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患者 女,14岁.因呕吐、厌食进行性加重,行走不稳7天于1995年2月22日入院.患者有癫痫病史11年,一直口服苯妥英钠0.1,3次/日,10天前其母擅自将剂量加大至0.125,3次/日,3天后出现上述症状.体检:体温36.5℃,血压14/10kPa,神志清楚,眼球震颤(+),桡反射及肱二头肌反射亢进,闭目难立征(+),指鼻试验及跟膝胫试验不准,轮替运动差,病理反射(一),入院后脑干听觉诱发电位(BAEP)检查结果示:左耳Ⅰ-Ⅲ、Ⅰ-Ⅴ波间潜伏期及Ⅲ波、Ⅴ波潜伏期均明显延长,右耳正常,两耳听阈无差别,刺激强度为60dBsL.查血苯妥英钠浓度为37μg/ml,遂停服苯妥因钠改用卡马西平,并对症处理,2周后复查BAEP结果正常,血苯妥英钠浓度为0.3μg/ml.讨论 苯妥英钠系二苯乙内酰脲的钠盐,在肝脏中代谢,其代谢情况取决于剂量大小,当服用剂量小,
The patient, aged 14. Because of vomiting, anorexia progressive aggravating, walking unsteady 7 days in February 22, 1995 admitted patients with history of epilepsy for 11 years, has been orally phenytoin 0.1, 3 times / day, 10 days ago The mother without the dose will be increased to 0.125, 3 times / day, 3 days after the above symptoms. Physical examination: body temperature 36.5 ℃, blood pressure 14 / 10kPa, conscientious, nystagmus (+), radial reflex and biceps hyperreflexia, (+), Finger nose test and knee-shin test, poor rotation, pathological reflex (a), after admission BAEP examination results show: the left ear Ⅰ-Ⅲ , Ⅰ-Ⅴ wave latency and Ⅲ wave, Ⅴ wave latency were significantly longer, normal right ear, ears hearing threshold was no difference, the stimulus intensity of 60dBsL. Check the concentration of sodium phenytoin 37μg / ml, then stop taking phenytoin sodium Switch to carbamazepine and symptomatic treatment, 2 weeks after the review of BAEP results were normal, sodium hematotripsy 0.3μg / ml.Conclusion Sodium phenytoin sodium diphenylhydantoin metabolism in the liver, its metabolism Depending on the dose size, when taking a small dose,