阿昔洛韦静脉滴注致急性肾功能衰竭

患者男,34岁。因纳差,乏力伴尿量减少2d,于2006年8月21日入院。4d前因生殖器疱疹在当地诊所予以阿昔洛韦0.75g+5%葡萄糖注射液250ml静脉滴注,次日下午出现双侧腰部疼痛、查尿蛋白(+),疑为药物所致遂停止使用阿昔洛韦。继而出现恶心、呕吐,尿量约为400ml。第4天来我院就诊,入院时查体:T36.7℃,P80次/min,R20次/min,BP130/100mmHg。双肾区有叩击痛,双下肢无水肿。患者平素体健,否认肾炎、高血压、糖尿病史。Cr424μmol/L,BUN11.54mmol/L,尿酸(UA)445μmol/L,CO2CP22mmol/L;尿沉渣:RBC1.2×105个/ml,均一型,WBC4～5个/HP。血、大便…     

阿昔洛韦静脉滴注致急性肾功能损害

患者男,35岁。因左颈部、肩部水疱,疼痛1周,腰痛3d,于2003年2月10日来院就诊。患者1周前劳累后左颈部、肩部突发米粒至绿豆大小丘疹、丘疱疹、水疱,皮疹渐增多,伴阵发性刺痛。发病第4天在当地医院诊断为“带状疱疹”,给予阿昔洛韦0.5g 5%葡萄糖注射液500mL静滴,1次/d。次日,当输入液体约150mL时,患者突感腰部疼痛,活动受限,立即终止输液,经卧床休息后,疼痛稍缓解。2d后,症状仍无明显改善,遂来我科就诊,门诊以“带状疱疹,腰痛待查”收入院。发病以来,无发热、畏寒,心悸、气促,腹痛、腹泻、头痛、呕吐、少尿、血尿等症状。精神尚可,食欲、睡…     

警惕阿昔洛韦导致急性肾功能损害

阿昔洛韦,为合成的核苷类抗病毒药,体内和体外对单纯性疱疹病毒Ⅰ型（HSV—1）、Ⅱ型（HSV-2）及水痘-带状疱疹病毒（VZV）均有抑制作用。临床用于治疗单纯疱疹病毒感染、带状疱疹、免疫缺陷者水痘等疾病。     

静脉滴注链霉素引起急性肾衰1例

病例 女性,52岁,农民,河北唐县人。主因少尿一周,无尿二天。于1995年1月19日入院。缘于半年前因肺结核,经口服抗痨药效果欠佳,7天前乡村医生给予硫酸链霉素2克加5％葡萄糖500毫升静滴,三日后出现少尿,24小时尿量400毫升左右,继之无尿,以急性肾功能衰竭收入院。 查体:体温37℃,脉博120次/分,血压26/     

对阿昔洛韦静脉滴注致急性肾衰竭的治疗

阿昔洛韦(无环鸟苷)为鸟苷衍生物,能选择性抑制和灭活病毒DNA多聚酶,阻断病毒DNA合成,有较强抗单纯疱疹、水痘、带状疱疹病毒的作用,临床应用广泛。不良反应主要有过敏反应及胃肠道不适,致急性肾损害报道较少。现就我院近年收治的阿昔洛韦致急性肾衰竭(acute renal failure,ARF     

阿昔洛韦静脉滴注致急性肾功能衰竭10例分析

阿昔洛韦为人工合成的第2代核苷类广谱抗病毒药物,对单纯性疱疹病毒、水痘带状疱疹病毒、巨细胞病毒等都具有高度选择性抑制作用,是临床治疗生殖器疱疹病毒感染、带状疱疹、免疫缺陷者水痘等疾病的一线药物[1、2]。因疗效好、不良反应少而广泛使用,近年来随着临床的推广,有关阿昔洛韦不良反应的报道也逐渐增多,尤其是导致急性肾功能衰竭(ARF)     

