Clinical features, laboratory findings and imaging appearances of venous diethylene glycol poisoning in patients with liver disease

Background There was a hospital outbreak of venous diethylene glycol poisoning in Guangzhou, China. It is the only massive episode of venous diethylene glycol poisoning in history. Here we report its clinical features, laboratory findings, and imaging appearances. Methods The clinical features of 15 venous diethylene glycol poisoning patients with liver disease were analyzed and summarized. Their laboratory findings and imaging appearances were comparatively analyzed before and after poisoning. Results All poisoned patients presented with oliguric acute renal failure with anuria after a mean of 6 days. Carbon dioxide combination power of 13 patients dropped after a mean of 9 days with valley value on the 10th day, when metabolic acidosis developed. Gastroenteric symptoms or aggravation of gastroenteric symptoms were displayed in 11 patients after a mean of 9 days. Neurological system impairment was observed in 10 patients after a mean of 14 days. Seven patients had low fever after a mean of 6 days. Causes of death of 14 patients included multiple organ dysfunction syndrome, severe lung infection and massive haemorrhage of digestive tract. Blood creatinine and urea nitrogen were abnormal after a mean of 5 days with peak value on the 11th and 14th days, respectively. Serum calcium had no obvious change, and phosphorus was distinctively increased. Liver functions did not change significantly. Poisoned patients had higher white blood cell counts, but lower red blood cell counts and hemoglobin value. Of the 7 patients who exhibited mild moderate or severe patchy consolidation shadowing in the lung, 2 manifested mild or severe gaseous distention and dilation of gastroentedc tract. Conclusions Main features of venous diethylene glycol poisoning in patients with liver disease include oliguric acute renal failure, metabolic acidosis, gastroenteric symptoms or aggravation of gastroenteric symptoms, neurological system impairment and low fever, with a mortality rate of 93.33% in poisoned patients. There is also higher white blood cell counts and anemia, patchy consolidation shadowing in the lung, gaseous distention and dilation of gastroenteric tract, which occurs later than mild patchy consolidation shadowing and earlier than moderate patchy consolidation shadowing in the lung.     

Cerebral depression due to propylene glycol in a patient with chronic epilepsy--the value of the plasma osmolal gap in diagnosis

A case of propylene glycol poisoning is described in a 39 year old woman which resulted in her admission to hospital in status epilepticus. She had had a long-standing history of uncontrollable epilepsy. The diagnosis of propylene glycol poisoning resulted directly from the finding of a high plasma osmolal gap on admission. This finding would have been missed if later samples only had been analysed. Plasma osmolality and the osmolal gap should be considered first line investigations in patients presenting with metabolic acidosis and cerebral signs and symptoms. Since her discharge from hospital a year ago the patient has had no further seizures.     

Phenacetin Nephropathy

Four patients who had ingested large amounts of phenacetin-salicylate medications were studied during a 12-month period. Renal failure had progressed slowly over a number of years. All patients took the drug because of psychogenic headache. Considerable skill was required to elicit the history of drug habituation. The major features of the nephropathy were multiple episodes of metabolic acidosis, minimal proteinuria, pyuria but no bacteriuria, and polyuria and polydipsia early in the course of drug ingestion. Papillary necrosis was not a prominent clinical feature of this series. Discontinuation of drug ingestion by one patient was associated with recovery of a considerable degree of renal function. Preliminary experimental evidence obtained in the dog suggests that salicylate impaired the efficiency of the counter-current multiplier by decreasing sodium transport in the ascending limb of Henle, and decreased the permeability to water of the distal convoluted and collecting tubule; phenacetin had no such effect.     

肺心病人临终前酸碱失衡及死亡原因的探讨

本文分析了179例肺心病人临终前动脉血气、血电解质和死亡原因。结果表明:肺心病人在临终前的酸碱失衡是常见的。其中慢性呼吸性酸中毒最常见,其它依次为三重酸碱失衡、慢性呼吸性酸中毒并代谢性酸中毒和慢性呼吸性酸中毒并代谢性碱中毒。慢性呼吸性碱中毒、慢性呼吸性碱中毒并代谢性碱中毒和代谢性酸中毒是少见的。肺心病人死亡的主要原因是并发上消化道出血,其次为直接死于酸碱失衡,特别是三重酸碱失衡。     

Diuresis or urinary alkalinisation for salicylate poisoning?

