静脉泵入超剂量甲氨蝶呤致异位妊娠患者急性肾损伤

Acute kidney injury due to venous pumping of overdose methotrexate in an ectopic pregnancy patient

1例36岁异位妊娠患者采用药物保守治疗。医嘱为米非司酮100 mg口服,1次/d,连续3 d;第4天甲氨蝶呤(MTX)80 mg入0.9%氯化钠注射液40 ml静脉泵入。第4天,当班护士未严格核对医嘱,误将规格为1 000 mg/瓶的MTX全部入0.9%氯化钠注射液40 ml并在30 min内静脉泵入。13 h后,患者出现恶心、呕吐、腹痛等症状。2 d后实验室检查示血清肌酐325 μmol/L,尿素氮8.6 mmol/L,尿酸501 μmol/L。考虑为急性肾衰竭,与MTX有关。患者转院并接受血液透析和对症治疗6 d后好转,12 d后复查:血清肌酐73 μmol/L,尿素氮4.1 mmol/L,尿酸363 μmol/L。

A 36-year-old female patient with ectopic pregnancy received conservative treatment with drugs.The doctor ordered oral mifepristone 100 mg once daily for 3 days and then a venous pumping of methotrexate(MTX)80 mg dissolved in 0.9%sodium chloride injection 40 ml.On the 4th day,the nurse on duty did not strictly check the doctor's orders.She mistakenly put a whole bottle of MTX(1000 mg/bottle)into 0.9%sodium chloride injection 40 ml and pumped it intravenously within 30 minutes.Thirteen hours later,the patient developed nausea,vomiting,and abdominal pain.Two days later,the laboratory tests showed serum creatinine 325μmol/L,urea nitrogen 8.6 mmol/L,and uric acid 501μmol/L.Acute kidney failure was considered,which might be related to MTX.The patient was transferred to another hospital and got better after receiving hemodialysis and symptomatic treatments for 6 days.Twelve days later,the reexamination results showed serum creatinine 73μmol/L,urea nitrogen 4.1 mmol/L,and uric acid 363μmol/L.