|
|
char = A;code = 65
char = c;code = 99
char = y;code = 121
char = c;code = 99
char = l;code = 108
char = o;code = 111
char = v;code = 118
char = i;code = 105
char = r;code = 114
char = -;code = 45
char = i;code = 105
char = n;code = 110
char = d;code = 100
char = u;code = 117
char = c;code = 99
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = f;code = 102
char = a;code = 97
char = i;code = 105
char = l;code = 108
char = u;code = 117
char = r;code = 114
char = e;code = 101
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = ;code = 32
char = o;code = 111
char = b;code = 98
char = e;code = 101
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = p;code = 112
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = .;code = 46
result sql = Acyclovir-induced renal failure in an obese patient.
Acyclovir-induced renal failure in an obese patient.char = <;code = 60
char = b;code = 98
char = >;code = 62
char = P;code = 80
char = U;code = 85
char = R;code = 82
char = P;code = 80
char = O;code = 79
char = S;code = 83
char = E;code = 69
char = ;code = 32
char = :;code = 58
char = ;code = 32
char = <;code = 60
char = /;code = 47
char = b;code = 98
char = >;code = 62
char = A;code = 65
char = ;code = 32
char = c;code = 99
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = a;code = 97
char = c;code = 99
char = y;code = 121
char = c;code = 99
char = l;code = 108
char = o;code = 111
char = v;code = 118
char = i;code = 105
char = r;code = 114
char = -;code = 45
char = i;code = 105
char = n;code = 110
char = d;code = 100
char = u;code = 117
char = c;code = 99
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = c;code = 99
char = u;code = 117
char = t;code = 116
char = e;code = 101
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = f;code = 102
char = a;code = 97
char = i;code = 105
char = l;code = 108
char = u;code = 117
char = r;code = 114
char = e;code = 101
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = ;code = 32
char = o;code = 111
char = b;code = 98
char = e;code = 101
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = p;code = 112
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = s;code = 115
char = c;code = 99
char = r;code = 114
char = i;code = 105
char = b;code = 98
char = e;code = 101
char = d;code = 100
char = .;code = 46
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = >;code = 62
char = S;code = 83
char = U;code = 85
char = M;code = 77
char = M;code = 77
char = A;code = 65
char = R;code = 82
char = Y;code = 89
char = ;code = 32
char = :;code = 58
char = ;code = 32
char = <;code = 60
char = /;code = 47
char = b;code = 98
char = >;code = 62
char = A;code = 65
char = ;code = 32
char = 6;code = 54
char = 0;code = 48
char = -;code = 45
char = y;code = 121
char = e;code = 101
char = a;code = 97
char = r;code = 114
char = -;code = 45
char = o;code = 111
char = l;code = 108
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = h;code = 104
char = i;code = 105
char = t;code = 116
char = e;code = 101
char = ;code = 32
char = m;code = 109
char = a;code = 97
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = r;code = 114
char = r;code = 114
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = t;code = 116
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = e;code = 101
char = m;code = 109
char = e;code = 101
char = r;code = 114
char = g;code = 103
char = e;code = 101
char = n;code = 110
char = c;code = 99
char = y;code = 121
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = t;code = 116
char = m;code = 109
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = l;code = 108
char = a;code = 97
char = i;code = 105
char = n;code = 110
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = n;code = 110
char = f;code = 102
char = u;code = 117
char = s;code = 115
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = d;code = 100
char = i;code = 105
char = s;code = 115
char = o;code = 111
char = r;code = 114
char = i;code = 105
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = .;code = 46
char = ;code = 32
char = H;code = 72
char = e;code = 101
char = ;code = 32
char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = 5;code = 53
char = ;code = 32
char = f;code = 102
char = t;code = 116
char = ;code = 32
char = 7;code = 55
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = a;code = 97
char = l;code = 108
char = l;code = 108
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = e;code = 101
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = 1;code = 49
char = 0;code = 48
char = 8;code = 56
char = .;code = 46
char = 9;code = 57
char = ;code = 32
char = k;code = 107
char = g;code = 103
char = .;code = 46
char = ;code = 32
char = H;code = 72
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = m;code = 109
char = e;code = 101
char = d;code = 100
char = i;code = 105
char = c;code = 99
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = s;code = 115
char = u;code = 117
char = r;code = 114
char = g;code = 103
char = i;code = 105
char = c;code = 99
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = s;code = 115
char = t;code = 116
char = o;code = 111
char = r;code = 114
char = i;code = 105
char = e;code = 101
char = s;code = 115
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = c;code = 99
char = l;code = 108
char = u;code = 117
char = d;code = 100
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = c;code = 99
char = h;code = 104
char = r;code = 114
