病例报告:急性意外碳酰胆碱中毒。
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舒尔茨M, Graefe T, Stuby K,安德森H, Kupfermann N, Schmoldt
病例报告:急性意外碳酰胆碱中毒。
暴击治疗。2006;10 (3):R84。doi: 10.1186 / cc4937。Epub 2006 6月1。
- PubMed ID
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16740173 (在PubMed]
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简介:与碳酰胆碱中毒,毒蕈碱的胆碱能受体激动剂是罕见的。我们报告一个有趣的案例研究(附近)致命的中毒。方法:一个84岁的男性的儿子发现了一个报纸报道说临床成功与植物提取物在阿尔茨海默氏症。行动的模式是类似的合成化合物“carbamylcholin”;氯化氨甲酰胆碱。他买了25克卡巴可作为制药、纯物质和父亲是管理400 - 500毫克。氯化氨甲酰胆碱浓度血清和尿液中1和2天的住院被HPLC-mass谱分析。结果:口服几分钟后,病人恶心、出汗和低血压,终于崩溃了。心动过缓,胆碱能症状,发生心搏停止。最初的心肺复苏术和立即治疗肾上腺素(肾上腺素),阿托品和速尿是成功的。 On hospital admission, blood pressure of the intubated, bradyarrhythmic patient was 100/65 mmHg. Further signs were hyperhidrosis, hypersalivation, bronchorrhoea, and severe miosis; the electrocardiographic finding was atrio-ventricular dissociation. High doses of atropine (up to 50 mg per 24 hours), adrenaline and dopamine were necessary. The patient was extubated 1 week later. However, increased dyspnoea and bronchospasm necessitated reintubation. Respiratory insufficiency was further worsened by Proteus mirabilis infection and severe bronchoconstriction. One week later, the patient was again extubated and 3 days later was transferred to a peripheral ward. On the next day he died, probably as a result of heart failure. Serum samples from the first and second days contained 3.6 and 1.9 mg/l carbachol, respectively. The corresponding urine concentrations amounted to 374 and 554 mg/l. CONCLUSION: This case started with a media report in a popular newspaper, initiated by published, peer-reviewed research on herbals, and involved human failure in a case history, medical examination and clinical treatment. For the first time, an analytical method for the determination of carbachol in plasma and urine has been developed. The analysed carbachol concentration exceeded the supposed serum level resulting from a therapeutic dose by a factor of 130 to 260. Especially in old patients, intensivists should consider intoxications (with cholinergics) as a cause of acute cardiovascular failure.
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