摘要
乙二醇为防冻剂的主要成分。乙二醇主要在肝脏内先后代谢为羟乙醛、乙醇醛、乙醇酸及草酸。这些代谢特可导致代谢性酸中毒。典型临床表现通常为3个阶段:第1阶段在摄入后12h内,乙二醇致中枢神经系统抑制;第2阶段在摄入12～24h后,出现代谢性酸中毒和心肺疾病;第3阶段在摄入后24～72h。出现肾小管坏死和肾衰竭。乙二醇致死量为1.4～1.6ml/kg[成人(70kg)约为100ml]。一旦怀疑乙二醇中毒,应尽快测定乙二醇和乙醇酸血浓度明确诊断。中毒治疗原则包括早期及时洗胃,给予乙醇或甲吡唑解毒剂,血液透析,碳酸氢钠vitB6等。大多数乙二醇中毒患者经早期诊断治疗后可恢复正常。本文报告3例急性乙醇中毒,3例患者均为男性(48岁),每人服用防冻液约为150ml。2例出现头痛有,1例出现上腹不适、兴奋、躁动。3例患者在摄入乙醇后12～18h出现代谢性酸中毒,24h出现血尿。经洗胃和血液透析,给予法莫替丁40mg,10%葡萄糖酸钙20ml。4%碳酸氢钠静脉注射,38%白酒200ml口服。2例治愈,1例于摄入乙二醇后29h死亡。
Ethylene glycol is the main ingredient in antifreeze. Ethylene glycol undergoes enzymatic metabolism principally in the liver, and converses to glycoaldehyde, glycolate, glycoxylate, and oxalate successively. These metabolites can cause metabolic acidosis. The typical clinical features of ethylene glycol poisoning are drowsiness, coma, elevated blood pressure, tachycardia, andhyperventilation. Many paiblished case reports described three stages of ethylene glycol poisoning： a neurological stage （30 minutes to 12 hours after injection） , central nervous system depression occurs; followed by a cardiopulmonary stage （ 12 - 24 hours after ingestion）, metabolic acidosis and cardiopulmonary disorders occur; and finally, a renal stage （24 - 72 hours after ingestion）, tubular necrosis and renal failure occur. The lethal dose of ethylene glycol is usually 1.4 -1.6 ml/kg[ about 100 ml in an about （70 kg） ]. The diagnosis is based on history of exposure, clinical features, and determination of ethylene glycol and the major acidic metabolite, glycolate, concentrations in blood and urine, The general principles of treatment include emptying the stomach, correction of acidosis, antidotes （ethanol or fomepizole） administration, haemodialysis, and supportive therapy. This paper reports 3 cases of ethylene glycol poisoning. Three male patients aged 48 years ingested about 150 ml of ethylene glycol each. The patients were presented with headache （2 cases）, abdominal discomfort and restlessness （ 1 case）. The three patients developed unconsevousness 9 hours after ingestion, metabolic acidosis 12 to 18 hours after ingestion, and hematuria 24 hours after ingestion. The patients were treated with gastric lavage, haemodialysis, famotidine 40 mg, 20 ml of IV calcium gluconate 10%, IV sodium bicarbonate 4% , oral administration of 200 ml of spirit （containing ethanol 38% ）, and vitaminB6. And then two patients were perfectly recovered from their illness. One patient died 29 hours after ingestion of ethyl
出处
《药物不良反应杂志》
2008年第1期41-46,共6页
Adverse Drug Reactions Journal
关键词
乙二醇
中毒
ethylene glycol
poisoning
