2021 Volume 53 Issue 1 Pages 39-43
Sialorrhea in children with severe motor and intellectual disabilities may result in medical problems such as dermatitis and dehydration ; however, a standard treatment for these complications has not been established. Sialorrhea can be categorized into two types : true sialorrhea and pseudo sialorrhea. The former is derived from increased amounts of saliva, whereas the latter is derived from dysphagia. Here, we report a case in which atropine sulfate and clonidine were successfully administered to a patient who developed serious sialorrhea with paroxysmal sympathetic hyperactivity (PSH). A boy aged 2 years and 5 months developed cerebral palsy caused by hypoxic-ischemic encephalopathy and he had been diagnosed with pseudo sialorrhea. At 10 months of age, he experienced cardiopulmonary arrest caused by dehydration due to severe sialorrhea and poor feeding of enteral nutrition. Hereafter, he also developed sympathetic hyperfunction symptoms such as hyperthermia, tachycardia, muscle hypertonia, and seizure, which exacerbated the sialorrhea. He was diagnosed with true sialorrhea by measuring the amount of saliva. We considered it complicated with PSH after he experienced cardiopulmonary arrest and administration of Roto extract and scopolamine ointment were not effective. Subsequently, continuous intravenous atropine sulfate was administered, and the amount of saliva markedly decreased. However, since the saliva volume was aggravated with PSH, it improved when clonidine was administered. As a result, hospitalization frequency due to dehydration decreased after treatment initiation. Sialorrhea in children with severe motor and intellectual disabilities may be complicated by PSH, suggesting that treatment with atropine sulfate should be effective.
