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*Only for medical professionals to read and refer to commonly used drugs, uncommon adverse reactions~ In recent years, more and more news reports have reported that XX was seriously ill due to taking a common medicine at home
.
This kind of household medicine can cause such great harm! It is really easy to step on the pit if you ignore it slightly! Not much to say, just introduce 2 cases and you will understand! Case: A 155-year-old female patient presented with "fever and vomiting for more than 2 months".
The highest body temperature was 40.
5℃, accompanied by chills, nausea, and vomiting.
The vomit was stomach contents and yellow-green bile-like substances, and no coffee grounds were seen.
The same substance, accompanied by upper abdominal discomfort, no obvious abdominal pain, occasional dry stool, accompanied by anal exhaust, reduced defecation, no diarrhea, no other discomfort, was hospitalized at the local hospital infection department 1 month ago, consider sepsis, incomplete Intestinal obstruction, no fever after anti-inflammatory treatment
.
However, "happiness" is always short-lived.
The patient recurred fever after being discharged from the hospital one day ago.
The specifics are unknown
.
Denies history of hypertension, coronary heart disease, history of hepatitis, tuberculosis, history of trauma, and history of food and drug allergy
.
Denies history of blood transfusion
.
Admission to the hospital was temporarily given symptomatic and supportive treatments such as acid suppression (omeprazole) and anti-infection; because the patient’s body temperature continued to be above 39.
5 ℃, he was given diclofenac sodium suppository 50 mg anus plug according to the doctor’s instructions.
35 minutes later, the patient had sudden chest tightness, palpitations, Sweating, trembling muscles, weakness, pale, indifferent, cold limbs, twitching limbs, shortness of breath, and dizziness
.
Measure blood pressure 55/35mmHg; heart rate 108 beats/min, breathing 32 beats/min
.
Why did the patient suddenly experience the above symptoms? Don't worry, then look down on another case
.
Case: A 278-year-old female patient was admitted to the hospital because of "bilateral back pain for more than 1 day"
.
Before 1 day, the patient was found to have bilateral back and waist pain without obvious inducement, the pain was intermittent pain, no abdominal pain, no radiation pain, accompanied by dizziness, headache, vertigo, and the main headache was slight pain in the forehead, and the symptoms were when shaking his head.
Exacerbation, accompanied by rotation of vision, intensified after activity or posture changes; no transient amaurosis; no tinnitus, nausea, vomiting, fever, palpitation, chest pain and other discomforts
.
Symptomatic treatments such as anti-infection, nourishment of brain cells, and improvement of circulation were given, and the patient had no adverse reactions
.
On the second day, the patient complained of pain in the lower abdomen and lumbosacral area with frequent urination, urgency, and painful urination for 1 day.
Combined with the patient’s auxiliary examination and physical signs, the urinary tract infection was considered.
After half an hour, the patient complained of numbness in his limbs, accompanied by pallor, dizziness, nausea, night sweats, dyspnea and other discomforts
.
The patient's body temperature was 36.
4℃, blood pressure was 40/20 mmHg, heart rate was 136 beats/min, and respiratory rate was 12 beats/min
.
The patient is confused, unconscious, breath sounds weakened, and a little wet rales can be heard
.
Seems different, but in fact, the two cases mentioned above seem to have no connection, one is fever and vomiting, the other is low back pain, but a closer look will find that they have the following 3 things in common: 1.
Both patients used diclofenac Sodium suppository; 2.
Both patients had discomfort within 30 minutes of medication; 3.
Both patients had discomforts such as blood pressure drop, pale complexion, and difficulty breathing
.
Seeing this, do you already have a little idea? The above is just our guess, and more laboratory tests are needed to further prove it
.
After the patient in the first case became unwell, the glucose was 2.
60 mmol/L, the urea nitrogen was 5.
28 mmol/L, the creatinine was 100.
9 μmol/L, the uric acid was 371.
9 μmol/L, and the electrolytes were normal
.
