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Author: Zhang Yaoshi This article is published by Yimaitong authorized by the author, please do not reprint without authorization.
Introduction Cephalosporin antibiotics have many varieties, wide antibacterial range and strong antibacterial ability, so they are increasingly used in clinical practice.
However, with the increase in application, reports of adverse reactions of cephalosporin antibiotics—disulfiram-like reactions are also increasing.
In addition, some drugs such as nitroimidazoles and sulfonylureas hypoglycemic agents can also cause disulfiram-like reactions.
reaction.
In clinical work, disulfiram-like reactions are easily overlooked or misdiagnosed as other diseases such as urticaria, coronary heart disease, and have the characteristics of rapid onset, severe symptoms, and critical illness.
Therefore, clinical attention should be paid.
Disulfiram and disulfiram-like reactions Disulfiram (disulfiram) is a drug for alcohol withdrawal, chemically named tetraethylthiuram disulfide.
After taking this medicine, even if you drink a small amount of alcohol, your body will have serious discomfort, and you will achieve the goal of abstaining from alcohol.
In 1948, Jacobsen and others in Copenhagen found that disulfiram, a vulcanization catalyst for rubber, can cause facial flushing, headache, abdominal pain, sweating, palpitations, and dyspnea after being absorbed by the human body in a small amount, especially after drinking alcohol.
obvious.
People call the symptoms of drinking alcohol after exposure to disulfiram as disulfiram-like reactions.
The mechanism of action of disulfiram-like reaction [1,2] After alcohol enters the body, it is first oxidized to "acetaldehyde" by "alcohol dehydrogenase" in liver cells, and acetaldehyde undergoes "acetaldehyde" in the mitochondria of liver cells.
The role of dehydrogenase is oxidized to "acetic acid", which is further metabolized into carbon dioxide and water to be excreted from the body (Figure 1).
Certain drugs inhibit the activity of acetaldehyde dehydrogenase in the mitochondria of liver cells, so that acetaldehyde cannot be further oxidized and metabolized after it is produced, which leads to the accumulation of acetaldehyde in the body and a disulfiram-like reaction (Figure 2).
Clinical manifestations of disulfiram-like reactions Disulfiram-like reactions usually occur 15 to 30 minutes after medication and drinking, and are manifested as facial fever, flushing, conjunctival hyperemia, severe pulsation of blood vessels in the head and neck, or pulsating headache, dizziness, and severe Patients may experience nausea, vomiting, sweating, dry mouth, abdominal cramps, chest pain, rapid heartbeat, decreased blood pressure, blurred vision, dyspnea, normal or partial changes in electrocardiogram (such as ST-T changes), etc.
, and some have acute facial features , Neck, trunk skin flushing with wind mass-like rash, etc.
, the severity of which is directly proportional to the dosage of the drug and the amount of alcohol consumed.
The elderly, children, cardiovascular and cerebrovascular patients and those who are sensitive to ethanol have more severe reactions.
In severe cases, they can cause respiratory depression, arrhythmia, myocardial infarction, acute congestive heart failure, loss of consciousness, acute liver injury, convulsions, shock, and even death.
Drugs that cause disulfiram-like reactions The common drugs that can cause disulfiram-like reactions are shown in Table 1.
In addition, ceftazidime [3], cefaclor [4], cefuroxime [5], cefepime [6], cefoxitin [7], cefathiamidine [8], etc.
, although they do not contain thiazide However, there are reports in the literature that these drugs may also undergo disulfiram-like reactions, and the reaction mechanism needs to be further studied.
However, not all cephalosporins can cause disulfiram reaction.
For example, ceftizoxime, cefixime, cefotizole, cefodizime, etc.
do not contain MTT structure, and there is currently no literature report that can cause disulfiram reaction.
It is necessary for the prevention and treatment of medical staff to have sufficient knowledge and attention to disulfiram-like reactions.
(1) During the diagnosis and treatment, the patient's medication history and allergy history should be carefully asked, and the drinking habits should be inquired.
For those who have a history of drinking within 12 hours, the use of drugs that can cause disulfiram-like reactions should be temporarily postponed.
(2) When nurses are using drugs that can cause disulfiram-like reactions, the intravenous infusion should not start too fast and should be closely observed.
Once allergic reactions occur, immediately stop the drug for rescue. (3) For patients who use drugs that can cause disulfiram-like reactions, they should be told to avoid drinking alcohol or eating alcohol-containing products (including beverages, food, and drugs) during the use of the above-mentioned drugs and within 7 days after stopping the drug, such as liquor, Rice wine, beer, wick chocolate, Huoxiang Zhengqi water, hydrocortisone injection, nimodipine injection, skin disinfection or scrubbing with alcohol to cool down, especially cardiovascular disease, abnormal liver function (including fatty liver), kidney Patients with insufficiency, elderly and infirm should pay more attention [9].
(4) Once the disulfiram-like reaction occurs, the drug and ethanol-related products should be stopped in time.
