替加环素致腹膜透析患者顽固性低血糖  

Refractory hypoglycemia induced by tigecycline in a peritoneal dialysis patient

作　　者：冉姗 张明[2] 何志高 Ran Shan;Zhang Ming;He Zhigao(Department of Pharmacy,Jinshan Hospital of Fudan University,Shanghai 201508,China;Department of Pharmacy,Longhua Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]复旦大学附属金山医院临床药学室,上海201508 [2]上海中医药大学附属龙华医院药学部,上海200032

出　　处：《药物不良反应杂志》2021年第10期555-557,共3页Adverse Drug Reactions Journal

摘　　要：1例78岁男性腹膜透析患者因夜间阵咳3周在常规进行腹膜透析维持治疗的同时给予橘红痰咳液10 ml、3次/d,金荞麦片4片口服、3次/d。治疗第5天腹膜透出液出现浑浊。实验室检查:白细胞计数(WBC)1.1×10^(9)/L,中性粒细胞0.65,血红蛋白(Hb)105 g/L,血小板计数(PLT)90×10^(9)/L;超敏C反应蛋白26.9 mg/L,降钙素原10.89μg/L;透出液检查示WBC 13131×106/L,中性粒细胞0.96。诊断为急性弥漫性腹膜炎。先后给予美罗培南、莫西沙星、去甲万古霉素、万古霉素及利奈唑胺腹膜透析给药,因感染仍控制不佳改为替加环素注射液50 mg静脉滴注、2次/d。应用替加环素第9天患者突发冷汗、心悸,伴乏力,头晕和饥饿感,血糖2.0 mmol/L,予50%葡萄糖静脉注射,血糖升高至5.8 mmol/L。患者既往无糖尿病史,考虑低血糖与替加环素有关,遂停用该药,改为利福平0.45 g口服、3次/d,万古霉素500 mg溶于0.9%氯化钠注射液100 ml静脉滴注、1次/12 h。停药3 d后患者清晨血糖3.0 mmol/L。继续静脉与口服补充葡萄糖治疗19 d,患者空腹血糖4.8~6.3 mmol/L。A 78‑year‑old male patient with peritoneal dialysis received Juhong Tanke(橘红痰咳液)solution 10 ml thrice daily and 4 Jinqiaomai tablets(金荞麦片)thrice daily orally because of cough at night for 3 weeks(conventional abdominal dialysis maintenance treatment was given according to the original schedule).On day 5 of treatments,the peritoneal exudate was turbid.Laboratory tests showed white blood cell count(WBC)1.1×10^(9)/L,neutrophils 0.65,hemoglobin(Hb)105 g/L,platelet count(PLT)90×10^(9)/L,high sensitivity C‑reactive protein 26.9 mg/L,and procalcitonin 10.89 mg/L;the examination for exudate showed WBC 13131×106/L and neutrophils 0.96.Acute diffuse peritonitis was diagnosed.Meropenem,moxifloxacin,norvancomycin,vancomycin,and linezolid were given successively along with the peritoneal dialysis,the infection was still not well controlled,and then the anti‑infective drugs were changed to an IV infusion of tigecycline 50 mg twice daily.On day 9 of tigecycline treatment,the patient had sudden cold sweats and palpitations with fatigue,dizziness,and hunger.The peripheral blood glucose level was 2.0 mmol/L.An intravenous injection of 50%glucose was given and the blood glucose increased to 5.8 mmol/L.The patient had no history of diabetes mellitus,it was considered that hypoglycemia was related to tigecycline.Then tigecycline was discontinued and replaced by oral rifampicin 0.45 g thrice daily and an IV infusion of vancomycin 500 mg dissolved in 0.9%sodium chloride injection 100 ml once every 12 hours.Three days after tigecycline withdrawal,the patient′s blood glucose level was 3.0 mmol/L at dawn.Intravenous and oral glucose supplementation treatments were continued,and 19 days later,the patient′s fasting blood glucose level was 4.8-6.3 mmol/L.

关 键 词：替加环素 低血糖 腹膜透析 

分 类 号：R969.3[医药卫生—药理学]