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2018, 20(5)
HighLights More»   
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· Study on management strategy of intravenous theophyllines based on failure mode and effect analysis
· Management strategy study on hypertonic glucose injection (≥20%) based on failure mode and effect analysis
· Study on risk points of medication errors in pediatric patients with digoxin therapy
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  --2018, 20 (5)   Published: 28 October 2018
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Liu fang, Zhang Xiaole, Zhu Zhu
. 2018, 20 (5): 321-323. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.001
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Hu Lihua, Meng Yao, Wang Xiaoling
. 2018, 20 (5): 324-328. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.002
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Hot!
Song Jie, Qiu Feng, Meng Long, Yang Jiadan, Xiao Mingzhao
. 2018, 20 (5): 329-333. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.003
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Study on management strategy of intravenous theophyllines based on failure mode and effect analysis Hot!
Li Sha, Li Ning, Yang Lijie, Ma Lan, Liu Fang, Wang Fang
. 2018, 20 (5): 334-339. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.004
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ObjectiveTo explore the risk points of medication errors in the management process of intravenous theophyllines by failure mode and effect analysis (FMEA) and improve the management measures to enhance the medication safety. MethodsThe potential safety risks in each link during intravenous theophyllines circulation in First Affiliated Hospital of PLA General Hospital and the First Affiliated Hospital of Harbin Medical University were analyzed using FMEA method and the risk priority number (RPN) was calculated. The risk points, whose RPN scores were >216, were taken as the key ones during the management of intravenous theophyllines. Management and technical strategies were drawn up for the key risk points and preventive effects before and after the improvement measures were compared.ResultsAfter comprehensive evaluation, the key risk points such as missing information of drug instructions, wrong dosage, inappropriate assessment for patients, omission of prescription checking, absence of blood concentration monitoring, and imperfection of doctor′s advice to patient and etc. were sorted out, and management and technical strategies were drawn up. The RPN scores of above risk points decreased from (269±41) to (53±27) before and after the implementation of preventive strategies and the difference was statistically significant (t=9.454, P<0.001).ConclusionThe importance of failure modes in safety management of drugs is quantified by FMEA method, priority sequence of improvement for high-alert medication management is pointed out, and medication safety is improved.
Management strategy study on hypertonic glucose injection (≥20%) based on failure mode and effect analysis Hot!
Wang Yiping, Qin Kan, Liu Fang, Chen Siyuan, Fan Luyan
. 2018, 20 (5): 340-345. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.005
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ObjectiveTo analyze the risks of hypertonic glucose injection ( 20%) (hypertonic glucose) in clinical application using failure mode and effect analysis (FMEA) method and improve the relevant management measures.MethodsA study group on risk prevention strategies of hypertonic glucose was established in the First People′s Hospital of Hefei. Domestic and foreign literature on medication error cases, preventive measures or management strategies, and data from questionnaires and on-the-spot investigations were collected. The failure modes in the process of hypertonic glucose application were analyzed and assessed. Severity (S), frequency of occurrence (O), and likelihood of detection (D) of the risks related to these failure modes were scored and the risk priority numbers (RPN) were determined. The failure modes with higher RPN were screened out and the corresponding prevention strategies were formulated. The incidence of medication errors and potential hazards, cognition rate of knowledge on drugs, qualification rate of drug storage, and satisfaction rate for management measures before and after the improvement were analyzed comparatively.ResultsAccording to the results from literature search, questionnaires, and on-the-spot investigations, a total of 24 failure modes were found in the 6 links relevant with hypertonic glucose application in clinical, which included links of prescription writing and delivery, pharmacist dispensing, nurse dispensing, post-administration monitoring, drug management, and information technology. Ranking the RPN from high to low, 7 major failure modes with higher RPN were selected from the 24 failure modes, including the existence of drugs with similar name and drugs with similar package, wrong drug dispensing, absence of post-administration monitoring, lack of marked labels for drugs, garbles caused by lack of medication knowledge, and untimely record and report of medication errors. The incidences of medication errors and potential safety hazards before and after management improvement were 3.2% (7/216) and 0.4% (1/234), respectively and the difference had no statistical significance (P=0.058). The average cognitive rates of physicians, nurses and pharmacists before and after the improvement were 65.2%(15/23), 54.2%(13/24), 67.9%(19/28) and 95.8%(23/24), 91.7%(22/24), 95.5%(21/22), respectively and the differences were statistically significant (P<0.05 for all). The qualification rates of drug storage before and after management improvement were 70.2%(151/215) and 98.7%(230/233), respectively and the difference was statistically significant (P<0.05). The average satisfaction degrees of medical staff with hyperosmotic glucose management were 81.3%(61/75) and 95.7%(65/70), respectively before and after the management improvement and the difference was statistically significant (P<0.05).ConclusionFailure modes in the process of hypertonic glucose use can be effectively identified using the FMEA method, and the risk events can be effectively reduced after the corresponding improvement measures.
