PDF(Pubmed)
Abstract：
Neurotoxicity can develop as a side effect of valacyclovir in patients with renal disease, especially without a renally adjusted dose. We present a 56-year-old female with end-stage renal disease (ESRD) on hemodialysis (HD) who presented to the emergency room (ER) with agitation and confusion and was found to have valacyclovir-associated neurotoxicity (VAN). Five days prior, she had been prescribed the standard treatment of 500 mg valacyclovir twice daily for three days for herpes simplex virus-1 (HSV-1); however, her creatinine clearance was low enough to require a renally adjusted dose. Her condition was worsened from missing a dialysis session due to acute confusion. She was treated with three days of hemodialysis sessions. Improvement in mentation and agitation was observed after the second day of hemodialysis, and a complete resolution of symptoms and return to cognitive baseline occurred two days later. There are reports of daily hemodialysis shortening the neurotoxicity period and resulting in a faster return to normal mentation. This case is important as the dose of valacyclovir must be adjusted in those with kidney disease.
摘要：
神经毒性可作为伐昔洛韦在肾病患者中的副作用，尤其是没有调整剂量的肾脏。我们介绍了一名56岁的女性，患有血液透析（HD）的终末期肾病（ESRD），她因激动和混乱而出现在急诊室（ER），并被发现患有伐昔洛韦相关的神经毒性（VAN）。五天前，她已被处方标准治疗500毫克伐昔洛韦，每天两次，持续三天治疗单纯疱疹病毒-1（HSV-1）；然而，她的肌酐清除率足够低，需要调整肾脏剂量。由于急性混乱，她的病情因错过透析而恶化。她接受了三天的血液透析治疗。血液透析第二天后观察到精神和躁动的改善，2天后症状完全缓解并恢复至认知基线.有报道称，每天进行血液透析会缩短神经毒性期，并导致更快地恢复正常状态。这种情况很重要，因为在患有肾脏疾病的患者中必须调整伐昔洛韦的剂量。
