复方妥英麻黄茶碱片致共济失调伴精神异常

Ataxia and mental disorders due to compound phenytoin sodium, ephedrin hydrochloride and theophylline tablets

1例70岁男性慢性阻塞性肺疾病患者口服复方妥英麻黄茶碱（每片含苯妥英钠50 mg，马来酸氯苯那敏1 mg，盐酸麻黄碱5 mg，咖啡因7.5 mg，可可碱12.5 mg，茶碱12.5 mg，颠茄流浸膏0.009 ml）3片，3次/d。用药29个月后出现步态不稳，双下肢活动不灵；用药35个月后患者症状加重，并出现发作性意识模糊、白天睡眠增多、胡言乱语等精神症状。实验室检查示苯妥英钠血药浓度30 mg/L，考虑为苯妥英钠中毒。停用复方妥英麻黄茶碱并给予对症支持治疗。10 d后患者意识转清，精神症状消失，苯妥英钠血药浓度15 mg/L。14 d后患者可独自行走。

A 70-year-old male patient with chronic obstructive pulmonary disease received compound phenytoin sodium, ephedrin hydrochloride and theophylline tablets（each tablet containing phenytoin sodium 50 mg, chlorpheniramine maleate 1 mg, ephedrine hydrochloride 5 mg, caffeine 7.5 mg, theobromine 12.5 mg, theophylline 12.5 mg, belladonna flow extract 0.009 ml） 3 tablets thrice daily by mouth. Gait instability and clumsiness of his lower limbs appeared after 29 months of medication and gradually worsened with mental disorders （such as sparoxysmal unconsciousness, increased daytime sleep and balderdash） after 35 months of medication. Laboratory tests showed that the blood phenytoin concentration was 30 mg/L. Phenytoin poisoning was considered. Compound phenytoin sodium, ephedrin hydrochloride and theophylline tablets were stopped, and symptomatic and supportive treatments were given. Ten days later, the patient became conscious, his mental disorders disappeared, and the blood phenytoin concentration decreased to be 15 mg/L. Fourteen days later, he could walk independently.