Seeing that blood sugar and blood pressure are so low, the patient's diagnosis is ready! That's right! It is hypoglycemic shock! Immediately give the patient 4-6 liters/min oxygen inhalation to speed up the rehydration rate, increase blood volume, keep warm, take 60ml of 50% glucose injection, intravenous drip of 10% glucose injection 500ml, etc.
The blood pressure rises to 90 after half an hour /65 mmHg, heart rate 94 beats/min, breathing 22 beats/min, chest tightness and palpitations were relieved, and the adverse reactions gradually disappeared.
Symptomatic supportive treatment was continued until the condition was relieved
.
So, is the second case also hypoglycemic shock? The patient in the second case was carefully questioned, and it was found that he had a history of drug allergy (skin rash and itching occurred about 5 minutes after oral diclofenac sodium enteric-coated tablets six months ago), and no history of food allergy
.
Considering the allergic reaction to diclofenac sodium suppository, immediately take out the diclofenac sodium suppository and establish an intravenous channel.
Give high-flow mask oxygen and anti-allergic treatment.
After half an hour, physical examination: body temperature 36.
6℃, heart rate 105 beats/min, blood pressure 101/56 mmHg, blood oxygen saturation 99%, breathing rate 33 times/min, the patient is conscious, and the spirit is gradually improving, without dizziness, headache, fever, chills, chills, nausea, vomiting, palpitations, fatigue and other discomforts
.
Diclofenac sodium suppository: Reduce adverse reactions and extend the duration of drug effect.
At present, the clinical treatment of rheumatoid arthritis (RA) is mainly based on anti-inflammatory drugs such as immunosuppressants and NSAIDs (diclofenac).
Patients cause serious adverse reactions, and patients are prone to drug-resistant reactions, which is not conducive to the smooth progress of treatment
.
The mechanism of action of anti-inflammatory drugs is to inhibit the activity of enzymes and block the production of prostaglandins, thereby preventing joint swelling and pain
.
However, the main adverse reaction of the drug is the patient's nausea and vomiting, which is not conducive to the absorption of the drug, and even severe patients may have gastrointestinal mucosal lesions, which may lead to ulcers or bleeding
.
Diclofenac sodium suppository is a commonly used clinical NSAIDs drug, which has anti-inflammatory, antipyretic, and analgesic effects.
In addition, diclofenac sodium suppository is mainly applied in the anal way, given a certain amount of warm water to moisturize the drug, and then the drug is inserted into the patient's anal dental line.
, To promote the direct ingestion of drugs in the mucous membrane, and exert the pain relief effect of the drugs
.
Anal administration can effectively avoid the first pass effect of the drug on the liver, shorten the onset speed of the drug, and prolong the duration of the drug effect
.
It can avoid adverse reactions such as nausea, vomiting and flatulence caused by oral medication
.
Be alert to allergic reactions and blood pressure drops! In addition to its application in RA, diclofenac sodium can also be used for short-term treatment of postoperative pain and fever caused by various reasons
.
Clinical studies have also pointed out that the anal administration of diclofenac sodium suppository can not only fully relieve the postoperative pain of patients, but also reduce the application of opioids, although the application of diclofenac sodium suppository in postoperative analgesia can ensure the effectiveness of analgesia And safety, but its adverse reactions should also be vigilant
.
In 2020, the National Food and Drug Administration revised the instructions for diclofenac sodium suppositories and added a warning: “This product can cause severe allergic reactions (including anaphylactic shock).
Patients should be closely observed during the administration.
Once allergic reactions or other serious Adverse reactions must be discontinued immediately and treated in time; it can cause collapse of the patient and drop in blood pressure.
The patient should be closely observed during the administration and treated in time if necessary
.
"The instructions specifically add warnings about allergic reactions and blood pressure drops, which is enough to show that you must be careful about these two points during the medication! The adverse reactions of diclofenac sodium suppository are as follows: immune diseases and infections: allergic reactions, allergic-like reactions, Anaphylactic shock; systemic damage: chest tightness, fatigue, hypothermia, edema (oral edema, periorbital edema, facial edema, lower extremity and ankle edema), chills, fever; respiratory diseases: dyspnea, shortness of breath, throat Edema; cardiovascular system: arrhythmia, lower blood pressure (hypotension, shock-like symptoms), shock, palpitations, chest pain, high blood pressure, heart attack, flushing; blood system: neutropenia, thrombocytopenia; skin and skin accessories Diseases: itching, skin rash, maculopapular rash, blisters, fixed drug eruption, exfoliative dermatitis, increased sweating; digestive system: stomach upset, heartburn, loss of appetite, acid reflux, nausea, vomiting, stomach pain, diarrhea, melena
.
