Vojjala Nikhil, Malegaonkar Srikant Kashinath, Arora Kajal, Sehgal Inderpaul Singh, Pannu Ashok Kumar
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Neurohospitalist. 2024 Oct;14(4):428-431. doi: 10.1177/19418744241254580. Epub 2024 May 24.
Anticholinergic toxicity and neuroleptic malignant syndrome (NMS) are common toxidromes in medical emergencies. However, their co-occurrence, resulting in a dual toxidrome, is rare and presents significant diagnostic and therapeutic challenges. We present the case of a 23-year-old young male with polysubstance dependence, admitted following combined trihexyphenidyl and risperidone toxicity. He was diagnosed with a dual toxidrome of anticholinergic storm and NMS. Treatment of NMS included lorazepam and bromocriptine. Due to the unavailability of physostigmine, the preferred antidote for anticholinergic syndrome, intrathecal neostigmine was administered. The patient subsequently recovered and was discharged. This case highlights the complexity of managing dual toxidromes and the need for alternative therapeutic strategies in resource-limited settings.
抗胆碱能毒性和抗精神病药恶性综合征（NMS）是医疗急症中常见的中毒综合征。然而，它们同时出现，导致双重中毒综合征的情况罕见，且带来了重大的诊断和治疗挑战。我们报告一例23岁有多种物质依赖的年轻男性病例，该患者因同时服用苯海索和利培酮中毒而入院。他被诊断为抗胆碱能风暴和NMS双重中毒综合征。NMS的治疗包括使用劳拉西泮和溴隐亭。由于抗胆碱能综合征的首选解毒剂毒扁豆碱无法获得，因此给予了鞘内注射新斯的明。患者随后康复并出院。该病例凸显了管理双重中毒综合征的复杂性以及在资源有限的环境中采用替代治疗策略的必要性。
