Hsiao C T, Yang C C, Deng J F, Bullard M J, Liaw S J
Chang-Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China.
J Toxicol Clin Toxicol. 1996;34(3):343-7. doi: 10.3109/15563659609013800.
Acute pancreatitis as a complication of organophosphate intoxication has been infrequently addressed. Previous reports have suggested that acute pancreatitis may follow the oral ingestion of several organophosphates, including parathion, malathion, difonate, coumaphos, and diazinon, or after cutaneous exposure to dimethoate. No cases of acute pancreatitis following mevinphos (CAS 7786-34-71) poisoning have been reported to date. The possible pathogeneses of the pancreatic insult in organophosphate intoxication are excessive cholinergic stimulation of the pancreas and ductular hypertension.
We describe a patient presenting with painless acute pancreatitis following an intentional ingestion of large amounts of mevinphos. Serum amylase and lipase values were increased and determination of amylase isoenzymes confirmed a pancreatic origin. A computerized tomograph of the abdomen showed diffuse swelling of the pancreas. The patient was discharged after a seven week clinical course, complicated by a delayed neuropathy.
As acute pancreatitis in organophosphate intoxication may be more common than reported, serum pancreatic enzymes and appropriate imaging studies should be more liberally utilized. Early recognition and appropriate therapy for acute pancreatitis may lead to an improved prognosis.
急性胰腺炎作为有机磷中毒的一种并发症，此前较少被提及。既往报道提示，口服几种有机磷（包括对硫磷、马拉硫磷、地虫硫磷、蝇毒磷和二嗪农）或皮肤接触乐果后可能会发生急性胰腺炎。迄今为止，尚无关于速灭磷（化学物质登录号7786 - 34 - 71）中毒后发生急性胰腺炎的病例报道。有机磷中毒时胰腺损伤的可能发病机制是胰腺受到过度胆碱能刺激和导管内高压。
我们描述了一名患者，在故意大量摄入速灭磷后出现无痛性急性胰腺炎。血清淀粉酶和脂肪酶值升高，淀粉酶同工酶测定证实为胰腺来源。腹部计算机断层扫描显示胰腺弥漫性肿胀。患者经过7周的临床病程后出院，并发迟发性神经病。
由于有机磷中毒所致的急性胰腺炎可能比报道的更为常见，应更广泛地应用血清胰腺酶和适当的影像学检查。对急性胰腺炎的早期识别和适当治疗可能会改善预后。
