were delivered, which might lead to the storage time of the liquid exceeding the requirements of the drug labels. Priority prescription review and delivery of cytotoxic antineoplastic drugs could effectively shorten the delivery time.
  • Research progress of sinusoidal obstruction syndrome associated with oxaliplatin
    Wang Yue, Zhu Chen, Zhang Chengliang
    2020, 22(9): 522-526. https://doi.org/10.3760/cma.j.cn114015-20191009-00805
    Abstract ( ) PDF ( )
    Oxaliplatin (OXA) is the third‑generation platinum antineoplastic agents, mainly used in the treatment of metastatic colorectal cancer. Sinusoidal obstruction syndrome (SOS) is a common and serious adverse reaction of OXA. The main clinical manifestations are splenomegaly, thrombocytopenia, abnormal liver function, and portal hypertension. The mechanism is closely related to OXA‑induced oxidative stress and inflammatory reactionsin the liver, which lead to injury of hepatic sinusoidal endothelial cells, and then lead to platelet aggregation and vascular obstruction in hepatic sinusoids. The occurrence of SOS is related to the accumulated dose and the treatment cycle of OXA. Splenomegaly is an independent predictor of OXA‑related SOS. Thrombocytopenia, elevated serum hyaluronic acid and aspartate aminotrans- ferase‑to‑platelet ratio index can also predict the occurrence of SOS. OXA should be used with caution in patients with chronic liver disease, especially in those with portal hypertension. Special attention should be paid to the occurrence of SOS during OXA treatment. For patients with symptoms of suspicious SOS, imaging examination should be performed in time. Early diagnosis and timely withdrawal of drugs are bene- ficial for the reversal of liver fibrosis, and the prognosis of patients with severe fibrosis is poor.
  • Immune‑related myocarditis due to combination use of nivolumab and ipilimumab
    Wei Min, Xia Zongling
    2020, 22(9): 527-528. https://doi.org/10.3760/cma.j.cn114015-20190513-00416
    Abstract ( ) PDF ( )
    A 63‑year‑old male patient with lung metastases from bladder cancer received IV infusions of nivolumab (1 mg/kg) and ipilimumab (3 mg/kg) once every 21 d. On day 3 after the second medication, the patient developed paroxysmal chest tightness, which could be self‑mitigated by lying down for several minutes. Laboratory tests showed high‑sensitive troponin Ⅰ 4 340 ng/L and creatine kinase  (CK)‑MB 98.9 μg/L. Immune‑related myocarditis due to combination use of nivolumab and ipilimumab was considered. After methylprednisolone with prednisone sequentially and symptomatic and supportive treatments such as fluid infusion, liver and stomach protection, improvement of myocardial metabolism, and reduction of oxygen consumption, the patient′s symptoms were improved obviously. Laboratory tests showed  high-sensitive troponin Ⅰ 192 ng/L and CK‑MB 28.4 μg/L.

     

  • Temporary urinary incontinence due to dexamethasone sodium phosphate injection
    Jiang Kun, Song Linjing, You Lina
    2020, 22(9): 529-530. https://doi.org/10.3760/cma.j.cn114015-20190508-00411
    Abstract ( ) PDF ( )
    A 64‑year‑old female patient with endometrial cancer received an IV infusion of dexamethasone sodium phosphate injection 10 mg dissolved in 5% glucose injection 100 ml before chemotherapy to prevent allergic reaction induced by paclitaxel. The infusion was finished within about 30 minutes and the patient had no discomfort during the infusion. About 2 hours later, the patient developed urinary incontinence without urgent and painful urination, which gradually disappeared. Two hours after the second intravenous infusion of dexamethasone sodium phosphate injection, urinary incontinence recurred. After the intravenous infusion of dexamethasone sodium phosphate injection was replaced by oral dexamethasone tablets, the symptoms of urinary incontinence were alleviated. It was considered that the temporary urinary incontinence was probably related to dexamethasone sodium phosphate.
  • Liver injury due to moluodan concentrated pill [摩罗丹（浓缩丸)]: report of 3 cases
    Gao Yue, Zhang Yanli
    2020, 22(9): 530-532. https://doi.org/10.3760/cma.j.cn114015-20190909-00749
    Abstract ( ) PDF ( )
    Three patients (patient 1, a 52-year-old female, with a history of hepatitis; patient 2, a 64-year-old female; patient 3, a 61-year-old female) were all treated with morodan concentrated pill (16 pills, thrice daily for all) for chronic gastritis. In patient 1, there were no combined drugs; in patient 2, sodium rabeprazole enteric-coated tablets were also used; in patient 3, sodium rabeprazole enteric-coated tablets and rebamipide tablets were combined. Patient 1, patient 2, and patient 3 developed abnormal liver function after 27, 22, and 19 days of morodan concentrated pill administration, respectively. Their alanine aminotransferase (ALT) increased by more than 5 times the upper limit of the reference value, accompanied by elevated bilirubin in patient 2 and patient 3. All the 3 patients were stopped to use morodan concentrated pill immediately. After 18, 22, and 24 days of liver-protective treatments, the liver function of patient 1, patient 2, and patient 3 returned to normal, respectively.
