Rocky Mountain Poison and Drug Center, Denver Health and Hospital, Denver, CO, USA.
Ann Pharmacother. 2013 Feb;47(2):e9. doi: 10.1345/aph.1R527. Epub 2013 Jan 29.
To report a case of accidental amphotericin B overdose that was treated with plasmapheresis.
A 60-year-old woman with a history of kidney transplant 4 years prior to presentation for a congenital abnormality was admitted for a suspected systemic fungal infection. The patient inadvertently received intravenous amphotericin B deoxycholate 250 mg (4.3 mg/kg) over 2 hours instead of prescribed liposomal amphotericin B. The medication error was discovered 16 hours after administration. She had normal vital signs at that time and reported abdominal pain and general malaise. Results of a metabolic panel were significant for a creatinine level of 2.1 mg/dL and CO₂ of 17 mg/dL. Her serum amphotericin B concentration 33 hours after the initial dose was 4.9 μg/mL. She subsequently received 5 courses of plasmapheresis and 3 courses of hemodialysis and ultimately did not develop any further renal injury, as well as hemolysis, cardiovascular collapse, dysrhythmias, or severe electrolyte abnormalities.
The dosing differences between nonliposomal and liposomal preparations of amphotericin B can be as high as 50-fold. Reported adverse events from overdose in both animal models and human case reports include renal insufficiency, hemolysis, thrombocytopenia, electrolyte abnormality, and cardiac dysrhythmias. There have been previous reports of similar errors that have led to death. Furthermore, amphotericin B has been shown to be poorly dialyzable. Our patient's serum amphotericin B concentration decreased after she received plasmapheresis, and she did not develop severe complications.
We describe a patient who survived a 4-fold overdose of amphotericin B because of a medication error. The use of plasmapheresis may have enhanced the elimination of amphotericin B and may have contributed to the positive outcome. However, the role of plasmapheresis in amphotericin overdose is not fully understood.
报告 1 例因意外使用两性霉素 B 过量而接受血浆置换治疗的病例。
1 名 60 岁女性，4 年前因先天性异常行肾移植术，因疑似全身真菌感染入院。患者在接受治疗时，不慎在 2 小时内静脉滴注两性霉素 B 脱氧胆酸盐 250mg（4.3mg/kg），而不是给予处方的脂质体两性霉素 B。用药错误在给药后 16 小时被发现。当时患者生命体征正常，主诉腹痛和全身不适。代谢组学检查结果显著异常，肌酐水平为 2.1mg/dL，二氧化碳水平为 17mg/dL。首次给药后 33 小时，患者的血清两性霉素 B 浓度为 4.9μg/mL。随后，患者接受了 5 次血浆置换和 3 次血液透析治疗，最终未发生进一步的肾损伤、溶血、心血管衰竭、心律失常或严重电解质异常。
非脂质体和脂质体制剂两性霉素 B 的剂量差异高达 50 倍。在动物模型和人类病例报告中，报道的用药过量的不良事件包括肾功能不全、溶血、血小板减少、电解质异常和心律失常。此前有报道称类似的错误导致了死亡。此外，两性霉素 B 的透析效果较差。我们的患者在接受血浆置换后，血清两性霉素 B 浓度降低，未发生严重并发症。
我们描述了 1 例因用药错误导致两性霉素 B 4 倍剂量过量的患者存活下来。使用血浆置换可能增强了两性霉素 B 的清除，有助于取得积极的治疗结果。然而，血浆置换在两性霉素 B 过量中的作用尚未完全阐明。
