Department of Emergency Medicine, School of Medicine, Hacettepe University, Ankara, Turkey.
Department of Emergency Medicine, School of Medicine, Du¨zce University, Turkey.
Riv Psichiatr. 2020 Jan-Feb;55(1):53-56. doi: 10.1708/3301.32720.
Clozapine, an antipsychotic medication, can ordinarily cause gastrointestinal hypomotility, but clozapine-related Ogilvie Syndrome (colonic pseudo-obstruction) has been reported rarely.
A 29-year-old male was admitted to the emergency department (ED) with complaints of vomiting, abdominal pain, and distension lasting for a day. He was on clozapine therapy due to schizophrenia. An abdominal-CT scan revealed dilation from the cecum to the ileum and he was diagnosed with Ogilvie syndrome. During the observation period in the ED, respiratory distress, hypotension, and alteration in consciousness were observed, and the patient was intubated electively. Arterial blood gas showed primary metabolic acidosis, with a normal anion gap with full respiratory compensation. In the control CT scan there was no visible perforation but distension persisted; the cecum diameter was 93 mm and the colonic wall was thickened. After the CT scan, the patient went into cardiac arrest and died 13 hours after his admission. In this case, excessive colonic dilatation, high WBC, and lactate levels and increased thickness of the colon wall suggest sepsis due to intestinal ischemia.
Clozapine-related gastrointestinal hypomotility (CRGH) is not a trivial symptom. It can cause Ogilvie syndrome, which can be fatal due to complications. In the current clozapine prescription content, information on CRGH is insufficient. Higher levels of suspicion, lower diagnostic thresholds in the case of mental and psychiatric patients may prevent delays in diagnosis and treatment and result in lower mortality.
氯氮平是一种抗精神病药物，通常会导致胃肠道动力不足，但很少有报道称氯氮平相关的奥格尔维氏综合征（结肠假性梗阻）。
一名 29 岁男性因呕吐、腹痛和腹胀持续一天而到急诊科就诊。他因精神分裂症而接受氯氮平治疗。腹部 CT 扫描显示从盲肠到回肠扩张，诊断为奥格尔维氏综合征。在急诊科观察期间，观察到呼吸窘迫、低血压和意识改变，并选择性进行了插管。动脉血气显示原发性代谢性酸中毒，正常阴离子间隙，完全呼吸代偿。在对照 CT 扫描中没有可见穿孔，但仍有扩张；盲肠直径为 93 毫米，结肠壁增厚。CT 扫描后，患者心跳骤停，入院后 13 小时死亡。在这种情况下，过度结肠扩张、高白细胞计数和乳酸水平以及结肠壁增厚提示由于肠缺血引起的败血症。
氯氮平相关的胃肠道动力不足（CRGH）不是一个小问题。它可导致奥格尔维氏综合征，由于并发症可能致命。在目前的氯氮平处方内容中，关于 CRGH 的信息不足。在精神和精神病患者中，提高警惕，降低诊断阈值，可能会防止诊断和治疗的延迟，从而降低死亡率。
