口服曲马多引起癫痫样发作1例

患者,男,35岁,因手部外伤来我院门诊外科就诊。就诊时,意识清楚,面色苍白,经体检未见其他部位损伤。主述手部剧烈疼痛,给予清创、缝合处置,并给予口服曲马多胶囊止痛。病人在口服止痛药物曲马多后约30 min即突发四肢抽搐,双眼上翻,此时测血压106/60 mmHg,心率118/min,抽搐约2 min左右,后逐步缓解。此后患者稍有情绪不安,烦躁,无其他阳性体征。40 min后恢复正常。此期间嘱病人平卧休息,未进行其它任何治疗。无任何不适时离开我院。     

口服番泻叶致癫痫样发作一例

<正> 本院职工刘某,女,53岁,便秘。经医师处方番泻叶30g,每次10g加热水20ml,泡水服,下午6时服下。服后2小时许,突然喉间痰鸣,呼吸急促,四肢抽搐,神志不清,呼之不应,经压人中穴,低流     

严重蛔虫病致痫样发作16例临床分析

蛔虫是人体内最常见的寄生虫．临床上小儿因蛔虫病而导致出现抽搐。意识障碍等时有发生．本对我科16例蛔虫感染引起痫样发作进行临床分析如下。     

曲马多长期口服致依赖

患者男,32岁。因“盐酸曲马多依赖8年10个月”,于2005年11月2日入院治疗。患者自述1997年1月因长期工作繁忙,作息不规则,睡眠差;关节炎致关节疼痛急性加重;突发中毒性肠炎致严重腹痛。为了改善睡眠和缓解疼痛,自行口服盐酸曲马多片剂150mg/d,自感疼痛缓解、睡眠改善。于是以后便经常服用,如不服用则出现焦虑、抑郁、烦躁、脾气孤僻、易激惹、流泪、流涕等症状。服用过程中曾2次因为肢体痉挛、抽搐、酸痛无力、手脚麻木、短暂晕厥而在当地医院住院治疗,治疗后症状缓解,但出院后仍继续服用。盐酸曲马多服用剂量由最初150mg/d,发展到最大剂量20…     

青霉素G钠皮内注射致颠痫样发作1例

患者,藏族,女,18岁,于1999年3月15日来我院门诊,诊断为上呼吸道感染。按医生处方常规行青霉素药敢试验,皮试液为观配现用,溶媒为0．9％氯化钠注射液,在无菌操作下取青霉素试验液0．lml内含叙单位,（标准为B卜一m单位户情前臂内侧皮内注射,约2分钟后,患者诉头晕,头痛,继之神志不清,双眼上翻,光反应稍迟钝。面色苍白,继而青紫,问话不能对答。头向后仰,颈项抵抗,牙关紧闭。立即平卧,吸氧,保暖,送人留现室。测T36．gi、P88次l分,R22次l分,BP14．6b．3KPa。双肺呼吸音清晰,心率同脉率,心律规则,各瓣膜听诊区未闻…     

氯苯那敏口服诱发痫性发作

1例40岁女性患者因皮肤瘙痒给予维生素C0.2g及氯苯那敏4mg口服。2h后患者出现头昏、乏力,非喷射性呕吐。随后出现四肢强直,口吐白沫,呼之不应,持续1～2min,后又出现2次同样发作。入院后第3天脑电图示中度异常,给予地西泮及卡马西平,患者症状未再发生。     

口服碘油丸致群体性癔病样发作36例

1997年 9月 2 9日下午 1 5时 ,焦作市郊上白作乡××小学给 5个年级的 91名 8～ 1 2 y儿童集体服用碘油丸 ,每人 1粒 ,服药后约 1 0 min,2名 1 0 y女生诉恶心 ,上腹部疼痛不适 ,头晕 ,继之哭泣不止。在不到 2 0 min时间内又有 8人出现类似体验 ,并迅速波及其他学生。至 1 6时许 ,共 36人 (1 4男 2 2女 )发病患儿全部送入医院急诊室观察。其中 7～ 9y 8例 ,1 0～ 1 2 y2 3例。对 36例发病儿童家庭条件分析发现 ,其中 2 0例 (55.5% )为外地农民因在本市打工而寄读该校者。他们平素性格内向 ,寡言怯懦 ,孤独自卑。本次发病者有 6例生活贫困 ,营…     

