Vogiatzis I, Koulouris E, Sidiropoulos A, Giannakoulas C
Department of Cardiology, General Hospital of Veroia, Greece.
Hippokratia. 2013 Apr;17(2):177-9.
Anaphylactic shock and pulmonary edema are unusual but life-threatening adverse reactions to drugs. We encountered a case of serious anaphylactic shock and acute pulmonary edema caused by a single oral intake of acetazolamide, a frequently used medication by several medical specialties especially in ophthalmology.
An 80-year-old female was admitted to our emergency Coronary Unit presenting symptoms and signs of shock with acute pulmonary edema. Patient was hospitalised at the Opthalmological Department with intention to undergo cataract surgery. Approximately, four hours before operation, half a tablet of acetazolamide 250 mg was given, in order to control her pre-operative intraocular pressure. Half an hour later, she complained of nausea, became cyanotic, and suffered acute respiratory failure with characteristic massive pulmonary edema. Ventilatory support was initiated and O2 saturation increased to 89%. She was administered 2 ampoules of intravenously furosemide. The blood chemistry panel was normal, as well as myocardial cytolysis tests. Chest radiograph showed enlarged cardiothoracic index, ill-defined vessels, peribronchial cuffing, alveolar edema. An echocardiogram showed normal atria and ventricles, normal systolic function, and excluded pulmonary hypertension. Furosemide (40 mg/IV, S: 1x3) and oxygen (8 Lt/min) were administered for the following 24 hours. Clinical improvement was seen and the O2 saturation was normalized. ECG controls were normal. The patient experienced a full recovery and was discharged 3 days later.
The relationship between anaphylactic shock with acute pulmonary edema and acetazolamide seems highly probable in this case, considering the short time between drug assumption and onset of symptoms (about 30 minutes) and the absence of previous diseases to which symptoms could be related. The patient was not previously treated with acetazolamide. Nowadays, the clinical use of acetazolamide is very limited. Its principal uses are in the preoperative treatment of closed angle glaucoma and continuative therapy of open angle glaucoma.
过敏性休克和肺水肿是罕见但危及生命的药物不良反应。我们遇到了一例因单次口服乙酰唑胺导致严重过敏性休克和急性肺水肿的病例，乙酰唑胺是多个医学专科尤其是眼科常用的药物。
一名80岁女性因休克和急性肺水肿的症状及体征被收入我们的急诊冠心病监护病房。患者因计划接受白内障手术而入住眼科。大约在手术前四小时，给予半片250毫克的乙酰唑胺以控制术前眼压。半小时后，她出现恶心、面色发绀，并出现急性呼吸衰竭及典型的大量肺水肿。开始进行通气支持，氧饱和度升至89%。给她静脉注射了2支速尿。血液生化指标正常，心肌溶解试验也正常。胸部X光片显示心胸指数增大、血管边界不清、支气管周围袖口征、肺泡水肿。超声心动图显示心房和心室正常、收缩功能正常，排除了肺动脉高压。在接下来的24小时内给予速尿（40毫克/静脉注射，1次/3次）和氧气（8升/分钟）。病情出现临床改善，氧饱和度恢复正常。心电图检查正常。患者完全康复，3天后出院。
考虑到用药与症状出现之间的时间间隔较短（约30分钟）且不存在可能与症状相关的既往疾病，在该病例中过敏性休克与急性肺水肿和乙酰唑胺之间的关系似乎很有可能。该患者此前未接受过乙酰唑胺治疗。如今，乙酰唑胺的临床应用非常有限。其主要用途是闭角型青光眼的术前治疗和开角型青光眼的持续治疗。
