急性甲醇中毒代谢性酸中毒的特点及急救处理

目的探讨急性甲醇中毒代谢性酸中毒的特点及治疗方法。方法:53例急性甲醇中毒的患者中出现代谢性酸中毒26例,表现为阴离子间隙(AG)增高正常血氯的代谢性酸中毒,予血液透析,碳酸氢钠补碱,维持电解质平衡,使用叶酸、激素等处理。结果:抢救成功52例(98.1%),死亡1例(1.9%)。经随访观察半年,总的伤残病例17例(32.1%),包括急性期死亡1例(1.9%),最终视力在低视力以下(中心视力低于0.3)9例(17.0%),包括双眼无光感2例(3.8%),盲目(中心视力低于0.05)有4人共6只眼,另有1例(1.9%)呈植物人状态。结论:急性甲醇中毒可引起视神经损害及代谢性酸中毒,代谢性酸中毒常是主要的致死原因,及时纠正酸中毒是抢救急性甲醇中毒并减少视功能障碍后遗症的重要措施。     

急性甲醇中毒代谢性酸中毒的特点及急救处理

目的:探讨急性甲醇中毒代谢性酸中毒的特点及治疗方法。方法:53例急性甲醇中毒的患者中出现代谢性酸中毒26例,表现为阴离子间隙(AG)增高正常血氯的代谢性酸中毒,予血液透析,碳酸氢钠补碱,维持电解质平衡,使用叶酸,激素等处理。结果:抢救成功52例(98．1%),死亡1例(1．9%)。经随访观察半年,总的伤残病例17例(32．1%),包括急性期死亡1例(1．9%),最终视力在低视力以下(中心视力低于0．3)9例(17．0%),包括双眼无光感2例(3．8％),盲目(中心视力低于0．05)有4人共6只眼,另有1例(1．9%)呈植物人状态。结论:急性甲醇中霉可引起视神经损害及代谢性酸中毒,代谢性酸中毒常是主要的致死原因,及时纠正酸中毒是抢救急性甲醇中毒并减少视功能障碍后遗症的重要措施。     

血液甲醇浓度测定在口服甲醇中毒治疗中的意义

目的探讨血液甲醇浓度（M）测定在口服甲醇中毒治疗中的意义。方法根据一次成功抢救的临床资料,观察42例口服甲醇中毒患者的M、血二氧化碳结合力（CO2CP）、阴离子间隙（AG）和眼部症状／体征,按是否需要行血液透析治疗分为应接受HD治疗组（GHD）、非HD治疗组（GNHD）;用气相色谱顶空进样法（GC）测定M;并按不同M水平进行分析。结果（1）两组间10gM、CO2CP和AG均有显著差异;（2）当M在0．5～7．8mmol／L时,两组间例数无显著性差异。结论M测定在口服甲醇中毒治疗中有重要意义,M≤7．8mmol／L时,可能已需要HD治疗。     

早产儿晚期代谢性酸中毒临床分析

早产儿晚期代谢性酸中毒常发生于生后2—3周,可影响患儿的生长发育,引起抵抗力下降,甚至危及生命。现将我院新生儿科收治的34例早产儿晚期代谢性酸中毒进行分析报告如下：     

代谢性酸中毒时碳酸氢钠对脑脊液pH的影响

研究通过复制犬碳酸氢钠纠正的急性代谢性酸中毒动物模型，动态观察动脉血和脑脊液（ＣＳＦ）酸碱变量。结果发现：当碳酸氢钠大剂量快速输入后，ｐＨａ虽恢复正常，而ｐＨＣＳＦ从代谢性酸中毒时的７．３５１下降到７．１９２，ＰＣＳＦＣＯ２从代谢性酸中毒时的５．３７１９ｋＰａ上升到８．５３１２ｋＰａ，ＣＳＦ发生急性呼吸性酸中毒。这可能是一些危重的代谢性酸中毒病人在使用较大剂量碳酸氢钠纠酸后出现种经精神症状的主要原因之一。     