Forty-four adults with aspirin poisoning were treated with oral fluids only, standard forced alkaline diuresis, forced diuresis alone, or sodium bicarbonate (alkali) alone. Alkali alone was at least as effective and possibly more effective than forced alkaline diuresis in enhancing salicylate removal. Unlike the diuresis regimens it did not cause fluid retention or biochemical disturbances. The renal excretion of salicylate depends much more on urine pH than flow rate, and forced diuresis alone had little useful effect. In overdosage aspirin causes sodium and fluid retention and may impair renal function. Attempts to force a diuresis are potentially hazardous and the spurious fall in plasma salicylate concentration caused by haemodilution gives a false impression of efficacy. Further studies are required to determine the optimum treatment for salicylate poisoning.     

横纹肌溶解综合征误诊为糖尿病酮症酸中毒1例报告及文献复习

目的：分析横纹肌溶解综合征（RM）误诊为糖尿病酮症酸中毒（DKA）的原因,阐明二者引起代谢性酸中毒的机制,提高临床医生对RM和代谢性酸中毒的认识。方法：收集1例以DKA转入本科室后诊断为RM患者的一般情况、临床表现和实验室检查结果,结合国内外文献,分析RM的病因、临床表现、并发急性肾损害（AKI）的治疗方案及预后和本例患者出现RM的病因,探讨RM所致AKI引起的代谢性酸中毒及DKA所致的代谢性酸中毒发生机制和治疗等方面的异同。结果：患者,女性,56岁,因血糖升高15年,乏力、恶心和呕吐4 d入院。查体见患者颜面部水肿,舌质干,皮肤弹性差,心率110 min^-1,四肢重度凹陷性水肿,肌力Ⅳ级。辅助检查提示血清肌酸激酶、肌红蛋白、尿素氮和肌酐水平明显升高,血气分析提示代谢性酸中毒,还存在电解质紊乱及血常规异常。结合病史、症状、体征和各项辅助检查,明确诊断为RM、急性肾衰竭、酸碱平衡失调-代谢性酸中毒并发呼吸性碱中毒及电解质紊乱等,给予大量补液、碱化和保护重要脏器等治疗后,患者临床症状改善,血肌酸激酶、肌红蛋白和肾功能等各项指标较入院时明显好转,预后良好。结论：糖尿病患者可出现多种原因所致的代谢性酸中毒,应注意鉴别。由AKI和DKA所致的代谢性酸中毒在发病机制及治疗上存在差异,临床医生在救治由RM并发AKI所致的代谢性酸中毒时,应尽早给予充足的补液、碱化等有效治疗,以改善患者预后。     

极低体质量儿并发晚期代谢性酸中毒86例分析

目的:探讨极低体质量新生儿（very low birth weight infant,VLBWI）并发晚期代谢性酸中毒的临床特点、治疗方法及预后。方法:选择86例出生时体质量1 000~<1 500 g VLBWI作为研究对象,应用同一样本的对照分析统计法,按照是否出现酸中毒分为酸中毒期和正常期。观察不同时期患儿嗜睡和喂养情况、面色和呼吸改变情况、体质量不增和体温不升情况、血糖升高情况、静脉营养状况、治疗效果和预后。结果:86例患儿主要为发生在出生9~20d的晚期酸中毒,酸中毒期患儿嗜睡和吃奶量减少,面色灰暗、口周发绀、呼吸不规则,血糖升高,体质量不增和体温不升的发生比例均明显高于正常期（P<0.01）。完全/部分胃肠外营养均对发生酸中毒有一定影响,所有酸中毒患儿经1.4%碳酸氢钠治疗后大多缓解。结论:VLBWI易并发晚期代谢性酸中毒,需密切监测其各项体征,部分和全母乳喂养可减低酸中毒的发生,可应用碳酸氢钠早期预防和治疗。     

