Gabrielli A, Hammett-Stabler C
Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA.
Chest. 1998 May;113(5):1419-22. doi: 10.1378/chest.113.5.1419.
A patient had extensive blunt trauma from a high-speed crash in which nitromethane fuel erupted from the fuel tank and soaked into his protective multilayer jumpsuit. The clinical diagnosis was complicated because the absorption of nitromethane fuel through the skin and by inhalation falsely increased the serum creatinine value when a modified Jaffe reaction was used in the laboratory. This spurious value was "unmasked" by the use of an enzymatic method to measure the serum creatinine level. A high serum creatinine value disproportionate to the level of BUN and recent skin exposure to nitromethane were the clinical indications that suggested the differentiation of massive rhabdomyolysis from spurious hypercreatinemia. This spurious value was a confounding factor in the diagnosis of crush syndrome and rhabdomyolysis.
一名患者因高速车祸遭受广泛钝器伤，事故中硝基甲烷燃料从油箱喷出并浸透了他的多层防护工作服。临床诊断较为复杂，因为当实验室使用改良的贾菲反应时，经皮肤吸收和吸入硝基甲烷燃料会错误地提高血清肌酐值。通过使用酶法测量血清肌酐水平，这个虚假值被“揭露”了。血清肌酐值过高与血尿素氮水平不成比例以及近期皮肤接触硝基甲烷是临床迹象，提示需区分大面积横纹肌溶解与假性高肌酐血症。这个虚假值是挤压综合征和横纹肌溶解诊断中的一个混杂因素。