  • Liver injury and rashes due to desloratadine citrate disodium tablets
    Zhang Hongmei, Liu Guangchen, Tian Xu, Zhou Wei
    2020, 22(9): 533-534. https://doi.org/10.3760/cma.j.cn114015-20190722-00588
    Abstract ( ) PDF ( )
    A 32‑year‑old male patient received oral desloratadine citrate disodium tablets 8.8 mg once daily for allergic rhinitis. On the 6th day of medication, he developed sporadic red rashes on his abdomen, but he didn′t pay attention to it. On the 7th day of medication, the rashes increased and were with itching; urine color became dark brown; and he developed yellowish discoloration of hand skin and sclera. Laboratory tests showed alanine aminotransferase (ALT) 323 U/L, aspartate aminotransferase (AST) 186 U/L, gamma glutamyl transferase (γ‑GT) 309 U/L, total bilirubin (TBil) 63.9 μmol/L, and direct bilirubin (DBil) 33.6 μmol/L. He was diagnosed as having drug‑induced liver injury and allergic dermatitis, which were considered to be caused by desloratadine citrate disodium. Then the drug was stopped and the patient was given liver‑protective treatments and external application of mometasone furoate cream. On day 2 of desloratadine citrate disodium withdrawal, the color of his urine became lighter. On day 4 of drug withdrawal, the color of the rashes became lighter, the color of urine returned to normal, and there were no new rashes. On day 9 of drug withdrawal, the rashes disappeared basically. Liver function examination showed ALT 84 U/L, AST 29 U/L, γ‑GT 187 U/L, TBil 19.5 μmol/L, and DBil 8.0 μmol/L. Two weeks later, his ALT was 54 U/L， and other examination results were within the reference fange.
  • Acute myocardial infarction induced by nilotinib
    Guo Ruipeng, Zhang Guoxiang, Shen Xuliang
    2020, 22(9): 535-536. https://doi.org/10.3760/cma.j.cn114015-20190722-00599
    Abstract ( ) PDF ( )
     A 62‑year‑old male patient with chronic myelogenous leukemia (chronic phase) received nilotinib 400 mg twice daily. The patient developed mild fatigue, precordial discomfort, and chest tightness 5 hours after the first medication, which were relieved after rest. One hour after the second medication on the same day, the symptoms of precordial discomfort and chest tightness recurred, and they were relieved after rest again. One hour after taking the medicine again the next day, the above symptoms recurred and were aggravated, which could not be relieved after rest. Laboratory tests showed that serum troponin I was 2.67 μg/L, myoglobin was 195.1 μg/L, and creatine kinase MB was 37.7 μg/L. Electrocardiogram (ECG) showed that ST segment depression was >0.1 mV in leads I, II, III, aVL, aVF, and V1‑V6, T-wave inversion, and QT/QTc was 350/402 ms. The patient was diagnosed as having acute non‑ST segment elevation myocardial infarction, which was considered to be related to nilotinib. After 3 weeks of drug withdrawal and vasodilator and anticoagulant therapy, the laboratory tests showed that serum troponin I was not detected, myoglobin was 21.7 μg/L, and creatine kinase MB was 0.8 μg/L. ECG examination showed ST segment depression and T-wave inversion disappeared in leads I, II, III, aVL, aVF and V1‑V6, and QT/QTc was 370/376ms.
  • Toxic epidermal necrolysis due to levofloxacin injection
    Chen Kuixia, Pan Dan, Li Li, Dou Nina, Zhao Kexin
    2020, 22(9): 537-538. https://doi.org/10.3760/cma.j.cn114015-20190904-00734
    Abstract ( ) PDF ( )
     A 77‑year‑old male patient received intravenous infusion of levofloxacin 0.5 g for preventing infection before transrectal prostate biopsy. Three hours after the infusion finished, erythema with pruritus appeared on his trunk, buttocks and limbs. Two days later, the patient developed fever, aggravated rash, and large area of blisters. Three days later, the blisters were broken and Nikolsky sign was positive. Toxic epidermal necrolysis was diagnosed, which was considered to be related to levofloxacin. Symptomatic treatments including combination use of glucocorticoid and human immunoglobulin and skin wound care were given. Fifteen days later, his rash completely subsided and the skin wound healed basically.
