苯佐那酯过量致心脏骤停伴 QRS 时限迅速变窄。
Benzonatate Overdose Presenting as Cardiac Arrest with Rapidly Narrowing QRS Interval.
机构信息
Department of Emergency Medicine, Barnes-Jewish Hospital, Washington University School of Medicine in Saint Louis, 660 Euclid Avenue, Saint Louis, MO, 63110 CB #8072, USA.
Department of Emergency Medicine, Division of Medical Toxicology, Washington University School of Medicine in Saint Louis, 660 Euclid Avenue, Saint Louis, MO, 63110 CB #8072, USA.
出版信息
J Med Toxicol. 2022 Oct;18(4):344-349. doi: 10.1007/s13181-022-00904-4. Epub 2022 Jul 5.
INTRODUCTION
Benzonatate is a local anesthetic-like sodium channel antagonist that is widely prescribed as an antitussive. While it may be reasonable to assume that patients would present with a prolonged QRS interval following benzonatate overdose, the published literature does not support this. We report a case of a patient presenting following a benzonatate overdose with a prolonged QRS on her initial electrocardiograph (ECG) rhythm strip with rapid normalization of QRS duration.
CASE REPORT
A 14-year-old girl presented in cardiac arrest following a benzonatate overdose. The patient was found in cardiac arrest within minutes of last being known well. Bystanders immediately provided cardiopulmonary resuscitation (CPR), and she was in asystole on emergency medical services (EMS) arrival. Return of spontaneous circulation (ROSC) was obtained following administration of intraosseous epinephrine and naloxone. EMS obtained an ECG rhythm strip following ROSC demonstrating a sinus rhythm with a QRS duration of 160 ms. Over the ensuing 30 minutes, there was progressive narrowing of the QRS. A 12-lead ECG obtained on arrival in the emergency department (ED) 44 minutes later demonstrated a QRS duration of 94 ms. Initially, EMS ECG rhythm strips were unavailable and an isolated benzonatate ingestion was considered less likely as ECG intervals were normal. Benzonatate exposure was later confirmed with a urine benzonatate concentration, which was 8.5 mcg/mL. The patient made a full recovery.
DISCUSSION
Cases of pediatric benzonatate overdose with rapid development of cardiac arrest and full recovery have been previously reported. In this case, evidence of cardiac sodium channel blockade was demonstrated with a prolonged QRS interval on initial ECG rhythm strip analysis. However, unlike previous cases, rapid resolution of QRS prolongation occurred in this case. While transient QRS prolongation may be observed, finding a normal QRS interval should not discount the possibility of benzonatate overdose.
简介
苯佐那酯是一种局部麻醉类似物钠离子通道拮抗剂，被广泛开处方作为镇咳药。虽然人们可能认为患者在苯佐那酯过量服用后会出现 QRS 间期延长，但已发表的文献并不支持这一观点。我们报告了一例患者在苯佐那酯过量服用后出现 QRS 间期延长的病例，其初始心电图（ECG）节律带显示 QRS 持续时间迅速正常化。
病例报告
一名 14 岁女孩在苯佐那酯过量服用后出现心脏骤停。该患者在最后一次被认为状态良好后几分钟内被发现处于心脏骤停状态。旁观者立即进行心肺复苏（CPR），她在紧急医疗服务（EMS）到达时处于心搏停止状态。在给予骨内肾上腺素和纳洛酮后，恢复了自主循环（ROSC）。EMS 在 ROSC 后获得了心电图节律带，显示窦性节律，QRS 持续时间为 160ms。在接下来的 30 分钟内，QRS 逐渐变窄。在随后 44 分钟到达急诊科（ED）时获得的 12 导联心电图显示 QRS 持续时间为 94ms。最初，EMS 心电图节律带不可用，并且考虑到 ECG 间隔正常，单独的苯佐那酯摄入不太可能。后来通过尿液苯佐那酯浓度证实了苯佐那酯暴露，其浓度为 8.5 mcg/mL。患者完全康复。
讨论
先前已经报道了几例儿科苯佐那酯过量服用导致心脏骤停和完全恢复的病例。在本例中，初始 ECG 节律带分析显示 QRS 间期延长，证明存在心脏钠离子通道阻滞。然而，与先前的病例不同，在本例中 QRS 延长迅速得到解决。虽然可能会观察到短暂的 QRS 延长，但发现正常的 QRS 间隔不应排除苯佐那酯过量的可能性。
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