Gorlitsky Barry R, Herion John T
The Edward Via College of Osteopathic Medicine Internal Medicine, Nephrology.
The Edward Via College of Osteopathic Medicine.
Hemodial Int. 2017 Jul;21(3):E58-E62. doi: 10.1111/hdi.12534. Epub 2017 Jan 9.
A 60-year-old male Dialysis patient presented with altered mental status and Hypertensive Urgency. He had a significant lesion noted on his glans penis. He was treated for infection and hypertension with expectant management, without significant improvement in his mental acuity. Laboratory and radiologic workup were unrevealing for the etiology. Upon detailed review it was noted he had recently been given Acyclovir for a presumed Herpes Simplex Virus infection. He had been prescribed what is considered correct dosing for an ESRD patient. An Acyclovir level was obtained and urgent Dialysis was undertaken, presuming Acyclovir neurotoxicity may be the culprit. Initially no improvement was noted and a 2nd level and hemodialysis were undertaken. This case and review of the literature will highlight key aspects of acyclovir neurotoxicity in ESRD patients, including how to diagnose and treat, which laboratory tests to obtain and what one can expect from various dialysis modalities. We will also reveal how to dose Acyclovir to avoid toxicity and other key elements of the drug.
一名60岁男性透析患者出现精神状态改变和高血压急症。其阴茎头发现有明显病变。给予抗感染和高血压治疗，采用观察等待处理，但精神敏锐度无明显改善。实验室和影像学检查未发现病因。经详细回顾发现，他近期因疑似单纯疱疹病毒感染而服用了阿昔洛韦。给他开的剂量被认为是适合终末期肾病（ESRD）患者的正确剂量。检测了阿昔洛韦血药浓度，并进行了紧急透析，推测阿昔洛韦神经毒性可能是病因。最初未见改善，于是再次检测血药浓度并进行血液透析。本病例及文献回顾将突出ESRD患者阿昔洛韦神经毒性的关键方面，包括如何诊断和治疗、应进行哪些实验室检查以及各种透析方式的预期效果。我们还将揭示如何调整阿昔洛韦剂量以避免毒性及该药物的其他关键要素。