肝病患者静脉二甘醇中毒的临床特点、实验室检查及影像学表现

目的 总结报道肝病患者静脉二甘醇中毒的临床特点、实验室检查及影像学表现.方法 分析总结15例肝病患者静脉二甘醇中毒的临床特点,比较分析中毒前后的实验室检查结果 及影像学表现.结果 中毒病例均出现少尿型急性肾功能衰竭,平均6 d后出现无尿.13例平均9 d后CO2结合力下降,10 d达谷值,代谢性酸中毒.11例平均9 d后出现胃肠道症状或胃肠道症状加重.10例平均14 d后出现神经系统损害.7例平均6 d后出现低热.14例死亡,原因包括多器官功能障碍综合征、肺部严重感染、消化道大出血.血清肌酐、尿素氮平均5 d异常,11、14 d分别达峰值.血清钙无明显变化,血清磷明显升高.肝功能未见明显变化.白细胞增高,红细胞、血红蛋白降低.7例肺部影像学表现为轻度、中度及重度片状实变影,其中2例胃肠道轻度或重度积气、扩张.结论 肝病患者静脉二甘醇中毒的主要特点为少尿型急性肾功能衰竭、代谢性酸中毒、胃肠道症状或胃肠道症状加重、神经系统损害及低热;中毒病死率93.33%;白细胞增高、贫血;肺部片状实变影;胃肠道积气扩张比肺部轻度片状实变影出现晚,比中度片状实变影出现早.     

The risk of severe salicylate poisoning following the ingestion of topical medicaments or aspirin.

Apart from isolated reports of severe salicylate poisoning after ingesting an unusually large amount of a medicinal oil, there are no published data on the threat arising from attempted suicide with topical medicaments containing methyl salicylate or wintergreen oil compared with aspirin tablets. In this retrospective study, the admission plasma salicylate concentrations and clinical presentations were compared in 80 subjects who had taken aspirin tablets (n = 42) or topical medicaments (n = 38). The proportions of subjects being symptomatic were similar in the two groups. Although the admission plasma salicylate concentrations were generally higher in subjects who had ingested aspirin tablets, the two highest readings (4.3 and 3.5 mmol/1) belonged to two of the subjects who had taken topical medicaments. Because of its liquid, concentrated form and lipid solubility, methyl salicylate poses the threat of severe, rapid-onset salicylate poisoning. The toxic potential of topical medicaments containing methyl salicylate or wintergreen oil should be fully appreciated by both physicians and the general public.     

Treatment of methanol poisoning with ethanol and hemodialysis.

Twelve cases of methanol poisoning are reviewed. The clinical presentation and biochemical features are described and the results of treatment with alkali, ethanol and dialysis reported. The outcome of methanol poisoning appears to be related more to the interval between the time of ingestion and the start of therapy and to the degree of acidosis than to the initial serum methanol level. Therefore, early and aggressive treatment with bicarbonate and ethanol and subsequent institution of hemodialysis are strongly recommended whenever methanol can be detected in the blood, especially when metabolic acidosis of the anion-gap type is present, when mental or visual disturbances are present, or when more than 30 ml of absolute methanol has been consumed.     

急性呼吸窘迫综合征的动态血气监测113例分析

目的：探讨动态监测血气对急性呼吸窘迫综合征（ARDS）的早期诊断,治疗和预后判断的临床意义。方法：回顾分析了我院16年间危重病患者并发ARDS 113例655例次动脉气分析,酸碱紊乱类型和氧合指数（PaO2/FiO2)等资料。结果（1）酸碱失衡类型：113例中单纯酸碱紊乱44例,含呼碱20例,呼酸11例,代酸10例,代碱3例,二重酸碱紊乱53例,含呼碱并代酸12例,呼碱并代碱14例,呼酸并代酸21例,呼酸并代碱6例,三重酸碱失衡（TABD）16例,含呼碱型TABD11例,酸型TABD5例,治愈各组以单纯呼碱（17例＿和呼碱并代碱（12例）等类型多见;死亡组以呼酸并代酸（19例）,TABD（14例）,呼酸（9例）＿等类型多见;（2）氧合指数,113 患者的氧合指数均＜26．7kPa;(3)113例ARDS治愈52例（46．0％）,死亡61例（54．0％）。结论：通过对113例危重患者并发ARDS的血气分析,动态监测血气和计算氧合指数,对ARDS的早期诊断和治疗具有重要的临床价值。而正确分析判断酸碱失衡类型是正确治疗和提高治愈率的重要环节。     

