Sahoo S K, Tripathy N, Debi B P
Lepr India. 1979 Apr;51(2):244-8.
Acute dapsone poisoning is rare and such cases are either accidental or suicidal. Though accidental DDS poisoning are reported in children, the same is fairly uncommon in adults. Only 2 such cases are reported in India literature. We here report 4 cases of fatal sucidial DDS poisoning in adults resulting death in 3 cases. The reported acute symptoms include nausea, vomiting, hyperexcitability followed by depression, Carpopedal spasm or convulsions. The most marked signs are dyspnoea and cyanosis. The symptoms are due to methaemoglobinaemia, and or sulphaemoglobinaemia. Normally dapsone induces red cell haemolysis and even with small therapeutic doses of 25-100 mg per day, and in toxic doses reduces the oxygen carrying capacity of blood and damages the red cells making them more vulnerable for haemolysis. The peculiarity of the presentation in this series are manifestation of severe haemorrhagic episode in one case and progressive jaundice in another besides cyanosis. None of the cases had carpopedal spasm or convulsion. Out of four cases three died inspite of intensive care, intravenous vitamin C, exchange transfusion (2 cases) and other supportive measures. Intravenous methylene blue could not be used in these cases due to non-availability.
急性氨苯砜中毒罕见，此类病例多为意外或自杀所致。虽然儿童意外氨苯砜中毒有报道，但在成人中相当少见。印度文献中仅报道过2例此类病例。我们在此报告4例成人自杀性氨苯砜中毒致死病例，其中3例死亡。报告的急性症状包括恶心、呕吐、兴奋过度继以抑郁、手足搐搦或惊厥。最显著的体征是呼吸困难和发绀。这些症状是由于高铁血红蛋白血症和/或硫化血红蛋白血症。正常情况下，氨苯砜会诱发红细胞溶血，即使每日治疗剂量小至25 - 100毫克，中毒剂量时也会降低血液的携氧能力并损害红细胞，使其更易发生溶血。本系列病例的特殊表现为1例出现严重出血发作，另1例除发绀外还出现进行性黄疸。所有病例均未出现手足搐搦或惊厥。4例中有3例尽管接受了重症监护、静脉注射维生素C、换血疗法（2例）及其他支持措施仍死亡。由于无法获得静脉注射亚甲蓝，这些病例未能使用。