  • Acute pancreatitis induced by magnesium valproate sustained release tablets
    Zhao Wenli, Jiang Lili, Luo Simin, Li Weiling, Li Lehua
    2020, 22(9): 539-540. https://doi.org/10.3760/cma.j.cn114015‑20190910‑00752-
    Abstract ( ) PDF ( )
    A 22-year-old male patient received magnesium valproate sustained release tablets with increased dosage of 1-000-mg/d and quetiapine fumarate 600-mg/d due to recurrence of bipolar disorder, on the basis of previous treatment with magnesium valproate sustained release tablets 500-750-mg/d and quetiapine fumarate 400-600-mg/d. Seventeen days later, the patient developed abdominal pain suddenly. Laboratory tests showed blood amylase 4-710-U/L, lipase 649-U/L, and urine amylase 9-116-U/L. Abdominal CT examination showed blurred images around the pancreas. Acute pancreatitis induced by magnesium valproate sustained release tablets was considered. The drug was discontinued and quetiapine fumarate was continued. At the same time, symptomatic and supportive treatments such as fasting, omeprazole, somatostatin, and ceftazidime were given. Three days later, the patient′s abdominal pain basically disappeared; 10 days later, his blood amylase was 101-U/L and lipase was 118-U/L.
  • Kidney injury induced by deferasirox dispersible tablets
    Jin Sisi, Jia Jinsheng
    2020, 22(9): 541-542. https://doi.org/10.3760/cma.j.cn114015-20191111-00901
    Abstract ( ) PDF ( )
    A 73-year-old male patient with myelodysplastic syndrome received deferasirox dispersible tablets (deferasirox) 500-mg once daily for post-transfusion iron overload. Renal function examination showed no obvious abnormality. Ten months later, the dose of deferasirox was increased to 1-000-mg once daily due to ineffective iron overload treatment. About 1 month after the dose adjustment, the patient′s fatigue was aggravated. Laboratory tests showed blood urea (BUN) 11.5-mmol/L, serum creatinine (Scr) 143-μmol/L, and estimated glomerular filtration rate (eGFR) 45-ml/(min·1.73 m2). Kidney injury was diagnosed, which was considered to be induced by deferasirox. Then deferasirox was stopped and Corbrin capsule (百令胶囊) was given. About 1 month after drug withdrawal, renal function of the patient was improved ［BUN 9.1-mmol/L, Scr 111-μmol/L, and eGFR 60-ml/(min·1.73 m2)]. Due to the iron overload, deferasirox was re-given at dose of 1-000-mg once daily. About 1 month after medication, the kidney injury recurred ［BUN 9.7-mmol/L, Scr 131-μmol/L, and eGFR 49-ml/(min·1.73 m2)]. The dose of deferasirox was reduced to 500-mg once daily immediately and 3 month later, renal function of the patient was improved ［BUN 8.8-mmol/L, Scr 104-μmol/L, and eGFR 65-ml/(min·1.73 m2)］.
  • Ventricular fibrillation caused by successive application of ciprofloxacin and levofloxacin
    Yan Shubin, Liu Xiao, Bu Yishan
    2020, 22(9): 543-544. https://doi.org/10.3760/cma.j.cn114015-20191230-01105
    Abstract ( ) PDF ( )
    An 86-year-old male patient received IV infusions of meropenem (1 g once per 12-hours) combined with ciprofloxacin lactate and sodium chloride injection (200-mg once daily) for pneumonia, respiratory failure, and multidrug resistant Pseudomonas aeruginosa infection suggested by sputum bacterial culture. On the 4th day of treatments, the patient developed a sudden drop in blood pressure, and his pulse could not be measured. ECG monitoring suggested ventricular fibrillation. After the treatments of electric defibrillation and amiodarone injection, his sinus rhythm restored. The next day the patient had another three episodes of ventricular fibrillation. All electrolytes were normal during emergency examination and ECG examination showed that the QT interval was normal. Ciprofloxacin was discontinued and replaced by meropenem combined with fosfomycin, and ventricular fibrillation did not recur. Twenty-six days later, the patient′s pneumonia was aggravated and sputum bacterial culture result showed multidrug resistant Pseudomonas aeruginosa infection, which was sensitive to ciprofloxacin and moderately sensitive to levofloxacin. Then meropenem (the same dosage and usage as before) combined with levofloxacin injection (200-mg once daily) were given. On the fifth day of treatments, the patient developed ventricular fibrillation again and his heart rhythm returned to normal after electric defibrillation and amiodarone treatment. Levofloxacin was discontinued and meropenem combined with fosfomycin were given again. Then ventricular fibrillation did not recur. The patient′s ventricular fibrillation was considered to be possibly related to ciprofloxacin and levofloxacin.