慢性铅中毒3例误诊分析

目的探讨慢性铅中毒误诊的原因。方法对3例慢性铅中毒的病例进行回顾性分析总结。结果2例因呼吸道吸人含铅的烟雾中毒,导致腹痛、轻度贫血为主的临床症状,1例因多次饮用锡壶盛的酒,引起类似冠心病症状为主的铅中毒。结论生活中接触铅的机会很多,而医生询问病史不详细、诊断思路不广,尤其对呼吸道吸入的铅中毒认识不足,对一些铅中毒少见的临床表现容易忽视,易造成误诊误治。     

新生儿呼吸衰竭机械通气前后酸碱失衡临床分析

目的 探讨新生儿呼吸衰竭机械通气前后酸碱失衡的类型及临床特点.方法 对81例呼吸衰竭新生儿机械通气前和机械通气12h后动脉血气进行回顾分析.结果 机械通气前检测动脉血气120次,发生酸碱失衡105次（87.5%）,其中呼吸性酸中毒（呼酸）及呼酸合并代谢性碱中毒（代碱）最常见,分别为38例次（36.2%）及28例次（26.7%）,其它依次为呼酸合并代谢性酸中毒（代酸）17例次（16%）,代酸9例次（8.57%）,呼吸性碱中毒（呼碱）并代酸6例次（5.71%）,呼酸5例次（4.76%）代碱2例次（1.90%）.单纯低氧血症6例次（5.71%）.机械通气后检测血气180例次,发生酸碱失衡104次（57.8%）,其中呼碱36例次（34.6%）最多见,其他依次为呼碱并代酸16例次（15.4%）,代碱14例次（13.5%）,呼酸并代碱12例次（11.5%）呼酸7例次（6.73%）,呼碱并代碱6例次（5.77%）,呼碱并代碱并代酸6例次（5.77%）,代酸5例次（4.81%）,呼酸合并代酸2例次（1.92%）.结论 新生儿呼吸衰竭患儿机械通气前血气以呼酸及呼酸合并代碱最多见,各种原因致通气不足和缺氧状态多引起代酸或双重酸中毒.机械通气后血气以治疗性呼碱、呼碱并代酸多见,医源性三重性酸碱平衡紊乱常被忽视.呼衰患儿合并酸碱失衡是影响呼衰转归的重要因素,在呼吸机治疗期间应定期监测血气,及时调整呼吸机参数,防止过度通气及医源性酸碱平衡紊乱的发生.     

支气管哮喘代谢性酸中毒的探讨

本文研究了31例哮喘住院病人的动脉血气及酸碱紊乱情况。结果表明,约41.9％(13/31)病人发生呼碱。32.3％发生代酸,16.1％发生代酸及9.7％发生呼酸;这些酸碱紊乱多混合存在,以呼碱+代酸出现率最高(8/31)。代酸者紫绀发生率明显高于非代酸者,PaO_2也较低(P<0.05)。心率及紫绀能够反映病人代酸发生情况。我们认为代酸在哮喘病人中并不罕见,可能与多种原因引起的乳酸中毒有关。     

Strychnine poisoning as an unusual cause of convulsions

A fatal case of strychnine poisoning is presented. The patient vomited then suffered a series of tonic convulsions which were triggered by tactile stimulation. In between paroxysms he was initially alert. Eventually the patient became comatosed due to anoxia and had a cardiac arrest. He presented with a marked metabolic acidosis and rapidly developed renal failure caused by acute rhabdomyolysis. This clinical picture is classical for strychnine poisoning and the complications which the intoxication produces. Attention is drawn to the fact that survival can even follow the ingestion of very large doses of strychnine providing there is no delay in diagnosis and treatment.     

Biguanide related lactic acidosis: incidence and risk factors.

