Makrides Constantinos, Koukouvas Mikes, Achillews Gewrgios, Tsikkos Sotiris, Vounou Emmeleia, Symeonides Marios, Christodoulides Panikos, Ioannides Marios
Department of Internal Medicine, Limassol General Hospital. Limassol, Cyprus.
JOP. 2005 Mar 10;6(2):166-71.
N-methyl carbamate insecticides are widely used in homes, gardens and agriculture. They share the capacity to inhibit cholinesterase enzymes with organophosphates and therefore share similar symptomatology during acute and chronic exposures. One of the serious effects of organophosphate and carbamate intoxication is the development of acute pancreatitis and subsequent intrapancreatic fluid formation.
An 18-year old Caucasian man was admitted to our Intensive Care Unit with cholinergic crisis symptomatology, after the ingestion of an unknown amount of a carbamate insecticide (methomyl). Pseudocholinesterase levels were 2 kU/L on the day of admission (reference range: 5.4-13.2 kU/L). Two days after admission, an abdominal CT scan revealed blurring of the peripancreatic fat planes, inflammation and swelling of the pancreas, and a substantial amount of ascitic fluid in the left anterior pararenal space and pelvis. Paracentesis and analysis of the ascitic fluid demonstrated findings diagnostic of pancreatic ascites. There had been no other evident predisposing factors for acute pancreatitis, other than methomyl intoxication. Eleven days after admission, pseudocholinesterase levels returned to normal, while a new abdominal CT scan revealed the formation of intrapancreatic fluid collection. The patient was discharged in good physical condition two weeks after admission. A follow up abdominal CT scan performed one month later showed a significant reduction in the size of the intrapancreatic fluid.
Acute pancreatitis is not uncommon after organophosphate intoxication and carbamates share the same risk as organophosphorus pesticides. The development of acute pancreatitis and subsequent intrapancreatic fluid collection after methomyl intoxication has not previously been reported. This is the first case reported of acute pancreatitis and pancreatic ascite formation after anticholinesterase insecticide ingestion.
氨基甲酸酯类杀虫剂广泛应用于家庭、花园和农业领域。它们与有机磷化合物一样具有抑制胆碱酯酶的能力，因此在急性和慢性接触过程中会出现相似的症状。有机磷和氨基甲酸酯类中毒的严重后果之一是急性胰腺炎的发生及随后胰腺内液体积聚。
一名18岁的白种男性因摄入未知量的氨基甲酸酯类杀虫剂（灭多威）后出现胆碱能危象症状，被收入我们的重症监护病房。入院当天假性胆碱酯酶水平为2 kU/L（参考范围：5.4 - 13.2 kU/L）。入院两天后，腹部CT扫描显示胰周脂肪平面模糊、胰腺炎症和肿胀，左肾前间隙和盆腔有大量腹水。腹水穿刺及分析结果诊断为胰源性腹水。除灭多威中毒外，没有其他明显的急性胰腺炎诱发因素。入院11天后，假性胆碱酯酶水平恢复正常，而新的腹部CT扫描显示胰腺内液体积聚形成。患者入院两周后身体状况良好出院。一个月后进行的随访腹部CT扫描显示胰腺内液体体积显著缩小。
有机磷中毒后急性胰腺炎并不罕见，氨基甲酸酯类与有机磷农药具有相同的风险。此前尚未报道过灭多威中毒后急性胰腺炎及随后胰腺内液体积聚的情况。这是首例报道的抗胆碱酯酶杀虫剂摄入后发生急性胰腺炎和胰源性腹水形成的病例。
