急性秋水仙碱中毒3例报告
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摘要
目的分析急性秋水仙碱中毒的临床特点及诊断治疗。方法回顾性分析3例急性秋水仙碱中毒病例的临床资料。结果 3例病例均有明确的秋水仙碱过量服食史,服毒剂量分别为30.0、50.0和58.5 mg,均有不同程度的胃肠道症状、骨髓抑制、横纹肌溶解、心肌损害及肝损害。经治疗后病例1、2好转出院。病例3既往有长期口服秋水仙碱史,早期出现严重代谢性酸中毒及凝血功能异常,病情凶险,予血液净化、糖皮质激素、凝血因子、护肝、护心和纠正水电解质失衡等治疗,于服用秋水仙碱后89 h抢救无效死亡。结论秋水仙碱中毒无特效解毒药;若早期出现严重代谢性酸中毒及凝血功能异常,提示预后不良。
Objective To analyze the clinical features, diagnosis and treatment of acute poisoning caused by colchicine. Methods The clinical data of 3 cases of acute colchicine poisoning were retrospectively analyzed. Results All the 3 cases had a clear history of colchicine overdose, at the doses of 30.0, 50.0 and 58.5 mg. These 3 cases had different degree of gastrointestinal symptoms, bone marrow restrain, rhabdomyolysis, myocardial damage and liver damage. After treatment, case 1 and case 2 were discharged. Case 3 had a long history of oral intake of colchicine. Severe metabolic acidosis and abnormal coagulation function occurred in the early stage, and the condition was dangerous. Despite active rescue treatments including blood purification, glucocorticoid, coagulation factors, liver pretection, heart protection and water electrolyte correction, death could not be prevented after taking colchicine 89 hours later.Conclusion There is no specific antidote for colchicine poisoning. The prognosis is poor if there is severe metabolic acidosis and abnormal blood coagulation in early stage.
Objective To analyze the clinical features, diagnosis and treatment of acute poisoning caused by colchicine. Methods The clinical data of 3 cases of acute colchicine poisoning were retrospectively analyzed. Results All the 3 cases had a clear history of colchicine overdose, at the doses of 30.0, 50.0 and 58.5 mg. These 3 cases had different degree of gastrointestinal symptoms, bone marrow restrain, rhabdomyolysis, myocardial damage and liver damage. After treatment, case 1 and case 2 were discharged. Case 3 had a long history of oral intake of colchicine. Severe metabolic acidosis and abnormal coagulation function occurred in the early stage, and the condition was dangerous. Despite active rescue treatments including blood purification, glucocorticoid, coagulation factors, liver pretection, heart protection and water electrolyte correction, death could not be prevented after taking colchicine 89 hours later.Conclusion There is no specific antidote for colchicine poisoning. The prognosis is poor if there is severe metabolic acidosis and abnormal blood coagulation in early stage.
引文
[1] 牛文凯,邱泽武.秋水仙碱中毒的诊断与处理[J].药物不良反应杂志,2006,8(5):368-369.
[2] 姚美芬,苏群.急性秋水仙碱中毒致多器官功能衰竭一例[J].中华危重症医学杂志(电子版),2011,4(4):258-259.
[3] 崔晶,王景文.急性秋水仙碱中毒及救治1例[J].药物不良反应杂志,2009,11(1):37-39.
[4] ARSLAN M N,_ZGgN A,DAS T,et al.Colchicine-induced rhabdomyolysis:an autopsy case[J].Am J Forensic Med Pathol,2016,37(2):57-59.
[5] ERDEN A,KARAGOZ H,GgMgSCg H H,et al.Colchicine intoxication:a report of two suicide cases[J].Ther Clin Risk Manag,2013,9:505-509.
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[7] ERTU～RUL ξ,POLAT E,_ZGgR S,et al.Acute colchicine intoxication complicated with complete AV block[J].Turk J Pediatr,2015,57(4):398-400.
[8] AGHABIKLOOEI A,ZAMANI N,HASSANIAN-MOGHADDAM H,et al.Acute colchicine overdose:report of three cases[J].Reumatismo,2014,65(6):307-311.
[9] 黄勤,陈云,刘先发,等.急性秋水仙碱中毒致多器官功能衰竭1例报道[J].赣南医学院学报,2010,30(2):292.