Mild cases can relieve themselves.
In severe cases, the patient should be placed in a supine position, keeping the airway unobstructed, inhaling 3 to 4 L/min of oxygen, measuring and recording vital signs; establishing intravenous channels, giving a large amount of vitamin C and glucocorticoids (but not available Hydrocortisone injection, because the drug contains 50% ethanol), the application of histamine drugs, patients with pain in the precordial area, and ST-T changes in electrocardiogram can be given nitroglycerin or other coronary drugs [10].
Give symptomatic treatment according to different situations.
References: [1] Liang Xinle, Sun Weimin.
Research progress of disulfiram-like reactions[J].
Clinical rational use of drugs, 2017, 10 (6A): 177-179.
[2] Sun Hongyan, Si Jigang.
Drug disulfiram Progress in the prevention and treatment of such reactions[J].
Chinese Drug Evaluation, 2014,31(2): 96-98.
[3] Zhang Yanhong.
A case of disulfiram-like reaction with myocardial ischemia after intravenous infusion of ceftazidime[J ].
Journal of Clinical Medicine Practice, 2007, 16(6): 471-472.
[4] Li Xia, Liu Pengtao.
Two cases of disulfiram-like reactions caused by the interaction of cefaclor and ethanol[J].
Ningxia Medical Journal, 2004, 26(4): 212.
[5] Li Na.
One case of disulfiram-like reaction caused by drinking alcohol after oral administration of cefuroxime axetil tablets[J].
China Medical Science, 2016, 6(20): 227-228.
[6 ] Wang Meiying.
A case of disulfiram reaction caused by drinking alcohol after intravenous infusion of cefepime[J].
Guide to Chinese Medicine, 2011, 9(24): 132-133.
[7] Chen Gengrong, Yu Houlong, Huang Chengyi.
Sudden double Emergency nursing care of a case of disulfiram-like reaction with blindness as a critical symptom[J].
Modern Medicine and Health, 2015, 31(19): 3044-3046.
[8] Zhang Qiang, Shi Guifen.
Intravenous infusion of cefathiamidine, fat-soluble Vitamin (II)-induced disulfiram reaction in one case[J].
Southwest National Defense Medicine, 2013,23(4):365.
[9] Cui Xinxia, Zhao Yunfang, Wang Jing.
Clinical prevention of disulfiram-like reaction[J] .
Clinical rational drug use, 2015,8(8): 98.
[10] Su Haiyan.
Discussion on nursing intervention measures for drug-induced disulfiram-like reactions in outpatient and emergency departments[J].
2015,12(35):120.
Introduction Cephalosporin antibiotics have many varieties, wide antibacterial range and strong antibacterial ability, so they are increasingly used in clinical practice.
However, with the increase in application, reports of adverse reactions of cephalosporin antibiotics—disulfiram-like reactions are also increasing.
In addition, some drugs such as nitroimidazoles and sulfonylureas hypoglycemic agents can also cause disulfiram-like reactions.
reaction.
In clinical work, disulfiram-like reactions are easily overlooked or misdiagnosed as other diseases such as urticaria, coronary heart disease, and have the characteristics of rapid onset, severe symptoms, and critical illness.
Therefore, clinical attention should be paid.
Disulfiram and disulfiram-like reactions Disulfiram (disulfiram) is a drug for alcohol withdrawal, chemically named tetraethylthiuram disulfide.
After taking this medicine, even if you drink a small amount of alcohol, your body will have serious discomfort, and you will achieve the goal of abstaining from alcohol.
In 1948, Jacobsen and others in Copenhagen found that disulfiram, a vulcanization catalyst for rubber, can cause facial flushing, headache, abdominal pain, sweating, palpitations, and dyspnea after being absorbed by the human body in a small amount, especially after drinking alcohol.
obvious.
People call the symptoms of drinking alcohol after exposure to disulfiram as disulfiram-like reactions.
The mechanism of action of disulfiram-like reaction [1,2] After alcohol enters the body, it is first oxidized to "acetaldehyde" by "alcohol dehydrogenase" in liver cells, and acetaldehyde undergoes "acetaldehyde" in the mitochondria of liver cells.
The role of dehydrogenase is oxidized to "acetic acid", which is further metabolized into carbon dioxide and water to be excreted from the body (Figure 1).
Certain drugs inhibit the activity of acetaldehyde dehydrogenase in the mitochondria of liver cells, so that acetaldehyde cannot be further oxidized and metabolized after it is produced, which leads to the accumulation of acetaldehyde in the body and a disulfiram-like reaction (Figure 2).
Clinical manifestations of disulfiram-like reactions Disulfiram-like reactions usually occur 15 to 30 minutes after medication and drinking, and are manifested as facial fever, flushing, conjunctival hyperemia, severe pulsation of blood vessels in the head and neck, or pulsating headache, dizziness, and severe Patients may experience nausea, vomiting, sweating, dry mouth, abdominal cramps, chest pain, rapid heartbeat, decreased blood pressure, blurred vision, dyspnea, normal or partial changes in electrocardiogram (such as ST-T changes), etc.
