Trakulsrichai Satariya, Chumvanichaya Kritsada, Sriapha Charuwan, Tongpoo Achara, Wananukul Winai
Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Ther Clin Risk Manag. 2020 Dec 16;16:1235-1241. doi: 10.2147/TCRM.S272863. eCollection 2020.
This study was performed to describe the clinical characteristics and outcomes of patients with toad poisoning in Thailand.
We carried out a retrospective study of patients with toad poisoning from the Ramathibodi Poison Center Toxic Exposure Surveillance System during a 5-year period (2012-2016).
We studied 36 patients poisoned by toad toxin. The median age was 31 years. Most patients were male (66.7%) and had ingested toad meat (50%). The most common presentation was gastrointestinal (GI) symptoms with a median onset of 2 h after ingestion. Twelve patients presented with bradycardia; seven presented with shock and one with cardiac arrest. In the initial EKGs of all patients, the most common abnormality was sinus bradycardia.Two patients developed cardiac arrest early during management in the emergency room (within 15 minutes after ER arrival or within 4.5 h after ingestion). During admission, one patient developed sinus bradycardia, and two developed bradyarrhythmia; however, all three were stable. No tachyarrhythmias such as ventricular tachycardia were detected in any patient. Some patients (11.1%) presented with hyperkalemia. Serum digoxin was detected in five of seven patients tested, ranging from 0.43 to >8 ng/mL. Most patients (75%) were admitted to the hospital; the median duration of hospitalization was 2 d (range 0.5-5 d). The overall mortality rate was 8.3%, and all three patients that died ate toad meat and/or eggs and developed cardiac arrest. All patients received supportive with/without symptomatic care including GI decontamination, inotropic drugs, cardiac pacing, and management of hyperkalemia. One patient received intravenous calcium for hyperkalemia but did not develop dysrhythmia after calcium administration. One patient received digoxin-specific antibody fragments (DsFab), after which he clinically improved and was discharged.
Toad poisoning commonly caused GI symptoms and bradycardia. However, in severe cases, death occurred. Tachyarrhythmia was not observed. Supportive, symptomatic care might be the main therapies for this poisoning, especially if DsFab is not available.
本研究旨在描述泰国蟾蜍中毒患者的临床特征及预后。
我们对拉玛蒂博迪中毒中心毒物暴露监测系统在5年期间（2012 - 2016年）的蟾蜍中毒患者进行了一项回顾性研究。
我们研究了36例蟾蜍毒素中毒患者。中位年龄为31岁。大多数患者为男性（66.7%），且食用了蟾蜍肉（50%）。最常见的表现是胃肠道（GI）症状，摄入后中位发病时间为2小时。12例患者出现心动过缓；7例出现休克，1例出现心脏骤停。在所有患者的初始心电图中，最常见的异常是窦性心动过缓。两名患者在急诊室治疗早期（到达急诊室后15分钟内或摄入后4.5小时内）发生心脏骤停。住院期间，1例患者出现窦性心动过缓，2例出现缓慢性心律失常；然而，这3例患者均病情稳定。任何患者均未检测到室性心动过速等快速性心律失常。部分患者（11.1%）出现高钾血症。在接受检测的7例患者中，有5例检测到血清地高辛，范围为0.43至>8 ng/mL。大多数患者（75 %）入院治疗；中位住院时间为2天（范围0.5 - 5天）。总死亡率为8.3%，所有3例死亡患者均食用了蟾蜍肉和/或蟾蜍卵并发生了心脏骤停。所有患者均接受了支持性治疗及对症治疗，包括胃肠道去污、强心药物、心脏起搏和高钾血症的处理。1例高钾血症患者接受了静脉补钙，但补钙后未发生心律失常。1例患者接受了地高辛特异性抗体片段（DsFab）治疗，之后临床症状改善并出院。
蟾蜍中毒通常会导致胃肠道症状和心动过缓。然而，在严重情况下会导致死亡。未观察到快速性心律失常。支持性对症治疗可能是这种中毒的主要治疗方法，尤其是在没有DsFab的情况下。
