左卡尼汀注射液诱发癫痫

L-carnitine injection induced epilepsy

1例56岁女性患者因胸部不适2 d且合并高血压、糖尿病，给予缬沙坦胶囊、琥珀酸美托洛尔缓释片、瑞舒伐他汀钙片、阿司匹林肠溶片、硝酸异山梨酯片和阿卡波糖口服，注射用泮托拉唑钠80 mg加入0.9%氯化钠注射液100 ml静脉滴注，1次/d；左卡尼汀注射液4.0 g加入0.9%氯化钠注射液250 ml静脉滴注，1次/d。用药第3天，在泮托拉唑钠、左卡尼汀相继输注完成后约2 h，患者突发呼之不应，意识丧失，四肢抽搐，双目凝视，牙关紧闭，口吐红色泡沫痰。立即行心电监护，开放气道，吸痰，氧疗，给予地西泮注射液10 mg肌内注射，甘油果糖氯化钠注射液 250 ml快速静脉滴注，20%甘露醇注射液125 ml快速静脉滴注。约10 min后患者停止抽搐，仍不能言语；次日恢复正常。考虑为症状性癫痫。颅脑CT和MRI功能成像等检查排除原发疾病导致的癫痫发作，怀疑与左卡尼汀注射液相关。停用该药，其他药物继续应用，患者未再出现癫痫发作。

A 56-year-old female patient was hospitalized because of suffering from chest discomfort for 2 days, and combined with hypertension and diabetes. She received oral valsartan capsules, metoprolol succinate sustained-release tablets, rosuvastatin calcium tablets, aspirin enteric-coated tablets, isosorbide dinitrate tablets, acarbose, and IV infusion of pantoprazole 80 mg＋0.9% sodium chloride injection 100 ml and L-carnitine injection 4.0 g＋0.9% sodium chloride injection 250 ml once daily. On the third day, about 2 hours after completion of pantoprazole and L-carnitine infusion, the patient presented with unresponsiveness to verbal stimuli, sudden loss of consciousness, limbs convulsion, eyes staring, trismus, and pink frothy sputum. Immediate ECG monitoring, open airway, sucking, oxygen therapy, intramuscular injection of 10 mg diazepam injection, rapid intravenous infusion of glycerol fructose sodium chloride injection 250 ml and 20% mannitol injection 125 ml were given. About 10 minutes later, the patient′s convulsion stopped but she still could not speak and she returned to normal the next day. Symptomatic epilepsy was considered. The probability of epilepsy induced by primary disease was excluded by brain CT and MRI functional imaging examinations and L-carnitine injection was suspected to be associated with the epilepsy. L-carnitine injection was discontinued and other drugs were continued and epilepsy did not recur.