A case of unexplained duodenal ulcer and massive gastrointestinal bleed.
A case of unexplained duodenal ulcer and massive gastrointestinal bleed.
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DOI：
10.1016/j.cca.2020.03.037
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发表时间：
2020-07
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
一名73岁的男子出现胃肠道(GI)大出血症状。手术治疗是为了控制十二指肠溃疡并十二指肠穿孔引起的出血。在调查这起案件的罪魁祸首时，一名中医在两周前开出的止痛药引起了人们的注意。患者入院时的血清样本和来源不明的止痛药使用了临床验证的LC-HRMS方法进行分析。非甾体抗炎药包括双氯芬酸、吡罗昔康和消炎痛，以及其他一些合成药物和天然产物。患者同时接触多种非甾体抗炎药显著增加了上消化道并发症的风险。有理由认为，大剂量使用非甾体抗炎药是十二指肠溃疡和消化道出血的主要原因。此外，阿托品和麻黄碱等已确认的天然产品有明确的毒性记录。重要的是提高不受管制药物的可见度，在可能接触有毒物质的情况下，执行非靶向质谱分析的能力提供了独特的诊断优势。
A 73-year-old man was displaying symptoms of massive gastrointestinal (GI) bleed. Surgical actions were performed to control the bleed caused by an erosive duodenal ulcer with duodenal perforation. When investigating the culprit of this case, the pain medications prescribed two weeks prior by a traditional Chinese medicine doctor raised attention. The patient’s admission serum sample and the pain medications from unknown sources were analyzed using a clinically validated liquid chromatography-high-resolution mass spectrometry (LC-HRMS) method. The NSAIDs diclofenac, piroxicam, and indomethacin were identified, as well as some other synthetic drugs and natural products. The patient’s concurrent exposure to multiple NSAIDs significantly increased the risk of upper GI complications. It is reasonable to argue that the high-dose use of the NSAIDs was a major cause of the duodenal ulcer and GI bleed. In addition, the identified natural products such as atropine and ephedrine have well-documented toxicities. It is important to increase the visibility of unregulated medications, and the capability to perform untargeted mass spectrometry analysis provides a unique diagnostic advantage in cases where exposure to toxic substances is possible.
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