Status epilepticus from an illegally imported Chinese rodenticide: "Tetramine"
Status epilepticus from an illegally imported Chinese rodenticide: "Tetramine"
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DOI：
10.1081/clt-120026523
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发表时间：
2003-01-01
期刊：
影响因子：
--
通讯作者：
Nelson, LS
中科院分区：
文献类型：
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作者：
Barrueto, F;Furdyna, PM;Nelson, LS
简介：下面的病例报告表明，难治性惊厥性癫痫持续状态的严重后果，从一个陌生的进口毒素，四亚甲基二磺基四胺（TETS），并确定违规代理的困难。病例报告：一名以前健康的15个月大的女孩被她的父母发现在玩一种从中国带来的白色杀鼠剂粉末。15分钟后，该儿童出现全身性癫痫发作，被送往急诊科（艾德）。她的初始手指针刺血糖为108 mg/dL。在艾德，患儿因癫痫持续状态接受插管。尽管用劳拉西泮、苯巴比妥和吡哆醇进行积极治疗，她仍有4次间歇性全身性癫痫发作。她在住院的第三天拔管，但似乎有失神发作和皮质盲。连续脑电图监测，周后进行，发现严重的弥漫性脑功能障碍与多个致痫灶。该儿童仍然发育迟缓，正在接受丙戊酸治疗以控制癫痫发作。中文包装标签的翻译未阐明其内容。最终通过气相色谱-质谱（GC-MS）确认了该杀鼠剂产品中的四亚甲基二磺基四胺，然后根据我们实验室合成的TETS标准品进行定量。结论：四亚甲基二磺基四胺与其他“笼状惊厥药”（如印防己毒素）一起归类，因为它们具有类似的嵌入循环分子结构，并通过非竞争性γ-氨基丁酸（GABA）拮抗作用引起癫痫发作。据估计，人类口服半数致死剂量（LD 50）低至100 μ g/kg。我们的病人有严重的弥漫性脑功能障碍，可能继发于暴露于TETS后的长期癫痫活动。
Introduction: The following case report demonstrates the severe consequences of refractory convulsive status epilepticus from an unfamiliar imported toxin, tetramethylenedisulfotetramine (TETS), and the difficulties of identifying the offending agent. Case Report: A previously healthy 15-month-old girl was found by her parents playing with a white rodenticide powder brought from China. Fifteen minutes later, the child developed generalized seizures and was brought to an Emergency Department (ED). Her initial fingerstick blood glucose was 108 mg/dL. In the ED, the child was intubated for status epilepticus. Despite aggressive therapy with lorazepam, phenobarbital, and pyridoxine, she had 4 It of intermittent generalized seizure activity. She was extubated on the third hospital day, but appeared to have absence seizures and cortical blindness. Continuous electroencephalogram monitoring, performed weeks later, revealed severe diffuse cerebral dysfunction with multiple epileptogenic foci. The child remains developmentally delayed and is on valproic acid therapy for seizure control. Translation of the Chinese package labeling did not clarify its contents. Tetramethylenedisulfotetramine was finally confirmed by gas chromatography-mass spectrometry (GC-MS) in this rodenticide product and then quantified against a TETS standard that was synthesized in our laboratory. Conclusion: Tetramethylenedisulfotetramine is grouped with other "cage convulsants," such as picrotoxin, since they have a similar intercalating cyclical molecular structure and cause seizures through non-competitive gamma-aminobutyric acid (GABA) antagonism. The oral lethal dose 50% (LD50) in humans is estimated to be as low as 100 mug/kg. Our patient has severe diffuse cerebral dysfunction likely secondary to prolonged seizure activity after exposure to TETS.