Mechanisms of toxicity, clinical features, and management of diquat poisoning: A review
Mechanisms of toxicity, clinical features, and management of diquat poisoning: A review
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DOI：
10.1081/clt-100100926
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发表时间：
2000-01-01
期刊：
影响因子：
--
通讯作者：
Vale, JA
中科院分区：
文献类型：
--
作者：
Jones, GM;Vale, JA
用途：敌草快（1，1 '-亚乙基-2，2'-联吡啶）是一种非选择性联吡啶除草剂，结构上与百草枯相关，百草枯既用作接触性除草剂，也用作收获前干燥剂。与百草枯相比，敌草快在农业中的使用要少得多。毒性机制：敌草快是一种有效的氧化还原循环剂，易于转化为自由基，与分子氧反应，产生超氧阴离子，随后产生其他氧化还原产物。这些产物可诱导细胞膜中的脂质过氧化，并可能导致细胞死亡。特点：在1968-1999年期间，文献中仅详细报告了30例敌草快中毒病例，其中13例（43%）死亡。据报告，在接触敌草快后会产生局部和全身效应，全身特征总是与摄入有关。在严重且通常致命的病例中，已报告胃肠道粘膜溃疡、麻痹性肠梗阻、低血容量性休克、急性肾衰竭和昏迷。管理层：在使用定性尿检快速确认诊断后，可以考虑在危及生命的摄入（>6 g）后1小时内出现的患者进行肠道去污。然后应采取支持措施，包括补充液体和电解质。虽然血液滤过和血液透析在并发肾衰竭时具有已证实的价值，但没有临床证据表明血液透析或血液灌流可清除毒理学上显著量的敌草快，从而降低器官衰竭的风险并防止严重病例中的致命结局。
Uses: Diquat (1,1'-ethylene-2,2'-bipyridilium) is a nonselective bipyridyl herbicide, related structurally to paraquat, which is used both as a contact herbicide and a preharvest desiccant. In comparison to paraquat, diquat is used much less widely in agriculture. Mechanisms of Toxicity: Diquat is a potent redox cycler and is readily converted to a free radical which, in reaction with molecular oxygen, generates superoxide anions and subsequently other redox products. These products can induce lipid peroxidation in cell membranes, and potentially cause cell death. Features: Over the period 1968-1999, only 30 cases of diquat poisoning were reported in detail in the literature, of which 13 (43%) were fatal. Local and systemic effects have been reported following diquat exposure with systemic features being invariably associated with ingestion. In severe and usually fatal cases, gastrointestinal mucosal ulceration, paralytic ileus, hypovolemic shock, acute renal failure, and coma have been reported. Management: After rapid confirmation of the diagnosis using a qualitative urine test, gut decontamination may be considered in patients who present within 1 hour of a life-threatening ingestion (>6 g). Supportive measures including fluid and electrolyte replacement should then be employed. Although hemofiltration and hemodialysis are of proven value if renal failure supervenes, there is no clinical evidence that hemodialysis or hemoperfusion removes toxicologically significant amounts of diquat, thereby reducing the risk of organ failure and preventing a fatal outcome in severe cases.