右美托咪定在抗胆碱能中毒综合征治疗中的新应用。
Novel use of dexmedetomidine for the treatment of anticholinergic toxidrome.
作者信息
Walker Ashley, Delle Donne Andrew, Douglas Elizabeth, Spicer Kristine, Pluim Thomas
机构信息
Department of Pediatrics, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA.
出版信息
J Med Toxicol. 2014 Dec;10(4):406-10. doi: 10.1007/s13181-014-0408-1.
INTRODUCTION
We report the case of an adolescent with anticholinergic toxidrome from diphenhydramine overdose, whose symptoms were treated with a novel application of dexmedetomidine.
CASE REPORT
A 13-year-old female developed an anticholinergic toxidrome after intentionally ingesting 9.5 mg/kg of diphenhydramine. Despite routine supportive therapies, to include appropriate doses of lorazepam, she continued to have significant agitation, psychosis, and hallucinations. A dexmedetomidine infusion was started to aid in the treatment of her agitation and psychosis with marked improvement of her symptoms.
DISCUSSION
Using dexmedetomidine for the treatment of anticholinergic toxidrome has not been previously described in the literature, but there are multiple reports of its use in alcohol withdrawal syndrome. We suggest that adding dexmedetomidine as an adjunctive agent in the therapy of anticholinergic toxidrome may relieve the symptoms of agitation, psychosis, tachycardia, and hypertension, without the attendant risk of respiratory depression associated with high doses of benzodiazepines.
引言
我们报告一例青少年因过量服用苯海拉明出现抗胆碱能中毒综合征，其症状通过右美托咪定的一种新应用得到治疗。
病例报告
一名13岁女性在故意摄入9.5毫克/千克苯海拉明后出现抗胆碱能中毒综合征。尽管进行了常规支持治疗，包括给予适当剂量的劳拉西泮，但她仍持续存在明显的躁动、精神病症状和幻觉。开始输注右美托咪定以帮助治疗她的躁动和精神病症状，症状有显著改善。
讨论
文献中此前未描述过使用右美托咪定治疗抗胆碱能中毒综合征，但有多项关于其用于酒精戒断综合征的报道。我们建议在抗胆碱能中毒综合征治疗中添加右美托咪定作为辅助药物，可能缓解躁动、精神病症状、心动过速和高血压症状，且无高剂量苯二氮䓬类药物相关的呼吸抑制风险。
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