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首页> 外文期刊>Asia Pacific Journal of Medical Toxicology >Inorganic Arsenic Poisoning Following An Intentional Overdose Of Realgar-Containing Niu Huang Jie Du Pian: A Case report and Literature Review
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Inorganic Arsenic Poisoning Following An Intentional Overdose Of Realgar-Containing Niu Huang Jie Du Pian: A Case report and Literature Review

机译：故意过量服用雄黄的牛黄解毒片后的无机砷中毒：一例病例并文献复习

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Background: Niu Huang Jie Du Pian (NHJDP) is a widely used realgar-containing Chinese medicine remedy. Most brands are composed of eight ingredients: Niuhuang (Calculus Bovis), Xionghuang (realgar), gypsum (calcium sulphate), Dahuang (Radix et Rhizoma Rhei), Huangqin (Radix Scutellariae), Jugeng (Platycodon grandiflorum), Bingpian (borneol), and Gancao (Radix Glycyrrhizae uralensis, licorice root). Most users are not aware that Xionghuang (realgar) contains arsenic disulphide [As2S2]. Inorganic arsenic poisoning after therapeutic overdoses has been reported in Chinese literature, but no report of acute, intentional overdose of NHJDP has been published. We report a case of intentional overdose of NHJDP leading to arsenic poisoning. Case Presentation: A 33-year-old woman ingested approximately 100 tablets of NHJDP bought over the counter, along with her usual antidepressants. She presented with somnolence, agitation, epigastric pain and repeated vomiting, compatible with clinical toxicities of NHJDP reported in Chinese literature. At presentation, blood and spot urine arsenic levels were 440.9 and 7,495 nmol/L, respectively. The patient’s condition improved rapidly after admission and chelation therapy was not deemed to be necessary. Discussion: Despite the self-limiting clinical course, the high arsenic level in the patient’s blood and urine raises safety concerns regarding the use of NHJDP in the community. Inconsistencies in the sales regulation of arsenic-containing products, and a lack of product label warning regarding arsenic content, may potentiate inadvertent arsenic poisoning. Conclusion: Clinician should be aware of the possibility of inorganic arsenic poisoning when treating patients with overdose of Chinese medicine remedies that contain Xionghuang (realgar). Proper product labelling may help reduce inadvertent arsenic poisoning.
机译：背景：牛黄解毒片（NHJDP）是一种广泛使用的含雄黄的中药。大多数品牌由八种成分组成：牛黄（微积分牛黄），雄黄（雄黄），石膏（硫酸钙），大黄（黄，），黄琴（黄cut），巨庚（桔梗），冰片（冰片），和甘草（甘草根，甘草根）。大多数用户不知道雄黄（雄黄）中含有二硫化砷[As2S2]。在中国文献中已经报道了过量治疗后的无机砷中毒，但尚未有关于NHJDP急性，故意过量的报道。我们报告了一例过量服用NHJDP导致砷中毒的案例。病例介绍：一名33岁的妇女摄入了从柜台购买的大约100片NHJDP及其通常的抗抑郁药。她表现出嗜睡，躁动，上腹疼痛和反复呕吐，与中国文献报道的NHJDP的临床毒性相称。报告时，血液和点尿中砷的含量分别为440.9和7495 nmol / L。入院后患者的病情迅速好转，认为不需要螯合疗法。讨论：尽管临床过程是自我限制的，但是患者血液和尿液中的高砷含量引发了人们对在社区使用NHJDP的安全性的担忧。含砷产品的销售法规不一致，以及缺乏有关砷含量的产品标签警告，可能会导致无意中毒。结论：在用过量的雄黄（雄黄）中药治疗患者时，临床医生应意识到无机砷中毒的可能性。正确的产品标签可能有助于减少意外的砷中毒。

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