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Multiorgan dysfunction syndrome due to high-dose cantharidin poisoning:A case report

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World Journal of Clinical Cases 2024年第12期12卷 2074-2078页

作者： Wan-Ling Xu Wen-Jing Tang Wei-Ying Yang Li-Chao Sun Ze-Qun Zhang Wei Li Xiu-Xian Zang Department of Emergency Medicine First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina Department of Chinese Traditional Medicine First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina

BACKGROUND This report delves into the diagnostic and therapeutic journey undertaken by a patient with high-dose cantharidin poisoning and multiorgan dysfunction syndrome(MODS).Particular emphasis is placed on the comprehensive elucidation of the clinical manifestations of high-dose cantharidin poisoning,the intricate path to diagnosis,and the exploration of potential underlying mechanisms.CASE SUMMARY A patient taking 10 g of cantharidin powder orally subsequently developed MODS.The patient was treated with supportive care,fluid hydration and antibiotics,and hemoperfusion and hemofiltration therapy for 24 h and successfully recovered 8 d after hospital admission.Cantharidin poisoning can cause lifethreatening MODS and is rare clinically.This case underscores the challenge in diagnosis and highlights the need for early clinical differentiation to facilitate accurate assessment and prompt intervention.CONCLUSION This article has reported and analyzed the clinical data,diagnosis,treatment,and prognosis of a case of high-dose cantharidin poisoning resulting in MODS and reviewed the relevant literature to improve the clinical understanding of this rare condition.

关键词： Cantharidin poisoning Multiorgan dysfunction syndrome Clinical treatment and management Case report

Severe liver injury and clinical characteristics of occupational exposure to 2-amino-5-chloro-N,3-dimethylbenzamide: A case series

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 186-194页

作者： Meng-Xiao Feng Hua Zou Yuan-Qiang Lu Department of Emergency Medicine The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province Hangzhou 310003China Occupational Health and Radiation Protection Institute Zhejiang Provincial Center for Disease Control and PreventionHangzhou 310051China

Background:The 2-amino-5-chloro-N,3-dimethylbenzamide is a key intermediate in the synthesis of pesticides and pharmaceuticals.However,no literature currently exists on 2-amino-5-chloro-N,3-dimethylbenzamide poisoning in humans.This study aimed to reveal the health hazard of this chemical for humans and summarize the clinical characteristics of patients with occupational 2-amino-5-chloro-N,3-dimethylbenzamide poisoning.Methods:This observational study included four patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning from June 2022 to July 2022.The entire course of the incidents was described in detail.Blood 2-amino-5-chloro-N,3-dimethylbenzamide concentrations were detected by a mass spectrometer.Hema-toxylin and eosin staining was performed to assess liver injury,and immunofluorescence was used to evaluate hepatic mitophagy.Results:The 2-amino-5-chloro-N,3-dimethylbenzamide powder(99%purity)entered the human body mainly via the skin and respiratory tract due to poor personal protective measures.The typical course of 2-amino-5-chloro-N,3-dimethylbenzamide poisoning was divided into latency,rash,fever,organic dam-age,and recovery phases in accordance with the clinical evolution.Rash and fever may be the important premonitory symptoms for further organ injuries.The chemical was detected in the blood of all patients and caused multiple organ injuries,predominantly liver injury,including kidney,myocardium,and micro-circulation.Three patients recovered smoothly after comprehensive treatments,including artificial liver therapy,continuous renal replacement therapy,glucocorticoids,and other symptomatic and supportive treatments.One patient survived by liver transplantation.The postoperative pathological findings of the removed liver showed acute liver failure,and immunofluorescence staining confirmed the abundance of mitophagy in residual hepatocytes.Conclusions:This study is the first to elaborate the clinical characteristics of patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning.The chemical enter

关键词： 2-amino-5-chloro-N,3-dimethylbenzamide poisoning Clinical characteristics Liver injury