新生儿高阴离子间隙(AG)代谢性酸中毒的病因与预后分析

新生儿期几乎所有的严重疾病均可导致酸碱失衡。代谢性酸中毒是新生儿酸碱失衡的主要类型之一,而最常见的主要是高AG代酸。为探讨其病因及预后,对湖南省儿童医院新生儿科2001年6月～2002年3月住院患儿中,针对124例AG≥20mmol/L的代酸病例进行回顾性分析,现报告如下:1资料与方法采用回顾性分析方法:124例中男98例,女26例;胎龄<37周33例,～42周79例,≥42周12例;出生体重<2500g39例,～3999g81例,≥4000g4例;入院时日龄<24h3例,～3d25例,～7d14例,≥7d12例。仪器为血液生化仪和血气分析仪,标本均为入院时第1次动脉血气和电解质,原发疾病中,新…     

重度急性甲醇中毒抢救成功一例

甲醇又称木醇,是一种无色、易燃的液体,误服5—10ml可致严重中毒,30ml以上可致死亡。2008年8月10日我院急诊收治1例口服甲醇中毒患者。报告如下。     

肾小管代谢性酸中毒合并人毛滴虫感染1例

患儿,男,年龄14个月。2个月时无明显诱因出现发热,低温38．7℃,伴抽搐,表现为意识不清,双眼上翻,口唇发绀,四肢曲张,肌张力增高,无口吐白沫,持续时间约2～3min,自动缓解,伴有呕吐,为胃内容物,量少,无咖啡样物,急就诊当地县医院,途中抽搐2次,表现同前。在医院就诊时患儿再次抽搐,同时伴有呼吸、心跳停止,给予心肺复苏及药物复苏后,情况不佳,家属放弃治疗,回家后患儿嗜睡,时有清醒,     

36例新生儿代谢性酸中毒病因分析

新生儿代谢性酸中毒常见于多种疾病及其病理过程,它的发生和发展将严重影响疾病或病理过程,甚至危及生命。由于新生儿代谢性酸中毒临床表现不典型,因此对其应有充分的认识,足够的重视才能及早发现及时处理。我院2006年1月至2009年12月因各种疾病收住的新生儿中36例合并代谢性酸中毒,现就其发生的原因分析报告如下。     

High anion gap refractory metabolic acidosis as a critical presentation of endosulfan poisoning

Organochloride insecticides are chlorinated cyclic hydrocarbons. One of such insecticides is endosulfan (6,7,8,9,10-10 hexachloro 1,5,5a,6,9,9a-hexahydro-6-methano-2,4,3-hexadithioxanthiep in 3-oxide) and it has been widely used in agriculture since 1960. The uncontrolled use of these compounds in developing countries has resulted in the deaths of animals and humans. Characteristic clinical signs following acute exposure are indicative of CNS disturbances or overstimulation. Mortality and morbidity rates are high and there is no specific antidote. We present an uncommon presentation of endosulfan poisoning in a 32-year-old male with high anion gap severe refractory metabolic acidosis. The patient was treated with continuous renal replacement therapy and was salvaged. Till date, there is no case report from India for endosulfan poisoning with severe metabolic acidosis and hypotension. Through this case report, we emphasize the role of continuous renal replacement therapy as a rescue therapy for endosulfan poisoning with severe refractory metabolic acidosis and hypotension, even though it is a non dialyzable poison.     

Profound metabolic acidosis and oxoprolinuria in an adult

Introduction

Profound metabolic acidosis in critically ill adults sometimes remains unexplained despite extensive evaluation.

Case Report

A 58-year-old female presented in a confused state to the emergency department; she had been confused for several days. Laboratory evaluation revealed a high anion gap metabolic acidosis and modestly elevated acetaminophen level. Lactic acid was only modestly elevated. There was no evidence of ketoacids, salicylate, methanol, or ethylene glycol. A urine sample submitted on day 1 of hospitalization revealed a markedly elevated level of 5-oxoproline.

Discussion

Originally described in children with an inherited defect of glutathione synthetase, 5-Oxoproline is an unusual cause of metabolic acidosis. More recently this disturbance has been recognized in critically ill adults without a recognized inherited metabolic disorder. In most of these cases there has been the concomitant use of acetaminophen. Any causal relationship between acetaminophen and this disturbance is speculative.

