Miyauchi Masato, Hayashida Makiko, Hirata Kimiko, Hirata Kiyotaka, Yokota Hiroyuki
Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
J Nippon Med Sch. 2013;80(4):307-11. doi: 10.1272/jnms.80.307.
Nicotine, which is found in tobacco, is one of the most toxic of all known poisons. A 31-year-old woman was brought to our emergency department 2 hours after ingesting a usually fatal dose of a tobacco extract. Although gastric lavage was once commonly used to treat poisoning cases of this type, lavage can lead to such complications as aspiration, hypoxia, oropharyngeal and gastric trauma, and electrolyte disturbances. Recent guidelines have suggested less-aggressive gastric-emptying procedures as initial treatments. Currently, there are no absolute indications for gastric lavage use. The present patient had a history of depressive episodes and had attempted suicide by ingesting an extract derived from 20 cigarettes mixed with alcohol. There was no evidence of vomiting or seizures occurring before arrival of the ambulance. Physical examination revealed no signs of sweating, although the patient appeared to be confused, which is often seen with nicotine intoxication. She admitted using 2 kinds of cigarette, each of which typically contain 11.2 mg of nicotine. The patient's nicotine level was suspected to be higher than 40 to 60 mg, which is normally fatal. To determine whether gastric lavage was indicated in this case, we performed ultrathin transnasal esophagogastroduodenoscopy, which neither requires sedation nor compromises the airways. Although 2 hours had passed since ingestion, the tobacco extract and food were directly visualized within the stomach. Subsequently, gastric lavage was performed with 2,000 mL of water administered through a nasogastric tube. Ultrathin esophagogastroduodenoscopy made it possible to directly observe the gastric lavage and to ensure the stomach contents had been completely removed. No changes were noted in the vital signs, and no obstruction of the airways was observed. The patient recovered quickly and was discharged the following day. Ultrathin esophagogastroduodenoscopy helped determine the diagnosis and ensure that gastric lavage had been performed without complications.
烟草中含有的尼古丁是所有已知毒物中毒性最强的毒物之一。一名31岁女性在摄入通常会致命剂量的烟草提取物两小时后被送往我们的急诊科。尽管洗胃曾常用于治疗此类中毒病例，但洗胃可能会导致诸如误吸、缺氧、口咽和胃部创伤以及电解质紊乱等并发症。最近的指南建议采用不太激进的胃排空程序作为初始治疗方法。目前，洗胃并没有绝对的适用指征。该患者有抑郁发作史，曾试图通过摄入由20支香烟混合酒精制成的提取物自杀。在救护车到达之前没有呕吐或癫痫发作的迹象。体格检查未发现出汗迹象，不过患者看起来神志不清，这在尼古丁中毒时很常见。她承认使用两种香烟，每种通常含有11.2毫克尼古丁。怀疑该患者的尼古丁水平高于40至60毫克，这通常是致命的。为了确定该病例是否需要洗胃，我们进行了超薄经鼻食管胃十二指肠镜检查，该检查既不需要镇静也不会影响气道。尽管摄入后已过去两小时，但仍可直接在胃内看到烟草提取物和食物。随后，通过鼻胃管注入2000毫升水进行洗胃。超薄食管胃十二指肠镜检查使直接观察洗胃过程并确保胃内容物已被完全清除成为可能。生命体征未见变化，也未观察到气道阻塞。患者恢复迅速，第二天出院。超薄食管胃十二指肠镜检查有助于明确诊断，并确保洗胃过程无并发症发生。
