{"id":4133,"date":"2019-03-09T22:17:16","date_gmt":"2019-03-09T15:17:16","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=4133"},"modified":"2019-03-09T22:17:16","modified_gmt":"2019-03-09T15:17:16","slug":"case-lam-sang-di-ung-amoxicillin-acid-clavulanic","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/case-lam-sang-di-ung-amoxicillin-acid-clavulanic\/","title":{"rendered":"[Case l\u00e2m s\u00e0ng] D\u1ecb \u1ee9ng amoxicillin \u2013 acid clavulanic"},"content":{"rendered":"<h2>Ca l\u00e2m s\u00e0ng<\/h2>\n<p>B\u1ec7nh nh\u00e2n n\u1eef, ti\u1ec1n s\u1eed kh\u1ecfe m\u1ea1nh, 1 tu\u1ea7n nay xu\u1ea5t hi\u1ec7n kh\u00f3 ch\u1ecbu, s\u1ed1t v\u00e0 ph\u00e1t ban. B\u1ec7nh s\u1eed kh\u00f4ng c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t tr\u1eeb vi\u1ec7c m\u1edbi \u0111\u00e2y m\u1eafc vi\u00eam xoang m\u0169i c\u1ea5p t\u00ednh do vi khu\u1ea9n kh\u00f4ng bi\u1ebfn ch\u1ee9ng, b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng amoxicillin \u2013 acid clavulanic 2 tu\u1ea7n tr\u01b0\u1edbc \u0111\u00f3, t\u1eeb \u0111\u00f3 h\u1ebft c\u00e1c tri\u1ec7u ch\u1ee9ng xu\u1ea5t ti\u1ebft d\u1ecbch m\u0169i v\u00e0 \u0111au v\u00f9ng m\u1eb7t. Kh\u00f4ng ho, kh\u00f4ng \u0111au b\u1ee5ng, kh\u00f4ng ti\u00eau ch\u1ea3y hay \u0111\u00e1i bu\u1ed1t.<\/p>\n<p>Kh\u00e1m th\u1ef1c th\u1ec3 th\u1ea5y s\u1ed1t 38,3 \u0111\u1ed9 C, huy\u1ebft \u00e1p 148\/92 mm Hg, t\u1ea7n s\u1ed1 tim 88 nh\u1ecbp\/ph\u00fat, nh\u1ecbp th\u1edf 14 l\u1ea7n\/ph\u00fat. Xu\u1ea5t hi\u1ec7n c\u00e1c ban d\u00e1t s\u1ea9n tr\u00ean ng\u1ef1c v\u00e0 l\u01b0ng. Kh\u00e1m c\u00e1c c\u01a1 quan b\u1ed9 ph\u1eadn kh\u00e1c kh\u00f4ng ph\u00e1t hi\u1ec7n g\u00ec b\u1ea5t th\u01b0\u1eddng.<\/p>\n<p>X\u00e9t nghi\u1ec7m th\u1ea5y n\u1ed3ng \u0111\u1ed9 creatinin l\u00e0 2,4 mg\/dL, so v\u1edbi n\u1ed3ng \u0111\u1ed9 1 n\u0103m tr\u01b0\u1edbc l\u00e0 0,9 mg\/dL (gi\u1edbi h\u1ea1n tham chi\u1ebfu l\u00e0 0,6 &#8211; 1,1).<\/p>\n<p>C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c c\u00f3 k\u1ebft qu\u1ea3 nh\u01b0 sau:<\/p>\n<ul>\n<li>Hematocrit (%): 37 (36 \u2013 46)<\/li>\n<li>S\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u (G\/L): 9,76 (4,5 \u2013 11,0)<\/li>\n<li>B\u1ea1ch c\u1ea7u trung t\u00ednh (G\/L): 6,80 (1,9 \u2013 7,6)<\/li>\n<li>Lympho b\u00e0o (G\/L): 2,00 (0,8 \u2013 4,1)<\/li>\n<li>B\u1ea1ch c\u1ea7u \u00e1i toan (G\/L): 0,75 (0 \u2013 0,35)<\/li>\n<li>Ti\u1ec3u c\u1ea7u (T\/L): 480 (150 \u2013 350)<\/li>\n<li>Natri (mEq\/L): 135 (136 \u2013 145)<\/li>\n<li>Kali (mEq\/L): 5,3 (3,5 \u2013 5,0)<\/li>\n<li>Urea (mg\/dL): 34 (10 \u2013 20)<\/li>\n<\/ul>\n<p>T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u th\u1ea5y b\u1ea1ch c\u1ea7u ni\u1ec7u 31 \u2013 40 \/ vi tr\u01b0\u1eddng (gi\u1edbi h\u1ea1n tham chi\u1ebfu 0 \u2013 2) v\u00e0 t\u1ec9 s\u1ed1 protein\/creatinine ni\u1ec7u l\u00e0 1,1 g\/g (&lt; 0,2).<\/p>\n<p>B\u01b0\u1edbc \u0111\u00e1nh gi\u00e1 ti\u1ebfp theo n\u00e0o sau \u0111\u00e2y l\u00e0 ph\u00f9 h\u1ee3p nh\u1ea5t tr\u00ean b\u1ec7nh nh\u00e2n n\u00e0y?