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Adverse Reaction To Diazepam; A Case Report

机译：地西p不良反应;个案报告

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Diazepam belongs to the group known as benzodiazepines tranquilizers, anxiolytics, and anti-convulsant agent. Its use as in most drugs has been associated with side effects and adverse reactions. Although a lot of therapeutic goals can be accrued to its use, the case report would highlight an unreported adverse reaction to Diazepam. A 25 years old man had an adverse reaction to diazepam after being administered as a premedication, 10mg intravenously. The observations were tachycardia, blisters all over the body, gross swelling of the right upper limb where the drug was administered, fever, diplopia, headache, as well as sudden hypotension preceded by hypertension. He was managed adequately with steroids, antihistamine, phenergan and intravenous fluid. Notwithstanding surgery for left inguinal hernia was carried-on. Introduction Diazepam belongs to the group of drugs known as benzodiazepines. It is a tranquilizer, anxiolytic as well as anti-seizure drug1. They are thought to stimulate y-amino butyric acid receptors in the ascending reticular activating system and they therefore block both the cortical and limbic arousal systems following stimulation of the brain stem reticular formation. They have been shown to depress electrical discharge in septum, amygdala and hippocampus which are components of the limbic system that regulate emotion2. Intravenous diazepam or midazolam are used by the majority of endoscopists as premedications. In the UK, the ratio of diazepam to midazolam users is approximately 2:13. Case Report The reported case is about a 25 year old man, a student who was first seen in the surgical outpatient clinic two months prior to surgery with a history of swelling in the left groin of four years duration. The swelling was painful and reducible. He denied any history of trauma, fever, abdominal swelling or vomiting. He was not a known epileptic or diabetic, nor was there a history of drug allergy. He did not take alcohol or take tobacco products in any form, and was the last child in a family of four.Examination revealed a young man, not pale nor jaundiced, with a pulse rate of 76 beat per minute, regular and good volume.His blood pressure was 110/70mmHg, and the heart sounds were normal.Abdominal examination revealed a reducible left inguinal hernia.Rectal examination revealed no abnormality.A diagnosis of left reducible inguinal hernia was made. Pre-operatively, His packed cell volume was 40%, Hemoglobin concentration of 14g/dl. The white blood cell count and urinalysis done were normal. He was booked for herniorraphy. As a premedication for ketamine anesthesia, he was given intravenous diazepam 10mg slowly through infusion line. As the drug was being administered, the patient complained of severe pains on the limb and within seconds, he began to complain of tightness’ in the chest, dizziness, severe headache and double vision. He became restless and physically aggressive. On examination, he was restless, acyanossed, conscious but disoriented in time, person and place. The pulse rate was 120 beat per minutes, bounding but regular. His blood pressure was 180/110 mmHg. Heart sounds were normal. An impression of adverse reaction to diazepam was made. Intravenous hydrocortisone 200mg and intramuscular 50mg phenergan were given and then the infusion changed from normal saline to dextrose water. Thereafter patient calmed down, the pulse was still 120 beats per minute. The blood pressure dropped to 160/ 100mmHg. However, the operation was carried-out using local infiltration with xylocaine-adrenaline. The operation lasted for about 30 minutes. In the immediate post-operative period, the pulse remained high at 130 beat per minutes while the blood pressure then crashed to 60/20mmHg. He was resuscitated with normal saline, plasma expanders, phenergan and hydrocortisone. He also had pain relief with pentazocine. His immediate postoperative pack cell volume was 40% and he was making adequate amount of urine. On the first pos
机译：地西p属于苯二氮卓类镇定剂，抗焦虑药和抗惊厥药。与大多数药物一样，它的使用与副作用和不良反应有关。尽管使用该药物可达到许多治疗目的，但该病例报告将突出未报告的地西p不良反应。一名25岁的男性在服用10mg静脉前药后对地西epa有不良反应。观察到的是心动过速，全身水泡，服用药物的右上肢明显肿胀，发烧，复视，头痛以及高血压前的突然低血压。用类固醇，抗组胺药，苯那芬和静脉输液对他进行了适当处理。尽管进行了手术治疗左腹股沟疝。简介地西p属于一种药物，称为苯二氮卓类。它是一种镇静剂，抗焦虑药和抗癫痫药1。据认为，它们在上升的网状激活系统中刺激γ-氨基丁酸受体，因此它们在刺激脑干网状结构形成后会阻断皮质和边缘觉醒系统。已显示它们可抑制间隔，杏仁核和海马中的放电，这些放电是调节情绪的边缘系统的组成部分2。静脉内地西epa或咪达唑仑被大多数内镜医师用作处方药。在英国，地西epa与咪达唑仑使用者的比例约为2:13。病例报告该病例约25岁，是一名学生，他是在手术前两个月首次在外科门诊就诊的学生，病史为四年，左腹股沟肿胀。肿胀疼痛且可减轻。他否认有外伤，发烧，腹部肿胀或呕吐的病史。他不是已知的癫痫病或糖尿病患者，也没有药物过敏史。他没有饮酒或服用任何形式的烟草制品，是四口之家中的最后一个孩子。检查显示，一个年轻人既不苍白也不黄疸，每分钟脉搏频率为76拍，规律且良好。血压为110 / 70mmHg，心律正常;腹部检查可减轻左腹股沟疝;直肠检查未见异常;诊断为左可减轻腹股沟疝。术前，他的细胞堆积体积为40％，血红蛋白浓度为14g / dl。白细胞计数和尿液检查正常。他被任命为疝气治疗师。作为氯胺酮麻醉的处方药，通过输液管线缓慢给他静脉注射地西epa 10mg。在服药期间，患者抱怨四肢剧烈疼痛，几秒钟后，他开始抱怨胸闷，头晕，剧烈头痛和复视。他变得躁动不安，身体变得好斗。经检查，他躁动不安，无氰状态，意识清醒，但在时间，人员和地点上迷失了方向。脉搏速率为每分钟120次搏动，但有规律但有规律。他的血压为180/110 mmHg。心音正常。对地西epa产生不良反应的印象。给予200mg氢化可的松和50mg肌肉注射的phenergan，然后从生理盐水改为葡萄糖水。此后患者平静下来，脉搏仍为每分钟120次。血压降至160 / 100mmHg。但是，该手术是通过使用二甲苯卡因-肾上腺素进行局部浸润进行的。手术持续了大约30分钟。术后即刻，脉搏保持在每分钟130次搏动的高位，而血压随后骤降至60 / 20mmHg。用生理盐水，血浆扩张剂，菲尔根和氢化可的松复苏。他还可以使用喷他佐辛缓解疼痛。术后他立即的包装细胞体积为40％，并且他正在制造足够量的尿液。在第一个位置上

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