Antituberculosis Drug Overdose-Induced Multiple Organ Failure: A Case Report and Literature Review

抗結合藥物過量引起之多重器官衰竭：病例報告及文獻回顧

胡漢忠(Han-Chung Hu) ； 林昌生(Chang-Sheng Lin) ； 曹昌堯(Thomas C.Y. Tsao) ； 蔡熒煌(Ying-Huang Tsai) ； 謝孟哲(Meng-Jer Hsieh)

《胸腔醫學》 18卷1期 (2003/02) Pp. 64-68

摘要

肺結核的感染率在最近幾年又有增加的趨勢，一般傳統上，治療肺結核多採用多重藥物合併給予至少六個月的模式，以達到足夠的治療。 臨床上，最常合併使用之藥物為 isoniazid，rifampin，pyrazinamide，ethambutol和streptomycin。各種藥物有各自的副作用，一般都相當輕微而安全，常見者如噁心、嘔吐、似感冒症狀、皮膚癢或視神經炎。但偶爾也有嚴重的副作用，甚至服用過量而致死的案例發生。我們報告一例老先生，因服用過量的isoniazid，rifampin和ethambutol 而造成急性腎衰竭，代謝性酸中毒，高血鉀症和血小板低下症。在支持性療法下，病人的血小板和腎功能確實逐步改善；同時我們也回顧了抗結核藥各自之副作用及合併使用後曾因過量所引起的後遺症，以做為臨床使用之參考。

關鍵字

結核病 ； 急性腎衰竭 ； 血小板低下症

並列摘要

The treatment of tuberculosis (TB) requires a more than six months’ multi-drug regimen of antituberculosis agents. The first-line antituberculosis drugs are isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA), ethambutol (EMB), and streptomycin (SM). Common side effects of antituberculosis drugs include nausea, vomiting, flu-like syndrome, pruritis, optic neuritis, and an elevated level of hepatic transaminases. These side effects are usually mild and reversible if the patients are monitored carefully and managed properly. Occasionally serious or fatal adverse effects have been reported. We report a male patient who developed acute renal failure, hyperkalemia, respiratory failure, metabolic acidosis, and thrombocytopenia after taking a large dose of isoniazid, rifampicin and ethambutol. The multiple organ failure improved with supportive care, but the patient expired 28 days later due to nosocomial pneumonia. The literature regarding drug overdose and multiple organ failure is also reviewed.

並列關鍵字

tuberculosis ； acute renal failure ； thrombocytopenia