Mangera Zaheer, Isse Said, Winnett Georgia, Lal Aroon, Cafferkey Michele
Department of Renal Medicine, Basildon University Hospital, Essex, UK.
BMJ Case Rep. 2010 Jul 21;2010:bcr0120102682. doi: 10.1136/bcr.01.2010.2682.
A 69-year-old man presented to the emergency department after being found unconscious by his son. He had experienced headache the previous day but had been otherwise well. Investigations revealed a severe metabolic acidosis, raised lactate and acute kidney injury. The calculated anion and osmolar gap were both elevated at 37.7 and 39.3, respectively. Due to his reduced Glasgow coma score (GCS) he was intubated and a CT scan performed: only a small, mature pontine infarct was found of uncertain significance. Further questioning of the family revealed accidental ingestion of 150 ml of a 'blue liquid' 24 h earlier (later identified as car screenwash). With ethylene glycol (EG) poisoning suspected, he was given intravenous ethanol, fomepizole (a competitive inhibitor of alcohol dehydrogenase) and haemofiltration. Despite the delayed presentation, prompt recognition and treatment of EG poisoning led to a successful discharge in this case.
一名69岁男性被儿子发现昏迷后被送往急诊科。他前一天曾头痛，但其他方面情况良好。检查发现严重代谢性酸中毒、乳酸升高和急性肾损伤。计算得出的阴离子间隙和渗透压间隙分别升高至37.7和39.3。由于他的格拉斯哥昏迷评分（GCS）降低，他被插管并进行了CT扫描：仅发现一个小的、成熟的脑桥梗死灶，意义不确定。对其家人进一步询问发现，24小时前他意外摄入了150毫升“蓝色液体”（后来确定为汽车挡风玻璃清洗剂）。怀疑是乙二醇（EG）中毒，给他静脉注射了乙醇、甲吡唑（酒精脱氢酶的竞争性抑制剂）并进行了血液滤过。尽管就诊延迟，但对EG中毒的及时识别和治疗使该患者成功出院。
