汽车油漆减色剂致急性肾损伤

Muzamil Latief, Zhahid Hassan, Mohd Latief Wani, F. Abbas, Summyia Farooq
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引用次数: 0

摘要

汽车工业的各个方面也伴随着职业健康危害的风险。甲苯也逐渐成为药物滥用者常用的药物。这些物质的意外暴露或自我中毒已在文献中报道。这些物质还可引起远端肾小管酸中毒(RTA)、急性肾小管坏死、肾小球肾炎和间质性肾炎、横纹肌溶解和肌红蛋白血症。在这个系列中,我们报告了三例因有机溶剂而出现肾脏症状的患者。三名患者中有两名摄入了降漆剂物质,第三名患者对吸入甲苯类降漆剂成瘾。所有患者均有自杀倾向,并发生急性肾损伤(AKI)和严重代谢性酸中毒。其中一名患者也有横纹肌溶解的特征。第三例患者是药物滥用者,吸入剂量高于正常水平,出现严重难治性酸中毒和轻度肾损伤,需要肾替代治疗(RRT)。所有患者最终都恢复了肾功能,并在随访期间表现良好。甲苯基有机溶剂可导致急性神经系统症状,并伴有严重的代谢改变、器官损伤和功能障碍。低钾性麻痹和代谢性酸中毒的发展与甲苯中毒的关系已被观察到。急性甲苯毒性的处理主要是保守的,包括电解质纠正、酸碱和液体异常以及严重AKI的肾脏替代治疗。有机溶剂暴露可导致急性肾小管坏死、横纹肌溶解、RTA和AKI,与摄入途径无关。临床怀疑器官功能障碍和衰竭并及时诱导支持性护理可获得良好的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Automobile Paint Reducer Induced Acute Kidney Injury
The various aspects of the automobile industry also carry with it the risk for occupational health hazards with it. Toluene has also evolved as a commonly used drug by substance abusers. Accidental exposure or self-poisoning with these substances has been reported in literature. These substances can also cause distal renal tubular acidosis (RTA), acute tubular necrosis, glomerulonephritis and interstitial nephritis, rhabdomyolysis and myoglobinemia.In this series, we report about three patients who developed renal manifestations because of organic solvents. Two of the three patients had ingested the paint reducer substance and the third one was addicted to sniffing the toluene based paint reducer. All the patients had in taken these substances with suicidal intent and developed acute kidney injury (AKI) and severe metabolic acidosis. One of the patients had features of rhabdomyolysis as well. The third patient was a substance abuser and had inhaled higher than usual dose and developed severe and refractory acidosis and mild kidney injury and required Renal Replacement Therapy (RRT) for acidosis. All the patients eventually recovered their kidney functions and were doing well during their follow-up.Toluene based organic solvents lead to acute neurological symptoms, accompanied by severe metabolic alterations, organ injury and dysfunc-tion. An association of the development of hypokalemic paralysis and metabolic acidosis with toluene intoxication has been observed. The management of acute toluene toxicity is mainly conservative, consisting of electrolytes correction, acid-base and fluid abnormalities and renal replacement therapy in severe AKI.Organic solvent exposure may result in acute tubular necrosis, rhabdomyolysis, RTA and AKI irrespective of the intake route. Clinical suspicion of organ dysfunction and failure and timely induction of supportive care leads to a good outcome.
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