char = o;code = 111
char = n;code = 110
char = i;code = 105
char = c;code = 99
char = ;code = 32
char = o;code = 111
char = b;code = 98
char = s;code = 115
char = t;code = 116
char = r;code = 114
char = u;code = 117
char = c;code = 99
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = p;code = 112
char = u;code = 117
char = l;code = 108
char = m;code = 109
char = o;code = 111
char = n;code = 110
char = a;code = 97
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = d;code = 100
char = i;code = 105
char = s;code = 115
char = e;code = 101
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = (;code = 40
char = C;code = 67
char = O;code = 79
char = P;code = 80
char = D;code = 68
char = );code = 41
char = ,;code = 44
char = ;code = 32
char = s;code = 115
char = l;code = 108
char = e;code = 101
char = e;code = 101
char = p;code = 112
char = ;code = 32
char = a;code = 97
char = p;code = 112
char = n;code = 110
char = e;code = 101
char = a;code = 97
char = ;code = 32
char = n;code = 110
char = o;code = 111
char = t;code = 116
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = q;code = 113
char = u;code = 117
char = i;code = 105
char = r;code = 114
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = b;code = 98
char = i;code = 105
char = p;code = 112
char = h;code = 104
char = a;code = 97
char = s;code = 115
char = i;code = 105
char = c;code = 99
char = ;code = 32
char = p;code = 112
char = o;code = 111
char = s;code = 115
char = i;code = 105
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = a;code = 97
char = i;code = 105
char = r;code = 114
char = w;code = 119
char = a;code = 97
char = y;code = 121
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = s;code = 115
char = s;code = 115
char = u;code = 117
char = r;code = 114
char = e;code = 101
char = ,;code = 44
char = ;code = 32
char = o;code = 111
char = b;code = 98
char = e;code = 101
char = s;code = 115
char = i;code = 105
char = t;code = 116
char = y;code = 121
char = ,;code = 44
char = ;code = 32
char = o;code = 111
char = x;code = 120
char = y;code = 121
char = g;code = 103
char = e;code = 101
char = n;code = 110
char = ;code = 32
char = s;code = 115
char = u;code = 117
char = p;code = 112
char = p;code = 112
char = l;code = 108
char = e;code = 101
char = m;code = 109
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = ,;code = 44
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = p;code = 112
char = p;code = 112
char = e;code = 101
char = n;code = 110
char = d;code = 100
char = e;code = 101
char = c;code = 99
char = t;code = 116
char = o;code = 111
char = m;code = 109
char = y;code = 121
char = .;code = 46
char = ;code = 32
char = H;code = 72
char = e;code = 101
char = ;code = 32
char = a;code = 97
char = l;code = 108
char = s;code = 115
char = o;code = 111
char = ;code = 32
char = h;code = 104
char = a;code = 97
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = s;code = 115
char = t;code = 116
char = o;code = 111
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = c;code = 99
char = y;code = 121
char = s;code = 115
char = t;code = 116
char = ;code = 32
char = d;code = 100
char = r;code = 114
char = a;code = 97
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = g;code = 103
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = b;code = 98
char = a;code = 97
char = c;code = 99
char = k;code = 107
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = n;code = 110
char = e;code = 101
char = c;code = 99
char = k;code = 107
char = ,;code = 44
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = c;code = 99
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = d;code = 100
char = r;code = 114
char = a;code = 97
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = g;code = 103
char = e;code = 101
char = ;code = 32
char = e;code = 101
char = m;code = 109
char = i;code = 105
char = t;code = 116
char = t;code = 116
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = a;code = 97
char = ;code = 32
char = f;code = 102
char = o;code = 111
char = u;code = 117
char = l;code = 108
char = ;code = 32
char = o;code = 111
char = d;code = 100
char = o;code = 111
char = r;code = 114
char = ,;code = 44
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = s;code = 115
char = u;code = 117
char = f;code = 102
char = f;code = 102
char = e;code = 101
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = c;code = 99
char = u;code = 117
char = r;code = 114
char = r;code = 114
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = h;code = 104
char = e;code = 101
char = r;code = 114
char = p;code = 112
char = e;code = 101
char = s;code = 115
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = l;code = 108
char = d;code = 100
char = ;code = 32
char = s;code = 115
char = o;code = 111
char = r;code = 114
char = e;code = 101
char = s;code = 115
char = ;code = 32
char = o;code = 111
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char = ;code = 32
char = h;code = 104
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = c;code = 99
char = h;code = 104
char = i;code = 105
char = n;code = 110
char = .;code = 46
char = ;code = 32
char = A;code = 65
char = ;code = 32
char = l;code = 108
char = u;code = 117
char = m;code = 109
char = b;code = 98
char = a;code = 97
char = r;code = 114
char = ;code = 32
char = p;code = 112
char = u;code = 117
char = n;code = 110
char = c;code = 99
char = t;code = 116
char = u;code = 117
char = r;code = 114
char = e;code = 101
