Arai H, Ikeda H, Ichiki M, Iino M, Kumai M, Ikeda M
Tohoku J Exp Med. 1983 Dec;141(4):473-80. doi: 10.1620/tjem.141.473.
A fatal case of poisoning by a mixture of methanol and ethylene glycol is described. A 72-year-old man was hospitalized when he was found stuporous to semicomatose, and despite massive bicarbonate therapy, died 36 hr after the admission. While the presence of numerous oxalate crystals in urine strongly suggested ethylene glycol intoxication, the GC analysis of the liquid the patient ingested revealed that he presumably drunk about 150 to 200 ml of a mixture of methanol (80%) and ethylene glycol (20%), the amount well over the lowest lethal dose when the additiveness of toxicity was considered. Retrospective evaluation of the signs suggested that while some of them such as oxalate crystalluria, elevated CPK, hypocalcemia, renal failure are attributable to the toxicity of ethylene glycol, others including elevated serum amylase and cyanosis are indicative of methanol poisoning. Disturbed consciousness was considered to be of metabolic origin; the high anion gap observed (38.2 mEq/liter) may be due not only to lactic acidosis but also to acidogenicity of the two chemicals ingested. The importance of gas chromatographic analysis for identification of the causative chemical(s) is stressed.
本文描述了一例甲醇和乙二醇混合中毒致死的病例。一名72岁男性被发现处于昏睡至半昏迷状态后住院，尽管进行了大量碳酸氢盐治疗，但入院36小时后死亡。虽然尿液中大量草酸盐晶体的存在强烈提示乙二醇中毒，但对患者摄入液体的气相色谱分析显示，他可能饮用了约150至200毫升甲醇（80%）和乙二醇（20%）的混合物，考虑到毒性的相加性，该量远超过最低致死剂量。对症状的回顾性评估表明，虽然其中一些症状如草酸盐结晶尿、肌酸磷酸激酶升高、低钙血症、肾衰竭可归因于乙二醇的毒性，但其他症状包括血清淀粉酶升高和发绀则提示甲醇中毒。意识障碍被认为是代谢性的；观察到的高阴离子间隙（38.2毫当量/升）可能不仅是由于乳酸酸中毒，还由于摄入的两种化学物质的产酸性。强调了气相色谱分析对鉴定致病化学物质的重要性。
