Yeo In-Hwan, Lim Jeong-Hoon
Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea.
Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea.
Medicina (Kaunas). 2021 Jun 2;57(6):564. doi: 10.3390/medicina57060564.
Tetramine in gastropods can cause poisoning symptoms with various side effects. Most of these symptoms are mild and spontaneously resolved due to the rapid excretion of tetramine through the kidneys; however, patients with kidney dysfunction can present severe symptoms. A 48-year-old woman with end-stage kidney disease due to diabetic nephropathy and undergoing peritoneal dialysis (PD) visited our emergency department (ED) with complaints of general weakness, vomiting, and shortness of breath after ingesting some sea snails. On ED arrival, she was in a respiratory failure state; therefore, invasive mechanical ventilation was immediately initiated. Chest radiography showed diffuse severe pulmonary edema and her vital signs fluctuated; thus, continuous renal replacement therapy (CRRT) was initiated at the intensive care unit to treat tetramine intoxication and control volume status. Her condition gradually improved, and she was successfully weaned from mechanical ventilation on the 5th day of admission and moved to the general ward on the 10th day. CRRT was switched to PD. She fully recovered and was discharged on the 15th day of admission. Therefore, clinicians should explain the risk associated with gastropod ingestion to patients with kidney dysfunction and recognize that the clinical course of tetramine toxicity can be critical.
腹足纲动物体内的四胺可引发中毒症状并伴有多种副作用。这些症状大多较为轻微，由于四胺可通过肾脏迅速排出，症状会自行缓解；然而，肾功能不全的患者可能会出现严重症状。一名48岁因糖尿病肾病导致终末期肾病且正在接受腹膜透析（PD）的女性，在食用了一些海螺后，因全身乏力、呕吐和呼吸急促前来我院急诊科就诊。到达急诊科时，她处于呼吸衰竭状态；因此，立即开始进行有创机械通气。胸部X线检查显示弥漫性严重肺水肿，且生命体征波动；于是，在重症监护病房开始进行连续性肾脏替代治疗（CRRT），以治疗四胺中毒并控制容量状态。她的病情逐渐好转，入院第5天成功脱机，第10天转至普通病房。CRRT改为PD。她完全康复，入院第15天出院。因此，临床医生应向肾功能不全的患者解释食用腹足纲动物相关的风险，并认识到四胺中毒的临床过程可能很危急。
