Bilics Gergely, Héger Júlia, Pozsgai Éva, Bajzik Gábor, Nagy Csaba, Somoskövi Csilla, Varga Csaba
Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary.
Institute of Primary Health Care, Medical School, University of Pécs, Rákóczi Street 2, Pécs, 7623, Hungary.
Int J Emerg Med. 2020 Sep 18;13(1):48. doi: 10.1186/s12245-020-00307-8.
Zinc phosphide (ZnP) is the basic component of several insecticides easily accessible worldwide. Intentional or accidental intoxication may lead to severe complications and multiple organ failure, resulting in high mortality. No known antidote is currently available. The iron-chelation and the antioxidative effects are well-known features of alpha-lipoic acid (ALA), although its use in the treatment of ZnP poisoning has not been documented previously. We describe the case of a patient with serious ZnP poisoning with multiple organ failure, where ALA was also included in the patient's supportive therapy.
A 65-year-old man ingested 125 g of Arvalin® (containing 5 g ZnP) and presented to the Emergency Department, with respiratory insufficiency and decreased consciousness. He developed hypokalemia, hypocalcemia, low white blood cell count, elevated C-reactive protein level, mixed acidosis, hepatic and kidney damage, thickening of the jejunal wall, and lung atelectasis, which served as a basis for the ensuing bacterial pneumonia. Antibiotics and adequate supportive therapy were provided. Laboratory tests indicated liver damage (slightly increased liver enzymes, low pseudocholinesterase levels; 706 U/L on day 2), possibly caused by the patient's chronic alcoholism or the ZnP poison itself, therefore, hepatoprotective agents, ALA (Thiogamma Turbo-Set®) with N-acetylcysteine were administered for six consecutive days. Pseudocholinesterase values increased sixfold until the end of the second week of care. Fifteen days after admission, the patient was relocated to the department of psychiatry with stable vital functions, clear consciousness, declining inflammatory markers, and improved liver function. He was discharged 1 month later, fully recovered.
Our case is the first documented voluntary and severe ZnP poisoning in Hungary. Our patient developed multiple organ failure and atelectasis, possibly resulting in the observed respiratory infection. The development of bacterial pneumonia highlighted the dangers of phosphine-induced atelectasis. The use of ALA in our patient's case, as an antioxidant and agent for metal chelation, suggested that this agent could be a promising tool in the prevention and treatment of ZnP-induced hepatic damage.
磷化锌（ZnP）是全球范围内几种易于获取的杀虫剂的基本成分。故意或意外中毒可能导致严重并发症和多器官功能衰竭，从而导致高死亡率。目前尚无已知的解毒剂。α-硫辛酸（ALA）具有铁螯合和抗氧化作用，这是众所周知的特性，尽管其在治疗ZnP中毒方面的应用此前尚无文献记载。我们描述了一例患有严重ZnP中毒并伴有多器官功能衰竭的患者的病例，该患者的支持治疗中也使用了ALA。
一名65岁男性摄入了125克Arvalin®（含5克ZnP），并因呼吸功能不全和意识减退被送往急诊科。他出现了低钾血症、低钙血症、白细胞计数降低、C反应蛋白水平升高、混合性酸中毒、肝和肾损伤、空肠壁增厚以及肺不张，这些情况成为随后细菌性肺炎的基础。给予了抗生素和充分的支持治疗。实验室检查表明存在肝损伤（肝酶略有升高，假性胆碱酯酶水平降低；第2天为706 U/L），这可能是由患者的慢性酒精中毒或ZnP毒物本身引起的，因此，连续六天给予了具有N-乙酰半胱氨酸的肝保护剂ALA（Thiogamma Turbo-Set®）。直到护理的第二周结束，假性胆碱酯酶值增加了六倍。入院15天后，患者生命体征稳定、意识清醒、炎症指标下降且肝功能改善，被转至精神科。1个月后他出院，已完全康复。
我们的病例是匈牙利首例有记录的自愿性严重ZnP中毒病例。我们的患者出现了多器官功能衰竭和肺不张，可能导致了观察到的呼吸道感染。细菌性肺炎的发生凸显了磷化氢诱导的肺不张的危险性。在我们患者的病例中使用ALA作为抗氧化剂和金属螯合剂，表明该药物可能是预防和治疗ZnP诱导的肝损伤的一种有前景的工具。
