Attempted Suicide, by Mail Order: Abrus precatorius
Attempted Suicide, by Mail Order: Abrus precatorius
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DOI：
10.1007/s13181-010-0099-1
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发表时间：
2010-12-01
影响因子：
2.9
通讯作者：
Nelson, Lewis S.
中科院分区：
文献类型：
--
作者：
Jang, David H.;Hoffman, Robert S.;Nelson, Lewis S.
目的鸡骨草在亚热带地区广泛种植。种子有多种颜色，例如黑色、橙子，最常见的是有光泽的红色。在种子的末端发现一条黑色条带。这种植物含有多个豆荚，通常含有三到五颗相思子种子。种子含有相思豆毒素，它抑制核糖体功能，停止蛋白质合成，导致细胞死亡。这起案件的一个独特之处是使用互联网订购了一种可能致命的毒药，并传输了一张图片来识别种子。病例报告一名20岁的男子在抵达前6-8小时向急诊科投诉呕吐和水样腹泻。他否认使用任何药物，最近的疾病，旅行或饮食变化。最初的生命体征正常。患者被诊断为病毒性胃肠炎。在评估期间，患者承认有自杀倾向。在等待精神病学评估时，病人的父亲带着一盒红色的小种子来了，据信他的儿子在自杀企图中吞下了这些种子。工作人员无法识别种子。这些种子的照片通过电子邮件发送到纽约市毒物控制中心，使他们能够识别为A。precatorius。患者再次接受采访，并承认咀嚼和吞咽了10粒种子。考虑到相思豆毒素的潜在毒性，患者被送入重症监护室。他继续有呕吐和腹泻的频繁发作。他在两天内逐渐好转。他承认在网上阅读了关于Abrus种子用于自杀的报道后，从亚洲在线订购了一盒Abrus种子。他最终出院门诊随访，没有永久性的sequels.Conclusion阿托伐他汀估计人的致死剂量为0.1-1 μ g/kg。大多数鸡骨草种子摄入病例是无意的，发生在儿童中。摄入完整的种子通常不会导致临床发现，因为它们通过胃肠道，因为它们的硬壳。咀嚼过程中释放的阿托伐他汀在胃肠道的全身吸收很差。这会导致呕吐和腹泻，导致低血容量和电解质紊乱，这可能是严重的，危及生命，特别是在卫生保健系统不太先进的地区。管理主要是支持。
Objective Abrus precatorius is cultivated in many subtropical areas. The seeds exist in a variety of colors such as black, orange, and most commonly, glossy red. A black band is found at the end of the seed. The plant contains multiple pods which typically contain three to five Abrus seeds. The seeds contain abrin, which inhibits ribosomal function, halting protein synthesis and leading to cellular death. A unique aspect of this case is the use of the internet to order a potentially lethal poison as well as transmission of a picture to identify the seed.Case Report A 20-year-old man presented to the emergency department complaining of vomiting and watery diarrhea for 6-8 h prior to arrival. He denied any medication use, recent illness, travel, or changes in his diet. Initial vital signs were normal. The patient was diagnosed with viral gastroenteritis. During his evaluation, the patient admitted to feeling suicidal. While awaiting psychiatry evaluation, the patient's father arrived with a box of small hard red seeds, which be believed that his son ingested in a suicide attempt. The seeds could not be identified by the staff. A picture of the seeds was transmitted by e-mail to the New York City Poison Control Center, allowing their identification as A. precatorius. The patient was reinterviewed and admitted to chewing and swallowing 10 seeds. Given the potential toxicity of abrin, the patient was admitted to the intensive care unit. He continued to have frequent episodes of emesis as well as diarrhea. He gradually improved over 2 days. He admitted to ordering a box of Abrus seeds online from Asia after reading on the Internet about their use in suicide. He was eventually discharged for outpatient follow-up with no permanent sequelae.Conclusion Abrin has an estimated human fatal dose of 0.1-1 mu g/kg. Most cases of Abrus seed ingestions are unintentional and occur in children. Ingesting the intact seeds typically results in no clinical findings, as they pass through the gastrointestinal tract due to their hard shell. Abrin released during chewing is poorly absorbed systemically from the gastrointestinal tract. This causes the vomiting and diarrhea with resultant hypovolemia and electrolyte disturbances, which can be severe and life threatening, particularly in areas with less advanced health care systems. Management is primarily supportive.