每日一题_2023.05.14

A 6-year-old boy was brought to a pediatrician two weeks ago because his teacher noticed he had begun “blanking out” in the classroom, staring into space, failing to respond to his name, and occasionally drooling. The pediatrician prescribed a drug for these episodes one week ago. The boy’s parents bring him to the emergency department because he has worsening gastrointestinal upset, pain on swallow- ing, and blistering around his nose and mouth. Which drug most likely caused this boy’s symptoms?

两周前一名6岁的男孩被带到儿科医生那里，因为他的老师注意到他开始在教室里“失神”，盯着天空，听不出他的名字，偶尔流口水。儿科医生一周前为这些发作症状开了药。男孩的父母带他到急诊科，因为他的胃肠不适加重，吞咽疼痛，鼻子和嘴巴周围起水泡。哪种药物最有可能引起这个男孩的症状?

(A) Carbamazepine 卡马西平

(B) Ethosuximide 乙琥胺

(C) Lamotrigine 拉莫三嗪

(D) Phenytoin 苯妥英

(E) Valproic acid 丙戊酸

答案解析：

根据对这个男孩“发作”的描述，他患有失神症。乙琥胺是唯一一种既用于治疗失神癫痫又用于治疗Stevens-Johnson综合征的药物。乙琥胺是一种用于失神发作的抗癫痫药，通过阻断t型钙通道发挥作用。一种罕见但严重的不良反应是药源性Stevens- Johnson综合征。其特征是表皮广泛脱落，鼻、口腔和生殖器黏膜以及结膜出现水泡。这导致吞咽时严重疼痛和脱水的主诉。随后可能出现红斑、可触及的紫癜和表皮坏死松解症。乙琥胺还会引起胃肠道(GI)紊乱、疲劳、头晕，在极少数情况下还会引起血液病。Stevens-Johnson综合征的治疗方法包括停药、控制液体平衡、预防皮肤继发感染，可能还包括使用皮质类固醇，但最后一种措施存在争议。

正确答案：B