Mattingly Jason E, Sullivan Janice E, Spiller Henry A, Bosse George M
Department of Emergency Medicine, University of Louisville, Louisville, Kentucky 40202, USA.
J Emerg Med. 2003 Nov;25(4):379-81. doi: 10.1016/s0736-4679(03)00235-x.
We describe a case of intermediate syndrome after chlorpyrifos ingestion in a toddler, despite a continuous pralidoxime infusion. A 16-month-old girl ingested a pesticide containing chlorpyrifos. She was brought to an Emergency Department where she became lethargic and tachycardic, and subsequently developed pulmonary edema requiring mechanical ventilation. Pralidoxime 150 mg i.v. was administered twice, and an infusion begun at 15 mg/kg/h. At 24.5 h post-ingestion the child had a normal neurologic examination, showed no signs of cholinergic excess, and was extubated successfully. At 27.5 h post-ingestion the child became flaccid, bradycardic and apneic. She was emergently re-intubated. The child's delayed onset of respiratory arrest and flaccid paralysis after an asymptomatic period is consistent with Intermediate Syndrome. This is an unusual case in that it occurred in a young child, was related to chlorpyrifos, and occurred despite continuous and adequate oxime therapy.
我们描述了一例幼儿摄入毒死蜱后发生中间综合征的病例，尽管持续静脉输注解磷定。一名16个月大的女孩摄入了一种含有毒死蜱的杀虫剂。她被送往急诊科，在那里变得嗜睡、心动过速，随后发展为肺水肿，需要机械通气。静脉注射150毫克解磷定两次，并以15毫克/千克/小时的速度开始输注。摄入后24.5小时，患儿神经系统检查正常，无胆碱能亢进迹象，并成功拔管。摄入后27.5小时，患儿出现全身无力、心动过缓和呼吸暂停。她被紧急重新插管。患儿在无症状期后延迟出现呼吸骤停和弛缓性麻痹，符合中间综合征。这是一个不寻常的病例，因为它发生在幼儿身上，与毒死蜱有关，并且尽管进行了持续且充足的肟类治疗仍发生了。