A small number of ulcers, bleeding, perforation; rare transient elevated liver enzymes, jaundice; nervous system diseases: headache, dizziness, dizziness, drowsiness, fatigue, excitement, numbness, tremor, visual disturbance; urinary system: renal Severe renal adverse reactions such as edema, oliguria, and electrolyte imbalance; others: abnormal vision, irritation of the medication site, burning of the medication site
.
How to prevent and treat? Although diclofenac sodium suppository is a commonly used clinical fever and analgesic, and rectal administration is effective It avoids common gastrointestinal adverse reactions, but the drug can also cause shock.
If it is found that the treatment is not timely, it may still threaten the safety of the patient.
Therefore, medical staff should pay attention to the clinic: (1) Be sure to ask if there is any History of drug allergy; (2) Inform patients and family members of adverse drug reactions before administration.
The patient’s condition should be closely monitored 2 hours after administration.
If anaphylactic shock or other types of shock occur, timely treatment measures should be taken to ensure medication.
Safety
.
According to the amount of fluid loss, you must ensure that you have enough water
.
(3) Learn more about the medicine and develop the habit of reading the instructions before taking the medicine, so as to reduce the incidence of allergic events
.
References: [1] Yang Xiaofen.
A case of anaphylactic shock caused by diclofenac sodium suppository[J].
China Practical Medicine, 2020,15(17):158-159.
[2]https:// /xxgk/ggtg/ypshmshxdgg/20200306110701413.
html Source of this article: Medical Rheumatism Channel Author: Volume Review of this article: Chen Xinpeng Deputy Chief Physician Responsible Editor: Cassette Copyright Statement
.
This kind of household medicine can cause such great harm! It is really easy to step on the pit if you ignore it slightly! Not much to say, just introduce 2 cases and you will understand! Case: A 155-year-old female patient presented with "fever and vomiting for more than 2 months".
The highest body temperature was 40.
5℃, accompanied by chills, nausea, and vomiting.
The vomit was stomach contents and yellow-green bile-like substances, and no coffee grounds were seen.
The same substance, accompanied by upper abdominal discomfort, no obvious abdominal pain, occasional dry stool, accompanied by anal exhaust, reduced defecation, no diarrhea, no other discomfort, was hospitalized at the local hospital infection department 1 month ago, consider sepsis, incomplete Intestinal obstruction, no fever after anti-inflammatory treatment
.
However, "happiness" is always short-lived.
The patient recurred fever after being discharged from the hospital one day ago.
The specifics are unknown
.
Denies history of hypertension, coronary heart disease, history of hepatitis, tuberculosis, history of trauma, and history of food and drug allergy
.
Denies history of blood transfusion
.
Admission to the hospital was temporarily given symptomatic and supportive treatments such as acid suppression (omeprazole) and anti-infection; because the patient’s body temperature continued to be above 39.
5 ℃, he was given diclofenac sodium suppository 50 mg anus plug according to the doctor’s instructions.
35 minutes later, the patient had sudden chest tightness, palpitations, Sweating, trembling muscles, weakness, pale, indifferent, cold limbs, twitching limbs, shortness of breath, and dizziness
.
Measure blood pressure 55/35mmHg; heart rate 108 beats/min, breathing 32 beats/min
.
Why did the patient suddenly experience the above symptoms? Don't worry, then look down on another case
.
Case: A 278-year-old female patient was admitted to the hospital because of "bilateral back pain for more than 1 day"
.
Before 1 day, the patient was found to have bilateral back and waist pain without obvious inducement, the pain was intermittent pain, no abdominal pain, no radiation pain, accompanied by dizziness, headache, vertigo, and the main headache was slight pain in the forehead, and the symptoms were when shaking his head.