Study on risk points of medication errors in pediatric patients with digoxin therapy Hot!
Jiang Ni, Zhang Xu, Shi Xiaoping, Wang Xiaoling, Li Ying, Ji Xing
. 2018, 20 (5): 346-352. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.006
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ObjectiveTo investigate the possible risk points of medication errors in process of digoxin therapy in pediatric patients.MethodsThe doctors, nurses, pharmacists, and patients involved in process of digoxin therapy in Beijing Children′s Hospital, Capital Medical University, Dalian Children′s Hospital of Dalian Medical University, and Children′s Hospital of Nanjing Medical University were investigated by questionnaires, and the places involved were investigated on-the-spot. According to the results of questionnaires, on-the-spot investigation, and bibliographic search, the possible risk points of medication errors in process of digoxin therapy in pediatric patients were analysed using method of failure mode and effect analysis. The risk priority numbers (RPN) were calculated and sorted from high to low. The risk points with higher RPN scores were deemed to be the high frequency ones in process of digoxin therapy in pediatric patients.ResultsA total of 33 risk points were found from 4 links, including doctor prescribing, drug dispensing, nurse dispensing, and patient medication. The results of RPN sorting showed that the risk point with the highest RNP scores in doctor prescribing was special note absence for digoxin in hospital information system (67.5); the risk scores point with the highest PRN scores in drug dispensing was inaccurate dose occurred when digoxin was divided into small parts (74.7); the risk point with the highest PRN scores in nurse dispensing was that the digoxin was not kept in a dark place in ward medicine cabinet (15.2); the risk point with highest PRN scores in medication process was that the children′ guardians were not clear about the clinical manifestations of digoxin overdose(47.5).ConclusionSpecial note absence for digoxin in hospital information system, inaccurate dosage of digoxin when divided into small parts, improper storage of digoxin in the ward, and lack of knowledge about the clinical manifestations of digoxin overdose are probably the high frequency risk points of medication errors in process of digoxin therapy in pediatric patients.
Survey on risks of epinephrine use in children and its prevention strategies
Shi Yali, Ji Xing, Guo Huilei, Li Ying, Zhu Mingmei, Wang Xuan, Xu Jing
. 2018, 20 (5): 353-358. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.007
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Department of Pharmacy, Children′s Hospital Affiliated to Nanjing Medical University, Nanjing 210008, China (Shi YL, Ji X, Guo HL, Zhu MM, Wang X, Xu J); Department of Pharmacy, Beijing Children′s Hospital, Capital Medical University, Beijing 100045, China(Li Y)
Corresponding author: Xu Jing, Email: njxujing@163.com【Abstract】ObjectiveTo investigate the risks of epinephrine use in children using healthcare failure mode and effect analysis (HFMEA) method.MethodsA project team was set up and data on adverse events of epinephrine use in children reported at home and abroad, data of medication errors in database of clinical medication safety monitoring network, and data from questionnaires and on-the-spot investigations were collected. Risk points in the process of epinephrine use were collected using HFMEA method. Severity (S), frequency of occurrence (O), and likelihood of detection(D) of risks were scored(the scores ranged from 1.0 to 5.0) and the risk priority numbers (RPN) were determined. The risk points with higher RPN scores or the score of severity up to 5.0 were screened out and the corresponding prevention strategies were formulated. ResultsThrough comprehensive evaluation on data from domestic and foreign databases and medication error databases in clinical medication safety monitoring network, as well as data from questionnaires and on-the-spot investigations, a total of 33 risk points in links of hospital information system, doctor prescribing, pharmacist dispensing, and nurse dispensing were obtained. Fourteen risk points with higher RPN scores and the score of severity up to 5.0 were screened out, including 2, 4, 4, and 4 risk points in links of hospital information system, doctor prescribing, pharmacist dispensing, and nurse dispensing, respectively. Fourteen preventive strategies corresponding to the risk points were established, including 6 mandatory, 4 recom-mended, and 4 conditional ones.ConclusionRisk points were found in the process of epinephrine use in children by HFMEA method and unified management standards were established.
