Lifshitz M, Rotenberg M, Sofer S, Tamiri T, Shahak E, Almog S
Toxicology Unit, Soroka Medical Center, Beer Sheba, Israel.
Pediatrics. 1994 Apr;93(4):652-5.
(1) Retrospective evaluation of the clinical course of carbamate poisoning and the effect of oxime therapy in children. (2) In vitro study of the effect of oximes on the reactivation of carbamylated cholinesterase.
(1) Clinical survey: The records of 26 children intoxicated with carbamates were examined retrospectively. The poisoning agents in all cases were positively identified as methomyl or aldicarb by gas chromatography-mass spectrometry. (2) Laboratory study: The direct effect of obidoxime and of pralidoxime on acetylcholinesterase activity in vitro was investigated in normal human packed red blood cells pretreated with an organophosphate (paraoxon) or a carbamate (aldicarb or methomyl).
Pediatric intensive care unit of a teaching hospital.
Twenty-six infants and young children (aged 1 to 8 years) admitted to the pediatric intensive care unit with severe carbamate intoxication.
All cases had been treated with repeated doses of atropine sulfate (0.05 mg/kg) administered every 5 to 10 minutes until muscarinic symptoms disappeared. Obidoxime chloride (Toxogonin, 6 mg/kg) was administered on admission, and again after 4 to 5 hours.
Predominant symptoms were related to central nervous system and nicotinic effects. All the patients showed marked improvement within several hours and recovered completely within 24 hours. None of the children deteriorated and none showed exacerbation of cholinergic symptoms after obidoxime treatment. In vitro, oximes reactivated acetylcholinesterase inhibited with paraoxon, whereas no significant effect of oximes on carbamylated enzyme activity was observed.
Based on the recovery of all cases, as compared with other reports of carbamate poisoning treated with atropine alone, it is concluded that, in the case of aldicarb or methomyl poisoning, oxime therapy apparently does not contribute to the recovery of poisoned patients. In cases of poisoning by an unknown pesticide or of mixed poisoning, oxime therapy can prove beneficial because no negative effects of the therapy can be discerned.
（1）回顾性评估儿童氨基甲酸酯中毒的临床病程及肟类疗法的效果。（2）体外研究肟类对氨基甲酰化胆碱酯酶再活化的作用。
（1）临床调查：回顾性检查26例氨基甲酸酯中毒儿童的记录。所有病例中毒剂经气相色谱 - 质谱法确认为灭多威或涕灭威。（2）实验室研究：在经有机磷酸酯（对氧磷）或氨基甲酸酯（涕灭威或灭多威）预处理的正常人浓缩红细胞中，研究氯解磷定和碘解磷定对体外乙酰胆碱酯酶活性的直接作用。
教学医院的儿科重症监护病房。
26例因严重氨基甲酸酯中毒入住儿科重症监护病房的婴幼儿（1至8岁）。
所有病例均每5至10分钟重复给予硫酸阿托品（0.05mg/kg）直至毒蕈碱样症状消失。入院时给予氯解磷定（氯磷定，6mg/kg），4至5小时后再次给药。
主要症状与中枢神经系统和烟碱样作用有关。所有患者在数小时内明显改善，并在24小时内完全康复。氯解磷定治疗后，无儿童病情恶化，无胆碱能症状加重。体外实验中，肟类可使被对氧磷抑制的乙酰胆碱酯酶再活化，而未观察到肟类对氨基甲酰化酶活性有显著影响。
基于所有病例均康复，与其他仅用阿托品治疗氨基甲酸酯中毒的报告相比，得出结论：在涕灭威或灭多威中毒的情况下，肟类疗法显然无助于中毒患者的康复。在不明农药中毒或混合中毒的情况下，肟类疗法可能有益，因为未发现该疗法有负面影响。
