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頁籤選單縮合
題名 | Acute Phenytoin Intoxication: Causes, Symptoms, Misdiagnoses, and Outcomes=急性癲能停中毒:原因,症狀,誤診及結果 |
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作 者 | 黃文柱; 蔡景仁; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷期 | 20:12 2004.12[民93.12] |
頁次 | 頁580-585 |
分類號 | 418.731 |
關鍵詞 | 急性癲能停中毒; 原因; 症狀; 誤診; 結果; Acute phenytoin intoxication; Causes; Symptoms; Misdiagnoses; Outcomes; |
語文 | 英文(English) |
中文摘要 | 癲能停是一種常用的抗癲癇藥物。由於藥物動力學的特性,急性癲能停中毒是急診醫學一個重要的課題。這個回溯性研究的目的是要探討急性癲能停中毒的原因,症狀,誤診及結果。我們收錄了過去13年來,在一個大學醫院,因急性癲能停中毒到急診室而住院的案件。共有30位病人(平均年齡,41.6±22.8歲)發36次的急性癲能停中毒被收錄分析。病人到院時平均血清癲能停濃度為47.3±9.7μg/mL(範圍,27.9±0.4μg/mL)。自己增加藥量,對處方不了解以及可能的藥物交互作用是導致急性中毒的主因。步態不穩,暈眩,噁心,嘔吐,全身無力及嗜睡是最常見的症狀。最初診斷正確的比例是67%,最常被誤診為腦幹或小腦中風。病人在暫時停用癲能停及支持性治療下,住院過程順利。我們的結論是急性癲能停中毒在急診室的正確診斷率偏低。雖然急性癲能停中毒沒有造成死亡,且病賽的預後、結果很好;但是因為走路不穩跌倒所造成的傷害仍然不可忽略。暫時停用癲能停及給予一般性支持療法是急性癲能停中毒的治療主軸。 |
英文摘要 | Phenytoin is a commonly prescribed antiepileptic drug. Due to its saturation (zero-order) pharmacokinetics, phenytoin carries a special risk of does-related toxicity that is an important issue in emergency medicine. The purpose of this cross-sectional case-series study was to investigate the causes, symptoms, misdiagnoses, and outcomes of acute phenytoin intoxicatin. It was based on a retrospective chart review of 30 inpatients (mean age, 41.6±22.8 years) with 36 episodes of acute phenytoin intoxication at our university hospital in the past 13years. The average initial serum phenytoin level was 47.3±9.7μg/ mL (range, 27.9-70.4μg/mL). Excessive self-medication, misunderstanding of the prescription order, and probable drug interaction were the three leading causes of acute phenytoin intoxication. Unsteady gait, dizziness/vertigo, nausea/vomiting, general weakness, and drowsiness were the most common presenting symptoms. The tentative diagnostic accuracy was 67%. The most common initial misdiagnosis was brainstem or cerebellum stroke (14%). The clinical course in all patients was uneventful under temporary withdrawal of phenytoin and supportive care. We concluded that acute phenytoin intoxication was relatively under-diagnosed in the emergency service. Although acute phenytoin intoxication causes no mrotality and has a good outcome, the unsteady gait increases the risk of injuries caused by falls. The management of acute phenytoin intoxication includes temporary withdrawal of phenytoin and supportive care. |
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