<\/p>\n<p>A. \u0110\u00e1nh gi\u00e1 kh\u00e1ng th\u1ec3 kh\u00e1ng kh\u00e1ng nguy\u00ean b\u00e0o t\u01b0\u01a1ng (ANCA)<br \/>\nB. \u0110\u1ecbnh l\u01b0\u1ee3ng hi\u1ec7u gi\u00e1 antistreptolysin O<br \/>\nC. \u0110\u00e1nh gi\u00e1 b\u1ea1ch c\u1ea7u \u00e1i toan trong n\u01b0\u1edbc ti\u1ec3u<br \/>\nD. Ti\u1ebfn h\u00e0nh sinh thi\u1ebft th\u1eadn<br \/>\nE. Kh\u00f4ng c\u1ea7n l\u00e0m ngay x\u00e9t nghi\u1ec7m; ng\u1eebng amoxicillin \u2013 acid clavulanic<\/p>\n<h2>\u0110\u00e1p \u00e1n: E<\/h2>\n<p>\u0110i\u1ec3m m\u1ea5u ch\u1ed1t: H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam th\u1eadn k\u1ebd do thu\u1ed1c c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1eb1ng l\u00e2m s\u00e0ng v\u00e0 s\u1ebd t\u1ef1 c\u1ea3i thi\u1ec7n n\u1ebfu ng\u1eebng s\u1eed d\u1ee5ng thu\u1ed1c g\u00e2y ph\u1ea3n \u1ee9ng.<\/p>\n<p>S\u1ed1t, ph\u00e1t ban v\u00e0 t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan m\u00e1u ngo\u1ea1i vi t\u1ea1o th\u00e0nh tam ch\u1ee9ng kinh \u0111i\u1ec3n g\u1ee3i \u00fd vi\u00eam th\u1eadn k\u1ebd c\u1ea5p t\u00ednh (AIN) trong b\u1ec7nh c\u1ea3nh t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p. Thu\u1ed1c l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t g\u00e2y AIN; c\u00e1c kh\u00e1ng sinh, thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m proton l\u00e0 c\u00e1c thu\u1ed1c hay \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp nh\u1ea5t. \u1ede \u0111\u00e2y, b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n tam ch\u1ee9ng kinh \u0111i\u1ec3n sau khi m\u1edbi b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng amoxicillin \u2013 acid clavulanic; th\u00eam v\u00e0o \u0111\u00f3, b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n ti\u1ec3u ra m\u1ee7 v\u00e0 protein ni\u1ec7u m\u1ee9c \u0111\u1ed9 v\u1eeba. T\u1ed5ng h\u1ee3p l\u1ea1i, c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y \u0111\u1ec1u ph\u00f9 h\u1ee3p v\u1edbi AIN.<\/p>\n<p>Khi l\u00e2m s\u00e0ng ngh\u0129 nhi\u1ec1u \u0111\u1ebfn AIN (nh\u01b0 trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y), kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i l\u00e0m ngay x\u00e9t nghi\u1ec7m. H\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n AIN do thu\u1ed1c \u0111\u1ec1u c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng m\u00e0 kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb n\u1ebfu ng\u1eebng thu\u1ed1c g\u00e2y ph\u1ea3n \u1ee9ng. N\u1ebfu kh\u00f4ng, c\u00f3 th\u1ec3 xem x\u00e9t sinh thi\u1ebft th\u1eadn \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n v\u00e0 gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng c\u00e1c quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb sau n\u00e0y.<\/p>\n<p>M\u1eb7c d\u00f9 th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 AIN, x\u00e9t nghi\u1ec7m b\u1ea1ch c\u1ea7u \u00e1i toan trong n\u01b0\u1edbc ti\u1ec3u c\u00f3 gi\u00e1 tr\u1ecb d\u1ef1 b\u00e1o d\u01b0\u01a1ng t\u00ednh v\u00e0 \u00e2m t\u00ednh th\u1ea5p trong ch\u1ea9n \u0111o\u00e1n AIN v\u00e0 c\u00f3 m\u1ee9c \u0111\u1ed9 \u1ee9ng d\u1ee5ng l\u00e2m s\u00e0ng h\u1ea1n ch\u1ebf.