 |
 초록접수: 4월 1일~5월 24일 |
| 사전등록: 5월 1일~6월 14일 |
|
|
|
|
제목 : A Case of Generalized tonic-clonic seizure after Doxylamine Overdose associated Rhabdomyolysis
발표자 : 송태진
저자 : Tae-Jin Song*
,Hanna Cho², Duk-Yong Kim¹, Jun-Bum Lee², Won-Joo Kim²
소속 : Department of Neurology , Cheju Jungang Hospital*
,Department of Neurology, Cheju Jungang Hospital1, Department of Neurology, Yongdong Severance Hospital, Yonsei University College of medicine, Seoul, Korea2. |
|
|
Purpose : Doxylamine is an antihistamine commonly used as an over-the-counter medication to relieve insomnia and frequently involved in overdoses. Large dose of doxylamine could prolong or stimulate seizure activity because histamine-1 receptors coalesce around epileptogenic foci in brain and inhibit generalization of seizure activity. Generalized tonic-clonic seizure induced doxylamine intoxication accompanying rhabdomyolysis has rarely been reported.
Case : A 22-year-old woman was admitted with a chief complaint of generalized tonic-clonic seizure and overdose of doxylamine with suicidal intent. She had decreased mental state, confusion, vomiting, tachycardia, pupil dilatation. Her medical history was unremarkable; no history of seizure, head trauma and metabolic disease. Laboratory tests demonstrated that metabolic acidosis in the arterial blood gas analysis (pH: 7.10, base excess: negative 18.0). Brain CT showed no abnormal findings. Sleep and awaking electroencephalography demonstrated abnormal findings (poorly regulated posterior dominant rhythm, occasional midline slow waves). Initially, serum creatine phosphokinase concentration was normal range (90 IU/L) and levels of liver enzymes were elevated (aspartate aminotransferase 21 IU/l; alanine aminotransferase 12 IU/l). At the third day, serum CK, myoglobin, AST and ALT increased to 92,878 IU/L, excess 40,000ng/ml, 549 IU/I and 211 IU/I. Fourth day after admission, she discharged from hospital voluntarily.
Conclusions : On considering the cause of this rhabdomyolysis, we could not regard the seizure as a main cause in view of plasma creatine kinase level and suppose that direct toxic effect of doxylamine may play a role to some extents. In all case of where such overdosages are suspected, we should make consideration of obtaining creatine kinase level in early periods to prevent the possibility of rhabdomyolysis and subsequent acute renal failure, especially in the presence of dehydration and acidosis. Also, we should be warned doxylamine overdose could rarely elicit generalized convulsion and rhabdomyolys, which may be fatal due to cardiopulmonary problem, renal failure and brain insult.
|
|
|
|
|
