Meenakshisundaram Rajadurai, Joseph Joshua Vijay, Perumal Prabakaran, Areeb Akmal, Pancheti Prathap, Sampath Dinesh Kannan, Jared Esther Monica
Apollo KH Hospital, Department of Emergency Medicine and Critical Care, Melvisharam, Tamil Nadu, India.
Clin Pract Cases Emerg Med. 2021 Nov;5(4):432-435. doi: 10.5811/cpcem.2021.7.52923.
Chloroform, a halogenated hydrocarbon, causes central nervous depression, hepatotoxicity, nephrotoxicity, and rhabdomyolysis. Historically, chloroform had been used as a general anaesthetic and today is still used in chemical industries. Lack of proper personal protective equipment and adequate knowledge about its toxic effects can lead to serious harm.
A 33-year-old gentleman presented to the emergency department (ED) with altered mental status. Given his depressed mental status, the decision was made to intubate shortly after arrival for airway protection. Further history raised suspicion of occupational chloroform exposure. Brown-colored urine further strengthened suspicion of chloroform poisoning with resultant rhabdomyolysis. Forced alkaline diuresis and N-acetylcysteine were started in the ED. His mental status and respiratory efforts improved on hospital day two, and he was ultimately extubated. Creatine phosphokinase and myoglobin levels were initially high but gradually came down by hospital day six. On hospital day 10, the patient was deemed stable and safely discharged.
A patient with chloroform inhalation who suffered resultant rhabdomyolysis and hepatotoxicity was successfully treated with early initiation of forced alkaline diuresis, N-acetylysteine, and hemodialysis.
氯仿是一种卤代烃，可导致中枢神经抑制、肝毒性、肾毒性和横纹肌溶解。历史上，氯仿曾被用作全身麻醉剂，如今仍用于化学工业。缺乏适当的个人防护设备以及对其毒性作用的充分了解可能会导致严重伤害。
一名33岁男性因精神状态改变被送至急诊科。鉴于其精神状态不佳，到达后不久决定进行插管以保护气道。进一步询问病史引发了对职业性氯仿暴露的怀疑。棕色尿液进一步强化了氯仿中毒并导致横纹肌溶解的怀疑。在急诊科开始进行强制碱性利尿和使用N-乙酰半胱氨酸治疗。他的精神状态和呼吸功能在住院第二天有所改善，最终拔除了气管插管。肌酸磷酸激酶和肌红蛋白水平最初较高，但在住院第六天时逐渐下降。住院第十天时，患者情况稳定并安全出院。
一名因吸入氯仿导致横纹肌溶解和肝毒性的患者通过早期开始强制碱性利尿、N-乙酰半胱氨酸和血液透析成功得到治疗。