Acute hepatic injury induced by intravenous amiodarone: clinical case analysis and review of the literature
Su Yunjuan, Song Yuqing, Dong Qian, Yang Liu, Chen Yongfu, Zhang Sujuan, Wu Qiming
. 2018, 20 (5): 359-365. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.008
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ObjectiveTo explore the clinical characteristics, prevention, and treatment of acute liver injury (AHI) induced by intravenous amiodarone.MethodsThe medical records data of 5 patients with AHI caused by intravenous amiodarone in our hospital were collected and retrospectively analyzed, and in the meantime, case reports on intravenous amiodarone-induced AHI in PubMed, CNKI and Wanfang Data were searched. The clinical data of 5 patients in our hospital and case reports from the literature were summarized and the clinical characteristics of AHI induced by intravenous amiodarone were analyzed.ResultsThe 5 patients with AHI induced by intravenous amiodarone in our hospital included 3 males and 2 females with ages of 22-70 years. The total doses of amiodarone were 450-750 mg, incubation periods (the period from drug use to AHI occurrence) were 24-48 h, and the types of liver injury were all hepatocyte type, of which 2 patients′  were liver failure. A total of 59 patients with amiodarone-induced AHI were collected (5 in our hospital and 54 from the literature), including 40 males (67.8%) and 19 females (32.2%) with ages from 1 year and 10 months to 93 years and a median age of 69 (58, 75) years. In these 59 patients, the incubation periods ranged from 6 hours to 8 days and the median period was 2 (1, 3) days, and that of 55 patients (93.2%) were less than or equal to 3 days. The incubation periods of 17 patients with liver failure and 42 patients with non-liver failure were 1 (1, 2) days and 2 (1, 3) days respectively, and the difference was statistically significant (P=0.033). The peak values of ALT, which were recorded in 55 patients, ranged from 178 to 8 400 U/L, and the median value was 2 418 (922, 4 250) U/L. The peak values of AST, which were recorded in 56 patients, ranged from 165 to 17 471 U/L, and the median value was 2 658(1 205,7 250)U/L. The AST peak values of 16 patients with liver failure and 42 patients with non-liver failure were 6 195 (3 370, 6 850) U/L and 2 383 (1 115, 5 040) U/L, respectively, and the difference was statistically significant (P=0.032). Among the 59 AHI patients, 44 patients′ liver function returned to normal, 4 patients′  liver function improved, and 11 patients died, of whom 9 (81.8%) developed liver failure.ConclusionAHI induced by intravenous amiodarone is an acute onset and severe disease with a short incubation period, and should be monitored timely.
Research progress in mechanism of psoriasis caused by tumor necrosis factor-α inhibitors
Guo Yingying, Wang Xiaoxia
. 2018, 20 (5): 366-369. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.009
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Tumor necrosis factor-α (TNF-α) plays an important role in inflammatory responses and immune system diseases. TNF-α inhibitors, including etanercept, infliximab and adalimumab, have become the effective therapies of some diseases such as rheumatoid arthritis, glomerular disease, psoriasis, and inflammatory bowel diseases. With the popularization of their clinical applications, there are more and more reports of new-onset or aggravated psoriasis caused by TNF-α inhibitors. This kind of adverse reactions may be related to cytokine imbalance among TNF-α, interleukins, and interferon etc., as well as to the genetic susceptibility. Types of TNF-α inhibitors and the blood concentration may also have contributions to the development of psoriasis.
