Kamada Hiroki, Suzuki Hideaki, Yamamoto Saori, Nomura Ryosuke, Kushimoto Shigeki
Division of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai Japan.
Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan.
Acute Med Surg. 2017 Mar 27;4(3):326-328. doi: 10.1002/ams2.267. eCollection 2017 Jul.
A 72-year-old man presented to our hospital after ingesting insecticide containing approximately 2 mL/kg diethylene glycol, which exceeded the lethal dose of 1 mL/kg. The patient recovered from critical symptoms on acute phase until day 3, but received artificial ventilation for muscle weakness secondary to sensorimotor neuropathy on days 11-54.
Even after marked improvement from sensorimotor neuropathy, the patient continued to complain of orthostatic hypotension. Autonomic neuropathy was identified by positive result of a head-up tilt test, and reduction in coefficient of variation of R-R intervals and cardiac iodine-123-metaiodobenzylguanidine uptake for the assessment of cardiac sympathetic activity. The patient's symptoms fully recovered 2 years after the exposure to diethylene glycol.
This case shows the first report of delayed autonomic neuropathy after recovery from severe sensorimotor neuropathy, and suggests the importance of continuous monitoring for late-onset neurological complications.
一名72岁男性在摄入含有约2毫升/千克二甘醇的杀虫剂后被送往我院，该剂量超过了1毫升/千克的致死剂量。患者在急性期直至第3天从严重症状中恢复，但在第11 - 54天因感觉运动神经病变继发的肌无力接受了人工通气。
即使感觉运动神经病变有明显改善，患者仍持续抱怨体位性低血压。通过头高位倾斜试验阳性结果、R - R间期变异系数降低以及用于评估心脏交感神经活动的心脏碘 - 123 - 间碘苄胍摄取减少，确诊为自主神经病变。患者在接触二甘醇2年后症状完全恢复。
本病例首次报告了严重感觉运动神经病变恢复后出现延迟性自主神经病变，并提示持续监测迟发性神经并发症的重要性。
