Skjøtø J, Reikvam A
Acta Med Scand. 1979;205(6):473-6. doi: 10.1111/j.0954-6820.1979.tb06087.x.
A young women ingested large amounts of different analgesics, mainly salicylate and paracetamol. On admission about 17 hours later, clearly toxic serum levels of both drugs were demonstrated. She was comatose with respiratory failure for 5 days. During the first day there was a period of several hours of therapy-resistant hyperthermia. A severe bleeding tendency was probably related to profound coagulation defects. Persistingly elevated serum levels of ASAT and ALAT for two weeks were presumably caused by a toxic effect of paracetamol on the liver. When consciousness was regained, widespread pareses of skeletal muscles, predominantly of the lower limbs, were demonstrated. These were related to extensive rhabdomyolysis as evidenced by extremely elevated serums levels of CPK for 6 weeks, and by muscle necrosis in biopsy specimens. There was a gradual improvement, but walking disturbances were still present after one year. The hyperthermia was probably related to the cerebral effects of salicylates or the combination of multiple drugs. The rhabdomyolysis might be related to a deleterious effect of hyperthermia on the muscles or to an effect of paracetamol on the skeletal muscles similar to that which might occur in the myocardium, or to a combination of these mechanisms.
一名年轻女性摄入了大量不同的镇痛药，主要是水杨酸盐和对乙酰氨基酚。在大约17小时后入院时，两种药物的血清水平均显示明显中毒。她昏迷并伴有呼吸衰竭达5天。在第一天，有一段持续数小时的难治性高热期。严重的出血倾向可能与严重的凝血缺陷有关。血清谷草转氨酶（ASAT）和谷丙转氨酶（ALAT）持续升高两周，可能是对乙酰氨基酚对肝脏的毒性作用所致。意识恢复后，出现了广泛的骨骼肌麻痹，主要是下肢，这与广泛的横纹肌溶解有关，血清肌酸磷酸激酶（CPK）水平极度升高6周以及活检标本中的肌肉坏死证明了这一点。病情逐渐好转，但一年后仍存在行走障碍。高热可能与水杨酸盐对大脑的影响或多种药物的联合作用有关。横纹肌溶解可能与高热对肌肉的有害作用、对乙酰氨基酚对骨骼肌类似于对心肌可能产生的作用，或这些机制的组合有关。
