Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
Leg Med (Tokyo). 2021 Nov;53:101935. doi: 10.1016/j.legalmed.2021.101935. Epub 2021 Jun 21.
The patient was a two-day-old female infant. The patient's mother was a primigravid in her 20 s who developed premature abruption of the normal placenta on the first day of the 33rd week of gestation. The infant was born by emergency cesarean section with severe neonatal asphyxia with a birth weight of 1928 g. Spontaneous circulation was returned 11 min after birth. The infant was treated under mechanical ventilation in the neonatal intensive care unit, and phenobarbital was administered for repeated seizures. On day 2, spontaneous respiration was observed; however, the patient developed seizures repeatedly. The dose of phenobarbital reached the maximum and was switched to midazolam. In the early morning of day 3, while midazolam was administered up to the maximum dose, the infant developed status epilepticus, and the anticonvulsant drug was changed to phenytoin. Due to a calculation error, the intravenous administration of phenytoin was started at 400 mg/30 min, which is 10-fold of the normal dose. Six minutes later, after 80 mg was administered, the administration was stopped due to a drop in blood pressure; however, the infant died of cardiac arrest. An autopsy, which was performed approximately 25 h after death, revealed the blood phenytoin concentration in the heart was 63.85 μg/mL. The cause of death was determined to be acute phenytoin toxicity. This is the first fatal case reported of the blood concentration of phenytoin caused by rapid intravenous administration.
患儿为女婴，出生 2 天。患儿母亲为 20 多岁初产妇，孕 33 周+1 日因正常胎盘早剥行急诊剖宫产娩出，新生儿重度窒息，出生体重 1928g，出生后 11min 恢复自主循环。患儿转入新生儿重症监护病房，予呼吸机辅助通气，并因反复抽搐予苯巴比妥镇静治疗。生后第 2 天患儿自主呼吸恢复，但仍反复抽搐，予苯巴比妥镇静，因剂量达最大，换用咪达唑仑。生后第 3 天凌晨，予咪达唑仑镇静至最大剂量时，患儿发生癫痫持续状态，换用苯妥英钠。因计算错误，予苯妥英钠静脉滴注，起始剂量 400mg/30min，为常规剂量的 10 倍。6min 后，输注 80mg 时因血压下降而停药，患儿最终因心跳骤停死亡。死亡后约 25h 行尸检，心脏血中苯妥英钠浓度为 63.85μg/ml。死因诊断为急性苯妥英钠中毒。这是首例因快速静脉推注导致血药浓度升高而死亡的病例报道。
