新加坡一自杀性水果食入致死的鹿尾草心糖苷中毒病例报告及文献复习

Y. Lee, Deepak Ghimiray, T. Lui, Yi Ju Yao
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引用次数: 1

摘要

案例介绍:我们介绍了一个摄入非洲菊果实的案例,突出了不寻常糖苷中毒的知识差距。尽管患者表现为无症状,但随后出现了危及生命的临床特征,如高钾血症、低血压和心律失常。采用活性炭(AC)、阿托品、高钾血症管理、地高辛Fab和静脉脂质乳剂(ILE)进行治疗。先进的心脏生命支持(ACLS)是建立在自动胸部压缩设备。尽管经过长时间的抢救,病人还是死了。鉴于毒理学的罕见表现和不可预测性,应认真考虑Cerbera糖苷毒性。讨论:我们强调了Cerbera物种在亚太地区的流行情况,并介绍了强心苷药理学的相似性。早期识别摄入和心脏监测尤为重要。在这种情况下,尽管血清地高辛水平正常,但患者病情恶化,我们强调了诊断和预后方面的挑战。由于缺乏Cerbera糖苷中毒治疗方案的证据,我们借此机会研究了在强心苷家族中假设相似药理学的治疗方案。我们主张使用地高辛Fab作为糖苷中毒的主要治疗方法。根据目前的证据,多剂量活性炭(MDAC)和ILE被认为具有生理基础。由于证据有限,对心律失常的电学和药理学治疗进行了探索。我们建议,在治疗失败的情况下,应始终考虑ECMO治疗心脏毒性,因为这种新疗法已显示出巨大的前景。由于死亡率高,必须进行密切的心脏监测。地高辛Fab应在毒理学家的指导下进行。由于毒素的不可预测性,所有病例都应将患者转移到ECMO中心进行观察。治疗的进一步调查正在等待中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Fatal Case of Suicide Fruit Ingestion in Singapore by Cerbera Cardiac Glycoside Intoxication: Case Report and Review of Literature
Case Presentation: We present a case of Cerbera fruit ingestion which highlight the knowledge gap in unusual glycoside poisoning. Despite the patient's asymptomatic presentation, life threatening clinical features such as hyperkalaemia, hypotension and arrhythmia occurred later. Treatments instituted were activated charcoal (AC), atropine, hyperkalaemia management, Digoxin Fab and intravenous lipid emulsion (ILE). Advanced Cardiac Life Support (ACLS) was instituted with automated chest compression device. The patient died despite prolonged of resuscitation effort. Cerbera glycoside toxicity warrants serious consideration in view of rare presentation and unpredictable nature of toxicology. Discussion: We highlight the prevalence of Cerbera species in Asia-Pacific and present the similarities of cardiac glycosides pharmacology. Early recognition of ingestion and cardiac monitoring are particularly important. In this case, we highlight the diagnostic and prognostic challenge as patient deteriorated despite normal serum digoxin level. As the evidence of Cerbera glycoside poisoning treatment options is lacking, we take this opportunity to examine treatment options assuming similar pharmacology among cardiac glycoside family. We argue for a case for use of Digoxin Fab which is the prevailing treatment for glycoside poisoning. Multi-dose-activated charcoal (MDAC) and ILE are postulated to have physiological basis given current evidence. Electrical and pharmacology treatment for arrhythmia were explored as there is limited evidence. We propose ECMO should always be considered for cardiac toxicity in anticipation of treatment failure as the novel therapy has shown great promise. Conclusion: Cerbera glycoside poisoning should be treated with utmost caution as the fruit is easily accessible and highly toxic. Close cardiac monitoring is a must due to high mortality risk. Digoxin Fab should be instituted as guided by toxicologist. Patients should be transferred to ECMO centre for observation in all cases due to the unpredictable nature of toxin. Further investigation of treatment is awaited.
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来源期刊
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审稿时长
12 weeks
期刊介绍: Asia Pacific Journal of Medical Toxicology (APJMT) aims to expand the knowledge of medical toxicology and tries to provide reliable information in this field for medical and healthcare professionals. APJMT mainly focuses on research related to medical toxicology issues in the Asia Pacific region and publishes articles on clinical and epidemiological aspects of toxicology, poisonings emergency care, addiction, drug interactions and adverse effects. The journal accepts and welcomes high quality papers in the form of original articles and rarely review articles, case reports and scientific letters relevant to medical practice in toxicology.
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