Omori Naoko, Mitsukawa Nobuyuki, Kubota Yoshitaka, Satoh Kaneshige
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
J Emerg Med. 2013 Feb;44(2):385-8. doi: 10.1016/j.jemermed.2012.06.024. Epub 2012 Aug 24.
Subcutaneous administration of hydrocarbons, categorized according to their toxicological profiles, is rare compared to oral, inhalational, and cutaneous routes of exposure. Furthermore, injection of n-hexane in humans has not been described.
This report demonstrates a singular case of subcutaneous administration of n-hexane.
A 21-year-old man presented to the Emergency Department (ED) 7 h after injecting his left antecubital fossa with approximately 5 cc of spot remover fluid, which contained more than 95% n-hexane, in a suicide attempt. There was redness in the left forearm, but no apparent swelling was observed. He was administered tetanus prophylaxis and discharged with follow-up. However, the patient returned to the ED 14 h later, complaining of progression of the swelling around the injection site extending to the axilla. Significant volume of air in the soft tissue of the affected extremity was noted on both the radiograph and computed tomography scan; therefore, an immediate extensive incision and debridement of the diseased limb was performed. The postoperative course was uneventful, and a complete resolution of emphysema without any functional deficits was obtained for 5 months of follow-up.
In patients suffering from n-hexane injection, initial physical examination findings may not be apparent. Thus, the patient must be monitored closely for evidence of a spread of subcutaneous gas with elevation and immobilization. If increase in tissue pressure or spread of gas is not prevented, as in our case, immediate incision and removal of the toxic substances should be planned.
与口服、吸入和皮肤接触途径相比，根据其毒理学特征分类的碳氢化合物皮下给药很少见。此外，尚未有关于人类注射正己烷的报道。
本报告展示了一例正己烷皮下给药的独特病例。
一名21岁男性在自杀企图中，于左肘前窝注射了约5毫升含有超过95%正己烷的去斑剂液体，7小时后被送往急诊科。左前臂发红，但未观察到明显肿胀。给他进行了破伤风预防处理并出院随访。然而，患者14小时后返回急诊科，抱怨注射部位周围肿胀进展并蔓延至腋窝。X线片和计算机断层扫描均显示患肢软组织中有大量气体；因此，立即对患肢进行了广泛的切开清创术。术后过程顺利，随访5个月，气肿完全消退，无任何功能缺陷。
对于注射正己烷的患者，最初的体格检查结果可能不明显。因此，必须密切监测患者，以观察皮下气体扩散的迹象，并抬高患肢并使其固定。如果像我们的病例一样，组织压力增加或气体扩散未得到阻止，应立即计划进行切开并清除有毒物质。