  • Pulmonary embolism induced by clozapine： report of 3 cases
    Cui Xiangli, Guo Heng, Wang Xiaojian, Wang Weina, Shen Su
    2020, 22(9): 545-547. https://doi.org/10.3760/cma.j.cn114015-20190731-00625
    Abstract ( ) PDF ( )
    Three patients (patient 1, ａ 48-years-old male; patient 2, a 65-years-old female; patient 3, a 58-years-old female) received clozapine for schizophrenia at daily doses of 200-mg, 175-mg, and 100-mg, respectively. Patient 1 developed venous thrombosis of lower limbs after 16 years of clozapine treatment, which was improved after thrombolytic therapy. Ten years later, the patient developed shortness of breath after activity and the symptom gradually worsened. Bilateral pulmonary embolism was diagnosed by computed tomographic pulmonary angiography (CTPA), and warfarin and rivaroxaban were given successively for anticoagulation. One year later, the patient developed cardiac insufficiency. The patient was diagnosed as having chronic thromboembolic pulmonary hypertension (pulmonary artery systolic pressure was 86-mmHg), chronic cor pulmonale, and cardiac insufficiency. Warfarin combined with cardiac glycosides, diuretics, and other symptomatic treatments were given. After 3 months of treatments, his dyspnea was markedly relieved and the pulmonary systolic pressure was reduced to 48-mmHg. Patient 2 developed pulmonary embolism after 5 years of clozapine treatment. After thrombolytic therapy, he was given oral warfarin and the drug was discontinued by himself 3 years later. Pulmonary embolism recurred 2 years after the drug withdrawal. Nadroparin calcium and warfarin anticoagulation was given successively and 3 months later, CTPA showed that pulmonary embolism basically disappeared. Patient 3 developed lower-extremity venous thrombosis after 2 years of clozapine treatment, and pulmonary embolism occurred 1 year later, which was improved after anticoagulation, diuretics, and other treatments. Three years later, the patient stopped warfarin by herself, and 10 months later, her pulmonary embolism recurred. Low-molecular-weight heparin sodium as bridge therapy to warfarin was given. Three months later, CTPA showed that pulmonary artery thrombosis basically disappeared.
  • Acute hemolytic reaction in patients with novel coronavirus pneumonia induced by high-dose ribavirin injection: report of 2 cases
    Gao Jian, Qiao Weichao, Xia Qing, Zhang Qing
    2020, 22(9): 547-549. https://doi.org/10.3760/cma.j.cn114015-20200412-00518
    Abstract ( ) PDF ( )
    Two female patients (patient 1, 22-year-old; patient 2, 50-year-old) received IV infusion of ribavirin injection (4 g in the first dose and the next day 1.2 g thrice daily), oral 2 lopinavir and ritonavir tablets twice daily, and aerosol inhalation of recombinant human interferon α2b for injection for novel coronavirus pneumonia. There was no obvious abnormality in blood routine and liver function before treatment. Laboratory tests showed red blood cell count (RBC) 2.89×1012/L, hemoglobin (Hb) 75-g/L, alanine aminotransferase (ALT) 22.8-U/L, aspartate aminotransferase (AST) 33.9-U/L, total bilirubin (TBil) 71.2-μmol/L, and indirect bilirubin (IBil) 63.5-μmol/L in patient 1 on the 2nd day of treatment, and RBC 3.46×1012/L, Hb 95-g/L, ALT 17.7-U/L, AST 21.3-U/L, TBil 86.1-μmol/L, and IBil 67.1-μmol/L in patient 2 on the 3rd day of treatment. The direct antiglobulin test was positive, indirect antiglobulin test was negative, and antinuclear antibody test was negative in both patients. They were diagnosed as having acute hemolytic anemia. Con- sidering the relationship to ribavirin, ribavirin was given in reduced dose and then finally discontinued in patient 1, and was discontinued directly in patient 2. On the basis of continued use of the other 2 drugs, both of them were treated with ursodeoxycholic acid. The Hb and bilirubin level of the 2 patients gradually returned to normal.
  • Interstitial pneumonia due to oxaliplatin
    Lu Xiaoyan, Dai Youqin, Wu Yamiao, Yang Sijia, Zou Junyong, Chen Wei
    2020, 22(9): 550-552. https://doi.org/10.3760/cma.j.cn114015-20190708-00548
    Abstract ( ) PDF ( )
    A 64-year-old male patient with colon cancer received one cycle chemotherapy of oxaliplatin+capecitabine and 7 cycles of oxaliplatin+raltitrexed chemotherapy. There were no interstitial changes in chest CT before operation. After 8 cycles of chemotherapy, the patient deve- loped chest tightness and shortness of breath. Chest CT showed interstitial changes in bilateral lungs, which were considered to be related to oxaliplatin. After 31 days of treatments with drugs such as broad-spectrum antibiotics, glucocorticoids, acetylcysteine, and reduced glutathione, as well as noninvasive ventilator assisted ventilation, oxygen inhalation, and other symptomatic treatments, his symptoms of chest tightness and shortness of breath were relieved, and chest CT showed that interstitial lesions in the bilateral lungs were obviously relieved.
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