<\/p>\n<p>C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1ng th\u1ec3 kh\u00e1ng kh\u00e1ng nguy\u00ean b\u00e0o t\u01b0\u01a1ng (ANCA) v\u00e0 hi\u1ec7u gi\u00e1 antistreptolysin O s\u1ebd c\u00f3 \u00fd ngh\u0129a n\u1ebfu ngh\u0129 \u0111\u1ebfn vi\u00eam m\u1ea1ch do ANCA hay vi\u00eam c\u1ea7u th\u1eadn sau nhi\u1ec5m li\u00ean c\u1ea7u. Vi\u00eam m\u1ea1ch ANCA c\u00f3 th\u1ec3 g\u00e2y c\u00e1c tri\u1ec7u ch\u1ee9ng \u1edf xoang v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn, nh\u01b0ng bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 th\u1eddi gian xu\u1ea5t hi\u1ec7n r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y ph\u00f9 h\u1ee3p v\u1edbi AIN h\u01a1n.<\/p>\n<p>Vi\u00eam c\u1ea7u th\u1eadn sau nhi\u1ec5m li\u00ean c\u1ea7u \u0111i\u1ec3n h\u00ecnh b\u1eaft \u0111\u1ea7u 10 &#8211; 14 ng\u00e0y sau kh\u1edfi ph\u00e1t vi\u00eam h\u1ecdng c\u1ea5p. Ph\u00e1t ban v\u00e0 t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan m\u00e1u ngo\u1ea1i vi kh\u00f4ng xu\u1ea5t hi\u1ec7n trong t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00ed n\u00e0y, \u0111\u00e2y l\u00e0 lo\u1ea1i r\u1ed1i lo\u1ea1n ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch ch\u1ec9 gi\u1edbi h\u1ea1n \u1edf th\u1eadn h\u01a1n l\u00e0 m\u1ed9t b\u1ec7nh l\u00ed to\u00e0n th\u00e2n. Ngo\u00e0i ra, t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u \u0111i\u1ec3n h\u00ecnh s\u1ebd th\u1ea5y \u0111\u00e1i m\u00e1u ho\u1eb7c h\u1ed3ng c\u1ea7u ni\u1ec7u, c\u1ea3 hai tri\u1ec7u ch\u1ee9ng \u0111\u1ec1u kh\u00f4ng xu\u1ea5t hi\u1ec7n trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/h2>\n<p>1. Muriithi AK et al. Biopsy-proven acute interstitial nephritis, 1993-2011: a case series. Am J Kidney Dis 2014 Oct; 64:558.<\/p>\n<p>2. Markowitz GS et al. Drug-induced glomerular disease: direct cellular injury. Clin J Am Soc Nephrol 2015 Jul 7; 10:1291.<\/p>\n<p>3. Muriithi AK et al. Utility of urine eosinophils in the diagnosis of acute interstitial nephritis. Clin J Am Soc Nephrol 2013 Nov; 8:1857.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ca l\u00e2m s\u00e0ng B\u1ec7nh nh\u00e2n n\u1eef, ti\u1ec1n s\u1eed kh\u1ecfe m\u1ea1nh, 1 tu\u1ea7n nay xu\u1ea5t hi\u1ec7n kh\u00f3 ch\u1ecbu, s\u1ed1t v\u00e0 ph\u00e1t ban. B\u1ec7nh s\u1eed kh\u00f4ng c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t tr\u1eeb vi\u1ec7c m\u1edbi \u0111\u00e2y m\u1eafc vi\u00eam xoang m\u0169i c\u1ea5p t\u00ednh do vi khu\u1ea9n kh\u00f4ng bi\u1ebfn ch\u1ee9ng, b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng amoxicillin \u2013 acid clavulanic 2 tu\u1ea7n [&#8230;]\n","protected":false},"author":1,"featured_media":4134,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-4133","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/4133","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=4133"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/4133\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/4134"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=4133"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=4133"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=4133"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}