Exacerbation, accompanied by rotation of vision, intensified after activity or posture changes; no transient amaurosis; no tinnitus, nausea, vomiting, fever, palpitation, chest pain and other discomforts
.
Symptomatic treatments such as anti-infection, nourishment of brain cells, and improvement of circulation were given, and the patient had no adverse reactions
.
On the second day, the patient complained of pain in the lower abdomen and lumbosacral area with frequent urination, urgency, and painful urination for 1 day.
Combined with the patient’s auxiliary examination and physical signs, the urinary tract infection was considered.
After half an hour, the patient complained of numbness in his limbs, accompanied by pallor, dizziness, nausea, night sweats, dyspnea and other discomforts
.
The patient's body temperature was 36.
4℃, blood pressure was 40/20 mmHg, heart rate was 136 beats/min, and respiratory rate was 12 beats/min
.
The patient is confused, unconscious, breath sounds weakened, and a little wet rales can be heard
.
Seems different, but in fact, the two cases mentioned above seem to have no connection, one is fever and vomiting, the other is low back pain, but a closer look will find that they have the following 3 things in common: 1.
Both patients used diclofenac Sodium suppository; 2.
Both patients had discomfort within 30 minutes of medication; 3.
Both patients had discomforts such as blood pressure drop, pale complexion, and difficulty breathing
.
Seeing this, do you already have a little idea? The above is just our guess, and more laboratory tests are needed to further prove it
.
After the patient in the first case became unwell, the glucose was 2.
60 mmol/L, the urea nitrogen was 5.
28 mmol/L, the creatinine was 100.
9 μmol/L, the uric acid was 371.
9 μmol/L, and the electrolytes were normal
.
Seeing that blood sugar and blood pressure are so low, the patient's diagnosis is ready! That's right! It is hypoglycemic shock! Immediately give the patient 4-6 liters/min oxygen inhalation to speed up the rehydration rate, increase blood volume, keep warm, take 60ml of 50% glucose injection, intravenous drip of 10% glucose injection 500ml, etc.
The blood pressure rises to 90 after half an hour /65 mmHg, heart rate 94 beats/min, breathing 22 beats/min, chest tightness and palpitations were relieved, and the adverse reactions gradually disappeared.
Symptomatic supportive treatment was continued until the condition was relieved
.
So, is the second case also hypoglycemic shock? The patient in the second case was carefully questioned, and it was found that he had a history of drug allergy (skin rash and itching occurred about 5 minutes after oral diclofenac sodium enteric-coated tablets six months ago), and no history of food allergy
.
Considering the allergic reaction to diclofenac sodium suppository, immediately take out the diclofenac sodium suppository and establish an intravenous channel.
Give high-flow mask oxygen and anti-allergic treatment.
After half an hour, physical examination: body temperature 36.
6℃, heart rate 105 beats/min, blood pressure 101/56 mmHg, blood oxygen saturation 99%, breathing rate 33 times/min, the patient is conscious, and the spirit is gradually improving, without dizziness, headache, fever, chills, chills, nausea, vomiting, palpitations, fatigue and other discomforts
.
Diclofenac sodium suppository: Reduce adverse reactions and extend the duration of drug effect.
At present, the clinical treatment of rheumatoid arthritis (RA) is mainly based on anti-inflammatory drugs such as immunosuppressants and NSAIDs (diclofenac).
Patients cause serious adverse reactions, and patients are prone to drug-resistant reactions, which is not conducive to the smooth progress of treatment
.
The mechanism of action of anti-inflammatory drugs is to inhibit the activity of enzymes and block the production of prostaglandins, thereby preventing joint swelling and pain
.
However, the main adverse reaction of the drug is the patient's nausea and vomiting, which is not conducive to the absorption of the drug, and even severe patients may have gastrointestinal mucosal lesions, which may lead to ulcers or bleeding
.
Diclofenac sodium suppository is a commonly used clinical NSAIDs drug, which has anti-inflammatory, antipyretic, and analgesic effects.