Impact of statin adherence on the prognosis of patients with myocardial infarction and cerebral infarction
Fu Xuewei, Ma Xin, Wan Yungao
. 2018, 20 (5): 370-375. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.010
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As the secondary preventive drug for cardiovascular and cerebrovascular diseases, statins can significantly improve the prognosis of patients with myocardial infarction and cerebral infarction. However, the investigations on the application of statins showed that statin withdrawal and dose reduction are very common in patients with acute myocardial infarction and cerebral infarction. After 6 months of treatment, patients with good adherence were less than 60%. With the prolongation of treatment time, the proportion of patients with poor adherence or discontinued treatment gradually increased. The decline of adherence to statin therapy was related to many factors, such as patients′ concern about drug safety, insufficient communication between doctors and patients, excessive combination of drugs, and economic status and educational levels of patients. Adherence to statin therapy could affect markedly the prognosis of atherosclerotic cardiovascular disease and poor statin adherence could increase the incidence of major adverse cardiovascular events. It is necessary to improve the physician′ awareness of importance of statin therapy, strengthen the education of medication adherence, rationally select treatment drugs, monitor adverse drug reactions, and enhance patients′  adherence to statin therapy.
Atorvastatin calcium tablets-induced rhabdomyolysis in a patient without OATP-SLCO1B1 C521T mutation
Mu Guangyan, Xiang Qian, Hu Kun, Cui Yimin
. 2018, 20 (5): 376-377. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.011
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A 55-year-old female patient with hyperlipemia received atorvastatin calcium tablets 20 mg, once daily orally. Two years later, the patient′s legs appeared ecchymosis with distending pain and numbness. Laboratory tests showed serum myoglobin 682 μg/L and creatine kinase 1 007 U/L. She had not received any other drugs during the same period. Atorvastatin-induced rhabdomyolysis was considered. Atorvastatin was stopped, and the patient received symptomatic and supportive treatment. Twenty days later, her symptoms disappeared and her serum myoglobin and creatine kinase level turned to normal. A gene test of SLCO1B1 C521T polymorphism of organic anion transporting polypeptides associated with statin-induced muscle injury was detected after rhabdomyolysis, and the result showed TT genotype (non-mutant genotype). This suggested that the SLCO1B1 C521T genotypes could not predict the myotoxicity of statins accurately.
Sirolimus-eluting stents related interstitial pneumonia
Liu Jun, Liu Zhigang, Gao Yuhong, Zhao Pitian
. 2018, 20 (5): 378-379. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.012
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A 54-year-old male patient underwent percutaneous coronary intervention(PCI) twice for acute myocardial infarction. Five sirolimus-eluting stents were implanted in the first PCI and the patient developed chest distress and short of breath 5 weeks after the operation. Exertional angina was considered. The second PCI with 2 sirolimus-eluting stents implantation was conducted on day 5 after the symptoms appeared. Chest distress recurred on day 4 after the second operation and gradually aggravated. The chest distress did not relieve after 2 days of treatments of cardiac insufficiency. Laboratory tests on day 5 after the second operation showed a white blood cell count of 15.5×109/L and neutrophils of 0.90. Anti-infection therapy with cefotiam was given but the symptom did not improved and fever appeared (up to 38.5 ℃). On day 9 after the second operation, chest CT examination showed interstitial pneumonia in bilateral lungs, which were considered to be induced by sirolimus-eluting stents. Methylprednisolone, imipenem, and oseltamivir were given. Two weeks later, the patient′s symptoms improved markedly and chest CT examination showed improvement of interstitial pneumonia in bilateral lungs.
Agranulocytosis and acute suppurative tonsillitis induced by sulfasalazine
Zhao Yi, Huang Xu, Liao Qiuju, Tian Zhen, Li Xuemei, Li Xiaoxia
. 2018, 20 (5): 380-381. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.013
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A 25-year-old woman with rheumatoid arthritis was treated with prednisone, leflunomide, hydroxychloroquine, and calcium carbonate vitamin D. Her condition was controlled well. Because of her fertility requirement, the therapeutic regimen was changed to sulfasalazine 1.0 g and hydroxychloroquine 0.2 g twice daily orally. About 2 months later, the patient developed fever, sore throat, swelling of bilateral tonsils (degreeⅡ) with purulent exudates on the surface, and bilateral cervical lymph nodes swelling. Laboratory tests showed white blood cell count 0.6×109/L and neutrophil count 0.01×109/L. The patient was diagnosed as having agranulocytosis induced by sulfasalazine accompanied by acute suppurative tonsillitis. Sulfasalazine and hydroxychloroquine were stopped and subcutaneous injection of recombinant human granulocyte colony stimulating factor 150 μg once daily were given for 6 consecutive days. Meanwhile, anti-infectious and symptomatic support treatments were given. Three weeks later, her white blood cell count and neutrophil count were returned to normal, and the clinical symptoms disappeared. Hydroxychloroquine and calcium carbonate vitamin D were given again. At 6 months of follow-up, the blood routine test results were normal and the condition of rheumatoid arthritis was stable.
