Department of Emergency Medicine, Pusan National University Hospital, Seo-Gu, Busan, Republic of Korea.
Clin Toxicol (Phila). 2010 Jul;48(6):566-8. doi: 10.3109/15563650.2010.496730.
Circulatory shock is a major cause of mortality in glyphosate-surfactant herbicide (GlySH) poisoning, and this condition responds poorly to conventional therapies. We report a case of GlySH poisoning with shock that was refractory to vasopressors but responsive to intravenous fat emulsion (IFE).
A 52-year-old man was brought to the emergency department by ambulance. He was found unconscious in his living room along with an empty bottle of GlySH herbicide, which contained glyphosate, polyoxyethyleneamine (POEA) surfactant, and water. He was drowsy at presentation. His heart rate was 44 beats/min, his blood pressure could not be measured with an arm cuff, but he had a palpable femoral pulse. After about 2.5 h of supportive care after admission, he remained hypotensive, and his systolic blood pressure was 80 mmHg. A 500 mL bottle of 20% IFE product was prepared. As a bolus, 100 mL of IFE was injected, and the remaining 400 mL was then infused. His blood pressure was 100/60 mmHg 1 h after the bolus injection. At 5 h after IFE injection, his blood pressure reached 160/100 mmHg and vasopressors were tapered.
IFE should be considered in cases of refractory hemodynamic instability caused by GlySH after aggressive fluid and vasopressor support.
循环休克是 glyphosate-surfactant 除草剂（GlySH）中毒导致死亡的主要原因，这种情况对常规治疗反应不佳。我们报告了一例对升压药无反应但对静脉内脂肪乳剂（IFE）有反应的 GlySH 中毒休克病例。
一名 52 岁男子被救护车送往急诊科。他被发现躺在客厅里昏迷不醒，旁边放着一瓶 GlySH 除草剂，里面含有草甘膦、聚氧乙烯胺（POEA）表面活性剂和水。他入院时意识模糊。他的心率为 44 次/分，血压无法用袖带测量，但可以触及股动脉脉搏。入院后约 2.5 小时的支持性治疗后，他仍低血压，收缩压为 80mmHg。准备了 500 毫升 20%IFE 产品。作为一次推注，给予 100 毫升 IFE，然后输注剩余的 400 毫升。推注后 1 小时，他的血压为 100/60mmHg。IFE 注射后 5 小时，他的血压达到 160/100mmHg，开始逐渐减少升压药。
在积极液体和升压药支持后，由于 GlySH 引起的难治性血流动力学不稳定的情况下，应考虑使用 IFE。