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = v;code = 118
char = e;code = 101
char = a;code = 97
char = l;code = 108
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = b;code = 98
char = n;code = 110
char = o;code = 111
char = r;code = 114
char = m;code = 109
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = c;code = 99
char = e;code = 101
char = r;code = 114
char = e;code = 101
char = b;code = 98
char = r;code = 114
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = s;code = 115
char = p;code = 112
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = f;code = 102
char = l;code = 108
char = u;code = 117
char = i;code = 105
char = d;code = 100
char = .;code = 46
char = ;code = 32
char = A;code = 65
char = ;code = 32
char = d;code = 100
char = i;code = 105
char = a;code = 97
char = g;code = 103
char = n;code = 110
char = o;code = 111
char = s;code = 115
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = h;code = 104
char = e;code = 101
char = r;code = 114
char = p;code = 112
char = e;code = 101
char = s;code = 115
char = ;code = 32
char = e;code = 101
char = n;code = 110
char = c;code = 99
char = e;code = 101
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char = h;code = 104
char = a;code = 97
char = l;code = 108
char = i;code = 105
char = t;code = 116
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = n;code = 110
char = s;code = 115
char = i;code = 105
char = d;code = 100
char = e;code = 101
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char = a;code = 97
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char = i;code = 105
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char = ;code = 32
char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = e;code = 101
char = m;code = 109
char = p;code = 112
char = i;code = 105
char = r;code = 114
char = i;code = 105
char = c;code = 99
char = a;code = 97
char = l;code = 108
char = l;code = 108
char = y;code = 121
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char = t;code = 116
char = r;code = 114
char = e;code = 101
char = a;code = 97
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char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = i;code = 105
char = .;code = 46
char = v;code = 118
char = .;code = 46
char = ;code = 32
char = a;code = 97
char = c;code = 99
char = y;code = 121
char = c;code = 99
char = l;code = 108
char = o;code = 111
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char = i;code = 105
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char = 1;code = 49
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char = e;code = 101
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char = 6;code = 54
char = 0;code = 48
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char = n;code = 110
char = u;code = 117
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char = e;code = 101
char = s;code = 115
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char = e;code = 101
char = v;code = 118
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char = r;code = 114
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char = e;code = 101
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char = g;code = 103
char = h;code = 104
char = t;code = 116
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char = h;code = 104
char = o;code = 111
char = u;code = 117
char = r;code = 114
char = s;code = 115
char = ,;code = 44
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = d;code = 100
char = o;code = 111
char = s;code = 115
char = a;code = 97
char = g;code = 103
char = e;code = 101
char = ;code = 32
char = b;code = 98
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = d;code = 100
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result sql = PURPOSE : A case of acyclovir-induced acute renal failure in an obese patient is described.
SUMMARY : A 60-year-old white man arrived at the emergency department complaining of confusion and disorientation. He was 5 ft 7 in tall and weighed 108.9 kg. His medical and surgical histories included chronic obstructive pulmonary disease (COPD), sleep apnea not requiring biphasic positive airway pressure, obesity, oxygen supplementation, and appendectomy. He also had a history of cyst drainage on the back of his neck, with recent drainage emitting a foul odor, and suffered recurrent herpes cold sores on his chin. A lumbar puncture revealed abnormal cerebral spinal fluid. A diagnosis of herpes encephalitis was considered, and the patient was empirically treated with i.v. acyclovir 1 g over 60 minutes every eight hours, with the dosage based on actual body weight. He was also given moxifloxacin 400 mg i.v. daily for possible COPD exacerbation and doxycycline 100 mg i.v. twice daily for possible leptospirosis meningitis. On hospital day 3, his serum creatinine (SCr) and blood urea nitrogen (BUN) concentrations rose to 2.8 g/dL and 32 mg/dL, respectively. Acyclovir was subsequently discontinued, as were all i.v. antibiotics. On day 7, hydration therapy was initiated, as was therapy to alkalinize the urine, and his neurologic status began to improve. At discharge, the patient's SCr and BUN levels were 3.1 g/dL and 38 mg/dL, respectively. His discharge diagnoses included encephalitis with possible viral origin and acyclovir-induced nephrotoxicity.
CONCLUSION : An obese man receiving excessive doses of i.v. acyclovir developed acute but reversible renal failure.