Cholestatic hepatitis due to methimazole
Yuan Ling, Shen Wei, Li Shuang, Yang Qing, Tong Deyin
. 2018, 20 (5): 382-384. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.014
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A 32-year-old female patient with hyperthyroidism received methimazole 10 mg orally thrice daily. Three weeks later, she developed fatigue, anorexia, deep-colored urine, and pruritus of whole body skin. Methimazole was stopped. Laboratory tests showed the total bilirubin (TBil) of 463.1 μmol/L, bilirubin direct (DBil) of 348.9 μmol/L, alanine aminotransferase (ALT) of 142 U/L, aspartate aminotransferase (AST) of 64 U/L, and alkaline phosphatase (ALP) of 499 U/L. Cholestatic hepatitis induced by methimazole was considered. The patient received IV infusion of reduced glutathione, polyene phosphatidylcholine, hepatocyte growth-promoting factors, alprostadil, adenosylmethionine 1,4-butanedisulfonate, and methylprednisolone sodium succinate, and oral ursodeoxycholic acid capsules. Thirteen days later, the laboratory tests showed TBil of 432.3 μmol/L, DBil of 260.6 μmol/L, and total bile acid (TBA) of 564.0 μmol/L. The patient received 4 times of plasmapheresis within 8 days because her pruritus was not improved. On day 3 after the last plasmapheresis, laboratory tests showed TBil of 271.3 μmol/L, DBil of 175.3 μmol/L, and TBA of 483.0 μmol/L. Liver-protective drugs and medications used to treat jaundice were continued. On day 47 after the last plasmapheresis, laboratory tests showed TBil of 22.4 μmol/L, DBil of 8.3 μmol/L, ALT of 35 U/L, AST of 20 U/L, ALP of 114 U/L, and TBA of 47.0 μmol/L. On day 51 after the last plasmapheresis, her pruritus and yellowish skin and sclera disappeared, her urine color returned to normal, and her physical strength recovered.
Docetaxel-related photosensitivity reaction
Wang Han, Li Gen
. 2018, 20 (5): 384-385. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.015
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A 44-year-old female patient received combined chemotherapy of docetaxel and cyclophosphamide after undergoing a resection of invasive ductal carcinoma of her left breast. One day before each cycle of chemotherapy, the patient received oral dexamethasone 8 mg twice daily for 3 consecutive days to prevent docetaxel-induced anaphylaxis. No  adverse reactions appeared in the patient after the first cycle of chemotherapy. On the 5th day of the second cycle of chemotherapy, the patient was exposed to the sun for 30 minutes. The next day, urticaria appeared on her back of neck, opisthenar, knee, and waist. The patient did not receive any other drugs and she also did not change her dietetic habits during the period of chemotherapy. The rash was considered to be photosensitivity reaction possibly induced by docetaxel. The patient received antianaphylaxis treatment, including oral loratadine 10 mg and IV infusion of methylprednisolone sodium succinate 40 mg, calcium gluconate 2.0 g, and vitamin C 2.0 g once daily. Eight days later, the patient′s rash improved.
Ataxia and mental disorders due to compound phenytoin sodium, ephedrin hydrochloride and theophylline tablets
Fan Limei, Ruan Shishuang
. 2018, 20 (5): 386-387. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.016
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A 70-year-old male patient with chronic obstructive pulmonary disease received compound phenytoin sodium, ephedrin hydrochloride and theophylline tablets(each tablet containing phenytoin sodium 50 mg, chlorpheniramine maleate 1 mg, ephedrine hydrochloride 5 mg, caffeine 7.5 mg, theobromine 12.5 mg, theophylline 12.5 mg, belladonna flow extract 0.009 ml)  3 tablets thrice daily by mouth. Gait instability and clumsiness of his lower limbs appeared after 29 months of medication and gradually worsened with mental disorders (such as sparoxysmal unconsciousness, increased daytime sleep and balderdash) after 35 months of medication. Laboratory tests showed that the blood phenytoin concentration was 30 mg/L. Phenytoin poisoning was considered. Compound phenytoin sodium, ephedrin hydrochloride and theophylline tablets were stopped, and symptomatic and supportive treatments were given. Ten days later, the patient became conscious, his mental disorders disappeared, and the blood phenytoin concentration decreased to be 15 mg/L. Fourteen days later, he could walk independently.
