Treatment
In 12 & 19 February 2020 , the patient received
the
third cycles of ABVD chemotherapy. However, the doctor gave the wrong
dose (150 USP, equivalent to ten times the common dose) of bleomycin and
the time of medication error was at 14:54 in 19 February 2020 .
The rest of the drugs were administered in the same doses as previously
performed.
The medication error was found at 13:00 in 20 February 2020. The
patient was immediately treated with intravenous rehydration (3000
ml/m2) and furosemide 20 mg to promote clearance of
drugs. Then to prevent lung injury, the methylprednisone was given 40 mg
qd via intravenous route for three days, which changed to 8 mg qd orally
for nine days and decreased to 4 mg qd orally for nine days. The
acetylcysteine solution for inhalation BID was administered for 12 days,
and the acetylcysteine tablets 0.6 g TID were used orally for 21 days.
At the same time, the pulmonary function test showed the lung function
of the patient was normal. No obvious abnormalities were detected by the
thoracoabdominopelvic CT scan and echocardiography. All lab values were
within normal range except for a decreased lymphocyte count of
0.87×109/L
(LYMPH, reference range, 1.10×109 to
3.20×109/L) and an elevated C-reactive protein level
of 17.44 mg/L (CRP, reference range, 0 to 5 mg/L).