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char = a;code = 97
char = n;code = 110
char = ;code = 32
char = o;code = 111
char = b;code = 98
char = e;code = 101
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = p;code = 112
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = .;code = 46
result sql = Acyclovir-induced renal failure in an obese patient.
char = b;code = 98
char = >;code = 62
char = P;code = 80
char = U;code = 85
char = R;code = 82
char = P;code = 80
char = O;code = 79
char = S;code = 83
char = E;code = 69
char = ;code = 32
char = :;code = 58
char = ;code = 32
char = <;code = 60
char = /;code = 47
char = b;code = 98
char = >;code = 62
char = A;code = 65
char = ;code = 32
char = c;code = 99
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = a;code = 97
char = c;code = 99
char = y;code = 121
char = c;code = 99
char = l;code = 108
char = o;code = 111
char = v;code = 118
char = i;code = 105
char = r;code = 114
char = -;code = 45
char = i;code = 105
char = n;code = 110
char = d;code = 100
char = u;code = 117
char = c;code = 99
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = c;code = 99
char = u;code = 117
char = t;code = 116
char = e;code = 101
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = f;code = 102
char = a;code = 97
char = i;code = 105
char = l;code = 108
char = u;code = 117
char = r;code = 114
char = e;code = 101
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = ;code = 32
char = o;code = 111
char = b;code = 98
char = e;code = 101
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = p;code = 112
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = s;code = 115
char = c;code = 99
char = r;code = 114
char = i;code = 105
char = b;code = 98
char = e;code = 101
char = d;code = 100
char = .;code = 46
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = >;code = 62
char = S;code = 83
char = U;code = 85
char = M;code = 77
char = M;code = 77
char = A;code = 65
char = R;code = 82
char = Y;code = 89
char = ;code = 32
char = :;code = 58
char = ;code = 32
char = <;code = 60
char = /;code = 47
char = b;code = 98
char = >;code = 62
char = A;code = 65
char = ;code = 32
char = 6;code = 54
char = 0;code = 48
char = -;code = 45
char = y;code = 121
char = e;code = 101
char = a;code = 97
char = r;code = 114
char = -;code = 45
char = o;code = 111
char = l;code = 108
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = h;code = 104
char = i;code = 105
char = t;code = 116
char = e;code = 101
char = ;code = 32
char = m;code = 109
char = a;code = 97
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = r;code = 114
char = r;code = 114
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = t;code = 116
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = e;code = 101
char = m;code = 109
char = e;code = 101
char = r;code = 114
char = g;code = 103
char = e;code = 101
char = n;code = 110
char = c;code = 99
char = y;code = 121
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = t;code = 116
char = m;code = 109
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = l;code = 108
char = a;code = 97
char = i;code = 105
char = n;code = 110
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = n;code = 110
char = f;code = 102
char = u;code = 117
char = s;code = 115
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = d;code = 100
char = i;code = 105
char = s;code = 115
char = o;code = 111
char = r;code = 114
char = i;code = 105
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = .;code = 46
char = ;code = 32
char = H;code = 72
char = e;code = 101
char = ;code = 32
char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = 5;code = 53
char = ;code = 32
char = f;code = 102
char = t;code = 116
char = ;code = 32
char = 7;code = 55
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = a;code = 97
char = l;code = 108
char = l;code = 108
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = e;code = 101
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = 1;code = 49
char = 0;code = 48
char = 8;code = 56
char = .;code = 46
char = 9;code = 57
char = ;code = 32
char = k;code = 107
char = g;code = 103
char = .;code = 46
char = ;code = 32
char = H;code = 72
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = m;code = 109
char = e;code = 101
char = d;code = 100
char = i;code = 105
char = c;code = 99
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = s;code = 115
char = u;code = 117
char = r;code = 114
char = g;code = 103
char = i;code = 105
char = c;code = 99
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = s;code = 115
char = t;code = 116
char = o;code = 111
char = r;code = 114
char = i;code = 105
char = e;code = 101
char = s;code = 115
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = c;code = 99
char = l;code = 108
char = u;code = 117
char = d;code = 100
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = c;code = 99
char = h;code = 104
char = r;code = 114
char = o;code = 111
char = n;code = 110
char = i;code = 105
char = c;code = 99
char = ;code = 32
char = o;code = 111
char = b;code = 98
char = s;code = 115
char = t;code = 116
char = r;code = 114
char = u;code = 117
char = c;code = 99
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = p;code = 112
char = u;code = 117
char = l;code = 108
char = m;code = 109
char = o;code = 111
char = n;code = 110
char = a;code = 97
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = d;code = 100
char = i;code = 105
char = s;code = 115
char = e;code = 101
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = (;code = 40
char = C;code = 67
char = O;code = 79
char = P;code = 80
