Kim Ki Hoon, Kim Se Hun, Her Charles
Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Department of Anesthesiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Korean J Crit Care Med. 2017 Nov;32(4):363-369. doi: 10.4266/kjccm.2016.00073. Epub 2017 Jan 17.
Although methidathion is an organophosphate insecticide, it is different from the other organophosphates in terms of toxicity. Because of its relatively high fat solubility, the apparent volume of methidathion distribution throughout the body is very high, indicating that hemoperfusion is not effective in removing this organophosphate from the body. Redistribution of methidathion from fat to blood can also occur when plasma levels diminish. Additionally, acetylcholinesterase aging, which is the loss of an alkyl side chain that prevents reactivation by oximes, is very rapid so that the effective reactivation by oximes is thwarted. Thus, methidathion's effect on acetylcholinesterase inhibition is long lasting, particularly with a high dose. In addition to its parasympatholytic effect and ability to induce muscle paralysis, methidathion poisoning is associated with a profound and long-lasting circulatory collapse due to sympathetic ganglion blockade. This report presents the case of a 55-year-old man who accidentally ingested a high dose of methidathion. He later developed enteroinvasive aspergillosis infection-induced multiple bowel perforations on two separate occasions while on mechanical ventilator support, resulting in a fatal outcome. The renin-angiotensin axis activated by sympathetic ganglion blockade may have reduced the patient's splanchnic blood flow, contributing to translocation of endotoxin. Also, the effect of excessive acetylcholine on non-neuronal acetylcholine receptors may have contributed to the development of fatal enteroinvasive aspergillosis in this patient.
虽然杀扑磷是一种有机磷酸酯类杀虫剂，但其在毒性方面与其他有机磷酸酯类不同。由于其相对较高的脂溶性，杀扑磷在全身的表观分布容积非常高，这表明血液灌流对从体内清除这种有机磷酸酯无效。当血浆水平降低时，杀扑磷也可从脂肪重新分布到血液中。此外，乙酰胆碱酯酶老化（即阻止肟类使其重新活化的烷基侧链丢失）非常迅速，因此肟类的有效重新活化受到阻碍。因此，杀扑磷对乙酰胆碱酯酶抑制的作用持久，尤其是在高剂量时。除了其抗副交感神经作用和诱导肌肉麻痹的能力外，杀扑磷中毒还与由于交感神经节阻滞导致的严重且持久的循环衰竭有关。本报告介绍了一名55岁男性意外摄入高剂量杀扑磷的病例。他后来在机械通气支持期间，两次分别发生侵袭性曲霉菌感染引起的多处肠穿孔，导致死亡。交感神经节阻滞激活的肾素 - 血管紧张素轴可能减少了患者的内脏血流，促进了内毒素的移位。此外，过量乙酰胆碱对非神经元乙酰胆碱受体的作用可能促成了该患者致命的侵袭性曲霉菌病的发生。