In addition, diclofenac sodium suppository is mainly applied in the anal way, given a certain amount of warm water to moisturize the drug, and then the drug is inserted into the patient's anal dental line.
, To promote the direct ingestion of drugs in the mucous membrane, and exert the pain relief effect of the drugs
.
Anal administration can effectively avoid the first pass effect of the drug on the liver, shorten the onset speed of the drug, and prolong the duration of the drug effect
.
It can avoid adverse reactions such as nausea, vomiting and flatulence caused by oral medication
.
Be alert to allergic reactions and blood pressure drops! In addition to its application in RA, diclofenac sodium can also be used for short-term treatment of postoperative pain and fever caused by various reasons
.
Clinical studies have also pointed out that the anal administration of diclofenac sodium suppository can not only fully relieve the postoperative pain of patients, but also reduce the application of opioids, although the application of diclofenac sodium suppository in postoperative analgesia can ensure the effectiveness of analgesia And safety, but its adverse reactions should also be vigilant
.
In 2020, the National Food and Drug Administration revised the instructions for diclofenac sodium suppositories and added a warning: “This product can cause severe allergic reactions (including anaphylactic shock).
Patients should be closely observed during the administration.
Once allergic reactions or other serious Adverse reactions must be discontinued immediately and treated in time; it can cause collapse of the patient and drop in blood pressure.
The patient should be closely observed during the administration and treated in time if necessary
.
"The instructions specifically add warnings about allergic reactions and blood pressure drops, which is enough to show that you must be careful about these two points during the medication! The adverse reactions of diclofenac sodium suppository are as follows: immune diseases and infections: allergic reactions, allergic-like reactions, Anaphylactic shock; systemic damage: chest tightness, fatigue, hypothermia, edema (oral edema, periorbital edema, facial edema, lower extremity and ankle edema), chills, fever; respiratory diseases: dyspnea, shortness of breath, throat Edema; cardiovascular system: arrhythmia, lower blood pressure (hypotension, shock-like symptoms), shock, palpitations, chest pain, high blood pressure, heart attack, flushing; blood system: neutropenia, thrombocytopenia; skin and skin accessories Diseases: itching, skin rash, maculopapular rash, blisters, fixed drug eruption, exfoliative dermatitis, increased sweating; digestive system: stomach upset, heartburn, loss of appetite, acid reflux, nausea, vomiting, stomach pain, diarrhea, melena
.
A small number of ulcers, bleeding, perforation; rare transient elevated liver enzymes, jaundice; nervous system diseases: headache, dizziness, dizziness, drowsiness, fatigue, excitement, numbness, tremor, visual disturbance; urinary system: renal Severe renal adverse reactions such as edema, oliguria, and electrolyte imbalance; others: abnormal vision, irritation of the medication site, burning of the medication site
.
How to prevent and treat? Although diclofenac sodium suppository is a commonly used clinical fever and analgesic, and rectal administration is effective It avoids common gastrointestinal adverse reactions, but the drug can also cause shock.
If it is found that the treatment is not timely, it may still threaten the safety of the patient.
Therefore, medical staff should pay attention to the clinic: (1) Be sure to ask if there is any History of drug allergy; (2) Inform patients and family members of adverse drug reactions before administration.
The patient’s condition should be closely monitored 2 hours after administration.
If anaphylactic shock or other types of shock occur, timely treatment measures should be taken to ensure medication.
Safety
.
According to the amount of fluid loss, you must ensure that you have enough water
.
(3) Learn more about the medicine and develop the habit of reading the instructions before taking the medicine, so as to reduce the incidence of allergic events
.
References: [1] Yang Xiaofen.
A case of anaphylactic shock caused by diclofenac sodium suppository[J].
China Practical Medicine, 2020,15(17):158-159.
[2]https:// /xxgk/ggtg/ypshmshxdgg/20200306110701413.
html Source of this article: Medical Rheumatism Channel Author: Volume Review of this article: Chen Xinpeng Deputy Chief Physician Responsible Editor: Cassette Copyright Statement
