Burke Douglas, Lal Rajiv, Finkel Kevin W, Samuels Joshua, Foringer John R
Division of Renal Diseases and Hypertension, The University of Texas Medical School, Houston, TX 77030-0708, USA.
Ann Pharmacother. 2006 Dec;40(12):2254-9. doi: 10.1345/aph.1H157. Epub 2006 Nov 7.
To report the clinical course of a woman with cryptococcal meningitis and no previous cardiac disease who developed a fatal cardiac arrhythmia after an acute overdose of amphotericin B and to review its toxicity.
A 41-year-old woman with a history of proliferative glomerulonephritis from systemic lupus erythematosus was admitted with a diagnosis of cryptococcal meningitis. Liposomal amphotericin B was prescribed at the standard dose of 5 mg/kg/day; however, amphotericin B deoxycholate 5 mg/kg was inadvertently administered (usual dose of the deoxycholate formulation is 0.5-0.8 mg/kg/day). The patient developed cardiac arrhythmias, acute renal failure, and anemia. The medication error was noticed after she had received 2 doses of amphotericin B deoxycholate, and it was then discontinued. Despite treatment in the intensive care unit, the woman died on the sixth day after admission.
Amphotericin B deoxycholate has been reported to produce significant cardiac toxicity, with ventricular arrhythmias and bradycardia reported in overdoses in children and in adults with preexisting cardiac disease, even when administered in conventional dosages and infusion rates. Use of the Naranjo probability scale indicated a highly probable relationship between the observed cardiac toxicity and amphotericin B deoxycholate therapy in this patient.
Given the fulminant course of amphotericin B deoxycholate overdosage and lack of effective therapy, stringent safeguards against its improper administration should be in place.
报告一名既往无心脏病史的女性隐球菌性脑膜炎患者在急性过量使用两性霉素B后发生致命性心律失常的临床过程，并回顾其毒性。
一名41岁患有系统性红斑狼疮所致增殖性肾小球肾炎的女性因隐球菌性脑膜炎入院。脂质体两性霉素B按标准剂量5mg/kg/天给药；然而，意外给予了5mg/kg的去氧胆酸盐两性霉素B（去氧胆酸盐制剂的常用剂量为0.5 - 0.8mg/kg/天）。患者出现心律失常、急性肾衰竭和贫血。在她接受了2剂去氧胆酸盐两性霉素B后发现用药错误，随后停药。尽管在重症监护病房进行了治疗，该女性在入院后第六天死亡。
据报道，去氧胆酸盐两性霉素B会产生显著的心脏毒性，儿童和已有心脏病的成人在过量用药时会出现室性心律失常和心动过缓，即使按常规剂量和输注速率给药也是如此。使用Naranjo概率量表表明，该患者观察到的心脏毒性与去氧胆酸盐两性霉素B治疗之间存在高度可能的关联。
鉴于去氧胆酸盐两性霉素B过量使用的暴发性病程以及缺乏有效治疗方法，应制定严格措施防止其不当给药。
