摘要
1例80岁男性患者因术后感染给予亚胺培南西司他汀钠、万古霉素、卡泊芬净、米卡芬净及美罗培南,效果不佳,后治疗改为联用美罗培南1.0 g,1次/8 h静脉滴注及伏立康唑200 mg(首日剂量400 mg,1次/12 h),1次/12 h静脉滴注。第5～9天,实验室检查示血清肌酐(SCr)154～208μmol/L,尿素氮(BUN)24.3～35.9 mmol/L,血清胱抑素C 4.54～5.44 mg/L;血pH值7.18～7.34,氯离子122～130 mmol/L,钾离子3.4～4.1 mmol/L,标准碳酸氢盐波动于12～15 mmol/L,实际碳酸氢盐13～14 mmol/L,阴离子间隙13～14 mmol/L。尿分析示红细胞3.8～4.8个/HP,蛋白±,pH值保持在5.5。诊断为肾小管性酸中毒、急性肾损伤。第9天,伏立康唑用法改为每晨静脉滴注200 mg,每晚鼻饲给药200 mg。调整用法后第3天患者出现高氯性酸中毒、低钾血症,第11天停用伏立康唑,美罗培南继续应用。停药2 d后,患者血清SCr及BUN水平升至最高,分别达282μmol/L及49.4 mmol/L,随后逐渐降低,分别于停药后第25天和停药后34天降至正常,血气分析各项指标于停药后第25天基本恢复正常。
An 80-year-old male patient was given imipenem/cilastatin,vancomycin,caspofungin,micafungin,and meropenem for post-operative infections,but these had no effect.The treatment was then switched to an IV infusion of meropenem 1.0 g every 8 hours combined with an IV infusion of voriconazole 400 mg every 12 hours on the first day followed by 200 mg every 12 hours.On days 5-9 of treatment,the laboratory tests showed the following levels： serum creatine（SCr） 154-208 μmol/L,blood urea nitrogen（BUN） 24.3-35.9 mmol/L,serum cystatin C 4.54-5.44 mg/L,blood pH 7.18-7.34,Cl-122-130 mmol/L,K＋3.4-4.1 mmol/L,standard bicarbonate 12-15 mmol/L,actual bicarbonate 13-14 mmol/L,anion gap 13-14 mmol/L.Urinalysis revealed the following levels： RBC count 3.8-4.8 cells/HP,protein ±,and pH 5.5.Acute renal tubular acidosis and acute renal injury were diagnosed.On day 9 of treatment,voriconazole administration was changed to a 200 mg intravenous infusion every morning and a 200 mg nasal feeding every night.But the patient presented with hyperchlorine acidosis and hypokalemia on day 3 after a change in administration and,on day 11,voriconazole was stopped and meropenem was continued.Two days after drug discontinuation,his SCr and BUN reached peak values of 282 μmol/L and 49.4 mmol/L,respectively.Subsequently,his SCr and BUN levels gradually decreased and normalized on days 25 and 34 after drug discontinuation,respectively.The blood gas analysis results basically returned to normal on day 25 after drug withdrawal.
出处
《药物不良反应杂志》
2012年第4期247-249,共3页
Adverse Drug Reactions Journal
关键词
肾小管酸中毒
肾功能不全
急性
伏立康唑
renal tubular acidosis
renal insufficiency
acute
voriconazole
