超剂量应用头孢唑肟钠致溶血性贫血死亡

Fatal hemolytic anemia induced by overdose of ceftizoxime sodium

1例76岁男性患者因支气管肺炎给予头孢唑肟钠2 g静脉滴注、2次/d,用药前WBC 10.8×109/L,中性粒细胞0.94,RBC 3.8×1012/L,Hb 121 g/L,TBil 12.6 μmol/L,IBil 8.7 μmol/L,Scr 151 μmol/L,BUN 10.7 mmol/L,内生肌酐清除率35 ml/min.第11天输注第22剂头孢唑肟钠约10 min时,患者出现腰痛、膀胱胀痛和皮肤、巩膜黄染.立即停止输注该药,导尿管引流出酱油色尿液约200 ml.实验室检查示WBC 15.7×109/L,中性粒细胞0.68,RBC 1.1×1012/L,Hb 73 g/L,网织红细胞0.023,TBil 83.8 μmol/L,IBil 61.8 μmol/L,Scr 127 μmol/L,BUN 11.9 mmol/L,D-二聚体9.8 mg/L,直接抗人球蛋白试验阳性;尿胆红素（＋＋）,潜血（＋＋）,镜检红细胞2~3个/HP.给予水化、碱化尿液和输注甲泼尼龙、洗涤红细胞等治疗,但患者尿量持续减少,黄疸加深,约8 h后抢救无效死亡.考虑急性溶血性贫血为超剂量应用头孢唑肟钠所致.

A 76-year-old man with bronchopneumonia received an IV infusion of ceftizoxime sodium 2 g twice daily.Before treatment, laboratory tests showed the following results： white blood cell count （WBC） 10.8×109/L, neutrophil 0.94, red blood cell count （RBC） 3.8×1012/L, hemoglobin （Hb） 121 g/L, total bilirubin （TBil） 12.6 μmol/L, indirect bilirubin （IBil） 8.7 μmol/L, serum creatinine （Scr） 151 μmol/L, blood urea nitrogen （BUN） 10.7 mmol/L, endogenous creatinine clearance rate 35 ml/min.On day 11, about 10 minutes after beginning infusion of the 22nd dosage of ceftizoxime, he developed low back pain with bladder distending pain and yellowish skin and sclera.Ceftizoxime sodium was withdrawn immediately.Urethral catheter drained soy sauce-colored urine 200 ml.Laboratory tests revealed the following results： WBC 15.7×109/L, neutrophil 0.68, RBC 1.1×1012/L, Hb 73 g/L, reticulocytes 0.023, TBil 83.8 μmol/L, IBil 61.8 μmol/L, Scr 127 μmol/L, BUN 11.9 mmol/L, D-dimer 9.8 mg/L, direct Coomb′s test positive, urine bilirubin （＋＋）, occult blood （＋＋）, 2-3 red blood cells per high power field.He received treatments such as hydration and urinary alkalinization, infusion of methylprednisolone, transfusion of washed red blood cells and etc.However, he had sustained low urine output, progressive jaundice, and finally died 8 hours later.Acute hemolytic anemia was considered to be induced by overdose of ceftizoxime sodium.