Cha Yong Sung, Kim Hyun, Cho Nam Hyub, Jung Woo Jin, Kim Yong Won, Kim Tae Hoon, Kim Oh Hyun, Cha Kyoung Chul, Lee Kang Hyun, Hwang Sung Oh, Nelson Lewis S
Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Kangwon, Republic of Korea.
New York University School of Medicine, New York, New York, USA.
Emerg Med J. 2014 Nov;31(11):899-903. doi: 10.1136/emermed-2013-202908. Epub 2013 Aug 19.
Although pyrethroids are known for low toxicity to humans, clinical systemic characteristics of pyrethroid poisoning remain undefined. We investigated atypical presentations of pyrethroid poisoning and the predictors, among those readily assessed in the emergency department.
59 pyrethroid poisoning cases that were diagnosed and treated at the emergency department of Wonju Severance Christian Hospital from September 2004 to December 2012 were retrospectively reviewed.
Atypical presentations were seen in 22 patients (39.3%). Atypical presentations after pyrethroid poisoning included respiratory failure requiring ventilator care (10 patients, 17.9%), hypotension (systolic blood pressure <90 mm Hg) (6 patients, 10.7%), pneumonia (4 patients, 7.1%), acute kidney injury (6 patients, 10.7%), Glasgow Coma Scale (GCS) <15 (19 patients, 33.9%), seizure (2 patients, 3.6%) and death (2 patients, 3.6%). There were differences between atypical versus typical groups in terms of age (62.1±3.7 vs 51.0±2.9, p=0.020), ingested amounts (300 (IQR 100-338) cc vs 100 (IQR 50-300) cc, p=0.002), and bicarbonate and serum lactate (17.4±1.1 vs 20.5±0.4, p=0.011; and 4.42 (IQR 3.60-7.91) mmol/L vs 3.01 (IQR 2.16-4.73) mmol/L, p=0.010, respectively) in initial arterial blood gas analysis. Predictors of the atypical presentations were ingested amount and serum lactate ((OR 1.004, 95% CI 1.001 to 1.008, p=0.013) and (OR 1.387, CI 1.074 to 1.791, p=0.012), respectively). The optimal points were 250 cc and 3.5 mmol/dL.
39.3% of pyrethroid poisoned patients had atypical presentations with the most common being respiratory failure requiring ventilator care. Predictors of atypical presentation were ingested amount >250 cc and serum lactate >3.5 mmol/L.
尽管拟除虫菊酯对人类毒性较低，但拟除虫菊酯中毒的临床全身特征仍不明确。我们调查了拟除虫菊酯中毒的非典型表现以及在急诊科易于评估的预测因素。
回顾性分析2004年9月至2012年12月在原州Severance基督教医院急诊科诊断和治疗的59例拟除虫菊酯中毒病例。
22例患者（39.3%）出现非典型表现。拟除虫菊酯中毒后的非典型表现包括需要呼吸机护理的呼吸衰竭（10例患者，17.9%）、低血压（收缩压<90 mmHg）（6例患者，10.7%）、肺炎（4例患者，7.1%）、急性肾损伤（6例患者，10.7%）、格拉斯哥昏迷量表（GCS）<15（19例患者，33.9%）、癫痫发作（2例患者，3.6%）和死亡（2例患者，3.6%）。非典型组与典型组在年龄（62.1±3.7对51.0±2.9，p=0.020）、摄入量（300（四分位间距100 - 338）cc对100（四分位间距50 - 300）cc，p=0.002）以及初始动脉血气分析中的碳酸氢盐和血清乳酸水平（17.4±1.1对20.5±0.4，p=0.011；以及4.42（四分位间距3.60 - 7.91） mmol/L对3.01（四分位间距2.16 - 4.73） mmol/L，p=0.010）方面存在差异。非典型表现的预测因素为摄入量和血清乳酸（分别为（比值比1.004，95%置信区间1.001至1.008，p=0.013）和（比值比1.387，置信区间1.074至1.791，p=0.012））。最佳临界点分别为250 cc和3.5 mmol/dL。
39.3%的拟除虫菊酯中毒患者有非典型表现，最常见的是需要呼吸机护理的呼吸衰竭。非典型表现的预测因素为摄入量>250 cc和血清乳酸>3.5 mmol/L。