Conclusion

In critically ill adults with unexplained metabolic acidosis, 5-Oxoproline should be considered in the differential.     

Pharmacokinetics of TRIS (hydroxymethyl-)aminomethane in healthy subjects and in patients with metabolic acidosis

Summary To investigate the pharmacokinetics of TRIS, an infusion of the buffer was given to 6 healthy volunteers (121 mg/kg=1 mmol/kg; pH 7.4) and to 20 patients suffering from metabolic acidosis (109–376 mg/kg; pH 10.9). The drug exhibited two-compartment characteristics in volunteers (t_0.5,=5.6 h) and patients with intact renal function (t_0.5,=16.3–45.6 h). The final volume of distribution (V) indicated uptake into tissues, but equilibration between body compartments was slow. Mainly unchanged TRIS was eliminated by the kidney; 82% of the administered dose was recovered from 24 h-urine of healthy subjects. In the patients a linear correlation between creatinine-clearance and TRIS-clearance was observed, the latter always being somewhat greater than the former. Only insignificant amounts of the drug were found in bile and gastric juice. In anuric patients the plasma concentration of TRIS declined monoexponentially, with a half-life between 10 and 58 h. Haemodialysis or haemofiltration did not influence this process. From the data it seems questionable whether cellular uptake of TRIS is an important factor in the therapy of intracellular acidosis, but the possibility of drug accumulation must be borne in mind if repeated doses are given to the same patient.     

急性一氧化碳中毒血浆NT-proBNP的变化及其与LVEF之间的关系

目的：探讨血浆N末端B型脑钠肽原（NT-proBNP）在急性一氧化碳中毒（ACOP）患者心功能评价中的临床意义。方法回顾性观察2010年10月～2014年2月在我科住院的急性一氧化碳中毒患者68例,按照中毒程度分为轻、中、重3组。取同一时期30例健康体检者作为对照。患者入院后2h内抽取静脉血测定血浆NT-proBNP水平,24h内超声心动图检测左室射血分数（LVEF）。结果和对照组比较,ACOP轻、中、重度组血浆NT-proBNP水平升高,LVEF则下降,与对照组比较有显著性差异（P〈0.01）。轻、中、重度ACOP 3组NT-proBNP相互比较,重度组高于中度及轻度组,中度组高于轻度组,有显著性差异（P〈0.01）,而LVEF则呈相反变化趋势,NT-proBNP和LVEF具有负相关。结论 ACOP患者血浆NT-proBNP升高,LVEF则下降,且NT-proBNP随中毒程度加深而显著升高,与左室射血功能密切相关,可作为ACOP的常规检查,对ACOP后心功能评估有着重要意义。     

Bialaphos poisoning with apnea and metabolic acidosis

A 64-year-old man with ethanol intoxication, ingested a bottle of Herbiace (100 ml, 32 w/v% of bialaphos, CAS #35597-43-4, Meiji Seika Kaisha, Tokyo, Japan). He had severe metabolic acidosis and was treated with infusions of sodium bicarbonate and furosemide, plus gastric lavage and enema. The metabolic acidosis improved 15 hours after treatment but nystagmus, apnea and convulsions were progressive. Although his sensorium was clear, spontaneous respirations were not observed for 64 hours. The electroencephalographic findings of atypical triphasic waves and slow waves suggest a unique response to bialaphos poisoning. His clinical course indicates that the management of apnea is critically important to recovery from bialaphos poisoning.     

