Symptoms of penicillin encephalopathy?
summary
Penicillin encephalopathy is a rare toxic reaction of penicillin to the central nervous system, and the causes of this situation are more and more complex. When the dosage is too large and the intravenous drip speed is too fast, a large number of drugs quickly enter the brain tissue, that is, the concentration of drugs in blood and cerebrospinal fluid increases, which interferes with the normal nerve function and causes serious central nervous system reaction. Symptoms of penicillin encephalopathy? I'd like to share my views with you.
Symptoms of penicillin encephalopathy?
Penicillins, especially penicillin G, can directly stimulate the cerebral cortex when the systemic dosage is too large or the intravenous drip is too fast, and the concentration of penicillin in cerebrospinal fluid is more than 8U / ml, resulting in severe reactions such as spasm, convulsion, epilepsy and even coma. It usually appears within 24-72 hours after medication. It often occurs in newborns, children and the elderly because drugs are easy to pass through the blood-brain barrier. For patients with renal dysfunction or renal failure, it is also easy to occur due to the disorder of drug excretion.
Penicillin intramuscular injection area can occur peripheral neuritis. Intrathecal injection of more than 20000 units or intravenous infusion of large dose of penicillin can cause muscle clonus, convulsion, coma and other reactions. This reaction is more common in infants, the elderly and patients with renal dysfunction. Penicillin can cause psychotic attack occasionally. After the application of procaine penicillin, some patients may have high fever, anxiety, fever and so on.
The disease is serious. On the basis of the original disease, sudden convulsions, dehydration, hypoxia, shortness of breath and blood biochemical changes (such as hypoglycemia, hyponatremia, acidemia), hypertension, fast heart rate, hallucinations, convulsions, coma and respiratory failure occurred. The mechanism of this reaction is unknown. Some children may also have limb paralysis, fontanel protrusion can be seen in children with patent fontanel, and a few children may have uncoordinated movement. Most of the above symptoms appeared 1-2 weeks after the original illness.
matters needing attention
1. Among the side effects of penicillin, anaphylactic shock is fatal and often attracts people's attention, while the neurotoxic effects of encephalopathy and peripheral nerve damage are easily ignored. We must get rid of the previous idea that penicillin is rarely toxic as long as it is not allergic. We must never abuse penicillin in large doses (including other antibiotics). When it must be used, intravenous infusion should be used as little as possible, especially for the elderly and children; In addition, it should be noted that penicillin combined with ampicillin is more likely to cause penicillin encephalopathy. When the elderly use antibiotics, the effect of elimination process is obviously slower. 2. Penicillin was originally an antibiotic with high efficiency and low toxicity. It has made great achievements in the history of human anti infection, and its reputation has not been reduced. Probably because of this, in recent years, there has been a trend that penicillin is used more and more widely and its dosage is increasing. A small number of medical staff infused patients with a large amount of penicillin intravenously, especially more than 8 million units of penicillin intravenously. Some of them used penicillin several times a day and continuously for several days. This not only causes the high concentration of penicillin in blood, but also increases the concentration of penicillin in cerebrospinal fluid. When the concentration of penicillin in cerebrospinal fluid is more than 8 units / ml, it will stimulate the brain nerve, and then lead to hyperreflexia, disturbance of consciousness, hallucination, convulsion, coma and other encephalopathy symptoms. It can also cause transient mental disorders, especially in patients with renal insufficiency The elderly and children are more likely to induce the disease. 3. Due to the decrease of renal function and plasma albumin, the blood concentration and cerebrospinal fluid drug concentration increase, resulting in central nervous system toxicity. Therefore, the dosage of antibiotics should be adjusted according to the renal function in the elderly. In order to prevent the occurrence of "penicillin encephalopathy", the dosage of such drugs should not be too large. If the disease requires a large dosage, the dosage should be given three to four times a day. Incidentally, many antibiotics such as cephalosporins, vancomycin, tetracycline and nalidixic acid can increase the serum concentration due to the decrease of renal function, resulting in increased toxic and side effects. Some drugs can be reduced, some better not, and switch to other antibiotics. 4. There are many kinds of antibiotics that can cause central nervous system damage, such as penicillin, cephalosporin, taineng, aminoglycosides, macrolides, chloramphenicol, polymyxin E, sulfanilamide, quinolone, isoniazid, acyclovir, ganciclovir and some other kinds of drugs can cause nervous system damage in varying degrees, There are various brain symptoms.
