头孢吡肟致老年肾功能不全患者精神异常

1例75岁女性患者，因间质性肺炎合并感染给予头孢西丁、二羟丙茶碱、乙酰半胱氨酸及托拉塞米治疗。用药前外周血白细胞计数9.8×109/ L，中性粒细胞0.76，白蛋白27.6 g/ L，尿素氮7.99 mmol/ L，肌酐130μmol/ L，尿酸388μmol/ L。入院第6天因抗感染治疗效果不佳，停用头孢西丁，换用头孢吡肟2.0 g、2次/ d 静脉滴注，余治疗不变。入院第9天患者出现躁狂，未予特殊处理。入院第10天患者出现躁动不安、言语混乱、谵妄，当日停用头孢吡肟、二羟丙茶碱、乙酰半胱氨酸，分2次肌内注射地西泮共10 mg。入院第12天患者精神症状消失，恢复二羟丙茶碱和乙酰半胱氨酸治疗。此后未再出现上述精神症状。

Cefepime induced mental abnormality in elderly patient with renal dysfunction

A 75-year-old female patient received treatments with cefoxitin,dyphylline,acetylcy-steine,and torasemide for interstitial pneumonia accompanied with infection. Before treatments,the laboratory test results were as follows：peripheral white blood cell count 9. 8 × 109 / L,neutrophile granulocyte 0. 76,albumin 27. 6 g/ L,urea nitrogen 7. 99 mmol/ L,creatinine 130 μmol/ L,uric acid 388 μmol/ L. On hospital day 6,she received an IV infusion of cefepime 2 g twice daily instead of cefoxitin because of poor treatment effect. Other therapies were the same as before. On hospital day 9,the patient developed mania and no special treatment was given. On hospital day 10,she developed restlessness, paraphasia,and delirium. Cefepime,dyphylline,and acetylcysteine were discontinued at the same day and IM injection of diazepam 5 mg twice daily was given. On hospital day 12,the mental symptoms disappeared, dyphylline and acetylcysteine treatments were given again. The mental symptoms did not recur.