口服奥硝唑致谵妄

1例67岁男性患者因牙龈炎口服奥硝唑（1.0 g,1次/d）、头孢拉啶（0.5 g,3次/d）和对乙酰氨基酚（0.5 g,2次/d）。3 d后疼痛减轻,但出现头晕、头痛及乏力症状。停用头孢拉啶和对乙酰氨基酚,继续服用奥硝唑。4 d后患者突然出现精神异常,症状昼轻夜重,脑电图检查示α波频率变慢,出现散在不规则θ波,诊断为谵妄。停用奥硝唑,给予氟哌啶醇5 mg,1次/d肌内注射;维生素B_6 0.2 g、三磷酸腺苷40 mg、辅酶A 200 U以及维生素C 2.0 g加入10%葡萄糖氯化钠注射液1000 ml中静脉滴注,1次/d;奥氮平5~10 mg,2次/d口服。3 d后患者神志恢复,停用氟哌啶醇;奥氮平减量至0.25 g,1次/d口服。治疗第6天患者头晕、头痛及乏力消失,体力恢复,脑电图检查正常。第7天停用抗精神病药。随访3个月余,患者精神状态正常。

Delirium caused by oral ornidazole

A 67-year-old male patient with gingivitis received ornidazole orally 1.0 g once daily, cefradine 0.5 g thrice daily,and paracetamol 0.5 g twice daily.Three days later,the pain was relieved,but the patient developed dizziness,headache,and fatigue.Cefradine and paracetamol were stopped and ornidazole was continued.Four days later,the patient developed sudden mental disorder,which was mild during the daytime and severe at night.EEG examination revealed that frequency of α waves became slow and irregular and scattered 9 waves appeared.The patient was diagnosed with delirium.Ornidazole was stopped.IM haloperidol 5 mg once daily,IV infusion of vitamin B_6 0.2 g,adenosine triphosphate 40 mg, coenzyme A 200 U,and vitamin C 2.0 g in 10%glucose and sodium chloride injection 1000 ml,and oral olanzapine 5 to 10 mg twice daily were given.Three days later,the patient＇s consciousness recovered. Then,haloperidol was stopped and the dose of olanzapine was reduced to 0.25 g once daily.On day 6 of treatments,the patient＇s dizziness,headache,and fatigue disappeared,physical strength recovered,and EEG examination showed normal results.On day 7 of treatments,antipsychotics were discontinued.After more than 3 months of follow-up,the patient＇s mental state was normal.