1例68岁女性患者因甲沟炎给予头孢曲松钠4 g加入0.9%氯化钠注射液250 ml,1次/d静脉滴注。用药期间出现腰痛,第3天因发生一过性晕厥、血尿而入院。入院时皮肤巩膜重度黄染。实验室检查:白细胞计数39.4×109/L,中性粒细胞0.97,红细胞计数1.9×1012/L,血红蛋白42 g/L,网织红细胞0.03,尿素氮15.0 mmol/l,肌酐336μmol/L,丙氨酸转氨酶(ALT)380 U/L,天冬氨酸转氨酶(AST)930 U/L,γ-L-谷氨酰转移酶60 U/L,总胆红素(TBil)235.1μmol/L,直接胆红素(DBil)130.6μmol/L,间接胆红素(IBil)104.5μmol/L,乳酸脱氢酶2198 U/L,肌酸激酶211 U/L,α-羟丁酸脱氢酶1538 U/L,肌酸激酶同工酶22 U/L,凝血酶原时间21.3 s,活化部分凝血活酶时间50.5 s,凝血酶时间29.6 s,纤维蛋白原含量1.03 g/L,D-二聚体10.4 mg/L;抗人球蛋白试验C3(+)。尿液检查:胆红素(++),潜血(+++),尿蛋白(++),红细胞3个/HP。考虑为头孢曲松钠引起的急性药物性溶血伴全身多器官功能衰竭。予静脉注射人免疫球蛋白、糖皮质激素。行连续性肾脏替代治疗和血液透析、血浆置换,反复输注洗涤红细胞、新鲜冰冻血浆及冷沉淀,同时接受碱化尿液、保护肝脏功能等对症支持治疗。第57天复查,红细胞计数4.0×1012/L,血红蛋白112 g/L,肌酐110μmol/L,ALT 13 U/L,AST 20 U/L,TBil 11.7μmol/L,DBil 4.5μmol/L,IBil 7.2μmol/L,患者症状好转出院。 A 68-year-old female patient received metoclofenac sodium ceftriaxone 4 g plus 0.9% sodium chloride injection 250 ml intravenously once daily. Low back pain during treatment, the first three days because of a transient syncope, hematuria and admission. Sclera severe yellow dye on admission. Laboratory tests: white blood cell count 39.4 × 109 / L, neutrophils 0.97, red blood cell count 1.9 × 1012 / L, hemoglobin 42 g / L, reticulocytes 0.03, urea nitrogen 15.0 mmol / l, creatinine 336μmol / L, 380 U / L of ALT, 930 U / L of aspartate aminotransferase (AST), 60 U / L of γ-L-glutamyltransferase, 235.1 μmol / L of total bilirubin, DBil 130.6 μmol / L, IBIL 104.5 μmol / L, lactate dehydrogenase 2198 U / L, creatine kinase 211 U / L, α-hydroxybutyrate dehydrogenase 1538 U / L, creatine kinase isoenzyme 22 U / L, prothrombin time 21.3 s, activated partial thromboplastin time 50.5 s, thrombin time 29.6 s, fibrinogen content 1.03 g / L, D-dimer Body 10.4 mg / L; anti-human globulin test C3 (+). Urine examination: bilirubin (++), occult blood (+++), urinary protein (++), red blood cells 3 / HP. Consider the acute drug-induced hemolysis caused by ceftriaxone with systemic multiple organ failure. Give intravenous injection of human immunoglobulin, glucocorticoid. Continuous renal replacement therapy and hemodialysis, plasma exchange, repeated infusion of washed red blood cells, fresh frozen plasma and cryoprecipitate, while receiving alkaline urine, liver function protection and other symptomatic and supportive treatment. On day 57, the erythrocyte count was 4.0 × 1012 / L, hemoglobin was 112 g / L, creatinine was 110 μmol / L, ALT was 13 U / L, AST was 20 U / L, TBil was 11.7 μmol / L, DBil was 4.5 μmol / μmol / L, the patient’s symptoms improved discharge.