Mushroom poisoning Outbreaks — China, 2021

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China CDC weekly 2022年第3期4卷 35-40,I0001-I0003页

作者： Haijiao Li Hongshun Zhang Yizhe Zhang Jing Zhou Yu Yin Qian He Shaofeng Jiang Peibin Ma Yutao Zhang Yuan Yuan Nan Lang Bowen Cheng Mei Wang Chengye Sun National Institute of Occupational Health and Poison Control Chinese Center for Disease Control and PreventionBeijingChina

Summary What is already known about this topic?Mushroom poisoning is one of the most serious food safety issues in China.Most poisoning incidents resulted from eating mushrooms causing gastroenteritis and psycho-neurological disorder from which patients usually could fully recover.Most deaths resulted from species causing acute liver failure and rhabdomyolysis,and the remaining deaths were attributed to acute renal failure and hemolysis.What is added by this report?In 2021,the total number of investigations was 327 from 25 provincial-level administrative divisions,involving 923 patients and 20 deaths,and the overall mortality was 2.17%.Overall,74 poisonous mushrooms causing 6 different clinical syndromes were successfully identified,15 of which were newly recorded in China as poisonous mushrooms.What are the implications for public health practice?Considering the potential huge risks for collecting and eating wild mushrooms,we strongly advise not collecting and eating unfamiliar wild mushrooms.Promoting knowledge about poisonous mushrooms is essential and urgent to reduce mushroom poisonings.Precise species identification timely after mushroom poisoning is important for appropriate diagnosis and treatment.Many deaths were ascribed to delayed hospitalization.

关键词： diagnosis attributed poisoning

Characteristics of poisoning Cases Admitted to Outpatient and Emergency Department—China,2019

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China CDC weekly 2023年第47期5卷 1052-1057页

作者： Xiao Deng Ye Jin Yuan Wang Pengpeng Ye Yuan Yuan Chengye Sun Leilei Duan National Institute for Occupational Health and Poison Control Chinese Center for Disease Control and PreventionBeijingChina National Center for Chronic and Noncommunicable Disease Control and Prevention Chinese Center for Disease Control and PreventionBeijingChina

Summary What is already known about this topic?poisoning constitutes a significant cause of mortality among individuals aged 1 to 44 in China.Nonetheless,the epidemiological understanding of poisoning incidents within... 详细信息

关键词： poisoning mortality Cases

Acute kidney injury due to intravenous detergent poisoning:A case report

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World Journal of Clinical Cases 2022年第6期10卷 2036-2044页

作者： Sungbin Park Hyun-Sik Ryu Jae-Kwang Lee Sung-Soo Park Sun-Jung Kwon Won-Min Hwang Sung-Ro Yun Moon-Hyang Park Yohan Park Department of Internal Medicine Division of NephrologyKonyang University HospitalCollege of MedicineDaejeon 35365South Korea Department of Emergency Medicine Konyang University HospitalCollege of MedicineDaejeon 35365South Korea Department of Internal Medicine Division of Respiratory and Critical Care MedicineKonyang University HospitalCollege of MedicineDaejeon 35365South Korea Department of Pathology Konyang University HospitalCollege of MedicineDaejeon 35365South Korea

BACKGROUND Detergent poisoning mostly occurs through oral ingestion(>85%),ocular exposure(<15%),or dermal exposure(<8%).Reports of detergent poisoning through an intravenous injection are extremely rare.In addition,th... 详细信息

