Mullins M E, Hammett-Stabler C A
Oregon Poison Center, Oregon Health Sciences University, Portland 97201-3098, USA.
J Toxicol Clin Toxicol. 1998;36(4):315-20. doi: 10.3109/15563659809028027.
This report describes two patients exposed to nitromethane-containing fuels and the resulting laboratory abnormalities. Patient 1 ingested model airplane fuel on two separate occasions; the second patient had dermal exposure from clothing saturated with fuel in a drag racing accident. After the exposure, both patients had unusually elevated serum creatinine concentrations.
We determined the cause of the increase in serum creatinine to be due to nitromethane interfering with the Jaffé reaction used to measure this analyte. The interference was determined by both adding increasing quantities of nitromethane to sera and remeasuring the apparent creatinine and by retesting some of the original samples using an enzyme-based creatinine method.
We found nitromethane, in the concentrations absorbed or ingested by the patients, increased the apparent creatinine 10- to 20-fold.
Nitromethane interferes with the most widely used colorimetric method used to measure creatinine. Management of this mixed poisoning should focus on the appropriate treatment for methanol toxicity. Extreme, but false, elevations of creatinine do not require hemodialysis when no other significant laboratory abnormality exists.
本报告描述了两名接触含硝基甲烷燃料的患者以及由此产生的实验室异常情况。患者1在两个不同的场合摄入了模型飞机燃料；第二名患者在一次赛车事故中因被燃料浸透的衣物而发生皮肤接触。接触后，两名患者的血清肌酐浓度均异常升高。
我们确定血清肌酐升高的原因是硝基甲烷干扰了用于测量该分析物的Jaffe反应。通过向血清中添加越来越多的硝基甲烷并重新测量表观肌酐，以及使用基于酶的肌酐方法对一些原始样本进行重新检测，来确定干扰情况。
我们发现，患者吸收或摄入浓度的硝基甲烷会使表观肌酐增加10至20倍。
硝基甲烷会干扰用于测量肌酐的最广泛使用的比色法。这种混合中毒的处理应侧重于对甲醇毒性的适当治疗。当不存在其他显著的实验室异常时，肌酐的极度但虚假的升高不需要进行血液透析。