静滴单剂量阿昔洛韦致急性肾衰1例

患者,男,43岁。因“头面部散在疱疹一周”于2007年8月28日给予阿昔洛韦（上海新亚药业有限公司,批号061004）750mg加入0．9％氯化钠注射液500ml,ivd qd,用药中突然出现双侧腰痛伴腹部隐痛不适。立即停药。但症状一直未缓解,并出现尿量减少。患者用药前无泡沫尿、肉眼血尿及肾区绞痛,亦无发热、关节疼痛及尿急、尿频、尿痛、下肢水肿等症状,无腰痛、尿常规及尿量异常病史,2007年3月查血肾功能正常。8月29日血肾功能：BUN 15．5mmol·L^-1．Cr516·μmol·L^-1。     

阿昔洛韦静脉滴注治疗带状疱疹疗效观察

带状疱疹是由水痘-带状疱疹病毒引起的急性疱疹性皮肤病,我们采用静脉滴注治疗20例带状疱疹患者,并进行对照观察,现小结如下。1　一般资料全部病例选自1998～2000年住院患者,以典型临床表现确诊为带状疱疹,肾功能损害者除外。治疗组20例,男14例,女6例。年龄23～69岁,平均52±15.97岁。受累神经:颅神经4例,颈神经4例,胸神经11例,腰神经1例。对照组:15例,男10例,女5例;年龄32～71岁,平均50±14.98岁。受累神经:颅神经4例,颈神经3例,胸神经8例。2　治疗方法两组均同时给予维乐生,并发感染者加用抗菌素。治疗组用阿昔洛韦注射液5mg/kg,加入5%葡…     

静脉滴注阿昔洛韦致重度过敏性休克一例

<正>患儿男,6岁。因发热、口腔疱疹在所居住社区就诊,给予5%葡萄糖250 mL+阿昔洛韦0.25 g静脉滴注,10 s后患儿烦躁不安未处理急来我院就诊。2 h后来诊观察患儿表情淡漠、意识模糊,查体:脉搏细弱200次/min,血压测     

阿昔洛韦过量致急性肾衰竭

例19岁男性传染性单核细胞增多症患者拟给予阿昔洛韦600 mg加入10%葡萄糖注射液250 ml中静脉滴注.但因用药错误将阿昔洛韦3.0 g加入10%葡萄糖注射液250 ml中静脉滴注.输注完毕后9 h,患者出现明显腰痛,尿量减少,尿蛋白(+ +),尿潜血(+ +).随后出现24 h无尿.第3天肾功能检查:血清肌酐557 μmol/L,尿素9.2 mmol/L.肾脏超声示双肾弥漫性病变.行血液净化,并给予甲泼尼龙40 mg/d静脉滴注,治疗2 d.肾功能逐渐好转,尿量增多.第15天患者肾功能及尿常规检查均无异常,痊愈出院.     

Acute liver failure following intravenous methamphetamine

A 41-y-o Pakistani man presented with psychosis, hyperthermia, rhabdomyolysis, and liver dysfunction approximately 6 h after i.v. injection of methamphetamine. Serum concentrations of methamphetamine and amphetamine on admission were 0.30 microg/mL and 0.04 microg/mL, respectively. Total serum bilirubin and alanine aminotransferase concentrations peaked on the 3rd hospital day at 8.6 mg/dL and 4155 IU/L, respectively, and gradually returned to normal with supportive care. The patient had no evidence of infectious hepatitis or intake of other drugs. Histologic examination of a liver biopsy specimen obtained on the 11th d showed confluent necrosis and ballooning degeneration in centrilobular zones. No inflammatory changes were seen in portal tracts. Liver damage can be a complication of illicit methamphetamine use, even in patients without viral infection or intake of other drugs.     

Acute renal failure following latrodectism

Latrodectism is considered dangerous for human beings. Acute renal failure after envenomation is not common and usually results from prerenal failure. We report a 59-y-o man with acute oliguric renal failure due to a combination of prerenal and renal causes after being bitten by a black Latrodectus spider. He had the characteristic anxiety, severe hypertension, tremor, facial edema, and generalized diaphoresis. The patient recovered within a week without sequelae. Clinicians should not overlook the possibility of acute renal failure in latrodectism.     