, and some have acute facial features , Neck, trunk skin flushing with wind mass-like rash, etc.
, the severity of which is directly proportional to the dosage of the drug and the amount of alcohol consumed.
The elderly, children, cardiovascular and cerebrovascular patients and those who are sensitive to ethanol have more severe reactions.
In severe cases, they can cause respiratory depression, arrhythmia, myocardial infarction, acute congestive heart failure, loss of consciousness, acute liver injury, convulsions, shock, and even death.
Drugs that cause disulfiram-like reactions The common drugs that can cause disulfiram-like reactions are shown in Table 1.
In addition, ceftazidime [3], cefaclor [4], cefuroxime [5], cefepime [6], cefoxitin [7], cefathiamidine [8], etc.
, although they do not contain thiazide However, there are reports in the literature that these drugs may also undergo disulfiram-like reactions, and the reaction mechanism needs to be further studied.
However, not all cephalosporins can cause disulfiram reaction.
For example, ceftizoxime, cefixime, cefotizole, cefodizime, etc.
do not contain MTT structure, and there is currently no literature report that can cause disulfiram reaction.
It is necessary for the prevention and treatment of medical staff to have sufficient knowledge and attention to disulfiram-like reactions.
(1) During the diagnosis and treatment, the patient's medication history and allergy history should be carefully asked, and the drinking habits should be inquired.
For those who have a history of drinking within 12 hours, the use of drugs that can cause disulfiram-like reactions should be temporarily postponed.
(2) When nurses are using drugs that can cause disulfiram-like reactions, the intravenous infusion should not start too fast and should be closely observed.
Once allergic reactions occur, immediately stop the drug for rescue. (3) For patients who use drugs that can cause disulfiram-like reactions, they should be told to avoid drinking alcohol or eating alcohol-containing products (including beverages, food, and drugs) during the use of the above-mentioned drugs and within 7 days after stopping the drug, such as liquor, Rice wine, beer, wick chocolate, Huoxiang Zhengqi water, hydrocortisone injection, nimodipine injection, skin disinfection or scrubbing with alcohol to cool down, especially cardiovascular disease, abnormal liver function (including fatty liver), kidney Patients with insufficiency, elderly and infirm should pay more attention [9].
(4) Once the disulfiram-like reaction occurs, the drug and ethanol-related products should be stopped in time.
Mild cases can relieve themselves.
In severe cases, the patient should be placed in a supine position, keeping the airway unobstructed, inhaling 3 to 4 L/min of oxygen, measuring and recording vital signs; establishing intravenous channels, giving a large amount of vitamin C and glucocorticoids (but not available Hydrocortisone injection, because the drug contains 50% ethanol), the application of histamine drugs, patients with pain in the precordial area, and ST-T changes in electrocardiogram can be given nitroglycerin or other coronary drugs [10].
Give symptomatic treatment according to different situations.
References: [1] Liang Xinle, Sun Weimin.
Research progress of disulfiram-like reactions[J].
Clinical rational use of drugs, 2017, 10 (6A): 177-179.
[2] Sun Hongyan, Si Jigang.
Drug disulfiram Progress in the prevention and treatment of such reactions[J].
Chinese Drug Evaluation, 2014,31(2): 96-98.
[3] Zhang Yanhong.
A case of disulfiram-like reaction with myocardial ischemia after intravenous infusion of ceftazidime[J ].
Journal of Clinical Medicine Practice, 2007, 16(6): 471-472.
[4] Li Xia, Liu Pengtao.
Two cases of disulfiram-like reactions caused by the interaction of cefaclor and ethanol[J].
Ningxia Medical Journal, 2004, 26(4): 212.
[5] Li Na.
One case of disulfiram-like reaction caused by drinking alcohol after oral administration of cefuroxime axetil tablets[J].
China Medical Science, 2016, 6(20): 227-228.
[6 ] Wang Meiying.
A case of disulfiram reaction caused by drinking alcohol after intravenous infusion of cefepime[J].
Guide to Chinese Medicine, 2011, 9(24): 132-133.
[7] Chen Gengrong, Yu Houlong, Huang Chengyi.
Sudden double Emergency nursing care of a case of disulfiram-like reaction with blindness as a critical symptom[J].
Modern Medicine and Health, 2015, 31(19): 3044-3046.
[8] Zhang Qiang, Shi Guifen.
Intravenous infusion of cefathiamidine, fat-soluble Vitamin (II)-induced disulfiram reaction in one case[J].
Southwest National Defense Medicine, 2013,23(4):365.
[9] Cui Xinxia, Zhao Yunfang, Wang Jing.
Clinical prevention of disulfiram-like reaction[J] .
Clinical rational drug use, 2015,8(8): 98.
[10] Su Haiyan.
Discussion on nursing intervention measures for drug-induced disulfiram-like reactions in outpatient and emergency departments[J].
2015,12(35):120.
