Department of Pharmacy, Rush University Medical Center, Chicago, IL, USA.
J Pharm Pract. 2020 Apr;33(2):222-225. doi: 10.1177/0897190018782787. Epub 2018 Jun 18.
Adverse effects of linezolid are typically limited to diarrhea, nausea, and headache when shorter durations are used; however, as extended durations of linezolid therapy are increasingly more common, additional monitoring parameters should be considered in these patients. We describe a unique case of hypoglycemia, lactic acidosis, and pancreatitis related to an extended duration of linezolid therapy. A 52-year-old woman presented with altered mental status, abdominal pain, and hypotension following six weeks of linezolid and ertapenem therapy. Laboratory data revealed an initial blood glucose of 40 mg/dL and metabolic acidosis secondary to lactic acidosis. Finally, her abdominal pain on admission was likely related to an enlarged pancreas noted on computed tomography of her abdomen. Due to suspected linezolid toxicity, the patient received two intermittent hemodialysis sessions to remove linezolid and correct the metabolic acidosis. Given limited data on long-term monitoring of patients receiving extended durations of linezolid therapy, we suggest periodic monitoring of lactate, arterial blood gas, and blood glucose. If patients present with this triad of symptoms secondary to linezolid therapy, adverse effects should be treated with dextrose and intravenous thiamine while reserving hemodialysis for those with metabolic acidosis refractory to thiamine.
利奈唑胺的不良反应通常仅限于腹泻、恶心和头痛，如果使用较短的疗程；然而，随着利奈唑胺治疗的延长越来越常见，应考虑这些患者的其他监测参数。我们描述了一例与利奈唑胺延长治疗时间相关的低血糖、乳酸性酸中毒和胰腺炎的独特病例。一名 52 岁女性在接受利奈唑胺和厄他培南治疗六周后出现精神状态改变、腹痛和低血压。实验室数据显示初始血糖为 40mg/dL，代谢性酸中毒继发于乳酸性酸中毒。最后，她入院时的腹痛可能与腹部计算机断层扫描显示的胰腺肿大有关。由于疑似利奈唑胺毒性，患者接受了两次间歇性血液透析以去除利奈唑胺并纠正代谢性酸中毒。鉴于接受利奈唑胺延长治疗的患者长期监测数据有限，我们建议定期监测乳酸、动脉血气和血糖。如果患者因利奈唑胺治疗而出现三联征症状，应使用葡萄糖和静脉注射硫胺素治疗不良反应，同时对代谢性酸中毒不耐受硫胺素的患者保留血液透析。
