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患者,男.21岁.曾有间歇性情绪低、少语、自卑;兴奋、话多、自诩症状4年.本次因兴奋、话多、夜间不眠2月第2次入院.入院体检正常,诊断为双相情感障碍躁狂相.给予湖南省湘中制药厂生产的丙戊酸镁系统治疗(批号9103043),初始剂量600mg/d,以后根据病情变化及不良反应情况渐增至1800mg/d.服到第7d时,患者当天下午出现大汗淋漓.全身肌肉持续性强直收缩,并渐进入昏睡状态.体检:T39.5℃,R25次/min,P149次/min,律齐,两肺细小罗音少许,双侧巴氏征(±),WBC 13.2×10~9/L(N0.83,L0.12,M0.05),考虑为丙戊酸镁所致恶性综合征,即停服丙戊酸镁,给予东莨菪碱肌注,使用退热药,输液以维持电解质平衡,抗生素预防感染及胞磷胆碱500mg/d静脉滴注.次日,测T36.8℃.P96次/min,WBC 9.5×10~9/L(N0.72、L0.27、M0.01),昏睡较浅,出汗及肌张力增高仍持续,继续以上治疗,至第4d.患者意识清楚,出汗停止,肌僵直缓解.双侧巴氏征(一),井能下床活动,自行进食.
Patients, male, 21 years old. Have had intermittent mood low, poor language, low self-esteem; excitement, words, self-esteem symptoms 4 years.The excitement, then many, sleepless at night in February 2nd admission. , Diagnosed as bipolar disorder manic phase.Provided Hunan Province in Hunan Pharmaceutical Factory production of magnesium valproate system treatment (lot number 9103043), the initial dose of 600mg / d, later based on changes in condition and adverse reactions increased to 1800mg / d. Served on the 7th day, the patient appeared sweating profusely on the afternoon of the same day, his body muscles continued to tonic contractions, and gradually into the lethargy state. Physical examination: T39.5 ℃, R25 times / min, P149 times / min, Small pulmonary rales a little, bilateral Pakistan’s sign (±), WBC 13.2 × 10 ~ 9 / L (N0.83, L0.12, M0.05), considered as magnesium valproate malignant syndrome, that Cessation of magnesium valproate, given scopolamine intramuscular injection, the use of antipyretics, infusion to maintain electrolyte balance, antibiotics to prevent infection and citicoline 500mg / d intravenous infusion the next day, T36.8 ℃ .P96 times / min, WBC 9.5 × 10 ~ 9 / L (N0.72, L0.27, M0.01), drowsiness shallow, perspiration and increased muscle tension continued, the above treatment, to the first 4d. Khan stop, muscle stiffness ease. Bilateral S sign (a), well able to get out of bed, eating on their own.