单次超剂量静脉滴注阿莫西林克拉维酸钾致急性肾损伤2例

Acute kidney injury due to single time overdosage intravenous infusion of amoxicillin and clavulanate potassium：report of 2 cases

2例女性患者（年龄分别为42和33岁）分别因子宫腺肌症和子宫肌瘤入院手术治疗，均无肾病史，分别于第2和第4次静脉滴注阿莫西林克拉维酸钾2.4 g 后出现恶心、呕吐、血尿、尿量减少、轻度水肿等症状，实验室检查示 Scr 和 BUN 异常（例1：Scr 423μmol/ L，BUN 7.2 mmol/ L；例2：Scr 443μmol/ L，BUN 6.8 mmol/ L）。2例患者均立即停用阿莫西林克拉维酸钾，接受止吐、止血、利尿和补液等对症治疗，并分别于用药后第5和第3天转外院肾内科进行血液透析。2例患者的尿量、Scr和 BUN 分别于转院后第18和第20天恢复正常（例1：Scr 49μmol/ L，BUN 4.1 mmol/ L；例2：Scr 55μmol/ L，BUN 5.1 mmol/ L）。

Two female patients who aged 42 and 33 years with adenomyosis and hysteromyoma, respectively were hospitalized for surgical treatment. They had not history of kidney disease. They developed the symptoms of nausea,vomit,hematuresis,hypourocrinia,and slight puffy swelling after the second and fourth times of IV infusion of amoxicillin and clavulanate potassium 2. 4 g,respectively. Laboratory examination showed the increase of serum creatinine（ Scr）and urea nitrogen（ BUN）（ case 1：Scr 423μmol/ L,BUN 7. 2 mmol/ L;case 2：Scr 443 μmol/ L,BUN 6. 8 mmol/ L）. Amoxicillin and clavulanate potassium were stopped to use in both patients immediately and symptomatic treatments which included those for relieving vomiting,hemostasis,diuresis,and fluid infusion were given to them. The two patients were transferred to another hospital＇ s nephrology department for hemodialysis on day 5 and 3 of receiving amoxicillin and clavulanate potassium,respectively. The two patients＇ urine volume,levels of Scr and BUN were returned to normal on day 18 and 20 after transferring,respectively（case 1：Scr 49 μmol/ L,BUN 4. 1 mmol/ L;case 2：Scr 55 μmol/ L,BUN 5. 1mmol/ L）.