Multiple drugs

Abstract

Multiple drugs Various toxicities: case report A man in his late 50s [exact age at reactions onset not stated] developed liver damage during treatment with albumin human, amlodipine, chloroquine, cobicistat/darunavir, dexmedetomidine, diazepam, fluconazole, furosemide, heparin, immune globulin, insulin, lopinavir/ritonavir, methylprednisolone, metformin, metoprolol, midazolam, nifedipine, olanzapine, piperacillin/ tazobactam, quetiapine, risperidone, thymalfasin and umifenovir. In addition, he experienced anxiety, depression and insomnia as manifestations of a poor mental state during treatment with quetiapine and risperidone. Further, he received off-label treatment with chloroquine, cobicistat/darunavir, immune globulin, lopinavir/ritonavir, thymalfasin and umifenovir for COVID-19 [not all routes stated; dosages not stated]. The man developed a fever on 25 January 2020, accompanied by a mild cough, chills and shortness of breath. Since the fever persisted, he was hospitalised in China on 1 February 2020. A review of his medical records revealed that he had hypertension (for which he was receiving metoprolol and nifedipine tablets daily, along with [amlodipine] amlodipine besylate tablets), type 2 diabetes (for which he was receiving metformin tablets daily) and schizophrenia (for which he was receiving risperidone and quetiapine [quetiapine fumarate] tablets daily). He stated that the control of his chronic diseases was acceptable; however, his mental state was poor, manifesting as anxiety, depression and insomnia. Physical examination revealed obvious schizophrenic symptoms. Following further analyses, he was diagnosed with COVID-19. He received oxygen via nasal catheter to increase oxygen saturation, and methylprednisolone to attenuate lung inflammation, alongside unspecified supportive psychotherapy. He also received antivirals (lopinavir/ritonavir [lopinavir and ritonavir] tablets), anti-schizophrenic drugs (quetiapine and risperidone tablets), antihypertensive agents (metoprolol and nifedipine sustained-release, SR tablets), antidiabetic agents (metformin SR tablets and insulin injection), and immunomodulators (IV immune globulin and thymalfasin injection). On the evening of 3 February 2020 (2 days post admission), his condition deteriorated. He was shifted to a negative pressure ward, after non-invasive ventilation rescue with ECG monitoring. In the meantime, he developed multiple complications, including type-II respiratory failure, sequelae of cerebral infarction, acute respiratory distress syndrome, electrolyte metabolism disorders and hyperlactic acidaemia, leading to a severe case of COVID-19. In order to improve the man's compliance to the treatment, quetiapine and risperidone were discontinued and replaced with olanzapine tablets, to minimise the side effects of headache, insomnia and anxiety. In addition, he received diazepam, midazolam injection and dexmedetomidine injection to ease anxiety and aid sleep. The supportive psychotherapy was strengthened; umifenovir [arbidol] and fluconazole capsules...