BACKGROUND Detergent poisoning mostly occurs through oral ingestion(>85%),ocular exposure(poisoning through an intravenous injection are extremely rare.In addition,there are very few cases of renal toxicity directly caused by detergents.Here,we report a unique case of acute kidney injury caused by detergent poisoning through an accidental intravenous injection.CASE SUMMARY A 61-year-old man was intravenously injected with 20 mL of detergent by another patient in the same room of a local hospital.The surfactant and calcium carbonate accounted for the largest proportion of the detergent.The patient complained of vascular pain,chest discomfort,and nausea,and was transferred to our institution.After hospitalization,the patient’s serum creatinine level increased to 5.42 mg/dL,and his daily urine output decreased to approximately 300 mL.Renal biopsy findings noted that the glomeruli were relatively intact;however,diffuse acute tubular injury was observed.Generalized edema was also noted,and the patient underwent a total of four hemodiafiltration sessions.Afterward,the patient’s urine output gradually increased whereas the serum creatinine level decreased.The patient was discharged in a stable status without any sequelae.CONCLUSION Detergents appear to directly cause renal tubular injury by systemic absorption.In treating a patient with detergent poisoning,physicians should be aware that the renal function may also deteriorate.In addition,timely renal replacement therapy may help improve the patient’s prognosis.

关键词： Detergents poisoning Intravenous injection Acute kidney injury Acute tubular injury Case report

Clinical analysis of pipeline dredging agent poisoning:A case report

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World Journal of Clinical Cases 2022年第28期10卷 10201-10207页

作者： Ya-Qian Li Guang-Cai Yu Long-Ke Shi Li-Wen Zhao Zi-Xin Wen Bao-Tian Kan Xiang-Dong Jian Department of poisoning and Occupational Diseases Emergency MedicineQilu Hospital of Shandong UniversityJinan 250012Shandong ProvinceChina School of Public Health Shandong UniversityJinan 250012Shandong ProvinceChina School of Nursing and Rehabilitation Cheeloo College of MedicineShandong UniversityJinan 250012Shandong ProvinceChina

BACKGROUND Pipeline dredging agents are new household deep cleaning products used to dredge blockages in kitchen and bathroom pipeline caused by grease,hair,vegetable residue,paper cotton fibre,and other organic substances.Pipeline dredging agents are corrosive chemicals that can cause poisoning through corrosive damage to the digestive tract;however,this has not been reported clinically.Therefore,this report emphasises that oral pipeline dredging agent poisoning can cause corrosive damage to the digestive tract and may have serious health consequences.CASE SUMMARY A 68-year-old man consumed liquor(200 m L) at approximately 13:00 on April 22,2021.At approximately 16:00,his family found him unresponsive with blackened lips,blood spots in the corners of the mouth,and blood stains on the ground,as well as an empty bottle of a pipeline dredging agent.One hour later,he was admitted to the emergency department of a local hospital.Considering the empty bottle,he was suspected to have sustained severe corrosive damage to the digestive tract and was transferred to our department at 23:15 on April 22,2021.He developed dysphagia and intermittent fever and experienced difficulty in opening his mouth throughout his hospital stay.The patient’s condition gradually stabilised.However,he suddenly developed respiratory failure on day 12,and endotracheal intubation and ventilator-assisted ventilation were performed.However,the patient died after 1.5 h despite emergency rescue efforts.CONCLUSION Pipeline dredging agents are highly corrosive and may cause corrosive damage to the digestive tract and asphyxia upon consumption.

关键词： Asphyxia Digestive tract injury Pipeline dredging agent poisoning Respiratory failure Case report

Twelve family members with tetramine poisoning after consumption of vegetables grown in polluted soils

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World Journal of Emergency Medicine 2023年第3期14卷 250-252页

作者： Yan-qing Liu Xiao-xia Lu Chun-yan Wang Ming-fei Peng Xiao-bo Peng Yun Jiang Le-xin Zheng Dan-dan Yuan Xi-gang Zhang Ze-wu Qiu poisoning Treatment Department Senior Department of Hepatologythe Fifth Medical Center of PLA General HospitalBeijing 100071China

The main toxic component of tetramine is tetramethylenedisulfotetramine(TETS).It is a sulfonamide derivative without special antidote,tasteless and tasteless,with high toxicity and high mortality.[1]It was first discovered by a German scientist Hagen in 1949.Although its use has been banned worldwide due to its high toxicity and mortality rate,it is still available in certain countries and has led to cases of intentional and unintentional poisoning.Tetramine blocksγ-neurons,leading to dizziness,fatigue,nausea,vomiting,convulsions,and other symptoms.[2-4]Due to the lack of recognized effective antidotes,many poisoned people suff ocate and die as a result of continuous spasms of the respiratory muscles.[5-7]Tetramine poisoning sometimes occurs,but it is rare for vegetables grown in tetraminecontaminated soil to cause group poisoning after being eaten.

