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首页> 外文期刊>BMC Emergency Medicine >Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study
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Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study

机译：急性甲苯中毒-临床表现，治疗和预后：一项前瞻性观察研究

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Background Toluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression. However, dangerous metabolic abnormalities are associated to acute toluene intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the condition, and could constitute risk factors for poor outcomes. The objective was to describe the clinical presentation, to characterize the renal and liver abnormalities, the management and prognosis associated to acute toluene intoxication. Methods We prospectively assessed 20 patients that were admitted to a single center’s emergency department from September 2012 to June 2014 with clinical and metabolic alterations due to acute toluene intoxication. Results The main clinical presentation consisted of weakness associated to severe hypokalemia and acidosis. Renal glomerular injury (proteinuria) is ubiquitous. Biliary tract injury (alkaline phosphatase and gamma-glutamyl transpeptidase elevations) disproportional to hepatocellular injury is common. Rhabdomyolysis occurred in 80?% of patients, probably due to hypokalemia and hypophosphatemia. There were three deaths, all female, and all associated with altered mental status, severe acidosis, hypokalemia and acute oliguric renal failure. The cause of death was in all cases due to cardiac rhythm abnormalities. Conclusion The hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Liver injury and rhabdomyolysis are common. On admission, altered mental status, renal failure, severe acidemia and female gender (not significant in our study, but present in all three deaths) could be associated with a poor outcome, and patients with these characteristics should be considered to be treated in an intensive care unit.
机译：背景技术甲苯是一种被广泛滥用的吸入药物，因为它具有包括兴奋和随后的抑郁之类的急性神经功能。但是，危险的代谢异常与急性甲苯中毒有关。先前已有报道，横纹肌溶解和急性肝肾损伤可能是该病的标志，并且可能构成不良预后的危险因素。目的是描述临床表现，以表征与急性甲苯中毒有关的肾脏和肝脏异常，治疗和预后。方法我们前瞻性地评估了2012年9月至2014年6月收治于单个中心急诊科的20例患者的急性甲苯中毒引起的临床和代谢改变的情况。结果主要临床表现为与严重低血钾和酸中毒相关的虚弱。肾小球肾损伤（蛋白尿）无处不在。与肝细胞损伤不成比例的胆道损伤（碱性磷酸酶和γ-谷氨酰转肽酶升高）很常见。横纹肌溶解症发生在80％的患者中，可能是由于血钾过低和血磷过少所致。三例死亡均为女性，均与精神状态改变，严重酸中毒，低血钾和急性少尿性肾衰竭有关。在所有情况下，死亡原因均归因于心律异常。结论急性甲苯中毒的特征是低钾性麻痹和代谢性酸中毒。肝损伤和横纹肌溶解很常见。入院时，精神状态改变，肾功能衰竭，严重的酸血症和女性性别（在我们的研究中不显着，但在所有三例死亡中均存在）可能与不良预后相关，因此应考虑将具有这些特征的患者接受治疗。重症监护室。

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