Serious disulfide like reaction caused by combined use of cefoperazone sodium and tazobactam sodium and hydrocortisone injection
Ye Qinglin, Wang Zizhao, Zhang Ning, Li Xianyu, Shi Xiaomei, Sun Jianhua
. 2018, 20 (5): 388-390. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.017
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A 77-year-old female patient underwent a laparoscopic left radical nephrectomy for renal malignant neoplasm. She received an IV infusion of cefoperazone sodium and tazobactam sodium 2 g about 30 minutes before surgery and an IV infusion of hydrocortisone injection 400 mg during the operation. On the 2nd day after surgery, intravenous infusion of cefoperazone sodium and tazobactam sodium (2 g twice daily) and hydrocortisone injection (200 mg once daily) were given sequentially. On the 3rd day after operation, about 30 min after completion of the IV infusion of hydrocortisone injection, the patient′s blood pressure dropped suddenly to 84/48 mmHg, her heart rate was 150 beats per minute, and clouding of consciousness, lethargy, generalized flush and sweating appeared. Adrenal crisis was considered. Dexamethasone, hydrocortisone, dopamine, epinephrine, and etc. were successively given to rescue her. About 30 minutes later, the patient′s symptoms improved slightly and then the patient was immediately transferred to ICU. In ICU, cefoperazone sodium and tazobactam sodium was continued according to the original scheme, hydrocortisone injection was changed to 150 mg twice daily, and the 2 groups of drugs were infused at 2-hour intervals. At the same time, dopamine 360 mg dissolved in 50 ml of 0.9% sodium chloride injection was administered intravenously via an infusion pump. The patient′s condition improved. On the 7th day after operation, the 2 groups of drugs were intravenously infused sequentially again and the similar symptoms appeared again. The pharmacist considered that the disulfiram-like reactions was caused by the combined use of cefoperazone sodium and tazobactam sodium and hydrocortisone injection and suggested that the two drugs should be discontinued. After the drugs withdrawal, no similar symptoms recurred.
Drug fever induced by apatinib mesylate tablets
Xue Honglin, Tan Yali, Liang Wen, Fei Yan
. 2018, 20 (5): 390-392. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.018
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A 68-year-old male patient with liver metastases from colon cancer received apatinib mesylate tablets 500 mg orally once daily after the hepatic arterial chemoembolization. On day 3 after the medication, the patient had a fever of 39 ℃ with fear of cold, and his proportion of neutrophils, C reactive protein, and procalcitonin levels slightly increased without any definite focus of infection. It was considered that the drug fever was related to apatinib mesylate tablets. Apatinib mesylate tablets were discontinued and anti-infection treatments were given. Ten days later, the patient′s body temperature returned to normal. Apatinib mesylate tablets were given again for the cancer but the patient had a fever again 3 days later. Apatinib mesylate tablets were stopped again, and then celecoxib capsules were given orally along with tepid sponge bathing to reduce fever. The patient′s body temperature returned to normal on day 3 after the drug withdrawal.
