注射用阿昔洛韦与意识障碍相关

Disturbance of consciousness associated with acyclovir for injection

1名57岁女性患者,因慢性肾功能不全急性加重入院。既往有2型糖尿病、高血压、脑梗死病史。住院期间因带状疱疹给予阿昔洛韦500mg静脉滴注,2次/d,治疗第3天患者出现意识障碍,定向力差、嗜睡,血电解质、血肌酐、血红蛋白、体温较前无明显变化,神经系统查体无阳性发现。头颅CT显示存在新发及陈旧脑梗死。给予桂哌齐特治疗,并将阿昔洛韦用量减至500mg,1次/d,但患者意识障碍继续加重。连续3d给予血液透析治疗,并停用阿昔洛韦后,患者的意识迅速恢复正常。

A 57-year-old woman, with a history of type 2 diabetes mellitus, hypertension, and cerebral infarction, was hospitalized with acute aggravated chronic renal failure. During hospitalization, she started receiving IV acyclovir 500 mg twice daily for herpes zoster infection. On day 3 after the IV acyclovir treatment, she developed disturbance of consciousness, disorientation, and somnolence. There was no obvious change in her serum electrolyte, serum creatinine, and haemoglobin levels, and in body temperature. An examination on nervous system revealed no positive signs. A head CT scan displayed new and old cerebral infarctions. Cinepazide was given and the dose of acyclovir was reduced to 500 mg once daily. However. the patient＇ s disturbance of consciousness continued to worsen. After withdrawal of acyclovir and dialysis therapy for 3 successive days, the patient regaiued normal consciousness rapidly.