Chang Y L, Yang C C, Deng J F, Ger J, Tsai W J, Wu M L, Liaw H C, Liaw S J
Chang-Gung Memorial Hospital, Taoyuan, Taiwan.
J Toxicol Clin Toxicol. 1999;37(4):497-504. doi: 10.1081/clt-100102442.
Methylene chloride is a solvent used in domestic and industrial preparations, such as paint removers and degreasing agents. Although it is considered of low toxicity, acute toxic manifestations have been reported following inhalation of methylene chloride, mainly from working in an enclosed environment. Oral ingestion of methylene chloride, however, remains rare and its consequences are less clearly understood.
The various clinical manifestations of 6 patients with oral ingestion of methylene chloride are reported. Central nervous system depression, tachypnea, and corrosive gastrointestinal injury were the most common presentations following ingestion. An elevated carboxyhemoglobin level was documented in only 2 patients (35% and 8.4% carboxyhemoglobin, respectively). Due to a frequent misleading history of "chloroform" ingestion and unawareness of probable carboxyhemoglobin production in these patients, carboxyhemoglobin was not routinely measured. Renal failure, hepatic failure, and acute pancreatitis occurred in the 2 most severe cases of methylene chloride ingestion.
Ingestion of methylene chloride can result in diverse manifestations, including a high carboxyhemoglobin level. Corrosive gastrointestinal injury is common in oral poisoning and needs further therapeutic consideration. A high index of suspicion and appropriate laboratory studies are needed in those patients who allegedly ingest "chloroform" but do not present the incriminating solvent to their treating physicians. The presence of an elevated carboxyhemoglobin level suggests the diagnosis of methylene chloride poisoning. Symptomatic and supportive measures remain the mainstay in the treatment of patients with oral methylene chloride poisoning.
二氯甲烷是一种用于家庭和工业制剂的溶剂，如脱漆剂和脱脂剂。尽管它被认为毒性较低，但吸入二氯甲烷后已报告有急性中毒表现，主要发生在封闭环境中工作时。然而，口服二氯甲烷仍然很少见，其后果也不太清楚。
报告了6例口服二氯甲烷患者的各种临床表现。摄入后最常见的表现是中枢神经系统抑制、呼吸急促和腐蚀性胃肠道损伤。仅2例患者记录到碳氧血红蛋白水平升高（分别为35%和8.4%的碳氧血红蛋白）。由于这些患者常有误导性的“氯仿”摄入史，且未意识到可能产生碳氧血红蛋白，因此未常规检测碳氧血红蛋白。2例最严重的二氯甲烷摄入病例发生了肾衰竭、肝衰竭和急性胰腺炎。
摄入二氯甲烷可导致多种表现，包括高碳氧血红蛋白水平。腐蚀性胃肠道损伤在口服中毒中很常见，需要进一步的治疗考虑。对于那些据称摄入“氯仿”但未向治疗医生出示 incriminating 溶剂的患者，需要高度怀疑并进行适当的实验室检查。碳氧血红蛋白水平升高提示二氯甲烷中毒的诊断。对症和支持措施仍然是口服二氯甲烷中毒患者治疗的主要手段。
