血液透析病人使用抗病毒藥物過量之病例報告

Antiviral Drug Overdose in a Hemodialysis Patient: A Case Report

施妙玲(Miao-Ling Shi) ； 林慈珍(Tzu-Chen Lin)

《臺灣腎臟護理學會雜誌》 20卷1期 (2021/09) Pp. 88-96

https://doi.org/10.3966/172674042021092001007

摘要

帶狀疱疹乃是水痘病毒在免疫力不全時再度活化的疾病。發生率會隨著年齡增加而上升，口服抗病毒藥物是主要治療方式。本文為59歲男性，常規血液透析病人，因帶狀疱疹接受口服抗病毒藥物Acyclovir每次800毫克每天5次的治療，約二天後出現肢體無力、感覺異常及意識混亂等神經學症狀。經過血液透析後，症狀呈現戲劇性的改善。本文嘗試以案例說明藥物史與用藥反應之評估，於慢性腎臟病病人之重要性，期能有助於達到慢性腎臟病病人用藥安全之目的。

關鍵字

血液透析 ； 帶狀疱疹 ； Acyclovir神經毒性 ； 用藥安全

並列摘要

Herpes Zoster is a disease caused by the reactivation of the varicella-zoster virus in immunocompromised patients. The incidence of this disease increases with age, and oral antiviral drugs are the main treatment. This article discusses the case of a 59-year-old man who was undergoing routine hemodialysis and was receiving the oral antiviral drug Acyclovir (800 mg five times a day) as treatment for herpes zoster. Two days after the treatment, the patient experienced neurological symptoms, such as limb weakness, sensory abnormalities, and consciousness disturbance. After hemodialysis, the symptoms showed dramatic improvements. This article attempts to demonstrate the importance of medication history and pharmacodynamic response to drug assessment in patients with chronic kidney disease and can help achieve drug safety in patients with chronic kidney disease.

並列關鍵字

hemodialysis ； herpes zoster ； acyclovir neurotoxicity ； drug safety

參考文獻

楊昆澈、姚建安、黃國晉（2011）‧帶狀疱疹病毒疫苗‧台北醫師公會會刊，55（3），18-20。http://dx.doi.org/10.29739/JTMA.201103.0001

Al-Mula Abed, Y. W. (2015). Varicellazoster virus associated encephalitis in a patient undergoing haemodialysis. Qatar Medical Journal, 2015(2), 19. http://dx.doi.org/10.5339/qmj.2015.19

Chowdhury, M. A., Derar, N., Hasan, S., Hinch, B., Ratnam, S., & Assaly, R. (2016). Acyclovir-Induced Neurotoxicity: A Case Report and Review of Literature. American Journal of Therapeutics, 23(3), e941-943. http://dx.doi.org/10.1097/mjt.0000000000000093

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Gentry, J. L., 3rd, & Peterson, C. (2015). Death Delusions and Myoclonus: Acyclovir Toxicity. The American Journal of Medicine, 128(7), 692-694. http://dx.doi.org/10.1016/j.amjmed.2015.03.001