Donoso Alejandro, Cruces Pablo, Camacho Jorge, Ríos Juan Carlos, Paris Enrique, Mieres Juan Jose
Pediatric Intensive Care Unit, Padre Hurtado Hospital, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
Clin Toxicol (Phila). 2007 Sep;45(6):714-6. doi: 10.1080/15563650701438912.
Copper is an essential element. Poisoning with elemental copper is infrequent and manifestations rarely include the ones that our case presented.
A previously healthy 2-year-old female patient unintentionally inhaled copper dust, developed respiratory failure a few hours later, and required mechanical ventilation. On hospital day three, the patient developed acute respiratory distress syndrome and was treated with high-frequency oscillatory ventilation for six days. She also developed hemolytic anemia, liver failure, oliguric renal failure, and evidence of acute tubular injury. During her stay in the intensive care unit she received inotropic support, packed red cells transfusion, and diuretics. A sample of bronchoalveolar lavage showed macrophages that stained positive for copper. Serum and urine copper concentrations were within the normal range after several days. Extubation was successfully achieved after two weeks and the patient was discharged on day 30 without sequelae. This is the first report of acute respiratory distress syndrome secondary to copper aspiration in a pediatric patient.
To our knowledge, this is the first case reported of acute respiratory distress syndrome secondary to elemental copper aspiration. It is important to the clinician to be aware of acute respiratory distress syndrome as a differential diagnosis to copper aspiration by treating the patient aggressively in an adequate clinical setting.
铜是一种必需元素。元素铜中毒并不常见，其表现很少包括我们病例中所呈现的那些。
一名既往健康的2岁女性患者意外吸入铜尘，数小时后出现呼吸衰竭，需要机械通气。住院第三天，患者发生急性呼吸窘迫综合征，并接受了六天的高频振荡通气治疗。她还出现了溶血性贫血、肝功能衰竭、少尿性肾衰竭以及急性肾小管损伤的证据。在重症监护病房期间，她接受了强心支持、浓缩红细胞输血和利尿剂治疗。支气管肺泡灌洗样本显示巨噬细胞铜染色呈阳性。几天后血清和尿液铜浓度在正常范围内。两周后成功脱机，患者于第30天出院，无后遗症。这是小儿患者因吸入铜导致急性呼吸窘迫综合征的首例报告。
据我们所知，这是首例因吸入元素铜导致急性呼吸窘迫综合征的报告。临床医生应意识到急性呼吸窘迫综合征可作为铜吸入的鉴别诊断，在适当的临床环境中积极治疗患者非常重要。