关键词： mortality poisoning vegetables

Repeated atrial arrhythmia induced by cochineal red poisoning:A case report

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World Journal of Clinical Cases 2023年第34期11卷 8184-8191页

作者： Hao Yang Yu-Jiao Wang Bao-Ping Xu Huai-Wen Peng Qing Xu Huai-Bin Yu Department of Intensive Care Unit Anhui Zhongke Gengjiu Hospital Affiliated To Anhui Medical UniversityHefei 230000Anhui ProvinceChina Graduate School Anhui University of Chinese MedicineHefei 230031Anhui ProvinceChina Department of Intensive Care Unit Traditional Chinese Hospital of Lu’an affiliated to Anhui University of Traditional Chinese MedicineLu’an 237000Anhui ProvinceChina

BACKGROUND Cochineal red is an organic compound widely used in food,cosmetics,pharmaceuticals,textiles,and other fields due to its excellent safety profile.poisoning caused by eating foods containing cochineal red is rare,and repeated atrial arrhythmia due to cochineal red poisoning is even rarer.CASE SUMMARY An 88-year-old Asian female patient was admitted to hospital due to a disturbance of consciousness.Twelve hours prior to presentation,the patient consumed 12 eggs containing cochineal red over a period of 2 h.At presentation,the patient was in a coma and had a score of 6 on the Glasgow Coma Scale(E2+VT+M4).The patient’s skin and mucous membranes were pink.Electrocardiography(ECG)revealed rapid atrial fibrillation without any signs of ischemia.We prescribed cedilan and fluid replacement for arrhythmia correction.Shortly after admission,the atrial fibrillation corrected to a normal sinus rhythm.On the day 2 of admission,the patient had a sudden atrial flutter accompanied by hemodynamic instability and rapidly declining arterial oxygen saturation between 85%and 90%.The sinus rhythm returned to normal after two electrical cardioversions.Six days after admission,the skin color of the patient returned to normal,and the ECG results were normal.The patient was transferred out of the intensive care unit and eventually discharged after 12 d in hospital.At the 2-mo follow-up visit,the patient was in good health with no recurrence of arrhythmia.CONCLUSION Although cochineal red is a safe,natural food additive,excessive consumption or occupational exposure can induce cardiac arrhythmias.

关键词： Cochineal red poisoning Cardiac arrhythmias Atrial fibrillation Atrial flutter Case report

Acute diquat poisoning case with multiorgan failure and a literature review:A case report

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世界临床病例杂志 2023年第27期11卷 6565-6572页

作者： Chun-Yang Fan Chen-Guang Zhang Peng-Shu Zhang Yu Chen Jian-Qiang He He Yin Xiao-Jie Gong Emergency Department Beijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijing 102218China

BACKGROUND With the withdrawal of paraquat from the market,diquat is widely used,so the treatment of diquat poisoning has become one of the focuses of emergency poisoning diagnosis and treatment.CASE SUMMARY We studied the case of a 17-year-old male patient who drank 200 mL(20 g/100 mL)of diquat solution two hours before arriving at the hospital.Despite the use of treatments such as gastric lavage,hemoperfusion,continuous hemodialysis,glucocorticoids,and organ support,the patient’s condition rapidly progressed to multiorgan failure,and he died 23.5 h after admission.CONCLUSION We summarized the clinical characteristics and treatment strategies of diquat poisoning through this case and performed a literature review to provide a basis and direction for clinical treatment.

关键词： Diquat poisoning Multiorgan dysfunction Treatment Case report