char = D;code = 68
char = );code = 41
char = ,;code = 44
char = ;code = 32
char = s;code = 115
char = l;code = 108
char = e;code = 101
char = e;code = 101
char = p;code = 112
char = ;code = 32
char = a;code = 97
char = p;code = 112
char = n;code = 110
char = e;code = 101
char = a;code = 97
char = ;code = 32
char = n;code = 110
char = o;code = 111
char = t;code = 116
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = q;code = 113
char = u;code = 117
char = i;code = 105
char = r;code = 114
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = b;code = 98
char = i;code = 105
char = p;code = 112
char = h;code = 104
char = a;code = 97
char = s;code = 115
char = i;code = 105
char = c;code = 99
char = ;code = 32
char = p;code = 112
char = o;code = 111
char = s;code = 115
char = i;code = 105
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = a;code = 97
char = i;code = 105
char = r;code = 114
char = w;code = 119
char = a;code = 97
char = y;code = 121
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = s;code = 115
char = s;code = 115
char = u;code = 117
char = r;code = 114
char = e;code = 101
char = ,;code = 44
char = ;code = 32
char = o;code = 111
char = b;code = 98
char = e;code = 101
char = s;code = 115
char = i;code = 105
char = t;code = 116
char = y;code = 121
char = ,;code = 44
char = ;code = 32
char = o;code = 111
char = x;code = 120
char = y;code = 121
char = g;code = 103
char = e;code = 101
char = n;code = 110
char = ;code = 32
char = s;code = 115
char = u;code = 117
char = p;code = 112
char = p;code = 112
char = l;code = 108
char = e;code = 101
char = m;code = 109
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = ,;code = 44
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = p;code = 112
char = p;code = 112
char = e;code = 101
char = n;code = 110
char = d;code = 100
char = e;code = 101
char = c;code = 99
char = t;code = 116
char = o;code = 111
char = m;code = 109
char = y;code = 121
char = .;code = 46
char = ;code = 32
char = H;code = 72
char = e;code = 101
char = ;code = 32
char = a;code = 97
char = l;code = 108
char = s;code = 115
char = o;code = 111
char = ;code = 32
char = h;code = 104
char = a;code = 97
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = s;code = 115
char = t;code = 116
char = o;code = 111
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = c;code = 99
char = y;code = 121
char = s;code = 115
char = t;code = 116
char = ;code = 32
char = d;code = 100
char = r;code = 114
char = a;code = 97
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = g;code = 103
char = e;code = 101
char = ;code = 32
char = o;code = 111
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = b;code = 98
char = a;code = 97
char = c;code = 99
char = k;code = 107
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = n;code = 110
char = e;code = 101
char = c;code = 99
char = k;code = 107
char = ,;code = 44
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = c;code = 99
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = d;code = 100
char = r;code = 114
char = a;code = 97
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = g;code = 103
char = e;code = 101
char = ;code = 32
char = e;code = 101
char = m;code = 109
char = i;code = 105
char = t;code = 116
char = t;code = 116
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = a;code = 97
char = ;code = 32
char = f;code = 102
char = o;code = 111
char = u;code = 117
char = l;code = 108
char = ;code = 32
char = o;code = 111
char = d;code = 100
char = o;code = 111
char = r;code = 114
char = ,;code = 44
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = s;code = 115
char = u;code = 117
char = f;code = 102
char = f;code = 102
char = e;code = 101
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = c;code = 99
char = u;code = 117
char = r;code = 114
char = r;code = 114
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = h;code = 104
char = e;code = 101
char = r;code = 114
char = p;code = 112
char = e;code = 101
char = s;code = 115
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = l;code = 108
char = d;code = 100
char = ;code = 32
char = s;code = 115
char = o;code = 111
char = r;code = 114
char = e;code = 101
char = s;code = 115
char = ;code = 32
char = o;code = 111
char = n;code = 110
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = c;code = 99
char = h;code = 104
char = i;code = 105
char = n;code = 110
char = .;code = 46
char = ;code = 32
char = A;code = 65
char = ;code = 32
char = l;code = 108
char = u;code = 117
char = m;code = 109
char = b;code = 98
char = a;code = 97
char = r;code = 114
char = ;code = 32
char = p;code = 112
char = u;code = 117
char = n;code = 110
char = c;code = 99
char = t;code = 116
char = u;code = 117
char = r;code = 114
char = e;code = 101
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = v;code = 118
char = e;code = 101
char = a;code = 97
char = l;code = 108
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = b;code = 98
char = n;code = 110
char = o;code = 111
char = r;code = 114
char = m;code = 109
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = c;code = 99
char = e;code = 101
char = r;code = 114
char = e;code = 101
char = b;code = 98
char = r;code = 114
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = s;code = 115
char = p;code = 112
char = i;code = 105
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = f;code = 102
char = l;code = 108
char = u;code = 117
char = i;code = 105
char = d;code = 100
char = .;code = 46
char = ;code = 32
char = A;code = 65
char = ;code = 32
char = d;code = 100
char = i;code = 105
