Department of Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Med Hypotheses. 2010 Feb;74(2):309-11. doi: 10.1016/j.mehy.2009.09.001. Epub 2009 Sep 27.
Organophosphorus (OP) pesticide self-poisoning is a major clinical problem in rural Asia and it results in the death of 200,000 people every year. At present, it is lack of effective methods to treat severe organophosphate poisoning. The high mortality rate lies on the amount of toxic absorption. Intravenous lipid emulsions can be used as an antidote in fat-soluble drug poisoning. The detoxification mechanism of intravenous lipid emulsions is "lipid sink", which lipid emulsions can dissolve the fat-soluble drugs and separate poison away from the sites of toxicity. Most of organophosphorus pesticides are highly fat-soluble. So, intravenous lipid emulsions have the potentially clinical applications in treatment of OP poisoning. Extracorporeal blood purification especially charcoal hemoperfusion is an efficient way to eliminate the poison contents from the blood. We hypothesize that the combination of intravenous lipid emulsions and charcoal hemoperfusion can be used to cure severe organophosphate poisoning. This novel protocol of therapy comprises two steps: one is obtained intravenous access to infuse lipid emulsions as soon as possible; another is that charcoal hemoperfusion will be used to clear the OP substances before the distribution of OP compounds in tissue is not complete. The advantages of this strategy lie in three points. Firstly, it will alleviate the toxic effect of OP pesticide in the patients by isolation and removal the toxic contents. Secondly, the dosage of antidotes can be reduced and its side-effects will be eased. Thirdly, a large bolus of fatty acids provide energy substrate for the patients who are nil by mouth. We consider that it would become a feasible, safe and efficient detoxification intervention in the alleviation of severe organophosphate poisoning, which would also improve the outcome of the patients.
有机磷（OP）农药中毒自杀是亚洲农村地区的一个主要临床问题，每年导致 20 万人死亡。目前，缺乏治疗严重有机磷中毒的有效方法。高死亡率取决于有毒物质的吸收量。静脉内脂肪乳剂可用作脂溶性药物中毒的解毒剂。静脉内脂肪乳剂的解毒机制是“脂质阱”，脂肪乳剂可以溶解脂溶性药物并将毒物从毒性部位分离出来。大多数有机磷农药都是高度脂溶性的。因此，静脉内脂肪乳剂在治疗有机磷中毒方面具有潜在的临床应用。体外血液净化，特别是活性炭血液灌流是从血液中消除毒物含量的有效方法。我们假设静脉内脂肪乳剂和活性炭血液灌流的联合应用可用于治疗严重的有机磷中毒。这种新的治疗方案包括两个步骤：一是尽快建立静脉通路输注脂肪乳剂；另一个是在 OP 化合物在组织中未完全分布之前，使用活性炭血液灌流清除 OP 物质。这种策略的优点有三点。首先，它通过隔离和去除有毒物质来减轻 OP 农药对患者的毒性作用。其次，可以减少解毒剂的用量并减轻其副作用。第三，大量的脂肪酸为不能进食的患者提供能量底物。我们认为，它将成为一种可行、安全和有效的解毒干预措施，以缓解严重的有机磷中毒，也将改善患者的预后。
