Lionte Cătălina
Medical Clinic, Sf.Ioan Emergency Clinic Hospital, Gr.T.Popa University of Medicine and Pharmacy, Iasi, Romania.
Hum Exp Toxicol. 2010 Jul;29(7):615-22. doi: 10.1177/0960327109357142. Epub 2010 Jan 5.
Chloroform is a potent central nervous system and respiratory depressant. The toxicities associated with chloroform frequently occur after inhalation. Hepatotoxicity is secondary to production of a toxic metabolite, with a peak elevation of liver enzymes 72 hours after exposure. Acute liver failure after chloroform inhalation is rarely described, this syndrome being produced mainly by viral hepatitis, idiosyncratic drug-induced liver injury, and acetaminophen ingestion. This report describes the case of a 46-year-old woman who presented to emergency department with coma, signs of respiratory failure, and solvent odor of her breath after chloroform inhalation and binge drinking. In evolution appeared lethal acute liver failure and rhabdomyolysis, despite maximum supportive care. Necroptic examination revealed microvesicular steatosis and tubular renal necrosis, specific for chloroform toxicity. This case illustrates the dramatic impact on liver of two well-recognized hepatotoxins. Mechanisms of chloroform and alcohol-induced liver toxicity are reviewed.
氯仿是一种强效的中枢神经系统和呼吸抑制剂。与氯仿相关的毒性反应常发生于吸入之后。肝毒性继发于一种有毒代谢产物的产生，接触后72小时肝酶水平达到峰值升高。吸入氯仿后发生急性肝衰竭的情况鲜有报道，该综合征主要由病毒性肝炎、特异质性药物性肝损伤及对乙酰氨基酚摄入所致。本报告描述了一名46岁女性的病例，她吸入氯仿并大量饮酒后出现昏迷、呼吸衰竭体征，呼气有溶剂气味，前来急诊科就诊。尽管给予了最大程度的支持治疗，病情仍进展为致命性急性肝衰竭和横纹肌溶解。尸检显示微泡性脂肪变性和肾小管坏死，这是氯仿毒性的特异性表现。该病例说明了两种公认的肝毒素对肝脏产生的巨大影响。本文对氯仿和酒精所致肝毒性的机制进行了综述。
