Nervous system toxicity of 2 cases of misdiagnosis of the disease[标标:作者]
[Keywords:] nervous system, toxic diseases, misdiagnosis
A case report
Example 1: male patients, aged 24, past the body and health, to "drink of consciousness, convulsions 6 hours," admitted to hospital, the patient friend on behalf of the state: 46 patients to drink liquor 600ml, "red wine 100ml" symptoms after drinking to early morning (about 6 hours after drinking in patients with convulsions, foaming at the mouth, and call not, incontinence, urgency to our hospital. examination: moderate coma, bilateral mydriasis, a diameter of about 6mm, light reflex, corneal reflex, neck without resistance, flaccid paralysis of the limbs. meningeal irritation sign was not elicited, both lower extremities Pakistan's sign (+, skin, mucous membrane was no bleeding, heart, lung, abdominal not seen the four diagnostic exception. auxiliary examination: Blood RT, urinary RT, head CT, blood biochemical examination, liver and renal function were normal. by "alcoholism" treatment, given gastric lavage, hypertonic glucose bolus, naloxone and other drugs, symptoms not relieved, restless. then give symptomatic, supportive treatment. a lot of fluid 5000ml / day, blood pressure, ice caps, nutritional support, prevention of respiratory tract, urinary tract infection, protect the gastrointestinal tract functions. about 8 days, the patient friends discovered that the patients drink "wine" turned out to be from the rat poison with (containing tetramine, specific concentration is unknown. continue to support the treatment, 10 patients in future awareness turned clear, no abnormal neurological examination, 15 after discharge. follow-up 18 months, the patient does not appear sequelae and complications.
Example 2: male patients, aged 32, past the body and health, to "limb weakness for 6 months" admission, the patient Readme: 6 months ago no obvious incentive to the distal limbs, weakness, had by "myasthenia gravis" treatment (specifically, situation is unknown, invalid. family no same or similar cases. Examination: ptosis, distal limb muscle strength, decreased muscle tone, fatigue test (+, neostigmine test (-. EMG Show: negative stimulus repetition frequency . Diagnosis: myasthenia syndrome, to support treatment, acupuncture, massage and steroid pulse therapy, slowly ease the symptoms, and 20
after discharge. follow-up 4 months later, symptoms had disappeared in patients with myasthenia gravis, can work, live, and differently from anyone else. It was learned later in patients 4 months before the onset of illness had taken the "dimethoate" suicide, symptomatic treatment in a nearby hospital and discharged after 2 improved. Therefore, amendments to the final diagnosis: organic phosphorus pesticide poisoning gravis syndrome. In this case follow-up 14 months, the patient did not have other abnormalities.
Analysis: The above two cases by emergency department revenue, have been misdiagnosed, nervous system toxicity is not uncommon in clinical disease, but these two patients were still Pofeizhouzhe, reasons are summarized below.
2 Discussion (1 history with relative privacy, due to various reasons to provide patients with a history of my or may cover up and / or omissions in the real history, resulting in the occurrence of misdiagnosis. Therefore, for some special patients, doctors should be repeated several times to understand all the patients kinds of information and detailed collection of relevant medical evidence, rigorous testing of evidence collected, filter out the real causes and solutions. (2 doctors should broaden their knowledge, for the special patient access to relevant information as quickly as possible to enhance the survival of patients rate. (3) supportive care is the treatment of rare diseases, the key to complex medical record, so clinicians should strengthen the importance of supportive care. (4) hospitals should be established toxicology tests on the suspected disease, poison, toxic, should be in a timely manner all kinds of body fluids, blood and other specimens sent to the relevant departments to identify toxic species for testing.
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