Department of Clinical Toxicology, Long Island Jewish Medical Center, Northwell Health, United States of America; Department of Emergency Medicine, Long Island Jewish Medical Center, Northwell Health, United States of America.
Department of Clinical Pharmacy, Long Island Jewish Medical Center, Northwell Health, United States of America.
Am J Emerg Med. 2018 Nov;36(11):2129.e1-2129.e2. doi: 10.1016/j.ajem.2018.05.035. Epub 2018 Jul 3.
We describe the hospital course of a 42-year-old patient who presented to the Emergency Department following an ingestion of an unknown quantity of chlorfenapyr, an organochlorine pesticide that acts as a mitochondrial uncoupler (MU). There is limited data on chlorfenapyr toxicity in humans, but reports indicate a 100% mortality rate after a 7-10 day quiescent period.3-6 Our patient was admitted for a 5-day asymptomatic observation period before becoming critically ill. Supportive care, antioxidant therapy, and late hemodialysis (HD) proved futile. The patient expired from complications due to uncontrollable hyperthermia on hospital day 6. This case represents the first reported fatality due to chlorfenapyr in North America, and illustrates: 1) its potency as a human toxin, 2) the futility of extracorporeal decontamination once late toxicity has set in; 3) the potential need for early and aggressive decontamination in the ED; and 4) the need for a better understanding of this unique poison.
我们描述了一位 42 岁患者的住院经过，该患者在摄入未知数量的氯氟吡氧乙酸（一种作用于线粒体解偶联剂（MU）的有机氯农药）后到急诊科就诊。有关氯氟吡氧乙酸毒性的人体数据有限，但报告表明，在 7-10 天的安静期后，死亡率为 100%。3-6 我们的患者在无症状观察期内住院 5 天，然后病情恶化。支持性护理、抗氧化治疗和晚期血液透析（HD）均无济于事。患者在入院第 6 天因无法控制的高热导致并发症死亡。本病例代表了北美首例因氯氟吡氧乙酸导致的死亡病例，并说明了：1）它作为人类毒素的效力；2）一旦发生晚期毒性，体外去污染的无效性；3）ED 中早期和积极去污染的潜在必要性；以及 4）需要更好地了解这种独特的毒物。
