Poisoning due to chlorophenoxy herbicides.

Sally M Bradberry, Alex T Proudfoot, J Allister Vale
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引用次数: 100

Abstract

Chlorophenoxy herbicides are used widely for the control of broad-leaved weeds. They exhibit a variety of mechanisms of toxicity including dose-dependent cell membrane damage, uncoupling of oxidative phosphorylation and disruption of acetylcoenzyme A metabolism. Following ingestion, vomiting, abdominal pain, diarrhoea and, occasionally, gastrointestinal haemorrhage are early effects. Hypotension, which is common, is due predominantly to intravascular volume loss, although vasodilation and direct myocardial toxicity may also contribute. Coma, hypertonia, hyperreflexia, ataxia, nystagmus, miosis, hallucinations, convulsions, fasciculation and paralysis may then ensue. Hypoventilation is commonly secondary to CNS depression, but respiratory muscle weakness is a factor in the development of respiratory failure in some patients. Myopathic symptoms including limb muscle weakness, loss of tendon reflexes, myotonia and increased creatine kinase activity have been observed. Metabolic acidosis, rhabdomyolysis, renal failure, increased aminotransferase activities, pyrexia and hyperventilation have been reported. Substantial dermal exposure to 2,4-dichlorophenoxy acetic acid (2,4-D) has led occasionally to systemic features including mild gastrointestinal irritation and progressive mixed sensorimotor peripheral neuropathy. Mild, transient gastrointestinal and peripheral neuromuscular symptoms have occurred after occupational inhalation exposure. In addition to supportive care, urine alkalinization with high-flow urine output will enhance herbicide elimination and should be considered in all seriously poisoned patients. Haemodialysis produces similar herbicide clearances to urine alkalinization without the need for urine pH manipulation and the administration of substantial amounts of intravenous fluid in an already compromised patient.

氯氧基除草剂引起的中毒。
氯苯氧类除草剂广泛用于阔叶杂草的防治。它们表现出多种毒性机制,包括剂量依赖性细胞膜损伤、氧化磷酸化解偶联和乙酰辅酶a代谢破坏。摄入后,早期症状为呕吐、腹痛、腹泻和偶尔的胃肠道出血。低血压是常见的,主要是由于血管内体积损失,尽管血管舒张和直接的心肌毒性也可能起作用。随后可能出现昏迷、强直、反射亢进、共济失调、眼球震颤、瞳孔缩小、幻觉、抽搐、抽搐和麻痹。通气不足通常继发于中枢神经系统抑制,但呼吸肌无力是一些患者发生呼吸衰竭的一个因素。肌病症状包括肢体肌肉无力、肌腱反射丧失、肌强直和肌酸激酶活性增加。代谢性酸中毒、横纹肌溶解、肾功能衰竭、转氨酶活性升高、发热和换气过度均有报道。大量皮肤暴露于2,4-二氯苯氧乙酸(2,4- d)偶尔会导致系统性症状,包括轻度胃肠道刺激和进行性混合感觉-运动周围神经病变。职业性吸入暴露后可出现轻微、短暂的胃肠道和周围神经肌肉症状。除支持治疗外,高流量尿量的尿液碱化可增强除草剂的消除,所有严重中毒患者均应考虑。血液透析产生与尿碱化相似的除草剂清除,而不需要对已经受损的患者进行尿液pH值操作和大量静脉输液。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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