儿童口服过量胃复安致帕金森综合征1例

患儿男,5岁,因发音困难、斜颈2小时入院,入院时查体:生命体征正常,19kg,精神欠佳,神志清楚,斜颈,双眼上翻注视,舌正常,咽充血,双侧扁桃体不肿大,双肺正常,心音正常,腹部正常,四肢正常。追问病史,患儿起病前一天曾服胃复安片10mg/次,日服3次,总共服5次,总服剂量50mg。入院后诊断为:胃复安过量引起帕金森综合征,给利尿、镇静治疗,3天后治愈出院。讨论胃复安又名灭吐灵,本品可通过阻滞多巴胺受体而作用于延脑催吐化学感应区,具有强大的中枢性镇吐作用,本品大剂量或长期应用可能因阻断多巴胺受体相对亢进而导致锥体外系反应(特别是年轻人)。主要…     

口服泻痢停过量致轻度昏迷1例

1病案摘要 患者，男，32岁。因夜间睡眠中突发抽搐，既而神志不清，急送我院就诊。查体，体温36．3℃，脉搏72次／分，呼吸18次／分，血压110／70mmHg，生命体征平稳，被动体位，意识丧失，对声、光刺激无反应，无自主运动。对疼痛刺激尚可出现痛苦的表情、肢体退缩等防御反应。     

Fatality resulting from cyclizine overdose

A case involving an overdose fatality of cyclizine is presented. Toxicological analysis revealed a cyclizine blood concentration of 80 micrograms/mL. The drug was quantified by gas chromatography/mass spectrometry (GC/MS). Qualitative analyses of urine and stomach contents were performed.     

Fatality resulting from methylphenidate overdose

A case involving an accidental overdose fatality resulting from an intravenous injection of crushed Ritalin (methylphenidate) tablets is presented. The drug was quantified by gas chromatography/nitrogen-phosphorus detection and confirmed by gas chromatography/mass spectrometry. Concentrations of drug were as follows: blood, 2.8 mg/L; bile, 5.7 mg/L; kidney, 3.0 mg/kg; liver, 2.1 mg/kg; and stomach contents, 1.6 mg total. Other drugs and volatile substances were not detected.     

Fatality resulting from metoprolol overdose

A death due to an intentional overdose of metoprolol is described. The drug was quantified by gas chromatography, and identification was confirmed by gas chromatography/mass spectrometry. Metoprolol concentrations in blood, bile, urine, and vitreous humor were 19.8 mg/L, 83.1 mg/L, 1.6 mg/L, and 15.1 mg/L, respectively. A blood ethanol concentration of 0.25 g/100 mL was the only other significant toxicologic finding.     

苯乙双胍过量致乳酸酸中毒

1例24岁女性患者一次服用苯乙双胍70片（25mg/片）,1d后出现呕吐、腹痛腹泻、呼吸困难、谵妄、躁动、意识丧失、呼之不应。BP70/39mmHg,HR114次/min。实验室检查：血糖0.06mmol/L,乳酸32.51mmol/L,SCr169μmol/L;pH值6.89,PCO220mmHg,PO271.2mmHg,SaO20.913,BE-19.8mmol/L,HCO3^-16.5mmol/L。给予50%葡萄糖注射液40mL静脉推注、5%碳酸氢钠250mL静脉滴注、补液、呼吸机支持、血液滤过等治疗,4d后患者神志转清,恢复自主呼吸,10d后好转出院。     

Rapid death resulting from mesoridazine overdose

A 23-year-old mentally retarded woman was brought to the emergency department 2-2.5 hr after ingesting an unknown quantity of mesoridazine. She was lethargic and somewhat uncooperative, but did answer questions. Her ECG was normal. She was treated with gastric lavage, 50 g activated charcoal, and 10 oz magnesium citrate solution. Her condition continued to decline until, at 2 hr after arrival, she was comatose and becoming increasingly hypotensive. Her ECG showed long runs of markedly widened QRS complexes. The patient was given an iv infusion of dobutamine to maintain blood pressure. She suffered a convulsion, loss of blood pressure, and developed ventricular tachycardia which progressed to ventricular fibrillation unresponsive to electrical cardioversion, pacing, and vigorous prolonged CPR. She was pronounced dead 6-6.5 hr after the ingestion. Antemortem blood level of mesoridazine was 16 micrograms/ml and no other drugs were detected. While sudden deaths have been reported with therapeutic doses of mesoridazine and its parent thioridazine, deaths are uncommon in overdose. Rapid death seen in this case emphasizes the importance of close monitoring and aggressive treatment of phenothiazine overdoses.     

