Litovitz T L, White J D
Am J Emerg Med. 1985 Jul;3(4):297-300. doi: 10.1016/0735-6757(85)90050-6.
A series of 78 cases of accidental levothyroxine ingestion in children (less than 12 years old) with treatment limited to ipecac-induced emesis and a single oral dose of activated charcoal is presented. No patient received any form of dialysis or hemoperfusion, propylthiouracil, cholestyramine, steroids, or serial doses of oral activated charcoal. Propranolol was used in one case despite the absence of clinical manifestations of toxicity. Only four children developed symptoms, limited to modest fever (38.3 degrees C), supraventricular tachycardia (120-176 beats/min), lethargy, irritability, vomiting, diarrhea, and abdominal pain. Peak T4RIA values in three patients were 32.8, 30.0, and 26.4 micrograms/dl, respectively, and two of these patients remained asymptomatic. Initial therapy for acute levothyroxine ingestions in children can be safely limited to routine gastrointestinal decontamination. Hospitalization or prophylactic treatment with propranolol, propylthiouracil, corticosteroids, cholestyramine, or extracorporeal detoxification are unnecessary in the early asymptomatic phase.
本文报告了78例12岁以下儿童意外摄入左甲状腺素的病例，治疗仅限于吐根糖浆催吐和单次口服活性炭。没有患者接受任何形式的透析、血液灌流、丙硫氧嘧啶、消胆胺、类固醇或多次口服活性炭治疗。尽管没有毒性临床表现，但有1例患者使用了普萘洛尔。只有4名儿童出现症状，表现为中度发热（38.3摄氏度）、室上性心动过速（120 - 176次/分钟）、嗜睡、易怒、呕吐、腹泻和腹痛。3例患者的促甲状腺素放射免疫分析（T4RIA）峰值分别为32.8、30.0和26.4微克/分升，其中2例患者无症状。儿童急性左甲状腺素摄入的初始治疗可以安全地限于常规胃肠道去污。在早期无症状阶段，无需住院或用普萘洛尔、丙硫氧嘧啶、皮质类固醇、消胆胺进行预防性治疗或体外解毒。
