误服超剂量复方地芬诺酯致幼儿中毒性脑病

Toxic encephalopathy in a child induced by mistaken use of compound diphenoxylate hydrochloride in overdose

1例2岁4个月男孩误服家长放在床边的复方地芬诺酯片10~20片。误服药后约2h出现嗜睡,约3h出现口唇发绀、昏睡伴打鼾,约6h送当地医院,接受洗胃、吸氧等治疗,约9h后转上级医院。经气管插管呼吸机辅助呼吸、纳洛酮解救、补液、利尿等对症支持治疗7d后,患儿意识好转,可自主呼吸,但四肢肌张力高,双侧腱反射亢进,双侧巴氏征阳性、踝阵挛阳性,间断发作性姿势异常。头颅磁共振成像检查示双侧小脑半球、顶枕叶、侧脑室旁、前后角旁及胼胝体多发异常信号灶。患儿被诊断为中毒性脑病、症状性癫痫。1年后电话随访,患儿重度智力发育落后。

A 2 years and 4 months old boy mistakenly took 10-20 tablets of compound diphenoxylate hydrochloride placed by his parents at the bedside. About 2 hours after taking the medicine by mistake, the boy developed lethargy and, about 3 hours after the medicine, he developed cyanosis of lips and lethargy accompanied by snoring. About 6 hours after the medicine, the boy was sent to the local hospital and treatments such as gastric lavage and oxygen inhalation were given. About 9 hours after the medicine, the boy was transferred to the General Hospital of Ningxia Medical University. After 7 days of symptomatic and supportive treatments, such as mechanical ventilation via tracheal intubation, naloxone rescue, fluid replacement, and diuresis, the consciousness of the child improved and he could breathe spontaneously. However, the boy still had high muscle tension of his limbs, exaggerated bilateral tendon reflexes, positive Babinski sign, positive ankle clonus, and intermittent paroxysmal postural abnormalities. The head Magnetic Resonance Imaging showed multiple abnormal signal foci in bilateral cerebellar hemisphere, parieto-occipital lobe, peri-lateral ventricle, anterior and posterior periventricular and corpus callosum. He was diagnosed as toxic encephalopathy and symptomatic epilepsy. One year later, it was known by telephone follow-up that the boy had severe mental retardation.