Arkun Alp, Van Deusen Shawn K, Grau Timothy, Birkhahn Robert H
Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, New York 11215, USA.
J Emerg Med. 2010 Apr;38(3):337-9. doi: 10.1016/j.jemermed.2008.01.006. Epub 2008 Aug 30.
Amiodarone is commonly used in the treatment of refractory paroxysmal atrial fibrillation. Much of the literature focuses on the toxic effects of this medication in the setting of rapid loading or long-term therapy with high maintenance doses. However, patients have been known to develop multi-organ toxicities with long-term low-dose therapy.
We present a 90-year-old man with paroxysmal atrial fibrillation undergoing low-dose amiodarone therapy for a period of 18 months without medical follow-up who developed signs and symptoms consistent with neurotoxicity and hepatotoxicity in association with hyperammonemia. Upon discontinuation of the medication and treatment of the hyperammonemia, the patient had a rapid decline in symptoms and a return to his baseline status.
Identifying toxicity early and correcting it rapidly may prevent life-threatening sequelae associated with amiodarone toxicity.
胺碘酮常用于治疗难治性阵发性心房颤动。许多文献关注的是在快速负荷给药或长期高维持剂量治疗情况下该药物的毒性作用。然而，已知患者在长期低剂量治疗时也会出现多器官毒性。
我们报告一名90岁阵发性心房颤动男性患者，接受低剂量胺碘酮治疗18个月，期间无医学随访，出现了与神经毒性、肝毒性相关并伴有高氨血症的体征和症状。停用该药物并治疗高氨血症后，患者症状迅速缓解，恢复至基线状态。
早期识别毒性并迅速纠正，可预防与胺碘酮毒性相关的危及生命的后遗症。