char = a;code = 97
char = g;code = 103
char = n;code = 110
char = o;code = 111
char = s;code = 115
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = h;code = 104
char = e;code = 101
char = r;code = 114
char = p;code = 112
char = e;code = 101
char = s;code = 115
char = ;code = 32
char = e;code = 101
char = n;code = 110
char = c;code = 99
char = e;code = 101
char = p;code = 112
char = h;code = 104
char = a;code = 97
char = l;code = 108
char = i;code = 105
char = t;code = 116
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = n;code = 110
char = s;code = 115
char = i;code = 105
char = d;code = 100
char = e;code = 101
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ,;code = 44
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = p;code = 112
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = ;code = 32
char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = e;code = 101
char = m;code = 109
char = p;code = 112
char = i;code = 105
char = r;code = 114
char = i;code = 105
char = c;code = 99
char = a;code = 97
char = l;code = 108
char = l;code = 108
char = y;code = 121
char = ;code = 32
char = t;code = 116
char = r;code = 114
char = e;code = 101
char = a;code = 97
char = t;code = 116
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = i;code = 105
char = .;code = 46
char = v;code = 118
char = .;code = 46
char = ;code = 32
char = a;code = 97
char = c;code = 99
char = y;code = 121
char = c;code = 99
char = l;code = 108
char = o;code = 111
char = v;code = 118
char = i;code = 105
char = r;code = 114
char = ;code = 32
char = 1;code = 49
char = ;code = 32
char = g;code = 103
char = ;code = 32
char = o;code = 111
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = ;code = 32
char = 6;code = 54
char = 0;code = 48
char = ;code = 32
char = m;code = 109
char = i;code = 105
char = n;code = 110
char = u;code = 117
char = t;code = 116
char = e;code = 101
char = s;code = 115
char = ;code = 32
char = e;code = 101
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = e;code = 101
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = t;code = 116
char = ;code = 32
char = h;code = 104
char = o;code = 111
char = u;code = 117
char = r;code = 114
char = s;code = 115
char = ,;code = 44
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = d;code = 100
char = o;code = 111
char = s;code = 115
char = a;code = 97
char = g;code = 103
char = e;code = 101
char = ;code = 32
char = b;code = 98
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = o;code = 111
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = c;code = 99
char = t;code = 116
char = u;code = 117
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = b;code = 98
char = o;code = 111
char = d;code = 100
char = y;code = 121
char = ;code = 32
char = w;code = 119
char = e;code = 101
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = t;code = 116
char = .;code = 46
char = ;code = 32
char = H;code = 72
char = e;code = 101
char = ;code = 32
char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = a;code = 97
char = l;code = 108
char = s;code = 115
char = o;code = 111
char = ;code = 32
char = g;code = 103
char = i;code = 105
char = v;code = 118
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char = l;code = 108
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char = p;code = 112
char = r;code = 114
char = o;code = 111
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char = e;code = 101
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char = ;code = 32
char = A;code = 65
char = t;code = 116
char = ;code = 32
char = d;code = 100
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char = s;code = 115
char = c;code = 99
char = h;code = 104
char = a;code = 97
char = r;code = 114
char = g;code = 103
char = e;code = 101
char = ,;code = 44
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char = t;code = 116
char = h;code = 104
char = e;code = 101
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char = t;code = 116
char = i;code = 105
char = e;code = 101
char = n;code = 110
char = t;code = 116
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char = s;code = 115
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char = C;code = 67
char = r;code = 114
char = ;code = 32
char = a;code = 97
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char = d;code = 100
char = ;code = 32
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char = U;code = 85
char = N;code = 78
char = ;code = 32
char = l;code = 108
char = e;code = 101
char = v;code = 118
char = e;code = 101
char = l;code = 108
char = s;code = 115
char = ;code = 32
char = w;code = 119
char = e;code = 101
char = r;code = 114
char = e;code = 101
char = ;code = 32
char = 3;code = 51
char = .;code = 46
char = 1;code = 49
char = ;code = 32
char = g;code = 103
char = /;code = 47
char = d;code = 100
char = L;code = 76
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = 3;code = 51
char = 8;code = 56
char = ;code = 32
char = m;code = 109
char = g;code = 103
char = /;code = 47
char = d;code = 100
char = L;code = 76
char = ,;code = 44
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = s;code = 115
char = p;code = 112
char = e;code = 101
char = c;code = 99
char = t;code = 116
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = l;code = 108
char = y;code = 121
char = .;code = 46
char = ;code = 32
char = H;code = 72
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = d;code = 100
char = i;code = 105
char = s;code = 115
char = c;code = 99
char = h;code = 104
char = a;code = 97
char = r;code = 114
char = g;code = 103
char = e;code = 101
