Castello G, Cacciapuoti A, Stellino M B
Servizio di Anestesia e Rianimazione, Ospedale S. Antonio Abate, Trapani.
Minerva Anestesiol. 2000 Jan-Feb;66(1-2):69-72.
A clinical case concerning differential diagnosis between tetanus, atropine poisoning and acute hypocalcemia is reported. A 51 year-old man has been hospitalized in ICU, coming from the emergency service of another hospital, with a diagnosis of suspected atropine poisoning (he had been under treatment with atropine collyrium 1% for same days). The patient at the moment of hospitalization presented: preserved coscience with good orientation in time and space, thrismus, slight nuchal rigidity, hypertonia to the inferior limbs, accentuated osteotendinous reflex to the four limbs, asthenia, intense perspiration, tachycardia, apyrexia and not appreciable ocular signs for previus pathology. At observation the patient showed to have had a thyroidectomy (presence of surgical scar), and he didn't remember to have been vaccinated against tetanus. Several small scars to the hands were observed (particularly a recent felon to the first finger of the rigth hand) all referable to his activity as agriculture laborer. The hematochemical examinations were performed and the slight hypocalcemia slightly laver than normal, the leukocytosis neutrophilia, apyrexia, abundant perspiration and preserved conscience in presence of thrismus and hypertonia to the inferior limbs led to the diagnosis of a possible case of tetanus.
报告了一例关于破伤风、阿托品中毒和急性低钙血症鉴别诊断的临床病例。一名51岁男性从另一家医院的急诊科转入重症监护病房（ICU），诊断为疑似阿托品中毒（他曾使用1%阿托品眼膏治疗数日）。患者入院时表现为：意识清醒，时间和空间定向良好，牙关紧闭，轻度颈项强直，下肢肌张力增高，四肢腱反射亢进，乏力，多汗，心动过速，无发热，且未发现既往病变的明显眼部体征。观察发现患者曾接受甲状腺切除术（有手术疤痕），且不记得曾接种过破伤风疫苗。手部可见多处小疤痕（特别是右手食指近期有脓性指头炎），均与其农业劳动者的活动有关。进行了血液化学检查，发现血钙略低于正常水平，白细胞增多伴中性粒细胞增多，无发热，多汗，且在牙关紧闭和下肢肌张力增高的情况下意识清醒，据此诊断可能为破伤风病例。
