Cheslik T A, Erramouspe J
WalMart Pharmacy, Idaho Falls, ID, USA.
Ann Pharmacother. 1996 Apr;30(4):360-3. doi: 10.1177/106002809603000407.
To describe the development of extrapyramidal symptoms (EPS) precipitated by an accidental overdose of risperidone in a 3.5-year-old boy.
The boy presented to the emergency department with bilateral upward eye gaze, jerky movements of his extremities, and motor restlessness following an accidental ingestion of a single 4-mg risperidone tablet. Decontamination with NaCl 0.9% lavage and activated charcoal with sorbitol was performed. His symptoms responded immediately to intravenous diphenhydramine (on 3 different occasions) during his first 9.5 hours of hospitalization. He experienced no additional EPS, and was discharged home approximately 33 hours following initial presentation. At home, he received three oral doses of diphenhydramine in the 24 hours following hospital discharge because of hand tremor, total body shivering, and eye wandering. These signs resolved without further complications.
Although the incidence of EPS associated with therapeutic risperidone use is low, its occurrence following overdose is less clearly defined. This represents the first published case, to our knowledge, of risperidone overdose in a child and highlights the potential for dystonic reactions at low doses in this population. Seven intentional overdoses of risperidone in adults (aged 21-68 y) have been reported in the literature and are reviewed. Amounts ingested ranged from 5 to 270 mg. All adult patients appeared to have a relatively benign course. Reported symptoms included drowsiness, slurred speech, altered levels of consciousness, hypertension, tachycardia, electrocardiogram abnormalities, atypical motor behavior, tremors, and other EPS (not specified).
Accidental ingestion of low doses of risperidone can cause EPS in children that may respond well to an anticholinergic agent. Overdose management includes gastrointestinal lavage, activated charcoal with cathartic, cardiovascular monitoring, and supportive therapy.
描述一名3.5岁男孩因意外过量服用利培酮而引发锥体外系症状（EPS）的情况。
该男孩因意外误服1片4毫克利培酮片剂后，出现双眼向上凝视、四肢抽搐及运动性不安，被送往急诊科。给予0.9%氯化钠洗胃及活性炭加山梨醇进行去污处理。在住院的最初9.5小时内，他的症状在静脉注射苯海拉明（共3次不同时间）后立即得到缓解。他未再出现其他EPS症状，首次就诊后约33小时出院。在家中，出院后24小时内他因手部震颤、全身发抖及眼球游动服用了3次口服苯海拉明。这些症状未出现进一步并发症而得以缓解。
虽然与治疗剂量使用利培酮相关的EPS发生率较低，但其过量服用后的情况尚不太明确。据我们所知，这是首例关于儿童利培酮过量的报道病例，突出了该人群低剂量时发生肌张力障碍反应的可能性。文献中报道了7例成人（年龄21 - 68岁）故意过量服用利培酮的病例并进行了综述。摄入剂量范围为5至270毫克。所有成年患者的病程似乎相对良性。报道的症状包括嗜睡、言语含糊、意识水平改变、高血压、心动过速、心电图异常、非典型运动行为、震颤及其他EPS（未具体说明）。
儿童意外摄入低剂量利培酮可导致EPS，抗胆碱能药物对此可能有良好疗效。过量处理包括胃肠道灌洗、活性炭加泻药、心血管监测及支持治疗。
