注射用阿昔洛韦致透析患者脑病1例

One case of encephalopathy caused by acyclovir injection in a dialysis patient

1例59岁男性患者,因“发现血糖升高14年,血肌酐升高7年,规律腹膜透析3年,腹膜透析联合血液透析1年,出现幻觉1d”入院。患者3年前诊断为慢性肾脏病5期,行规律腹膜透析,1年前改为腹膜透析联合血液透析治疗。5d前无明显诱因出现右侧下肢“带状疱疹”,就诊于当地医院予注射用阿昔洛韦(2g,q24h)治疗3d后,患者出现幻觉,症状持续1d后入我院治疗。既往无癫痫等精神神经系统病史。急检指标与前无特殊改变,头颅CT无明显异常。药师考虑该患者的脑病症状可能是注射用阿昔洛韦所致,建议停用阿昔洛韦,加强血液透析治疗,8d后患者幻觉消失,病情好转出院。

A 59-year-old male patient was admitted to the hospital due to 14 years of elevated blood glucose,7 years of elevated serum creatinine,3 years of regular peritoneal dialysis,1 year of peritoneal dialysis combined with hemodialysis,and 1 day of hallucination.He was diagnosed with stage 5 chronic kidney disease 3 years ago and received regular peritoneal dialysis which was changed to peritoneal dialysis combined with hemodialysis one year ago.5 days ago,he developed herpes zoster in the right lower extremity without obvious cause and was given acyclovir injection(2 g,q 24 h)in local hospital.After 3 days,he developed hallucination and was admitted into our hospital for treatment after 1 day of symptoms.He had no past medical history of psychiatric nervous system such as epilepsy.Results of emergency lab test showed no obvious changes than before and brain CT scan was normal.Encephalopathy caused by acyclovir injection was considered and it was suggested by pharmacist to stop acyclovir injection and enhance hemodialysis.8 days later,hallucination disappeared and he was discharged with improved condition.