请选择 进入手机版 | 继续访问电脑版
设为首页收藏本站

老西部英语

 找回密码
 立即注册

只需一步,快速开始

[大学生论坛]:阿莫西林结晶尿

15

主题

15

资源

66

积分

注册会员

Rank: 2

积分
66
萨摩耶 发表于 2017-12-31 12:30:40 | 显示全部楼层 |阅读模式
阿莫西林结晶尿

Macroscopic amoxicillin crystalluria


2013年9月,一62岁女性因发热、关节疼痛和呼吸困难6 d来我院就诊。患者除高血压和吸烟外,无其他病史。入院时肾小球滤过率为82 ml/ (min·1.73 m2) [正常范围≥90 ml/(min·1.73 m2)],血培养发现无乳链球菌,并由经食管超声心动图快速诊断为急性主动脉感染性心内膜炎。立即予患者大剂量阿莫西林[200 mg/ (kg·d)]与庆大霉素(每天1次,每次200 mg)静脉滴注。4 d后,患者出现尿液混浊伴细小颗粒状物(附图)。尿常规检查显示尿液pH为5.5,直接镜检证实为阿莫西林结晶尿, 可见大量针状结晶典型聚集, 在偏振光显微镜下呈双折射(附图)。24 h内患者病情急剧恶化,出现少尿、急性肾衰竭及肺水肿。再次行超声心动图检查显示为明显的主动脉瓣环脓肿。行紧急瓣膜置换术和肾脏替代疗法后,患者恢复良好,于2013年10月出院,之后未再接受肾脏替代疗法,肾功能恢复良好。2014年3月,最后一次检查时肾小球滤过率为45 ml/(min·1.73 m2)。2014年9月最后一次随访时,患者无任何症状。

In September 2013, a 62 - year - old woman with fever, joint pain and breathing difficulties 6 d to our hospital.Patients in addition to high blood pressure and smoking, no other medical history.On glomerular filtration rate of 82 ml/min (1.73 m2) [normal range or 90 ml/min (1.73 m2)], blood culture showed no milk streptococcus, and by the rapid diagnosis of acute aortic transesophageal echocardiography (tee) infective endocarditis.Immediately in the patients with high-dose amoxicillin (200 mg/(kg · d)] and gentamicin (200 mg) 1 times a day, every time an intravenous drip.After 4 d, patients with turbid urine with tiny particles (chart).Routine urine examination showed urine pH 5.5, direct microscopy confirmed to amoxicillin crystallization urine, visible typical gathered a large number of acicular crystal, under polarized light microscope in birefringence (chart).With a sharp deterioration in patients within 24 h, oliguria, acute renal failure and pulmonary edema.Line again echocardiography displayed as obvious aortic ring abscess.Line after emergency valve replacement and renal replacement therapy, the patient recovered well, hospital in October 2013, after not receiving renal replacement therapy, renal function recovered well.In March 2014, the last time to check the glomerular filtration rate for 45 ml/min (1.73 m2).In September 2014 at the time of last follow-up, patients without any symptoms.



阿莫西林能够引起结晶尿广为人知,但阿莫西林结晶尿发病率仍不明确。阿莫西林结晶尿通常由大剂量阿莫西林治疗引起,尿pH低且比重高(主要原因为液体摄入量不足)。显微镜或肉眼观均可发现阿莫西林结晶尿。在有相关用药史的背景下,典型的镜下表现即可诊断阿莫西林结晶尿,但如有必要,这些晶体中的阿莫西林成分可以采用红外线分光技术证实。阿莫西林结晶尿可以没有症状,也可以是肾小管内沉积及尿路梗阻导致的血尿症或肾衰竭的原因。本例患者的急性肾衰竭由多种原因导致,但我们推测阿莫西林结晶尿在其中起到部分作用。

静脉滴注高剂量阿莫西林的处方在全球十分常见,因此医生应警惕阿莫西林治疗的并发症——结晶尿,碱化尿液和增加补液量或许可以预防结晶尿。

Amoxicillin can cause crystallization urine is well known, but the incidence of amoxicillin crystallization urine is still not clear.Amoxicillin crystallization urine is usually caused by high-dose amoxicillin therapy, urine pH lower and the proportion of high (the main reason for the lack of fluid intake).Microscope or naked eye view all can find amoxicillin crystallization urine.Under the background of relevant medical history, performance under typical mirror can diagnose amoxicillin crystallization urine, but if necessary, these crystals in amoxicillin composition can be confirmed by infrared spectroscopy technology.Amoxicillin crystallization urine can be asymptomatic, may also be the malpighian tube sedimentation and hematuria caused by urinary tract obstruction or kidney failure.The patients of acute renal failure caused by a variety of reasons, but we suspect that amoxicillin crystalluria play a part in it.

Intravenous drip of high-dose amoxicillin prescriptions is especially popular in the whole world, so the doctor should be wary of amoxicillin for complications - crystallization urine, alkalize urine and increase rehydration may prevent crystallization urine.





2014级单梦妍3141204005


友荐云推荐
评论

使用道具 举报


QQ|关于我们|联系我们|网络条款|建议反馈|小黑屋|老西部英语 ( 版权所有 粤ICP备11103350号  

GMT+8, 2018-12-17 07:00 , Processed in 0.337536 second(s), 39 queries .

Powered by Discuz! X3

© 2001-2013 Comsenz Inc.