Sudakin D L, Mullins M E, Horowitz B Z, Abshier V, Letzig L
Veterans Administration Medical Center, Oregon Health Science University, Oregon Poison Center, Portland 97201-3098, USA.
J Toxicol Clin Toxicol. 2000;38(1):47-50. doi: 10.1081/clt-100100915.
A 33-year-old female ingested an unknown quantity of malathion in a suicide attempt. Cholinergic signs consistent with severe organ, phosphate intoxication developed and were treated within 6 hours of ingestion. Intravenous atropine and a continuous infusion of pralidoxime (400 mg/h) were administered. Prolonged depression of plasma and red blood cell cholinesterases were documented. Despite an initial clinical improvement and the presence of plasma pralidoxime concentrations exceeding 4 microg/mL, the patient developed profound motor paralysis consistent with the diagnosis of Intermediate Syndrome. In addition to the dose and frequency of pralidoxime administration, other factors including persistence of organophosphate in the body, the chemical structure of the ingested organophosphate, and the time elapsed between ingestion and treatment may limit the effectiveness of pralidoxime as an antidote in organophosphate ingestions. This case study suggests that these factors should be taken into account in assessing the risk of Intermediate Syndrome after intentional organophosphate ingestions.
一名33岁女性为自杀企图摄入了未知量的马拉硫磷。出现了与严重有机磷中毒相符的胆碱能体征，并在摄入后6小时内接受了治疗。给予了静脉注射阿托品和持续输注解磷定（400毫克/小时）。记录到血浆和红细胞胆碱酯酶的长期抑制。尽管最初临床症状有所改善且血浆解磷定浓度超过4微克/毫升，但患者仍出现了与中间综合征诊断相符的严重运动麻痹。除了解磷定的给药剂量和频率外，其他因素，包括体内有机磷的持续存在、摄入有机磷的化学结构以及摄入与治疗之间的时间间隔，可能会限制解磷定作为有机磷摄入解毒剂的有效性。本案例研究表明，在评估故意摄入有机磷后发生中间综合征的风险时应考虑这些因素。
