伐昔洛韦片致血液透析患者脑病1例

Encephalopathy caused by valaciclovir tablets in a hemodialysis patient

1例83岁女性患者,因“规律血液透析9年半,咳嗽、咳痰3d”入院。既往无癫痫等精神系统及神经系统病史,平时规律血透,1周3次。入院后因带状疱疹应用喷昔洛韦注射液(250mg,qd)及伐昔洛韦片(300mg,bid)。应用3d后患者突发意识不清,胡言乱语,肢体震颤,急检指标与前无特殊改变,头颅CT无明显异常。药师考虑为伐昔洛韦片导致的脑病症状,建议停用伐昔洛韦片,并加强血液透析,未停用喷昔洛韦等其他药物,医师采纳药师建议。加强血液透析4d后患者神志转清,肢体震颤消失,好转出院。

One 83-year-old female patient was hospitalized due to regular hemodialysis (3 times per week) for 9 and a half years, cough and expectoration for 3 days. The patient had no previous history of nervous system disease including epilepsy. Penciclovir injection (250 mg, qd) and valaciclovir tablets (300 mg, bid) were given to the patient for herpes zoster after admission. Three days later, the patient suddenly developed unconsciousness, babbing, limbs tremor. There was no special changes in the emergency lab tests indexes and head CT scan. Considering that the symptoms of encephalopathy was might caused by valaciclovir tablets, the pharmacist suggested stopping valaciclovir tablets and strengthening hemodialysis. After 4 days, the patient's consciousness was clear, limb tremors disappeared, and the patient was discharged after improvement.