RESUMO
For vancomycin therapy of severe infections, the Infectious Diseases Society of America recommends high vancomycin trough levels, whose potential for inducing nephrotoxicity is controversial. We evaluated the incidence and risk factors of acute kidney injury (AKI) in critically ill patients given continuous intravenous vancomycin with target serum vancomycin levels of 20 to 30âmg/L.We retrospectively studied 107 continuous intravenous vancomycin treatments of ≥48 hours' duration with at least 2 serum vancomycin levels ≥20âmg/L in critically ill patients. Nephrotoxicity was defined according to the Kidney Disease Improving Global Outcomes Clinical Practice Guideline for AKI (ie, serum creatinine elevation by ≥26.5âµmoL/L or to ≥1.5 times baseline). Risk factors for AKI were identified by univariate and multivariate analyses.AKI developed in 31 (29%) courses. Higher serum vancomycin levels were associated with AKI (Pâ<â0.01). Factors independently associated with AKI were highest serum vancomycin ≥40âmg/L (odds ratio [OR], 3.75; 95% confidence interval [CI], 1.40-10.37; Pâ<â0.01), higher cumulative number of organ failures (OR, 2.63 95%CI, 1.42-5.31; Pâ<â0.01), and cirrhosis of the liver (OR, 5.58; 95%CI, 1.08-31.59; Pâ=â0.04).In this study, 29% of critically ill patients had AKI develop during continuous intravenous vancomycin therapy targeting serum levels of 20 to 30âmg/L. Serum vancomycin level ≥40âmg/L was independently associated with AKI.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Antibacterianos/efeitos adversos , Vancomicina/efeitos adversos , Injúria Renal Aguda/epidemiologia , Idoso , Antibacterianos/administração & dosagem , Estado Terminal , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Vancomicina/administração & dosagemRESUMO
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) has well-established links with several drugs. Whether a link also exists with serotonin-norepinephrine reuptake inhibitor such as duloxetine is unclear. METHODS: We report on a patient who developed PRES with a coma and myoclonus related to hypertensive encephalopathy a few days after starting duloxetine treatment. Magnetic resonance imaging was performed and catecholamine metabolites assayed. RESULTS: The patient achieved a full recovery after aggressive antihypertensive therapy and intravenous anticonvulsant therapy. CONCLUSIONS: The clinical history, blood and urinary catecholamine and serotonin levels, and response to treatment strongly suggest that PRES was induced by duloxetine. Duloxetine should be added to the list of causes of PRES.
Assuntos
Antidepressivos/efeitos adversos , Cloridrato de Duloxetina/efeitos adversos , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Idoso de 80 Anos ou mais , Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Feminino , Humanos , Neuroimagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Reanimação Cardiopulmonar , Parada Cardíaca/terapia , Estado Epiléptico/tratamento farmacológico , Ácido Valproico/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Parada Cardíaca/complicações , Parada Cardíaca/diagnóstico , Mortalidade Hospitalar/tendências , Humanos , Hipóxia/complicações , Hipóxia/diagnóstico , Infusões Intravenosas , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estado Epiléptico/etiologia , Estado Epiléptico/mortalidade , Análise de Sobrevida , Sobreviventes , Resultado do TratamentoRESUMO
BACKGROUND: Alcoholic hand rubs (AHRs) have been proven effective in preventing nosocomial infections, and healthcare authorities include AHRs use among quality-of-care criteria. Since the onset of the influenza A (H1N1) pandemic, AHRs have gained considerable popularity among the general public. METHODS: We report a case of intentional AHRs self-poisoning inducing rapid coma with hyperlactatemia, and a full recovery. The relevant literature was reviewed. To our knowledge, this is the third reported case of intentional AHRs poisoning. 3 patients presented with a picture of acute alcohol intoxication, of variable severity depending on the amount ingested and speed of ingestion. RESULTS: The blood alcohol level was 414 mg/dl and tests for other drugs were performed 30 min after admission. The blood lactate level increased briefly to 4.8 mmol/l, without renal or hepatic function disturbances. She regained consciousness after 6 h then achieved a full recovery allowing extubation and readmission to the psychiatric ward after 24 h. She reported gulping down the entire contents of the Aniosgel bottle. CONCLUSION: Whereas overdrinking in social settings (wine and liquor) leads to a gradual increase in blood alcohol levels, AHRs poisoning is usually characterized by a sudden massive alcohol load. The unusual nature of the alcohol source may lead to diagnostic wanderings. AHRs are currently available in bottles that facilitate the ingestion of large amounts. Unit-dose packaging or dispensing might decrease the risk of AHRs poisoning.