Blackstone Nicholas G, Olson April, Ainapurapu Bujji
Internal Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA.
Cureus. 2020 Nov 28;12(11):e11739. doi: 10.7759/cureus.11739.
Physostigmine is a cholinesterase inhibitor used therapeutically in patients with anticholinergic delirium that is so severe that intubation may be required for airway protection. Given that a wide variety of medications have anticholinergic properties, and the current standard of care is typically a central nervous system depressant, hospitalizations are often lengthy and normally require a critical-care level of attention. Despite this, physostigmine is often underutilized and poorly understood in the clinical setting. We report a case of a 43-year-old female who presented to the emergency department one hour after ingesting approximately 150 tablets of diphenhydramine in a suicide attempt. She was treated with benzodiazepines with minimal success, and airway protection became imminent as her mentation continued to decline. Through the use of physostigmine, we were able to save this patient from endotracheal intubation and the potential complications of mechanical ventilation.
毒扁豆碱是一种胆碱酯酶抑制剂，用于治疗抗胆碱能谵妄患者，此类患者病情严重，可能需要插管以保护气道。鉴于多种药物具有抗胆碱能特性，且当前的护理标准通常是使用中枢神经系统抑制剂，住院时间往往很长，通常需要重症监护级别的护理。尽管如此，毒扁豆碱在临床环境中常常未得到充分利用且了解不足。我们报告一例43岁女性病例，她在试图自杀服用了约150片苯海拉明后1小时被送往急诊科。她接受了苯二氮䓬类药物治疗，但效果甚微，随着她的意识状态持续下降，气道保护迫在眉睫。通过使用毒扁豆碱，我们成功使该患者避免了气管插管以及机械通气的潜在并发症。
