Department of Pediatrics, St. Stephen's Hospital, Tis Hazari, New Delhi, India.
Ann Pharmacother. 2011 Jan;45(1):e7. doi: 10.1345/aph.1P332. Epub 2010 Dec 28.
To document ondansetron-induced dystonia, hypoglycemia, and seizures in a child.
A 4-year-old boy was admitted with dystonia following an intravenous dose of ondansetron 2 mg (0.13 mg/kg) that he had received for vomiting that day. In the emergency department, he developed generalized tonicclonic seizures lasting for a few minutes. He was administered lorazepam 1.5 mg (0.1 mg/kg) to control the seizures. His blood glucose level was 10 mg/dL; the hypoglycemia responded promptly to intravenous dextrose 10% (7 mL/kg). Serum electrolytes, renal profile, capillary blood gas, and results of a computed tomography scan of the brain were normal. Subsequent blood glucose values were within normal range. On follow-up after 7 days, the child was healthy with no recurrences of the symptoms. A provisional diagnosis of ondansetron-induced acute dystonia with seizures and hypoglycemia was made.
Ondansetron is an antiemetic known for its safety profile. There have been a few case reports of extrapyramidal adverse effects and seizures from this drug but none of ondansetron-associated hypoglycemia. 5-Hydroxytryptamine (5-HT(3)) receptors are involved in arginine vasopressin-mediated release of adrenocorticotropin hormone and cortisol in response to stress. Blunting of this stress response by ondansetron, a 5-HT(3) receptor antagonist, could have caused the hypoglycemia in this patient. According to the Naranjo scale, ondansetron was probably the cause of the dystonia and seizures, and possibly the cause of the hypoglycemia. Other potential explanations for hypoglycemia were considered but were thought to be less likely.
Dystonia and seizures have been associated with ondansetron in a few case reports. In addition, clinicians need to consider hypoglycemia as a possible adverse effect of ondansetron.
记录昂丹司琼引起的儿童肌张力障碍、低血糖和癫痫发作。
一名 4 岁男孩因当天呕吐接受静脉注射昂丹司琼 2 毫克（0.13 毫克/公斤）后出现肌张力障碍而入院。在急诊室，他出现持续数分钟的全身强直阵挛性癫痫发作。给予劳拉西泮 1.5 毫克（0.1 毫克/公斤）以控制癫痫发作。他的血糖水平为 10 毫克/分升；低血糖症对静脉注射 10%葡萄糖（7 毫升/公斤）迅速反应。血清电解质、肾功能、毛细血管血气和脑部计算机断层扫描结果均正常。随后的血糖值在正常范围内。7 天后随访时，患儿健康，症状无复发。暂诊为昂丹司琼引起的急性肌张力障碍伴癫痫发作和低血糖症。
昂丹司琼是一种止吐药，安全性良好。已有少数关于该药物出现锥体外系不良反应和癫痫发作的病例报告，但无昂丹司琼相关低血糖症的报告。5-羟色胺（5-HT（3））受体参与精氨酸加压素介导的促肾上腺皮质激素和皮质醇释放以应对应激。5-HT（3）受体拮抗剂昂丹司琼可能会削弱这种应激反应，导致该患者发生低血糖症。根据 Naranjo 量表，昂丹司琼可能是导致肌张力障碍和癫痫发作的原因，也可能是导致低血糖症的原因。还考虑了其他潜在的低血糖症解释，但认为不太可能。
在少数病例报告中，肌张力障碍和癫痫发作与昂丹司琼有关。此外，临床医生需要考虑昂丹司琼可能引起低血糖症这一不良反应。
