Shihana Fathima, Dawson Andrew H, Buckley Nicholas A
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka .
NSW Poisons Information Centre, Sydney Children's Hospital Network, Australia .
Bull World Health Organ. 2016 Aug 1;94(8):622-5. doi: 10.2471/BLT.15.158147. Epub 2016 Jun 14.
Propanil is an aniline herbicide that is widely used for rice cultivation, but is also used for self-poisoning. Toxicity from propanil is largely due to methemoglobinemia. In resource-poor settings, the capacity to determine methemoglobin concentration is insufficient and prevents effective case management, which results in increased deaths from propanil poisoning.
Blood with a methemoglobin concentration greater than 15% of total haemoglobin levels appears brownish in colour. We introduced a colour reference chart that can be used to semiquantitatively determine methemoglobinemia. Each ward in three rural hospitals received a chart. Ward staff, medical officers and trainee doctors were given a presentation describing the test method and how it should be used with the relevant national treatment guidelines.
In three rural hospitals in Sri Lanka, 401 patients were admitted with a diagnosis of propanil poisoning before the introduction of this test (2003-2007) and 262 patients after it was introduced (2008-2014), 46 of 663 patients died.
The chart can be freely produced with any good-quality colour printer. In three rural hospitals, deaths from propanil poisoning fell from 10% of those admitted with this diagnosis in 2003-2007 (38/401) to 3% (8/262) in 2008-2014 and the use of methylene blue increased from 10% (13/136) to 55% (59/107) over this period.
This simple bedside test was associated with increased use of the first line treatment for propanil poisoning and improved survival. In 2011, the test was included in the national guidelines for the management of propanil poisoning.
敌稗是一种苯胺类除草剂，广泛用于水稻种植，但也被用于自我中毒。敌稗中毒主要是由于高铁血红蛋白血症。在资源匮乏地区，测定高铁血红蛋白浓度的能力不足，阻碍了有效的病例管理，导致敌稗中毒死亡人数增加。
高铁血红蛋白浓度超过总血红蛋白水平15%的血液呈褐色。我们引入了一种颜色参考图表，可用于半定量测定高铁血红蛋白血症。三家农村医院的每个病房都收到了一张图表。病房工作人员、医务人员和实习医生参加了一个介绍会，会上描述了检测方法以及如何结合相关国家治疗指南使用该方法。
在斯里兰卡的三家农村医院，在引入该检测方法之前（2003 - 2007年）有401例被诊断为敌稗中毒的患者入院，引入之后（2008 - 2014年）有262例患者入院，663例患者中有46例死亡。
该图表用任何高质量彩色打印机均可免费制作。在三家农村医院，敌稗中毒死亡人数从2003 - 2007年诊断为此病入院患者的10%（38/401）降至2008 - 2014年的3%（8/262），在此期间亚甲蓝的使用从10%（13/136）增加到55%（59/107）。
这种简单的床边检测与增加敌稗中毒一线治疗的使用及提高生存率相关。2011年，该检测被纳入敌稗中毒管理的国家指南。
