Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Commonwealth University Health Sys tem, Richmond, VA, 23219, USA.
Mil Med. 2021 Feb 26;186(3-4):e451-e453. doi: 10.1093/milmed/usaa284.
Clonidine is a central alpha-2 agonist well known to produce a syndrome of bradycardia and hypotension in overdose. However, few examples of overt clinical clonidine toxicity secondary to cutaneous absorption have been reported. We report a case of unintentional systemic clonidine toxicity in an adult because of a compounded preparation of clonidine applied to a degraded skin barrier. A 35-year-old male suffered a motorcycle accident 48 hours before presentation resulting in an abrasion to his distal left leg. On the day of presentation, he self-treated the wound by repeated application of a family member's pain-relieving cream. Later he was found confused and unable to stand by a family member. The family member recognized the thick visible coat of cream as the likely cause and decontaminated the patient while calling 911. Prehospital vitals were notable for a blood pressure of 80/30 mm Hg and heart rate of 38 beats per minute. In the emergency department, the patient was resuscitated with intravenous fluids with resultant normalization of blood pressure. Upon later review, the cream was determined to have been created by a local compounding pharmacy for the use in neuropathic pain and was labeled to contain clonidine, lidocaine, ketamine, and gabapentin. Cutaneous absorption of the pain cream was greatly increased because of loss of skin integrity. Military physicians and compounding pharmacies should ensure that patients are aware of the proper application of compounded creams and the potential risk for systemic toxicity with overuse or degraded skin.
可乐定是一种中枢α-2 激动剂，众所周知，在过量使用时会导致心动过缓和低血压综合征。然而，由于皮肤吸收而导致明显的临床可乐定毒性的病例很少见。我们报告了一例因应用于受损皮肤屏障的复合可乐定制剂而导致的成年患者非故意的全身性可乐定毒性。一名 35 岁男性在就诊前 48 小时发生摩托车事故，导致左小腿远端擦伤。就诊当天，他自行反复使用一名家庭成员的止痛乳膏来处理伤口。后来他被发现意识混乱，无法站立，是一名家庭成员发现他身上有厚厚的可见乳膏涂层，认为这可能是导致他出现这种状况的原因，并在呼叫 911 的同时对他进行了清除污染。院前生命体征表现为血压 80/30mmHg，心率 38 次/分钟。在急诊科，患者通过静脉补液进行复苏，随后血压恢复正常。后来的检查发现，该乳膏是由当地的一家配药药房为治疗神经病理性疼痛而配制的，标签上注明含有可乐定、利多卡因、氯胺酮和加巴喷丁。由于皮肤完整性丧失，疼痛乳膏的皮肤吸收大大增加。军队医生和配药药房应确保患者了解正确使用配制乳膏的方法，并认识到过度使用或皮肤受损会导致全身性毒性的潜在风险。