Understanding lactic acidosis in paracetamol (acetaminophen) poisoning

Paracetamol (acetaminophen) is one of the most commonly taken drugs in overdose in many areas of the world, and the most common cause of acute liver failure in both the UK and USA. Paracetamol poisoning can result in lactic acidosis in two different scenarios. First, early in the course of poisoning and before the onset of hepatotoxicity in patients with massive ingestion; a lactic acidosis is usually associated with coma. Experimental evidence from studies in whole animals, perfused liver slices and cell cultures has shown that the toxic metabolite of paracetamol, N-acetyl-p-benzo-quinone imine, inhibits electron transfer in the mitochondrial respiratory chain and thus inhibits aerobic respiration. This occurs only at very high concentrations of paracetamol, and precedes cellular injury by several hours. The second scenario in which lactic acidosis can occur is later in the course of paracetamol poisoning as a consequence of established liver failure. In these patients lactate is elevated primarily because of reduced hepatic clearance, but in shocked patients there may also be a contribution of peripheral anaerobic respiration because of tissue hypoperfusion. In patients admitted to a liver unit with paracetamol hepatotoxicity, the post-resuscitation arterial lactate concentration has been shown to be a strong predictor of mortality, and is included in the modified King's College criteria for consideration of liver transplantation. We would therefore recommend that post-resuscitation lactate is measured in all patients with a severe paracetamol overdose resulting in either reduced conscious level or hepatic failure.     

Mass methanol poisonings in the Czech Republic

Abstract

The article provides detailed information on the case of 2012–2013 Czech mass methanol poisoning caused by the consumption of spirits with methanol added during manufacture. The article compares basic characteristics of methanol and ethanol. It also gives toxicological properties of methanol and describes therapy of methanol afflicted patients with the medicinal product Fomepizole. Having provided an overview of the short-term remedies to the Czech 2012–2013 poisoning problems, the authors suggest long-term measures for prevention of possible future mass poisoning cases like legislative changes and extension of school education with courses on ethanol and methanol effects in human organism.     

The relationship between features of metabolic syndrome and blood adipocytokine concentrations in the morbid obese patients during dynamic weight loss

Bariatric surgery is the most effective method to achieve weight loss in obese subjects. The aim of this study was to evaluate some adipocytokines and insulin, as well as parameters of metabolic syndrome of the obese patients, for three and six months after vertical banded gastroplasty, in the time of dynamic weight loss. Seven males and two females aged 28 to 49 years, with long lasting simple obesity and the presence of metabolic syndrome, were studied. After surgical treatment the values of the body mass index, waist circumference, systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, triglycerides, and blood concentrations of leptin decreased significantly. Before surgical operation of all obese patients no statistically significant correlations between studied parameters were noted. Three and six months later a lot of correlations between studied parameters appeared. In conclusion, (a) vertical-banded gastroplasty is a valuable method in treatment of obese subjects, leading to a significant decrease in body weight and improvement in some parameters of metabolic syndrome in a few months after surgery, (b) adipocytokines, together with an unknown gastric factor, may be key factors in the control of some features of the metabolic syndrome.     

血液灌流联合血液透析治疗重度药物中毒的临床研究

目的观察血液灌流联合血液透析（HPD）治疗重度药物中毒的临床疗效。方法将来我科进行急诊治疗的94例重度药物中毒患者随机分为观察组和对照组,其中对照组47例,采用常规方法治疗;观察组47例,在常规治疗的基础上采用HPD治疗,比较两组的临床疗效。结果观察组治愈率为97.9%,对照组治愈率为80.9%。观察组的治愈率显著高于对照组,差异有统计学意义（P〈0.05）;观察组患者意识恢复时间和住院时间分别为（4.5±2.7）h和（8.3±1.5）d,明显比对照组短,差异有统计学意义（P〈0.05）。结论重度药物中毒在常规治疗的基础上加用血液灌流联合血液透析治疗具有很好的临床疗效,能显著减少病死率,缩短意识恢复时间和住院时间,值得推广应用。     

急性重度中毒血液灌流联合血液透析疗效观察

目的 探讨血液灌流联合血液透析(HP HD)在各种重度毒物和药物中毒治疗中的疗效,以及影响患者预后的相关因素.方法 回顾分析2001年6月～2006年3月本院救治的31例急性重度中毒患者的临床资料和治疗效果.结果 31例患者中治愈27例,1例因经济及其它原因经一次血液净化治疗好转后自动出院,死亡3例.结论 HP HD对急性重度中毒的抢救疗效肯定.