Poisons and Toxicovigilance Centre (PCT), University Hospital Angers, 4 rue Larrey, Angers Cedex 09, France.
Clin Toxicol (Phila). 2011 Jun;49(5):416-22. doi: 10.3109/15563650.2011.585472.
Introduction. The objective was to evaluate the toxicity of poisoning by metam sodium, a dithiocarbamate fumigant, the breakdown products of which are methyl isothiocyanate (MITC), carbon disulphide (CS2), and dihydrogen sulphide (H2S). Methods. This is a retrospective, observational case series of metam sodium exposure cases reported to the Angers Poison and Toxicovigilance Centre from 1992 through 2009. Results. A total of 106 cases of metam sodium exposure were recorded and 102 cases were included in this study. All cases of exposure were unintentional. Occupational poisoning occurred in eight cases. The most common route of exposure was inhalation (n = 96). In 79 cases, the patients were people living near fields where metam sodium had recently been applied. Most of the reported symptoms involved irritation of the eyes (n = 76), throat and nose (n = 65), attributable to MITC. Cough and dyspnoea occurred in four cases but no persistent, irritant-induced asthma or persistent exacerbation of asthma was observed. Sixteen patients at two different sites of pollution were exposed to emanations from the drainage system in their homes following the illicit discharge of metam sodium into the sewers. Most presented with nausea and headaches, but only four experienced eye or throat irritation. A breakdown product other than MITC was involved: air analysis at one site revealed the presence of CS2 (337 mg/m(3)) and no H2S. Two of these patients, who had consumed some alcohol, experienced dysgeusia but no disulfiram-like reaction. The only lethal case recorded was a truck driver who was found dead of acute lung injury after falling into a tank that had previously contained metam sodium. Two patients who ingested a dilute solution, presented with mild epigastric pain. Four skin exposures caused erythema (n = 2), moderate burns (n = 1), and urticaria (n = 1). According to the poisoning severity score, their symptoms were minor in 99% of cases. Conclusion. Acute metam sodium exposure usually causes minor symptoms. They vary as a function of the circumstances of exposure, which determine the degradation product that forms. On contact with moist soil, metam sodium decomposes into MITC and causes irritant symptoms. Under specific conditions, such as a spillage in the drainage system, metam sodium can degrade into CS2 and cause neurological signs.
简介。目的是评估代森锰钠（一种二硫代氨基甲酸盐熏蒸剂）中毒的毒性，其分解产物为甲基异硫氰酸酯（MITC）、二硫化碳（CS2）和硫化氢（H2S）。方法。这是一项回顾性、观察性的个案系列研究，报告的代森锰钠暴露病例来自安热毒理学监测中心 1992 年至 2009 年的数据。结果。共记录到 106 例代森锰钠暴露病例，其中 102 例纳入本研究。所有暴露均为非故意。职业暴露发生在 8 例。最常见的暴露途径是吸入（n = 96）。在 79 例患者中，患者为居住在代森锰钠近期使用过的农田附近的人员。报告的大多数症状涉及眼睛刺激（n = 76）、喉咙和鼻子刺激（n = 65），归因于 MITC。在 4 例患者中出现咳嗽和呼吸困难，但未观察到持续性、刺激性哮喘或哮喘持续恶化。在两个不同的污染点，有 16 名患者因代森锰钠非法排入下水道而接触到家中排水系统散发的物质。大多数患者出现恶心和头痛，但只有 4 名患者出现眼睛或喉咙刺激。涉及到 MITC 以外的分解产物：一个地点的空气分析显示存在 CS2（337mg/m3），但没有 H2S。这 2 名患者饮用了一些酒精，出现味觉障碍，但没有双硫仑样反应。记录到的唯一致死病例是一名卡车司机，他掉入一个曾经装有代森锰钠的罐中后死亡，死因是急性肺损伤。两名摄入稀溶液的患者出现轻度上腹痛。4 例皮肤暴露引起红斑（n = 2）、中度烧伤（n = 1）和荨麻疹（n = 1）。根据中毒严重程度评分，99%的患者症状轻微。结论。急性代森锰钠暴露通常引起轻微症状。症状随暴露情况的不同而变化，这取决于形成的降解产物。接触潮湿土壤时，代森锰钠分解为 MITC 并引起刺激性症状。在特定条件下，如排水系统溢出，代森锰钠可能会分解为 CS2 并引起神经系统症状。