char = ;code = 32
char = d;code = 100
char = i;code = 105
char = a;code = 97
char = g;code = 103
char = n;code = 110
char = o;code = 111
char = s;code = 115
char = e;code = 101
char = s;code = 115
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = c;code = 99
char = l;code = 108
char = u;code = 117
char = d;code = 100
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = e;code = 101
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char = c;code = 99
char = e;code = 101
char = p;code = 112
char = h;code = 104
char = a;code = 97
char = l;code = 108
char = i;code = 105
char = t;code = 116
char = i;code = 105
char = s;code = 115
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = p;code = 112
char = o;code = 111
char = s;code = 115
char = s;code = 115
char = i;code = 105
char = b;code = 98
char = l;code = 108
char = e;code = 101
char = ;code = 32
char = v;code = 118
char = i;code = 105
char = r;code = 114
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = o;code = 111
char = r;code = 114
char = i;code = 105
char = g;code = 103
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = c;code = 99
char = y;code = 121
char = c;code = 99
char = l;code = 108
char = o;code = 111
char = v;code = 118
char = i;code = 105
char = r;code = 114
char = -;code = 45
char = i;code = 105
char = n;code = 110
char = d;code = 100
char = u;code = 117
char = c;code = 99
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = n;code = 110
char = e;code = 101
char = p;code = 112
char = h;code = 104
char = r;code = 114
char = o;code = 111
char = t;code = 116
char = o;code = 111
char = x;code = 120
char = i;code = 105
char = c;code = 99
char = i;code = 105
char = t;code = 116
char = y;code = 121
char = .;code = 46
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = >;code = 62
char = C;code = 67
char = O;code = 79
char = N;code = 78
char = C;code = 67
char = L;code = 76
char = U;code = 85
char = S;code = 83
char = I;code = 73
char = O;code = 79
char = N;code = 78
char = ;code = 32
char = :;code = 58
char = ;code = 32
char = <;code = 60
char = /;code = 47
char = b;code = 98
char = >;code = 62
char = A;code = 65
char = n;code = 110
char = ;code = 32
char = o;code = 111
char = b;code = 98
char = e;code = 101
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char = e;code = 101
char = ;code = 32
char = m;code = 109
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char = n;code = 110
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = c;code = 99
char = e;code = 101
char = i;code = 105
char = v;code = 118
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = e;code = 101
char = x;code = 120
char = c;code = 99
char = e;code = 101
char = s;code = 115
char = s;code = 115
char = i;code = 105
char = v;code = 118
char = e;code = 101
char = ;code = 32
char = d;code = 100
char = o;code = 111
char = s;code = 115
char = e;code = 101
char = s;code = 115
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = i;code = 105
char = .;code = 46
char = v;code = 118
char = .;code = 46
char = ;code = 32
char = a;code = 97
char = c;code = 99
char = y;code = 121
char = c;code = 99
char = l;code = 108
char = o;code = 111
char = v;code = 118
char = i;code = 105
char = r;code = 114
char = ;code = 32
char = d;code = 100
char = e;code = 101
char = v;code = 118
char = e;code = 101
char = l;code = 108
char = o;code = 111
char = p;code = 112
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = c;code = 99
char = u;code = 117
char = t;code = 116
char = e;code = 101
char = ;code = 32
char = b;code = 98
char = u;code = 117
char = t;code = 116
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = s;code = 115
char = i;code = 105
char = b;code = 98
char = l;code = 108
char = e;code = 101
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = n;code = 110
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = f;code = 102
char = a;code = 97
char = i;code = 105
char = l;code = 108
char = u;code = 117
char = r;code = 114
char = e;code = 101
char = .;code = 46
result sql = PURPOSE : A case of acyclovir-induced acute renal failure in an obese patient is described.
SUMMARY : A 60-year-old white man arrived at the emergency department complaining of confusion and disorientation. He was 5 ft 7 in tall and weighed 108.9 kg. His medical and surgical histories included chronic obstructive pulmonary disease (COPD), sleep apnea not requiring biphasic positive airway pressure, obesity, oxygen supplementation, and appendectomy. He also had a history of cyst drainage on the back of his neck, with recent drainage emitting a foul odor, and suffered recurrent herpes cold sores on his chin. A lumbar puncture revealed abnormal cerebral spinal fluid. A diagnosis of herpes encephalitis was considered, and the patient was empirically treated with i.v. acyclovir 1 g over 60 minutes every eight hours, with the dosage based on actual body weight. He was also given moxifloxacin 400 mg i.v. daily for possible COPD exacerbation and doxycycline 100 mg i.v. twice daily for possible leptospirosis meningitis. On hospital day 3, his serum creatinine (SCr) and blood urea nitrogen (BUN) concentrations rose to 2.8 g/dL and 32 mg/dL, respectively. Acyclovir was subsequently discontinued, as were all i.v. antibiotics. On day 7, hydration therapy was initiated, as was therapy to alkalinize the urine, and his neurologic status began to improve. At discharge, the patient's SCr and BUN levels were 3.1 g/dL and 38 mg/dL, respectively. His discharge diagnoses included encephalitis with possible viral origin and acyclovir-induced nephrotoxicity.
