Boseniuk S, Rieger C
Klinik für Anästhesiologie und Intensivmedizin, Klinikums Frankfurt/Oder.
Anaesthesiol Reanim. 1994;19(3):80-2.
We report on a female patient who attempted suicide by drinking 400 ml of 25% acetic acid. This amount is normally considered to be a lethal dose. Treatment was initiated about 2 hours after ingestion. Pain and shock were treated at first followed by the symptoms of haemolysis and renal failure. In severe corrosive injuries of the upper respiratory tract, intubation and ventilation are mandatory. After acid absorption, plasma separation is the quickest and most effective way of detoxication and removal of the products of haemolysis. In cases of severe haemolysis, exchange transfusion is necessary. In addition, careful management of the acid-base status is recommended. Disseminated intravascular coagulation or anaemia may develop. In this case, we used low dose heparin, erythrocyte transfusion and AT III substitution. In secondary renal failure, haemodialysis is recommended. When the acute intoxication has been treated, attention must be paid to fluid management and calorie intake. Care must be taken to exclude injury or stricture of the oesophagus or stomach. This case underlines the importance of immediate treatment of the haemolysis and detoxification with plasma separation with the immediate substitution of blood and clotting factors. In spite of an initial deterioration, the initiation of therapy led to a rapid improvement in circulation and renal function.
我们报告了一名女性患者，她饮用400毫升25%的醋酸企图自杀。这个量通常被认为是致死剂量。摄入后约2小时开始治疗。首先治疗疼痛和休克，随后是溶血和肾衰竭的症状。在上呼吸道严重腐蚀性损伤中，插管和通气是必需的。酸吸收后，血浆分离是解毒和清除溶血产物最快、最有效的方法。在严重溶血的情况下，需要进行换血治疗。此外，建议仔细管理酸碱状态。可能会发生弥散性血管内凝血或贫血。在本病例中，我们使用了低剂量肝素、红细胞输注和抗凝血酶III替代治疗。对于继发性肾衰竭，建议进行血液透析。急性中毒得到治疗后，必须注意液体管理和热量摄入。必须注意排除食管或胃的损伤或狭窄。本病例强调了立即治疗溶血和通过血浆分离解毒并立即补充血液和凝血因子的重要性。尽管最初病情恶化，但治疗的开始导致循环和肾功能迅速改善。