Hypoglycemia caused by colchicine
Gong Rui, Liu Hong
. 2018, 20 (5): 392-393. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.019
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A 71-year-old male patient received sodium bicarbonate 1.0 g and colchicine 0.5 mg orally thrice daily, and benzbromarone 50 mg orally once daily for hyperuricemia with left ankle joint pain. On the first day, the patient took sodium bicarbonate and colchicine about 1 hour after dinner and developed palpable sense of hungry, accompanied with palpitations, vertigo, fatigue, and watery stool about 1 hour after the medication. The above symptoms relieved after having a small amount of porridge. On the second day, the above symptoms appeared after each dose and could relieve after eating a little food. On the third morning, the patient was found coma by a family member and admitted to hospital emergency department. On account of the random fingertip capillary and fasting venous blood glucose of 1.0 mmol/L and 1.8 mmol/L, the patient was immediately given 40 ml of 50% glucose injection intravenously, followed by intravenous infusion of a mixture, which contained 20 ml of 50% glucose injection and 500 ml of 10% glucose injection. Five minutes after the intravenous injection, the patient began to regain consciousness. Nine minutes after the intravenous injection, the patient′s consciousness was fully recovered and he could answer questions correctly. On day 2 after the hospitalization, the patient′s blood glucose level returned to normal and he had no discomfort symptoms. The patient continued to take benzbromarone and sodium bicarbonate after discharge and did not have hypoglycemia at 1 year of follow-up.
High-degree atrioventricular block secondary to hydroxychloroquine in a patient with systemic lupus erythematosus
Jiang Jiaxi, Sun Haiyan
. 2018, 20 (5): 394-395. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.020
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A 67-year-old female patient with systemic lupus erythematosus (SLE) complicated with hypertension and carotid atherosclerosis received oral hydroxychloroquine tablets 100 mg twice daily, total glucosides of paeony capsules 0.6 g thrice daily, mycophenolate mofetil dispersible tablets 0.5 g twice daily, nifedipine sustained-release tablets 30 mg once daily, simvastatin tablets 20 mg once daily, and aspirin enteric tablets 100 mg once daily, and an IV infusion of sodium succinate for injection 30 mg dissolved in normal saline 100 ml once daily. Six days later, IV infusion of sodium succinate for injection was changed to oral prednisone tablets 30 mg once daily. On day 13 of medication, the patient suddenly developed syncope and electrocardiogram showed high-degree atrioventricular block. It was considered that hydroxychloroquine induced the high-degree atrioventricular block. Hydroxychloroquine was discontinued while the other drugs were continued. Three days after the drug withdrawal, atrioventricular block disappeared.
Leukoencephalopathy due to 5-fluorouracil in a patient with invasive mole
Ning Jing, Yang Zhentao, Liu Fuquan, Li Li′an
. 2018, 20 (5): 396-398. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.021
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A 36 year-old female patient with stage II invasive mole (low-risk type) received single drug chemotherapy with 5-fluorouracil (5-Fu). The 5-Fu (30 mg/kg) was given by an intravenous infusion from the first day to the eighth day in each 22-day chemotherapy cycle. The patient developed dysarthria and dysphagia during the 5-Fu treatment on day 6 in the third cycle. The result of head magnetic resonance imaging (MRI) showed extensive white matter injury. 5-Fu was immediately discontinued and nutritional supportive treatments to brain cells were given. Five hours later, the above symptoms disappeared. Twenty-four hours later, the above symptoms recurred and above-mentioned supportive treatments were given again. Three hours after the treatment, the above symptoms disappeared again. Then the chemotherapy regimen was changed to be an IV infusion of actinomycin D (0.4 mg/d) from the first day to the fifth day in each 19-day cycle. During the treatment, the patient′s vital signs were stable and her pronunciation and ingurgitation functions were normal.
Coagulation disorders due to ceftriaxone sodium for injection
Chen Weizhi
. 2018, 20 (5): 398-399. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.022
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A 65-year-old male patient received an IV infusion of ceftriaxone sodium 3.0 g/d for cough in local clinic. Sixteenth hours after the medication, he developed swelling and pain, ecchymosis and blister on skin of his forearms, haematoma at the venipuncture spot, and gross hematuria. No other drugs were applied at the same time. The results of laboratory test showed prothrombin time (PT)>100 s, activated partial thromboplastin time (APTT) >180 s, urine red blood cell(+++), urine occult blood(+++), urine white blood cell (+), and urine protein(++). The patient′s coagulation disorder was considered to be related to ceftriaxone sodium. IV infusion of vitamine K1, IV bolus of fresh frozen plasma, and local debridement were given. Fifteen days later, the patient′s skin ecchymosis alleviated and blisters disappeared. The results of laboratory test showed PT 14 s and APTT 30 s, and routine urine test was normal.

. 2018, 20 (5): 400-400. ;  doi: 10.3760/cma.j.issn.1008-5734.2018.05.023
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