病例报告:重度磷中毒的治疗。

IF 3.6 Q2 TOXICOLOGY
Frontiers in toxicology Pub Date : 2025-05-09 eCollection Date: 2025-01-01 DOI:10.3389/ftox.2025.1581362
Wang Kunlun, Yuan Jun, Xu Shiming, Shen Jie, Gao Mingqiang, Zhang Yuxia, Mo Weichun
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引用次数: 0

摘要

背景:磷酸盐是一种剧毒有机磷农药。由于其成本低、杀虫力强,在中国部分地区仍被广泛使用,造成了职业中毒和生命中毒事件。本文介绍了磷酸盐中毒的治疗过程和监测体内有毒代谢物的术语。病例报告:一名23岁男性患者在入院前4小时摄入约300毫升(180克)60%磷酸乳剂。病人摄入了致死剂量的300多倍。住院期间监测患者胆碱酯酶、磷酸酯及其代谢物阿托品和氯哌啶肟(PAM)水平。磷酸盐很快被血液吸收,产生五种代谢物。在血液灌流(HP)前,不能检测到血液中磷酸盐的浓度。在第一次HP检查后,我们在血液中发现了五种磷酸盐代谢物(甲氧磷亚砜、甲氧磷砜、甲氧磷砜、甲氧磷亚砜、甲氧磷亚砜和甲氧磷)。在后续治疗中,5种代谢物浓度逐渐降低。磷亚砜和磷砜的浓度随HP的悬浮而反弹,但其他代谢物的浓度没有反弹。20天后,胆碱酯酶恢复正常。治疗包括多轮HP,阿托品化和PAM胆碱酯酶再激活。患者34天后康复出院。结论:磷酸盐被氧化催化生成5种代谢物,引起毒性作用。这些代谢物的浓度最高的是亚砜,其次是砜,其次是磷酸亚砜,其次是磷酸亚砜,最后是光毒素。HP治疗显著降低了血清中有毒代谢物的水平。如果HP治疗中断,血清中亚砜和硫砜的水平有再次升高的趋势。严重的磷酸盐中毒后,胆碱酯酶需要很长时间才能恢复。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Case report: Treatment of severe phorate poisoning.

Background: Phorate is a highly toxic organophosphorus pesticide. Owing to its low cost and insecticidal potency, it is still widely used in parts of China, resulting in cases of occupational and life poisoning. This article presents the treatment process for phorate poisoning and monitoring the toxic metabolites terminology in the body.

Case report: A 23-year-old male patient ingested about 300 mL (180 g) of 60% phorate emulsion 4 h before admission at our hospital. The patient had ingested over 300 times the lethal dose. During hospitalization, the patient's levels of cholinesterase, phorate and its metabolites, atropine and pralidoxime chloride (PAM), were monitored. Phorate was quickly absorbed into the blood, producing five metabolites. Before hemoperfusion (HP), the concentration of phorate in the blood could not be detected. After the first HP we found five metabolites of phorate in the blood (phoratoxon sulfoxide,phoratoxon sulfone, phorate sulfone, phorate sulfoxide, and phoratoxon). In the follow-up treatment, the concentration of five metabolites gradually decreased. The concentration of the phorate sulfoxide and phorate sulfone rebounded with the suspension of HP, but that of the other metabolites did not rebound. It took 20 days for cholinesterase to recover. Treatment included multiple rounds of HP, atropinization, and reactivator of cholinesterase by PAM. The patient recovered after 34 days and was discharged from hospital.

Conclusion: Phorate is oxidized and catalyzed into five metabolites, which cause the toxic effects. Phoratoxon sulfoxide has the highest concentration of these metabolites, followed by phoratoxon sulfone, phorate sulfone, phorate sulfoxide, and phoratoxon, respectively. HP treatment significantly lowered the serum levels of the toxic metabolites terminology. If HP treatment is interrupted, the serum levels of phorate sulfoxide and phorate sulfone tend to rise again. It takes a long time for cholinesterase to recover from severe phorate poisoning.

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CiteScore
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