Guilhem I, Charasse C, Gary J, Gie S, Rivalan J, Le Pogamp P, Beneton C, Lokiec F
Service de Néphrologie, CHU de Rennes, France.
Nephrologie. 1991;12(5):241-3.
We report a case of reversible myoclonic encephalopathy which appeared after intravenous acyclovir treatment in a patient in CAPD for which pharmacological dosages have been made in serum, peritoneal dialysate and cerebrospinal fluid (CSF). Encephalopathy appeared after two intravenous doses of 7.33 mg/kg (doses higher than recommended), administered on admission and 16 hours later. Pharmacological dosages indicated that acyclovir peritoneal clearance was negligible, and that acyclovir persisted a long time in plasma and CSF. Neurological symptoms persisted although serum concentrations returned to normal value. The diagnostic value of pharmacological dosages in serum and CSF is discussed. In addition, neurological symptoms disappeared following two consecutive hemodialysis procedures. Hence we suggest that hemodialysis could be used for drug removal in case of acyclovir overdose in CAPD patients.
我们报告了一例可逆性肌阵挛性脑病病例，该病例出现在一名持续性非卧床腹膜透析（CAPD）患者静脉注射阿昔洛韦治疗后，已对其血清、腹膜透析液和脑脊液（CSF）中的药物剂量进行了测定。在入院时及16小时后静脉注射了两剂7.33mg/kg（高于推荐剂量）的阿昔洛韦后，脑病出现。药物剂量测定表明阿昔洛韦的腹膜清除率可忽略不计，且阿昔洛韦在血浆和脑脊液中持续存在很长时间。尽管血清浓度恢复到正常值，但神经症状仍持续存在。讨论了血清和脑脊液中药物剂量测定的诊断价值。此外，连续两次血液透析治疗后神经症状消失。因此，我们建议在CAPD患者阿昔洛韦过量的情况下，血液透析可用于药物清除。
