Ito Hiroshi, Nakashima Toshiya, Kobanawa Satoshi, Oshida Jura, Kodama Taisuke, Fukui Sayato, Kobayasi Daiki
Department of Internal Medicine Division of General Internal Medicine Tokyo Medical University Ibaraki Medical Center, Ibaraki Japan.
J Acute Med. 2024 Jun 1;14(2):90-93. doi: 10.6705/j.jacme.202406_14(2).0004.
Fenitrothion is one of the most globally used organophosphorus pesticides, which can cause neurological symptoms, including involuntary movements. However, due to the limited number of case report, information on its treatment is also scarce. Here we presented a 74-year-old Japanese woman who was admitted to our hospital due to a persistent nausea and vomiting after ingesting 200 mL of 50% fenitrothion for a suicidal attempt. She received continuous intravenous infusion of atropine and 2-pyridine aldoxime methiodide under mechanical ventilation and continuous hemodiafiltration. However, she developed fasciculations of the face and right arm on day 11, which raised suspicions of delayed neuropathy associated with organophosphorus poisoning. To reduce the risk of respiratory depression, she received intravenous levetiracetam at a dosage of 1,000 mg/day. However, as her fasciculations persisted, the levetiracetam dosage was adjusted to 2,000 mg/day on day 14. On the following day, her fasciculations subsided. Neurologic symptoms of lipid-soluble organophosphorus poisoning, including fenitrothion, can sometimes delay following ingestion. Temporary administration of levetiracetam may prove effective in alleviating fasciculations.
杀螟硫磷是全球使用最广泛的有机磷农药之一，可导致包括不自主运动在内的神经症状。然而，由于病例报告数量有限，关于其治疗的信息也很稀缺。在此，我们报告一名74岁的日本女性，她因自杀企图摄入200毫升50%杀螟硫磷后出现持续恶心和呕吐而入住我院。她在机械通气和持续血液透析滤过的情况下接受了阿托品和碘解磷定的持续静脉输注。然而，她在第11天出现了面部和右臂的肌束震颤，这引发了对有机磷中毒相关迟发性神经病的怀疑。为降低呼吸抑制的风险，她接受了剂量为1,000毫克/天的静脉注射左乙拉西坦。然而，由于她的肌束震颤持续存在，左乙拉西坦剂量在第14天调整为2,000毫克/天。次日，她的肌束震颤消退。包括杀螟硫磷在内的脂溶性有机磷中毒的神经症状有时在摄入后会延迟出现。临时给予左乙拉西坦可能对缓解肌束震颤有效。