曲唑酮和可乐定致心动过缓

患者男,36岁。吸食海洛因8年,1～3g/d,曾3次自愿戒毒后又复吸。2003年11月在某医院进行可乐定脱毒治疗。可乐定0.075mg,3次/d,2周后因失眠、呃逆、腰背疼痛、情绪低落,于12月5日转住我院。既往无心脏病史。入院检查,P88次/min,BP120/90mmHg(1mmHg=0.133KPa),化验ALT30U/L,心电图检查正常范围。根据患者临床表现,考虑是脱毒戒断反应。给予曲唑酮(美舒郁)150mg/d,第4天加至300mg/d。次日患者出现心动过缓,全身无力,心慌、站立眩晕。检测HR30～38次/min。立即停止曲唑酮治疗,换用参脉注射液,山莨菪碱、阿托品治疗,予心电监护,绝对卧床护…     

Stereoselective pharmacokinetic analysis of tramadol and its main phase I metabolites in healthy subjects after intravenous and oral administration of racemic tramadol

The kinetics of tramadol enantiomers are stereoselective when doses of the racemic drug are given orally. To document whether the route of administration determines the stereoselective kinetics of tramadol enantiomers, healthy volunteers received 100 mg oral or intravenous doses of racemic tramadol, and serial blood samples were obtained to assay tramadol enantiomers and their main phase I metabolites, O-demethyltramadol and N-demethyltramadol. To assess accurately the involvement of their metabolites in the pharmacokinetics of tramadol, it is essential to determine the rate and extent of the formation of the enantiomers of these metabolites. A simultaneous pharmacokinetic model describing the plasma concentration-curves of the generated metabolites and the parent compounds after intravenous and oral drug administration is developed and presented. Tramadol and O-demethyltramadol were the major compounds detected in plasma after intravenous administration. Nevertheless, the N-demethylation of tramadol showed a significant increase when the oral route was used. After both oral and intravenous doses, the kinetics of the tramadol enantiomers were stereoselective. The AUC for (R )-(+)-tramadol was greater than the AUC for (S)-(-)-tramadol. The formation of N-demethyltramadol also was enantioselective after oral administration of racemic tramadol, with a greater AUC for (R)-(+)-N-demethyltramadol than for (S)-(-)-N-demethyltramadol. In the opposite form, (S)-(-)-O-demethyltramadol was formed faster than (R)-(+)-O-demethyltramadol. The metabolism of tramadol was also route-dependent with a different enantiomeric ratio for tramadol and its main phase I metabolites after intravenous and oral administration. The disposition of N-demethyltramadol was concentration-dependent.     

使君子过量致儿童持续性Ⅲ度房室传导阻滞

患儿男,8岁。因头昏1d,加重伴抽搐1次,于2002年8月28日下午6:00入院。1d前因阵发性腹痛在外院诊断为“肠蛔虫病”,给予口服中药使君子驱虫,患儿父母给其一次服用约50颗。来院当日晨起患儿感头昏,眼前发黑。来院前0.5h突然跌倒,四肢抽搐,意识丧失,小便失禁。约5min后渐苏醒,醒后诉全身无力,感头昏明显加重。既往体健,无癫痫病史,近2周无上呼吸道感染及腹泻史。母孕期体健,足月顺产,出生时无窒息、产伤史,心、肺及神经系统查体无阳性体征,急查心电图示:室性逸搏心律(心率36次/min),电轴不偏,Ⅲ度房室传导阻滞。血生化:K+4.8mmol/L,Na+136mmo…     

Effect of metoclopramide dose on preventing emesis after oral administration of N-acetylcysteine for acetaminophen overdose

OBJECTIVE: To determine the effect of the metoclopramide dose on the prevention of vomiting of N-acetylcysteine in acetaminophen overdose. METHODS: Patients with acetaminophen ingestions receiving metoclopramide prior to emergency department administration of N-acetylcysteine were included. Emergency Department and poison center records were reviewed for administration of metoclopramide pre-N-acetylcysteine and incidence of subsequent vomiting. The treatment group was defined as patients receiving high-dose metoclopramide (20-50 mg intravenously) prior to the loading dose of N-acetylcysteine. Controls were patients receiving standard-dose (< 20 mg intravenously) metoclopramide prior to loading dose of N-acetylcysteine. Outcome was vomiting within 60 minutes of N-acetylcysteine administration. RESULTS: Twelve of 19 patients (63%) receiving standard-dose metoclopramide vomited N-acetylcysteine. Only 5 of 23 patients (22%) receiving high-dose metoclopramide vomited N-acetylcysteine (crude odds ratio: 6.2; 95% CI [1.3-30.3]). After controlling for confounding in the logistic regression model, the effect of high-dose metoclopramide in preventing vomiting of N-acetylcysteine remained significant (adjusted odds ratio: 17.0; 95% CI [2.6-110.0]). CONCLUSION: This study supports the efficacy of high-dose metoclopramide to prevent emesis after the oral loading dose of N-acetylcysteine.