Ciszowski Krzysztof, Szpak Dorota, Wilimowska Jolanta, Groszek Barbara
Klinika Toksykologii i Chorób Srodowiskowych, Uniwersytet Jagielloński Collegium Medicum w Krakowie
Przegl Lek. 2011;68(8):506-9.
Despite above 40 years the presence of sulpride on the pharmaceutical market, the acute poisonings are poorly reported in the medical literature. The discussed case of sulpiride intoxication concerns ingestion probably dose of 12 g, that exceeded 10-fold maximum therapeutic dose. 16-year-old girl, with no previous sulpiride treatment, was admitted to the Toxicology Department about 3 hours after ingestion. In clinical picture she presented quantitative consciousness disturbances with maximum 10 scores in GCS scale, with tendency to low BP (minimum 88/45 mmHg) and episode of orthostatic hypotension. The ECG demonstrated: normogram, sinus tachycardia with a heart rate of 125 beats/min, PQ = 120 ms, QRS = 80 ms, prolongation of QTc to 519,6 ms and unspecific changes of ST-T syndrome. The qualitative toxicological test confirmed the presence of chlorprothixene in urine, but the serum therapeutic concentration (0.126 microg/ml) excluded the overdose. The quantitative determination of sulpiride serum concentration confirmed acute sulpiride poisoning. The measured sulpiride toxic concentration on admission and in the consecutive hours were from 13.2 to 8.2 microg/ml. Sulpiride toxicokinetic parameters such as t max = about 3 h, t 1/2 = 24.02 h, k(el) = 0.029 h(-1) were also estimated. They point out that the absorption rate is similar and the elimination is prorogated in sulpiride acute poisoning compared to therapeutic doses.
尽管舒必利已在药品市场上存在40多年，但医学文献中关于急性中毒的报道却很少。本文讨论的舒必利中毒病例涉及摄入剂量可能达12克，超过最大治疗剂量10倍。一名16岁此前未接受过舒必利治疗的女孩，在摄入药物约3小时后被送入毒理学部。临床症状表现为意识障碍，格拉斯哥昏迷量表（GCS）评分最高为10分，有低血压倾向（最低88/45 mmHg）及体位性低血压发作。心电图显示：正常心电图，窦性心动过速，心率125次/分钟，PQ = 120毫秒，QRS = 80毫秒，QTc延长至519.6毫秒，ST-T综合征有非特异性改变。定性毒理学检测证实尿液中存在氯丙硫蒽，但血清治疗浓度（0.126微克/毫升）排除了过量用药。舒必利血清浓度的定量测定证实为急性舒必利中毒。入院时及随后数小时测得的舒必利中毒浓度为13.2至8.2微克/毫升。还估算了舒必利的毒代动力学参数，如t max约为3小时，t 1/2 = 24.02小时，k(el) = 0.029小时-1。这些参数表明，与治疗剂量相比，舒必利急性中毒时的吸收速率相似，但消除时间延长。
