Clinical outcomes and kinetics of propanil following acute self-poisoning: a prospective case series.
Clinical outcomes and kinetics of propanil following acute self-poisoning: a prospective case series.
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DOI：
10.1186/1472-6904-9-3
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发表时间：
2009-02-16
期刊：
影响因子：
--
通讯作者：
Eyer P
中科院分区：
文献类型：
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作者：
Roberts DM;Heilmair R;Buckley NA;Dawson AH;Fahim M;Eddleston M;Eyer P
丙烯是农药急性中毒的重要致死原因，甲基血红蛋白血症是其重要表现。然而，关于临床毒性和动力学的信息有限。本研究的目的是描述急性故意自我中毒后丙炔的临床结果和动力学。在斯里兰卡农村医院进行的一项大型、多中心前瞻性队列研究中，从2002年至2007年收治了431例丙炔中毒史患者，其中40例患者同时摄入了丙炔和至少一种其他毒物，未作进一步考虑。其余391例患者根据临床结果使用简单的分级系统进行分类；由于资源有限，无法对甲基血红蛋白血症进行量化。入院时采集血液样本，一部分患者提供多个样本用于丙烯及其代谢物3,4-二氯苯胺（DCA）的动力学分析。42例死亡（中位死亡时间1.5天），病死率为10.7%。尽管进行了治疗，但仍发生了与甲基血红蛋白血症一致的发绀、镇静、低血压和严重乳酸酸中毒。治疗主要包括亚甲基蓝（1 mg/kg，一剂或两剂）、换血和临床诊断为甲基血红蛋白血症时的支持治疗。入院时血浆丙炔和DCA浓度反映临床预后。丙烯的消除半衰期为3.2 h(95%置信区间为2.6 ~ 4.1 h)， DCA浓度普遍高于丙烯，且持续时间更长，变化更大。丙烯是斯里兰卡仅次于百草枯的最致命的除草剂。亚甲基蓝主要以低剂量处方，并作为间歇性丸剂施用，考虑到亚甲基蓝、丙烯和DCA代谢物的动力学，预计这是次优的。但在缺乏对照研究的情况下，这些和其他治疗方法的疗效尚不明确。急性丙烯中毒的最佳处理还需要更多的研究。
Propanil is an important cause of death from acute pesticide poisoning, of which methaemoglobinaemia is an important manifestation. However, there is limited information about the clinical toxicity and kinetics. The objective of this study is to describe the clinical outcomes and kinetics of propanil following acute intentional self-poisoning. 431 patients with a history of propanil poisoning were admitted from 2002 until 2007 in a large, multi-centre prospective cohort study in rural hospitals in Sri Lanka. 40 of these patients ingested propanil with at least one other poison and were not considered further. The remaining 391 patients were classified using a simple grading system on the basis of clinical outcomes; methaemoglobinaemia could not be quantified due to limited resources. Blood samples were obtained on admission and a subset of patients provided multiple samples for kinetic analysis of propanil and the metabolite 3,4-dichloroaniline (DCA). There were 42 deaths (median time to death 1.5 days) giving a case fatality of 10.7%. Death occurred despite treatment in the context of cyanosis, sedation, hypotension and severe lactic acidosis consistent with methaemoglobinaemia. Treatment consisted primarily of methylene blue (1 mg/kg for one or two doses), exchange transfusion and supportive care when methaemoglobinaemia was diagnosed clinically. Admission plasma concentrations of propanil and DCA reflected the clinical outcome. The elimination half-life of propanil was 3.2 hours (95% confidence interval 2.6 to 4.1 hours) and the concentration of DCA was generally higher, more persistent and more variable than propanil. Propanil is the most lethal herbicide in Sri Lanka after paraquat. Methylene blue was largely prescribed in low doses and administered as intermittent boluses which are expected to be suboptimal given the kinetics of methylene blue, propanil and the DCA metabolite. But in the absence of controlled studies the efficacy of these and other treatments is poorly defined. More research is required into the optimal management of acute propanil poisoning.