[10] 何新华,李春盛,张海燕,等.极量秋水仙碱中毒并发多脏器功能衰竭1例[J].中国急救医学,2009,29(2):189-190.
[11] 刘鹏,何跃忠,李光,等.急性秋水仙碱中毒[J].中国工业医学杂志,2008,21(3):160-162.
[12] JOUFFROY R,LAMHAUT L,PETRE SOLDAN M,et al.A new approach for early onset cardiogenic shock in acute colchicine overdose:place of early extracorporeal life support (ECLS) [J].Intensive Care Med,2013,39(6):1163.
[13] AMROLLAHI-SHARIFABADI M,SEGHATOLESLAMI A,AMROLLAHI-SHARIFABADI M,et al.Fatal colchicine poisoning by accidental ingestion of Colchicum persicum:a case report[J].Am J Forensic Med Pathol,2013,34(4):295-298.
[14] HIRAYAMA I,HIRUMA T,UEDA Y,et al.A critically ill patient after a colchicine overdose below the lethal dose:a case report[J].J Med Case Rep,2018,12(1):191.
[15] 郑宇红,黄笑夏,夏迎春.秋水仙碱中毒致死亡1例[J].海峡药学,2011,23(6):270-271.
[16] EDDLESTON M,FABRESSE N,THOMPSON A,et al.Anti-colchicine Fab fragments prevent lethal colchicine toxicity in a porcine model:a pharmacokinetic and clinical study[J].Clin Toxicol (Phila),2018,56(8):773-781.
[2] 姚美芬,苏群.急性秋水仙碱中毒致多器官功能衰竭一例[J].中华危重症医学杂志(电子版),2011,4(4):258-259.
[3] 崔晶,王景文.急性秋水仙碱中毒及救治1例[J].药物不良反应杂志,2009,11(1):37-39.
[4] ARSLAN M N,_ZGgN A,DAS T,et al.Colchicine-induced rhabdomyolysis:an autopsy case[J].Am J Forensic Med Pathol,2016,37(2):57-59.
[5] ERDEN A,KARAGOZ H,GgMgSCg H H,et al.Colchicine intoxication:a report of two suicide cases[J].Ther Clin Risk Manag,2013,9:505-509.
[6] 庄耘,沈云志.秋水仙碱中毒致多脏器功能衰竭死亡1例[J].中国医师进修杂志,2007,30(11):3.
[7] ERTU～RUL ξ,POLAT E,_ZGgR S,et al.Acute colchicine intoxication complicated with complete AV block[J].Turk J Pediatr,2015,57(4):398-400.
[8] AGHABIKLOOEI A,ZAMANI N,HASSANIAN-MOGHADDAM H,et al.Acute colchicine overdose:report of three cases[J].Reumatismo,2014,65(6):307-311.
[9] 黄勤,陈云,刘先发,等.急性秋水仙碱中毒致多器官功能衰竭1例报道[J].赣南医学院学报,2010,30(2):292.
[10] 何新华,李春盛,张海燕,等.极量秋水仙碱中毒并发多脏器功能衰竭1例[J].中国急救医学,2009,29(2):189-190.
[11] 刘鹏,何跃忠,李光,等.急性秋水仙碱中毒[J].中国工业医学杂志,2008,21(3):160-162.
[12] JOUFFROY R,LAMHAUT L,PETRE SOLDAN M,et al.A new approach for early onset cardiogenic shock in acute colchicine overdose:place of early extracorporeal life support (ECLS) [J].Intensive Care Med,2013,39(6):1163.
[13] AMROLLAHI-SHARIFABADI M,SEGHATOLESLAMI A,AMROLLAHI-SHARIFABADI M,et al.Fatal colchicine poisoning by accidental ingestion of Colchicum persicum:a case report[J].Am J Forensic Med Pathol,2013,34(4):295-298.
[14] HIRAYAMA I,HIRUMA T,UEDA Y,et al.A critically ill patient after a colchicine overdose below the lethal dose:a case report[J].J Med Case Rep,2018,12(1):191.
[15] 郑宇红,黄笑夏,夏迎春.秋水仙碱中毒致死亡1例[J].海峡药学,2011,23(6):270-271.
[16] EDDLESTON M,FABRESSE N,THOMPSON A,et al.Anti-colchicine Fab fragments prevent lethal colchicine toxicity in a porcine model:a pharmacokinetic and clinical study[J].Clin Toxicol (Phila),2018,56(8):773-781.