Minamisawa S, Tezuka T, Enomoto K, Nozaki Y, Funatomi H, Hatta Y
Second Department of Internal Medicine, Showa University School of Medicine.
Arukoru Kenkyuto Yakubutsu Ison. 1991 Oct;26(5):367-72.
A 55-year-old man with addiction of alcohol was admitted to our hospital with hematoemesis. After admission, the rupture of esophageal varices was observed and it was treated with endoscopic injection sclerotherapy. On the 3rd hospital day, the patient showed alcohol withdrawal syndrome and therefore haloperidol was administered intramuscularly and intravenously. After a half day of this treatment, high fever, diaphoresis, hypotension, tachycardia, muscular rigidity and tremor developed. With the laboratory data including high serum levels of CK, LDH, GOT and GPT, neuroleptic malignant syndrome (NMS) was suspected. Regardless of intensive care, hepatic failure, DIC and acute renal failure promptly developed, and he died on the 11th hospital day. Neuroleptics may cause serious side effects, such as NMS, when the physical status of patients was deteriorated. Especially in exhausted patient such as our case, even the small dose of neuroleptics caused NMS within short term. Thus, it seemed to be important for clinicians to pay attention to choice of neuroleptics.
一名55岁有酒精成瘾的男性因呕血入院。入院后，观察到食管静脉曲张破裂，并接受了内镜注射硬化疗法治疗。入院第3天，患者出现酒精戒断综合征，因此给予肌肉注射和静脉注射氟哌啶醇。经过半天的这种治疗后，出现了高热、出汗、低血压、心动过速、肌肉强直和震颤。结合包括血清CK、LDH、GOT和GPT水平升高等实验室检查结果，怀疑为抗精神病药恶性综合征（NMS）。尽管进行了重症监护，患者仍迅速出现肝功能衰竭、弥散性血管内凝血（DIC）和急性肾衰竭，并于入院第11天死亡。当患者身体状况恶化时，抗精神病药物可能会引起严重的副作用，如NMS。特别是像我们病例中的这种极度疲惫的患者，即使是小剂量的抗精神病药物也会在短期内引发NMS。因此，临床医生注意抗精神病药物的选择似乎很重要。