Acute renal failure associated with intravenous immunoglobulins

Intravenous immunoglobulins (i.v.IG) are increasingly used in various clinical situations for which they have been considered to be safe and effective. However, since 1987, some cases of renal toxicity have been reported. Forty-nine cases of acute renal failure have been notified to the French Regional Pharmacovigilance Centers between 1992 and mid 1998. In this series, marked serum creatinine increases (mean 387%+/-181%) appeared within 8 h to 8 days after initiation of i.v.IG therapy. Oliguria was observed in 80% of the cases. Haemodialysis was required for 34% of the patients. The renal failure persisted for a mean duration of 10 days after discontinuation of the i.v.IG treatment. Although risk factors have not been definitely established, preexisting renal impairment and old age seem to predispose to i.v.IG-associated acute renal failure as well as diabetes mellitus or the use of diuretics. The mechanism of renal injury remains speculative but a hyperoncotic overloading may be contributory. Finally, close monitoring of renal function is required in patients with preexisting renal failure, with older age and with diabetes mellitus.     

Acute renal failure following ingestion of manganese-containing fertilizer

Fertilizers are used to promote the survival and growth of plants and crops and have a good safety record when used properly. The basic elements in fertilizer include phosphorus, nitrite, and potassium. In addition, there are additive agents that vary for different crops and which may include some metals. Acute intoxication by ingesting fertilizer includes damage to various organ systems as well as severe cardiovascular or respiratory distress. We report the case of a 64-year-old man who ingested about 700 mL of fertilizer and suffered acute renal failure, hyperkalemia, and mild methemoglobinemia. After supportive care and emergent hemodialysis for hemodynamic instability due to hyperkalemia, the renal function of the patient recovered in four days.     

儿童静脉滴注头孢曲松钠出现急性溶血性贫血

1例1．5岁男孩首次静脉滴注头孢曲松钠1．0g治疗上呼吸道感染时出现寒战、发热，而后转入我院。入院时精神萎靡、面色苍黄。血常规示：Hb92g／L，RBC4．21×10^12／L，红细胞平均体积（MCV）68．4fl，红细胞压积（PCV）0．288，网织红细胞（Ret）0．01。入院第2天再次给予头孢曲松钠1．0g加入5％葡萄糖注射液100ml静脉滴注。5h后，患儿全身皮肤黄染，又2h后出现酱油色尿，T39℃。实验室检测：Hb45g／L，RBC1、83×10^12／L，PCV0．12，Ret0．03，直接Coombs试验（＋）。诊断为急性溶血性贫血，立即停药。患者经静脉注射地塞米松、静脉注射丙种球蛋白及输注红细胞后，上述症状缓解，实验室检测示：RBC3．60×10^12／L，Hb91g／L，PCV0、289，Ret0．036。     

林可霉素静脉滴注致血尿

患者男,20岁。因“咽部肿痛伴发热3d”,于2005年4月8日来诊入院。既往体健,否认药物过敏史。查体:T38.9℃,P86次/m in,BP110/70m m H g(1m m H g=0.133kPa)。一般状况尚可,咽红,扁桃体II度肿大,心肺听诊未见异常,腹部及神经系统无阳性体征。化验:血W BC13.8×109/L,G R76%;尿、粪常规(-)。诊断:急性扁桃体炎。给予林可霉素1.2g加入0.9%氯化钠注射液250m l静脉滴注,1次/d(60滴/m in)。2d后患者临床症状有所缓解,但出现血尿,无发热,无腰痛,无尿频、尿急、尿痛。查体:T36.8℃,P72次/m in,BP115/75m m H g。皮肤黏膜无黄染、无出血点,双…     

帕珠沙星静脉滴注引发低血糖

1例89岁男性2型糖尿病和高血压患者，因肺部感染住院。患者于停用降血糖和降血压药物后，静脉滴注帕殊沙星0.3g，2次／d。在第3次静脉滴注1h后突然出冷汗，血糖自10mmol／L降至2．7mmol／L。立即停用帕殊沙星，静脉注射50％葡萄糖注射液60ml，静脉滴注10％葡萄糖注射液，并增加进食量。24h后血糖逐渐上升至5．6mmol／L。