Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Clin Toxicol (Phila). 2021 Jun;59(6):480-487. doi: 10.1080/15563650.2020.1832231. Epub 2020 Oct 28.
This study describes the clinical characteristics, outcomes, and factors at presentation associated with death of cases poisoned by glutaraldehyde (GA)-containing products.
We performed a 5-year retrospective cohort study (July 2013-June 2018) using data from the Ramathibodi Poison Center.
There were 244 cases included in this study. Most were men with a median age of 37 years. The GA-containing products were mainly used as farm disinfectants (99.2%), with a median concentration of 15%. Most products (76.2%) contained co-formulants such as cationic detergents and formaldehyde.Most circumstances were accidental (56.9%). The others were suicide attempts by ingestion, except one patient who intentionally injected GA subcutaneously. The most common route of exposure was ingestion (95.0%). Local symptoms in areas of exposure were common. Ingestion resulted in more severe local effects than other routes, and corrosive effects occurred in 23 cases (9.4%). Systemic signs and symptoms occurred in 149 patients (61.1%). Systemic effects included abnormal vital signs, desaturation, altered mental status, hypo/hypernatremia, hypokalemia, low bicarbonate/metabolic acidosis, acute kidney injury (AKI), hepatitis, and rhabdomyolysis. Systemic effects mostly resulted from ingestion. Most patients had mild severity, received only supportive treatment, and fully recovered. The median length of hospital stay was 2 days. The one case of subcutaneous injection developed both local and systemic effects but survived. The mortality rate was 3.7%. Multivariate analysis indicated that either neurological symptoms or AKI at presentation were associated with death.
In our study, patients were exposed to GA-containing products that were mainly used as farm disinfectants and were generally co-formulated with other substances. Poisoning with these products commonly resulted in mild local irritative symptoms. However, some cases developed corrosive symptoms, systemic effects, or even died. As neurological symptoms or AKI could prognosticate deaths; physicians should look for these factors in patients with GA exposure at presentation for close monitoring and aggressive treatment.
本研究描述了含戊二醛（GA）产品中毒病例的临床特征、结局以及与死亡相关的就诊时因素。
我们进行了一项回顾性队列研究（2013 年 7 月至 2018 年 6 月），使用 Ramathibodi 中毒中心的数据。
本研究共纳入 244 例病例。大多数为男性，中位年龄为 37 岁。含 GA 的产品主要用作农用消毒剂（99.2%），中位浓度为 15%。大多数产品（76.2%）含有阳离子清洁剂和甲醛等共溶剂。大多数情况为意外接触（56.9%）。另有 1 例患者故意皮下注射 GA，其余为自杀性吞服。最常见的暴露途径为口服（95.0%）。接触部位有局部症状。口服所致的局部效应比其他途径更严重，23 例（9.4%）发生腐蚀性效应。149 例（61.1%）出现全身症状和体征。全身效应包括生命体征异常、低氧血症/呼吸衰竭、意识状态改变、高/低钠血症、低钾血症、低碳酸氢盐/代谢性酸中毒、急性肾损伤（AKI）、肝炎和横纹肌溶解。全身效应主要由口服引起。大多数患者病情较轻，仅接受支持治疗，完全康复。中位住院时间为 2 天。1 例皮下注射患者发生局部和全身效应但存活。死亡率为 3.7%。多变量分析表明，就诊时存在神经症状或 AKI 与死亡相关。
在本研究中，患者接触的含 GA 产品主要用作农用消毒剂，通常与其他物质共同配制。这些产品中毒常导致轻度局部刺激性症状。然而，一些病例出现腐蚀性症状、全身效应，甚至死亡。由于神经症状或 AKI 可能预示死亡，因此医生在患者就诊时应注意 GA 暴露的这些因素，密切监测并积极治疗。
