Suresh Sumanyu, Panda Prasan K
Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India.
Indian J Crit Care Med. 2021 Mar;25(3):337-339. doi: 10.5005/jp-journals-10071-23746.
Hypotension can be explained by the cardiotoxic effects of an organophosphate poison, but a distributive shock is a rare event. This is a case report of a young north Indian man who presented to the emergency room in a comatose state and distributive shock. He was initially managed with intravenous crystalloids but required inotropic therapy to maintain the desired mean arterial pressure and organ perfusion and also required mechanical ventilation. He improved during the hospital stay only after 4 days when cocktail treatment of atropine was started considering the possibility of organophosphorus toxin exposure and had tapered off the inotropes and mechanical ventilation. Dichlorvos ingestion was confirmed later on after recovery from the coma. At 4-week follow-up, he developed delayed neuropathy. This case is a torchlight toward organophosphorus poisoning presenting as a distributive shock. Atropine may be used as a cocktail treatment in distributive shock where the diagnosis is uncertain. Suresh S, Panda PK. Dichlorvos Poisoning: A Mystery Case of Distributive Shock Unraveling with Atropine. Indian J Crit Care Med 2021;25(3):337-339.
低血压可由有机磷中毒的心脏毒性作用来解释，但分布性休克是一种罕见情况。本文报告了一名年轻的印度北部男性病例，该患者昏迷并伴有分布性休克被送至急诊室。他最初接受静脉晶体液治疗，但需要使用血管活性药物来维持理想的平均动脉压和器官灌注，还需要机械通气。考虑到有机磷毒素暴露的可能性，在住院4天后开始使用阿托品联合治疗，之后他的病情才有所改善，并逐渐停用血管活性药物和机械通气。患者从昏迷中恢复后，后来证实摄入了敌敌畏。在4周的随访中，他出现了迟发性神经病。该病例为以分布性休克形式出现的有机磷中毒提供了线索。在诊断不确定的分布性休克中，阿托品可作为联合治疗药物使用。苏雷什·S，潘达·PK。敌敌畏中毒：一例用阿托品解开谜团的分布性休克病例。《印度重症监护医学杂志》2021年；25(3):337 - 339。
