【摘要】 <正> 在近二年内,我们曾遇到了9例经应用抗疟药物后发生明显的毒性反应,其中2例极为严重,几乎危及生命。兹将该9例作一简要报导,并复习有关文献,以供参考。一、乙氨嘧啶引起昏迷一例: 住院号77836,女性,2岁。患者于1961年11月4日起有间歇性高热,5天后被当地诊所诊断为瘧疾,给口服乙氨嘧啶,自当日上午八时起在5小时半的时间内共服乙氨嘧啶三次,总更多还原

【Abstract】 Toxic reactions to antimalarial drugs were encountered during last two years in nine pa-tients admitted to the First Teaching Hospital of the Shanghai First Medical College. The drugs used for the acute malarial attacks in these nine patients were pyrimethamine, quinine,chloroquine, and primaquine.Pyrimethamine, in an overdosage of 150mg.to a young girl of two years of age in three di- vided doses during a short interval of five and half hours, produced very serious intoxication.The child soon became unconscious and suffered from repeated attacks of convulsions. She was soon admitted and lavaged, and was treated with anticonvulsants and saline infusions. She remain-ed semiconcious when she was discharged after eight days of hospitalization.Quinine, injected intramuscularly to a male adult, brought out an allergic reaction in the form of thrombocytopenic purpura. This unto-ward effect happened on the next day after the second injection of quinine which was given one month apart from his previous one. On admis-sion there appeared diffuse purpuric spots over his extremities and trunk. His platelet count was reduced to 16000/cu. mm. Without any speci-fic treatment his condition recovered spontan-eously after eight days of hospitalzation.Chloroquine dipbosphate, in a single dose of l.5gm. by mouth induced six hours later psycho-sis in an adult male patient. On admission he looked excited and confused. Sedatives and saline infusions were given. He recovered after twelve hours of treatment. In another patient, chloro-quine diphosphate initiated repeated attacks of Adams-Stokes syndrome. This patient was a fe-male adult. Prior to chloroquine therapy she had taken digitalis for two weeks for her decompen-sated rheumatic mitral valvular disease. Adams-Stokes syndrome occurred after an initial dose of 1gm. of chloroquine diphosphate and recurred after a subsequent dose of 0.5gm. on another day. The convulsive seizures were successfully controlled by intravenous procaine amide.Primaquine elicited cyanosis in four patients and loss of conciousness in addition in another.Among the four cases of cyanosis the daily dosage of primaquine was 15mg. in one ease,22.5mg. in the other two, 60mg. for the first day and 120mg. for the second day in another.Cyanosis was slight to moderate in degree. It appeared from the second to the third day, of primaquine administration and disappeared quic-kly after intravenous injection of methylene blue. The fifth patient had not only cyanosis but also neurological complications. The amount of primaquine taken by this patient was 90mg. in three divided doses within fourteen hours.After admission, gastric lavage and intravenous saline infusion were soon started. The patient recovered on the second day of hospitalization. Of all these nine cases, in some the toxic reactions may be due to some immunological implications or to inborn errors. It is postulated by some authors that the thrombocytopenic pur-pura induced by quinine is due to the presence of certain antibody in the serum. The antibody combines with quinine and platelets to form qui-nine-platelet complex with consequent reduction of circulating platelets. The main cause of prima- quine cyanosis is an inborn deficiency of glucose-6-phosphate dehydrogenase in the red corpuscles.As chloroquine has effect on the cardiac conduc-tion system, due attention should be paid when it is given to the patient with cardiac disease,especially when he is digitalized. Overdose of any of these antimalarial drugs may result in serious hazards. Patients should be instructed with emphasis to follow the prescriptions closely.更多还原