# 一名因Alzheimer病服用galantamine 16 mg/日的病人，被送到急診時有大量流涎、心搏過慢（HR 42）、腹部絞痛、腹瀉與瞳孔縮小。優先護理行動是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391759&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名因Alzheimer病服用galantamine 16 mg/日的病人，被送到急診時有大量流涎、心搏過慢（HR 42）、腹部絞痛、腹瀉與瞳孔縮小。優先護理行動是什麼？

## 選項

1. 再給galantamine以維持用藥一致性
2. 給予naloxone並監測呼吸
3. 鼓勵口服水分並2小時後重新評估
4. 準備給予atropine IV，因病人正在發生膽鹼危象 **✔ 正確答案**

**正確答案: 4**

## 解析

正解 (2): Galantamine過量後出現SLUDGE症狀、心搏過慢與縮瞳，是典型膽鹼危象。治療為atropine、支持呼吸道/呼吸與ECG監測。(1) 再給藥會惡化。(3) Naloxone逆轉opioid，不處理膽鹼過量。(4) 延誤很危險。

## 深入解析

Memory Tip Cholinergic crisis = SLUDGE + DUMBELS。解毒藥 = Atropine。Caution 需與myasthenic crisis區分，後者會因ChEi改善；不確定時可用edrophonium test。

## 臨床情境

Scenario 75歲男性使用galantamine 16 mg/日；女兒昨天誤給雙倍劑量。出現流涎、HR 42、縮瞳、腹部絞痛、腹瀉、冒汗。

## 重要概念

- **膽鹼危象** — Acetylcholinesterase inhibitor毒性造成SLUDGE、心搏過慢、縮瞳、無力與呼吸衰竭。
- **Atropine** — 治療膽鹼危象的抗膽鹼解毒藥；以IV滴定給予。
- **DUMBELS** — 記憶法：Diarrhea, Urination, Miosis, Bronchospasm/Bradycardia, Emesis, Lacrimation, Salivation/Sweating。

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