Rapid infusion of excessive phenytoin: A newborn autopsy case
Rapid infusion of excessive phenytoin: A newborn autopsy case
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DOI：
10.1016/j.legalmed.2021.101935
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发表时间：
2021-06-26
期刊：
影响因子：
1.5
通讯作者：
Ikegaya, Hiroshi
中科院分区：
文献类型：
--
作者：
Idota, Nozomi;Shintani-Ishida, Kaori;Ikegaya, Hiroshi
患者是一名两天大的女婴。患者的母亲是20岁的初产妇S，在妊娠第33周的第一天出现正常胎盘过早早剥。新生儿出生体重1928g，为急诊剖宫产，新生儿重度窒息，11min后自主循环恢复。这名婴儿在新生儿重症监护病房接受机械通气治疗，并因反复癫痫发作而服用苯巴比妥。在第二天，观察到自发呼吸；然而，患者反复发作。苯巴比妥的剂量达到最大，改用咪达唑仑。在第3天凌晨，当咪达唑仑达到最大剂量时，婴儿出现癫痫持续状态，抗惊厥药物改为苯妥英钠。由于计算错误，开始静脉注射苯妥英钠的剂量为400毫克/30分钟，是正常剂量的10倍。六分钟后，在注射80毫克后，由于血压下降，给药停止；然而，婴儿死于心脏骤停。在死亡约25小时后进行的尸检显示，心脏中苯妥英的血药浓度为63.85微克/毫升。死亡原因被确定为急性苯妥英中毒。这是首例因快速静脉给药而导致苯妥英血药浓度升高的致死病例。
The patient was a two-day-old female infant. The patient's mother was a primigravid in her 20 s who developed premature abruption of the normal placenta on the first day of the 33rd week of gestation. The infant was born by emergency cesarean section with severe neonatal asphyxia with a birth weight of 1928 g. Spontaneous circulation was returned 11 min after birth. The infant was treated under mechanical ventilation in the neonatal intensive care unit, and phenobarbital was administered for repeated seizures. On day 2, spontaneous respiration was observed; however, the patient developed seizures repeatedly. The dose of phenobarbital reached the maximum and was switched to midazolam. In the early morning of day 3, while midazolam was administered up to the maximum dose, the infant developed status epilepticus, and the anticonvulsant drug was changed to phenytoin. Due to a calculation error, the intravenous administration of phenytoin was started at 400 mg/30 min, which is 10-fold of the normal dose. Six minutes later, after 80 mg was administered, the administration was stopped due to a drop in blood pressure; however, the infant died of cardiac arrest. An autopsy, which was performed approximately 25 h after death, revealed the blood phenytoin concentration in the heart was 63.85 mu g/mL. The cause of death was determined to be acute phenytoin toxicity. This is the first fatal case reported of the blood concentration of phenytoin caused by rapid intravenous administration.