Robinson Hannah Mary, Kinchen James, De Silva Aminda
Department of Gastroenterology, Royal Berkshire Hospital, Reading, UK.
BMJ Case Rep. 2011 Jun 30;2011:bcr0520114205. doi: 10.1136/bcr.05.2011.4205.
A 44-year-old gentleman was admitted with a deliberate overdose of olanzapine, paracetamol and bisoprolol. On admission, he was hypothermic, bradycardic and hypotensive and his body mass index was 12 kg/m(2). Problems identified on admission included polypharmacy overdose, risk of refeeding syndrome and sepsis. Despite careful reintroduction of feeding and generous electrolyte replacement, he developed persistent hypophosphataemia, hypokalaemia and a marked transaminitis. Several days later, he was noted to be hypothermic and hypoglycaemic. No increase in white cell count or C reactive protein was noted and his clinical appearance was otherwise unremarkable. Nevertheless, given these signs he was started on broad spectrum antibiotics for possible sepsis, which was subsequently confirmed on chest radiograph in addition to a further finding of likely aspergilloma on a later chest CT. His metabolic function stabilised after 3 weeks of carefully titrated nutrition and the sepsis responded to antibiotics and antifungal therapy.
一名44岁男性因故意过量服用奥氮平、对乙酰氨基酚和比索洛尔入院。入院时，他体温过低、心动过缓且血压低，体重指数为12kg/m²。入院时发现的问题包括多种药物过量、再喂养综合征风险和败血症。尽管谨慎地重新开始喂养并大量补充电解质，但他仍出现持续的低磷血症、低钾血症和明显的转氨酶升高。几天后，发现他体温过低且血糖过低。白细胞计数和C反应蛋白没有升高，其他方面临床症状不明显。然而，鉴于这些症状，他开始接受针对可能败血症的广谱抗生素治疗，随后胸部X光片证实了败血症，后来的胸部CT还进一步发现可能存在曲菌球。经过3周精心调整的营养治疗后，他的代谢功能稳定，败血症对抗生素和抗真菌治疗有反应。
