Department of Emergency Medicine, Chonnam National University Medical School, Dong-gu, Gwangju, Republic of Korea.
Undersea Hyperb Med. 2020 Third Quarter;47(3):455-459. doi: 10.22462/03.07.2020.6.
Isocyanates are the raw materials that make up all polyurethane products. Isocyanate is a powerful irritant to the mucosal membrane of the respiratory tract, eyes and skin. Pulmonary symptoms, especially occupational asthma, are predominant manifestations of isocyanate toxicity.
We report mental changes and compartment syndrome complicated with rhabdomyolysis as an extraordinary manifestation of acute isocyanate toxicity observed in a patient during the waterproofing of a water tank. A 58-year-old man recovered consciousness after six hours in the emergency department and complained of severe pain in the lower leg. The results of his laboratory test showed that his serum creatine kinase (15,250 IU/L) level had increased. The tissue pressure in both the lower legs had increased to 180 mmHg/170 mmHg (right/left). We performed fasciotomy on the second day of hospitalization. The patient was provided hyperbaric oxygen (HBO2) therapy of 2.0 ATA for 90 minutes twice a day for seven days. His condition gradually improved over five months, and he did not require amputation. He had a mild neurological disorder in his foot and was transferred to a rehabilitation center five months after hospitalization.
It is important to note that when working with isocyanate, non-specific complications such as a change in consciousness as well as compartment syndrome with rhabdomyolysis can occur in a confined space or high-temperature environment. In addition, we found that compartment syndrome caused by isocyanate toxicity can be effectively treated with fasciotomy and HBO2 therapy.
异氰酸酯是构成所有聚氨酯产品的原材料。异氰酸酯对呼吸道、眼睛和皮肤的黏膜组织具有很强的刺激性。肺部症状，特别是职业性哮喘，是异氰酸酯毒性的主要表现。
我们报告了一例在水箱防水处理过程中观察到的急性异氰酸酯毒性的异常表现，即精神改变和伴有横纹肌溶解症的间隔综合征。一名 58 岁男性在急诊科昏迷 6 小时后恢复意识，并主诉小腿剧痛。实验室检查结果显示，他的血清肌酸激酶（15250IU/L）水平升高。双小腿的组织压力分别升高至 180mmHg/170mmHg（右/左）。我们在住院第二天进行了筋膜切开术。患者接受了为期 7 天、每天 2 次、2.0ATA 的高压氧（HBO2）治疗 90 分钟。经过 5 个月的治疗，他的病情逐渐好转，无需截肢。他的脚部有轻度神经障碍，住院 5 个月后转至康复中心。
值得注意的是，在使用异氰酸酯时，在密闭空间或高温环境中可能会出现意识改变以及伴有横纹肌溶解症的间隔综合征等非特异性并发症。此外，我们发现异氰酸酯毒性引起的间隔综合征可以通过筋膜切开术和 HBO2 治疗有效治疗。
