Valaciclovir overdose
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Acute kidney injury: case report A 49-year-old man developed acute kidney injury following an overdose of valaciclovir, olanzapine, venlafaxine and alcohol [routes and time to reaction onset not stated]. The man was hospitalised with an acute overdose of valaciclovir 30g, olanzapine 2.5g, venlafaxine 4.2g and alcohol; he had been previously taking valaciclovir 500mg twice daily. Upon admission, he had a BP of 87/57mm Hg, a heart rate of 135 beats/min, a lactic acid level of 5.8 mmol/L, a serum creatinine level of 104 µmol/L and a blood alcohol level of 0.21%. Urinalysis revealed pH of 5.0, specific gravity of 1.015, and birefringent needle-shaped crystals on a spun specimen. After receiving fluids, the man’s BP increased to 129/75mm Hg and his lactate level decreased to 2.1 mmol/L. The following day, his serum creatinine level increased to 223 µmol/L. Valaciclovir-induced crystalluria was suspected, and his fluid intake was increased. At 72 hours, he had a peak serum creatinine level of 538 µmol/L. His serum creatinine level gradually decreased over the following week, and repeat urinalysis was normal. Author comment: "The patient was previously taking valacyclovir 500mg twice daily without renal impairment. It is presumed the acute kidney injury was a result of the overdose." Roberts DM, et al. Acute kidney injury due to crystalluria following acute valacyclovir overdose. Kidney International 79: 574, No. 5, Mar 2011 803058191 Australia
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Reactions 30 Jul 2011 No. 1362
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