CONCLUSION : An obese man receiving excessive doses of i.v. acyclovir developed acute but reversible renal failure.
Publication: Am J Health Syst Pharm 2009 Jul 15 ;66(14)::1288-91. :doi: 10.2146/ajhp080307.
Publication Date: 2009 Jul 15
Study Author(s): Hernandez, Jovino Ocasio;Norstrom, Jeni;Wysock, Glenn;
Institution: Pharmacy, Winter Haven Hospital, 200 Avenue F NE, Winter Haven, FL 33881, USA. [email protected]
Shortcut link to this study:
Publication Date: 2009 Jul 15
Study Author(s): Hernandez, Jovino Ocasio;Norstrom, Jeni;Wysock, Glenn;
Institution: Pharmacy, Winter Haven Hospital, 200 Avenue F NE, Winter Haven, FL 33881, USA. [email protected]
Shortcut link to this study:
PURPOSE : A case of acyclovir-induced acute renal failure in an obese patient is described.
SUMMARY : A 60-year-old white man arrived at the emergency department complaining of confusion and disorientation. He was 5 ft 7 in tall and weighed 108.9 kg. His medical and surgical histories included chronic obstructive pulmonary disease (COPD), sleep apnea not requiring biphasic positive airway pressure, obesity, oxygen supplementation, and appendectomy. He also had a history of cyst drainage on the back of his neck, with recent drainage emitting a foul odor, and suffered recurrent herpes cold sores on his chin. A lumbar puncture revealed abnormal cerebral spinal fluid. A diagnosis of herpes encephalitis was considered, and the patient was empirically treated with i.v. acyclovir 1 g over 60 minutes every eight hours, with the dosage based on actual body weight. He was also given moxifloxacin 400 mg i.v. daily for possible COPD exacerbation and doxycycline 100 mg i.v. twice daily for possible leptospirosis meningitis. On hospital day 3, his serum creatinine (SCr) and blood urea nitrogen (BUN) concentrations rose to 2.8 g/dL and 32 mg/dL, respectively. Acyclovir was subsequently discontinued, as were all i.v. antibiotics. On day 7, hydration therapy was initiated, as was therapy to alkalinize the urine, and his neurologic status began to improve. At discharge, the patient's SCr and BUN levels were 3.1 g/dL and 38 mg/dL, respectively. His discharge diagnoses included encephalitis with possible viral origin and acyclovir-induced nephrotoxicity.
CONCLUSION : An obese man receiving excessive doses of i.v. acyclovir developed acute but reversible renal failure.
SUMMARY : A 60-year-old white man arrived at the emergency department complaining of confusion and disorientation. He was 5 ft 7 in tall and weighed 108.9 kg. His medical and surgical histories included chronic obstructive pulmonary disease (COPD), sleep apnea not requiring biphasic positive airway pressure, obesity, oxygen supplementation, and appendectomy. He also had a history of cyst drainage on the back of his neck, with recent drainage emitting a foul odor, and suffered recurrent herpes cold sores on his chin. A lumbar puncture revealed abnormal cerebral spinal fluid. A diagnosis of herpes encephalitis was considered, and the patient was empirically treated with i.v. acyclovir 1 g over 60 minutes every eight hours, with the dosage based on actual body weight. He was also given moxifloxacin 400 mg i.v. daily for possible COPD exacerbation and doxycycline 100 mg i.v. twice daily for possible leptospirosis meningitis. On hospital day 3, his serum creatinine (SCr) and blood urea nitrogen (BUN) concentrations rose to 2.8 g/dL and 32 mg/dL, respectively. Acyclovir was subsequently discontinued, as were all i.v. antibiotics. On day 7, hydration therapy was initiated, as was therapy to alkalinize the urine, and his neurologic status began to improve. At discharge, the patient's SCr and BUN levels were 3.1 g/dL and 38 mg/dL, respectively. His discharge diagnoses included encephalitis with possible viral origin and acyclovir-induced nephrotoxicity.
CONCLUSION : An obese man receiving excessive doses of i.v. acyclovir developed acute but reversible renal failure.
PMID: 19574603
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