The objective of this study was to evaluate in an open population the incidence and risk factors of biguanide related lactic acidosis. All patients currently treated in the Department of Diabetes and Lipid Metabolism of the Instituto Nacional de la Nutrición and their records were reviewed for the present use or history of administration of biguanides. The study was complemented with a revision of all admissions of diabetic patients to the emergency room during 1987-1990. In the outpatient study, 235 cases were included. No case of lactic acidosis was found. A high percentage of the biguanide treated patients had one or more lactic acidosis related risk factors. In the emergency study, 609 admissions of 273 patients were included. In 17 patients a metabolic non-ketotic acidosis was diagnosed. The frequency of non-ketotic acidosis for the different treatments was: 29.4 cases x 1000 emergency admissions for sulphonylurea treated group, 32 for sulphonylurea plus phenformin treated and 47.94 for type II insulin treated patients. All cases had severe precipitant diseases that can cause lactic acidosis with or without associated biguanide administration. No metformin related cases were found. The conclusions of this study are that biguanides in general and metformin in particular are not associated with a high risk of lactic acidosis. Severe systemic dysfunction associated with intercurrent diseases, frequently observed in diabetic patients, is the main determinant for the appearance of lactic acidosis.     

Hyperkalaemic quadriparesis secondary to chronic diclofenac treatment

A 76 year old woman presented with a quadriparesis associated with hyperkalaemia. She had a 10 month history of treatment with oral diclofenac sodium. On admission she had hyperkalaemic metabolic acidosis with a normal anion gap and mild renal impairment. Her weakness resolved after withdrawal of diclofenac and medical correction of her hyperkalaemia. Non-steroidal anti-inflammatory drugs are known to cause hyperkalaemic acidosis and should be used with caution, especially in the presence of renal impairment.     

酒精中毒合并颅脑损伤误诊原因分析

目的探析酒精中毒合并颅脑损伤患者的临床表现及误诊原因。方法选取该院2013年3月—2014年3月符合标准的急性酒精中毒合并颅脑损伤患者16例,对其入院时临床症状既往病史及检查结果等资料进行分析并对误诊情况进行统计并总结。结果 16例病例初始时均拟为急性酒精中毒,最后由颅脑CT确诊并治愈。结论针对急性中毒合并颅脑损伤的患者应进行全面详细的检查并通过药物将乙醇对大脑的影响拮抗后观察其是否存在其他病变,降低误诊率。向家属询问既往史及发病原因的同时,医务人员应对酒精中毒与颅脑损伤间的关系有全面正确的认识,在详细观察病情并完善各项体征及影像学、实验室检查后根据结果进行判断。对提高疾病诊断效率,及时进行治疗,降低患者死亡率并促进其预后恢复具有重要意义。     

Effect of metabolic alkalosis on respiratory function in patients with chronic obstructive lung disease.

Eleven instances of a mixed acid-base disorder consisting of chronic respiratory acidosis and metabolic alkalosis were recognized in eight patients with chronic obstructive lung disease and carbon dioxide retention. Correction of the metabolic alkalosis led to substantial improvement in blood gas values and clinical symptoms. Patients with mixed chronic respiratory acidosis and metabolic alkalosis constitute a common subgroup of patients with chronic obstructive lung disease and carbon dioxide retention; these patients benefit from correction of the metabolic alkalosis.     

肺心病酸碱失衡血气值与SaO2偏移度的临床分析

目的：探讨肺心病不同类型酸碱失衡的SaO2偏移度及其临床意义。方法：为78例肺心病患者测定动脉血气，根据酸碱失衡的不同类型分为9组，应用氧离曲线方程计算出标准SaO2，再用血气实测SaO2-标准SaO2，得出SaO2偏移度，对各血气值及SaO2偏移度进行统计学处理，计算各值的均数及标准差。结果：呼酸，代酸，呼酸并代酸，代酸并呼碱时SaO2偏移度为负值；呼碱，代碱，呼碱并代酸时SaO2偏移度为正值，结论：临床上计算酸碱失衡紊乱时肺心病患者的SaO2偏移度，判定氧离曲线的偏移状，可正确评估重要脏器的真实氧供情况，为临床治疗提供帮助。