1/5. Possible gatifloxacin-induced hyperglycemia.OBJECTIVE: To report a case of possible gatifloxacin-induced hyperglycemia in a nondiabetic middle-aged woman. CASE SUMMARY: A 64-year-old Indian woman with an extensive cardiovascular history was admitted for urosepsis. On admission, her blood glucose was 117 mg/dL. She was empirically started on gatifloxacin 400 mg/day; after 3 days of gatifloxacin therapy, her blood glucose was 607 mg/dL. On day 4, therapy was changed to cefazolin for sensitive escherichia coli and her blood glucose levels began to return to normal. DISCUSSION: Although gatifloxacin has been previously reported as a potential cause of both hyper- and hypoglycemia, the exact mechanism is unknown. Several factors that may have been involved in our patient's hyperglycemia are discussed. She experienced hyperglycemic changes more rapidly than did the typical patients of previous reports. The Naranjo probability scale suggests a possible drug-related event. CONCLUSIONS: The temporal relationship between gatifloxacin administration and the patient's hyperglycemia suggests an iatrogenic cause. Based on our experience and the product labeling, clinicians should be more aware of the blood glucose-altering effects of gatifloxacin.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
2/5. phenazopyridine-induced sulfhemoglobinemia.OBJECTIVE: To report a case of sulfhemoglobinemia in a patient receiving phenazopyridine for a urinary tract infection. CASE SUMMARY: A 63-year-old white woman presented to the emergency department with complaints of fatigue and bluish discoloration of her body that had gradually progressed over the previous 6-8 weeks. About 4 months prior to presenting to the emergency department, she had started taking phenazopyridine, an over-the-counter medication for symptoms of dysuria. Because the cyanosis did not improve after the patient received oxygen and methylene blue, sulfhemoglobinemia was suspected and confirmed by spectrophotometer analysis. DISCUSSION: Sulfhemoglobin is a green-pigmented molecule containing a sulfur atom in one or more of the porphyrin rings. It is a rare cause of cyanosis, which is usually drug induced. sulfhemoglobinemia is suspected when a cyanotic patient has normal to near-normal oxygen tension, laboratory reports of elevated methemoglobin, and does not respond to methylene blue therapy. sulfhemoglobinemia is relatively rare, despite the widespread use of drugs that have been reported to cause it. Predisposing factors, such as chronic constipation, present in our patient, have been suggested as a source of hydrogen sulfide. CONCLUSIONS: This case of sulfhemoglobinemia, which occurred after the patient took phenazopyridine, is considered a probable adverse event according to the Naranjo probability scale.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
3/5. Evaluating dysuria in adolescent females.adolescent females presenting with acute dysuria in primary care settings are often assumed to have urinary tract infections and are evaluated accordingly. dysuria, with or without a change in vaginal discharge, is also often associated with sexually transmitted infections, usually urethritis, even when the patient does not report a history of sexual activity. An adolescent female with dysuria, an abnormal urinalysis, and a negative urine culture has a high probability of having a sexually transmitted infection. Although providers who treat adolescents should not assume all of their patients are sexually active, it is essential that they ask questions about their patients' past and present sexual activity and consider the possibility of sexually transmitted diseases in young women presenting with this symptom.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
4/5. Hypotonia during amikacin administration in a patient treated with continuous ambulatory peritoneal dialysis.In this report we present the history of a patient treated with continuous ambulatory peritoneal dialysis (CAPD) in whom episodes of hypotonia can be related to the administration of amikacin, an antibiotic from the aminoglycosides group. The 68-year-old female patient was admitted for initiation of renal replacement therapy with CAPD. Her renal failure was probably attributable to hypertension. Three days after catheter implantation, the patient reported dysuric symptoms, and a urine culture showed significant growth of escherichia coli. amikacin 250 mg and cefazolin 1.0 g were administered intravenously once daily in accordance with the antibiogram. On the third day of antibiotic administration, the patient fainted, showing an arterial blood pressure of 90/60 mmHg. On the subsequent 2 days, decreases of postural arterial blood pressure to between 90/60 mmHg and 80/50 mmHg were reported two or three times daily. The patient was treated with antibiotics for the next 6 days and felt very bad the entire time, with an arterial blood pressure of 80/50 mmHg. The patient's condition improved 2 days after discontinuation of treatment with antibiotics, and episodes of hypotonia stopped. The decrease in the arterial blood pressure observed in our patient during intravenous administration of amikacin can, with a high probability, be related to the calcimimetic activity of this aminoglycoside and the resulting inhibition of parathyroid secretion.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
5/5. tongue discoloration in an elderly kidney transplant recipient: Treatment-related adverse event?BACKGROUND: With the increased occurrence of methicillin-resistant staphylococcus aureus infections, linezolid treatment might be administered more often. New rare adverse events are likely to follow. CASE SUMMARY: A 65-year-old man (weight, 91 kg; height, 185 cm) presented to the emergency department at the University of virginia-affiliated Salem veterans Affairs Medical Center, Salem, virginia, after a recent (8 weeks) kidney transplantation with a 24-hour history of fatigue, chills, arthralgias, increased urinary frequency, and onset of tongue discoloration. Two days before admission, he completed a 14-day course of linezolid 600 mg PO BID for ampicillin-resistant enterococcal urinary tract infection. He was afebrile on admission and the dorsal aspect of his tongue was blackened centrally, browner peripherally, with normal pink mucosa on the periphery. Based on the Naranjo probability scale, the calculated score for tongue discoloration as a drug-related adverse event was 7 out of a maximum score of 13 points, designating it as a probable cause. The patient's tongue discoloration improved moderately during the hospital stay and resolved 6 months after the discontinuation of linezolid. CONCLUSIONS: We report a rare association of linezolid and tongue discoloration in an elderly kidney transplant recipient that improved with discontinuation. We present this case to increase clinicians' awareness of the potential adverse event.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |