Nielsen Visti Torbjørn, Wijayasinghe Nelun, Høgberg Lotte Christine Groth, Bøgevig Søren
Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
The Danish Poisons Information Centre, Bispebjerg Hospital, Copenhagen, Denmark.
Front Med (Lausanne). 2023 Apr 24;10:1125653. doi: 10.3389/fmed.2023.1125653. eCollection 2023.
Pregabalin (PB) overdose causes mild symptoms and coma is rarely seen unless the patient has also ingested sedatives and/or has preexisting renal disease. We present a case report of a suicide attempt with PB where the patient presented in a comatose state that was successfully treated with continuous renal replacement therapy (CRRT). Treatment of PB overdose is usually supportive. However, previous reports of PB overdose have been treated with intermittent hemodialysis (IHD) in patients with preexisting renal disease. The problem with IHD is that it is only available in specialist centers and unsuitable for unstable patients. In the following case report, the patient presented to the emergency department (ED) unconscious and hypotensive. It was thought that the patient tried to commit suicide by taking an overdose of zopiclone tablets, as empty packets of zopiclone tablets were found beside the patient. There was no effect with flumazenil treatment, so the patient was intubated, mechanically ventilated, and admitted to the intensive care unit (ICU) where inotropic support was started. Despite supportive therapy, there was no improvement in the patient's condition. Further investigation into the patient's medical records uncovered prescriptions of PB. Based on this finding, plasma PB levels were measured and found to be 20 times the upper limit of the therapeutic reference range. CRRT was instituted and after 6 h of treatment the patient woke up. Hospitals with ICUs often have CRRT available in their units whereas IHD is less readily available. This case report demonstrates that CRRT is an effective method for treating PB overdose in an unconscious unstable patient that was unsuitable for transfer to another hospital.
普瑞巴林（PB）过量导致的症状较轻，除非患者同时服用了镇静剂和/或存在肾脏疾病，否则很少出现昏迷。我们报告一例PB过量自杀未遂病例，该患者呈昏迷状态，通过持续肾脏替代疗法（CRRT）成功治愈。PB过量的治疗通常是支持性的。然而，既往关于PB过量的报道中，有肾脏疾病的患者采用间歇性血液透析（IHD）进行治疗。IHD的问题在于它仅在专科中心可用，且不适用于不稳定患者。在以下病例报告中，患者被送往急诊科时昏迷且血压过低。据推测患者试图通过过量服用佐匹克隆片自杀，因为在患者身旁发现了空的佐匹克隆片包装。氟马西尼治疗无效，因此患者被插管、机械通气，并收入重症监护病房（ICU），开始使用血管活性药物支持治疗。尽管进行了支持性治疗，患者病情仍无改善。进一步查阅患者病历发现了PB的处方。基于这一发现，检测血浆PB水平，发现其为治疗参考范围上限的20倍。于是实施了CRRT，治疗6小时后患者苏醒。设有ICU的医院其科室通常配备有CRRT，而IHD则较难获得。该病例报告表明，CRRT是治疗昏迷不稳定PB过量患者的有效方法，这类患者不适于转至其他医院。
