小剂量甲氨蝶呤用药错误致慢性肾功能不全患者严重多系统损伤的药学监护一例

Pharmaceutical care of a chronic renal insufficiency patient with severe multisystem damage caused by medication error with low-dose methotrexate

本文报道1例既往确诊为结节病并伴有慢性肾功能不全的61岁女性患者,在错误服用甲氨蝶呤2.5 mg每日1次后,引起严重口腔溃疡、严重皮疹、急性肾损伤及重度骨髓抑制。入院后临床药师协助医师制订个体化给药方案并进行药学监护,停用甲氨蝶呤,予叶酸进行解毒,碱化尿液促进甲氨蝶呤排泄,同时针对各不良反应进行对症处理,患者好转后出院。

This article reports a case of a 61-year-old female patient with a previous diagnosis of sarcoidosis and chronic renal disease who developed severe oral ulcers,severe rash,acute kidney injury,and severe myelosuppression after mistakenly taking methotrexate at 2.5 mg once daily.After hospitalization,the clinical pharmacist assisted the physician develop an individualized dosing regimen and provided pharmaceutical care,which included discontinuing methotrexate,administering folic acid for detoxification,alkalinizing the urine to promote methotrexate excretion,and symptomatic treatment for each adverse reaction.The patient improved and was discharged from the hospital.