University of Edinburgh and National Poisons Information Service, Royal Infirmary of Edinburgh, Edinburgh, UK.
Br J Clin Pharmacol. 2009 Dec;68(6):916-9. doi: 10.1111/j.1365-2125.2009.03533.x.
Many patients acutely poisoned with organophosphorus insecticides have co-ingested alcohol. Although clinical experience suggests that this makes management more difficult, the relationship between plasma concentration of alcohol and insecticide is unknown. We aimed to determine whether acute intoxication results in ingestion of larger quantities of insecticide in dimethoate self-poisoning and a worse clinical outcome.
We set up a prospective study of acute dimethoate self-poisoning in Sri Lankan district hospitals. An admission plasma sample was analysed to identify the ingested insecticide; in patients with detectable dimethoate, plasma alcohol was measured.
Plasma from 37 of 72 (51.4%) dimethoate-poisoned patients had detectable alcohol [median concentration 1.10 g l(-1)[110 mg dl(-1)][interquartile range (IQR) 0.78-1.65]] a median of 3 h post ingestion. The median plasma dimethoate concentration was higher in patients who had ingested alcohol [479 micromol l(-1) (IQR 268-701) vs. 145 micromol l(-1) (IQR 25-337); P < 0.001]. Plasma dimethoate concentration was positively correlated with plasma alcohol (Spearman's rho= 0.34; P= 0.0032). The median alcohol concentration was higher in the 21 patients who died compared with survivors (0.94 vs. 0.0 g l(-1), P= 0.018). Risk of death was greater amongst individuals who consumed alcohol [odds ratio (OR) 4.3, 95% confidence interval (CI) 1.2, 16.4]; this risk was abolished by controlling for dimethoate concentration (OR 0.3, 95% CI 0.0, 8.8), indicating that deaths were not due to the direct toxic effects of alcohol.
Alcohol co-ingestion is associated with higher plasma concentrations of dimethoate and increased risk of death. Larger studies are required to assess this finding's generalizability, since efforts to reduce deaths from self-poisoning may benefit from concurrent efforts to reduce alcohol consumption.
急性酒精中毒常使急性有机磷农药中毒复杂化。
目前尚无数据表明酒精中毒如何影响急性有机磷农药中毒的结局。
特别是，血浆酒精浓度与血浆有机磷浓度或结局之间的关系尚不清楚。
酒精共摄入与较高浓度的有机磷杀虫剂二甲基氧膦有关，可能是因为摄入的剂量更大。
酒精共摄入导致的二甲基氧膦浓度升高会增加二甲基氧膦中毒的死亡风险。酒精本身对结局没有可检测到的影响。
减少杀虫剂自杀中毒死亡的努力可能受益于同时减少酒精消费的努力。
许多急性有机磷杀虫剂中毒的患者都有酒精共摄入。尽管临床经验表明这会使管理更加困难，但目前尚不清楚血浆中酒精和杀虫剂的浓度之间的关系。我们旨在确定急性中毒是否会导致在二甲基氧膦自我中毒中摄入更大剂量的杀虫剂，并导致更严重的临床结局。
我们在斯里兰卡地区医院开展了一项急性二甲基氧膦自我中毒的前瞻性研究。分析入院时的血浆样本以确定摄入的杀虫剂；对于可检测到二甲基氧膦的患者，测量血浆中的酒精含量。
在 72 例二甲基氧膦中毒患者中，有 37 例（51.4%）的血浆中可检测到酒精[中位数浓度为 1.10 g l(-1)[110 mg dl(-1)][四分位距（IQR）0.78-1.65]]，在摄入后 3 小时中位数浓度为 479 μmol l(-1)（IQR 268-701）与 145 μmol l(-1)（IQR 25-337）；P < 0.001）。与未摄入酒精的患者相比，摄入酒精的患者血浆中二甲基氧膦浓度更高（Spearman's rho= 0.34；P= 0.0032）。与幸存者相比，21 例死亡患者的酒精中位数浓度更高（0.94 与 0.0 g l(-1)，P= 0.018）。与未摄入酒精的患者相比，摄入酒精的个体死亡风险更高（比值比（OR）4.3，95%置信区间（CI）1.2，16.4）；通过控制二甲基氧膦浓度，该风险被消除（OR 0.3，95%CI 0.0，8.8），表明死亡不是由于酒精的直接毒性作用所致。
酒精共摄入与较高的血浆二甲基氧膦浓度和更高的死亡风险有关。需要更大的研究来评估这一发现的普遍性，因为减少自我中毒死亡的努力可能受益于同时减少酒精消费的努力。
