Leikin J B, Shicker L, Orlowski J, Blair A T, McAllister K
Emergency Services, Rush Poison Control Center, Rush Presbyterian St Luke's Medical Center, Chicago, Illinois 60612, USA.
Vet Hum Toxicol. 1995 Jun;37(3):233-4.
A 59-y-old with a history of chronic renal failure on hemodialysis was diagnosed with herpes zoster and begun on 800 mg acyclovir 5 times daily. Two days later the patient developed visual hallucinations, ataxia, confusion and memory loss along with focal myoclonus, nausea and vomiting. No fever, elevated WBC count or significant electrolyte imbalance was found. CT scan of the brain was unremarkable. The patient was then dialyzed for presumed acyclovir toxicity. Her acyclovir level was later found to have been 3.4 micrograms/ml (normal peak range 0.4-2 micrograms/ml) prior to dialysis. After 3 h of hemodialysis, her post-dialysis acyclovir level was 1.9 micrograms/ml. After a second course of hemodialysis the next day the patient's mental status improved, and she was discharged 5 d later. Due to its low volume of distribution (0.6 L/kg), low protein binding (about 15%) and water solubility, acyclovir is an example of the ideal drug that can be removed by hemodialysis. About 45% of the total body amount can be extracted through a 3-h course of hemodialysis with resultant improvement in symptoms.
一名59岁有慢性肾衰竭且正在接受血液透析治疗的患者被诊断为带状疱疹，并开始每日5次服用800毫克阿昔洛韦。两天后，患者出现视幻觉、共济失调、意识模糊和记忆丧失，伴有局灶性肌阵挛、恶心和呕吐。未发现发热、白细胞计数升高或明显的电解质失衡。脑部CT扫描无异常。随后该患者因推测的阿昔洛韦毒性接受透析治疗。后来发现其透析前阿昔洛韦水平为3.4微克/毫升（正常峰值范围为0.4 - 2微克/毫升）。经过3小时的血液透析后，其透析后阿昔洛韦水平为1.9微克/毫升。次日经过第二个血液透析疗程后，患者的精神状态有所改善，5天后出院。由于阿昔洛韦分布容积低（0.6升/千克）、蛋白结合率低（约15%）且具有水溶性，它是可通过血液透析清除的理想药物的一个例子。通过3小时的血液透析疗程可清除约45%的全身药量，症状随之改善。
