PDF(Pubmed)
Abstract：
Central and autonomic nervous system signs of organophosphate poisoning (OP), such as altered consciousness, noticeable lacrimation, and salivation, can be influenced by medications used in intensive care settings, such as atropine and pralidoxime methyl (PAM). Because of this, there are no established methods for assessing the duration of OP while receiving antidotal treatment. In the present case, we used the Neurological Pupil Index (NPi) to evaluate the duration of OP in an 82-year-old woman who attempted suicide by ingesting up to 100 mL of fenitrothion. Until hospitalization day (HD) 20, discontinuation of atropine led to the recurrence of altered consciousness, while its reinstatement resulted in improvement; this made it difficult to assess the prolongation of OP based on signs and symptoms. Until HD 20, the NPi remained at 0/0, and subsequently, it increased. Additionally, even after discontinuing atropine, consciousness, tearing, and salivation did not worsen, indicating recovery from OP. On HD 26, serum acetylcholinesterase (AChE) levels were elevated above the measurable level for the first time, following an increase in the NPi. In this case, assessing the persistence of OP based on signs was challenging because these signs improved with atropine and PAM treatment. The improvement in NPi levels coincided with an improvement in poisoning, suggesting that NPi is useful for evaluating the duration of OP. NPi is noninvasive and sensitive compared to AChE, which is used to gauge the persistence of OP and could be used to allow earlier cessation of medication and guide appropriate treatment durations.
摘要：
有机磷中毒（OP）的中枢和自主神经系统的迹象，比如意识改变，明显的流泪，和流涎,可能会受到重症监护环境中使用的药物的影响，如阿托品和甲基吡肟（PAM）。正因为如此,目前还没有确定的方法来评估接受解毒治疗时OP的持续时间.在目前的情况下,我们使用神经瞳孔指数(NPi)来评估一名82岁女性的OP持续时间,该女性通过摄入最高100mL的杀尼特硫磷试图自杀.直到住院天数（HD）20，停用阿托品导致意识改变的复发，虽然其恢复导致改善;这使得难以根据体征和症状评估OP的延长。直到HD20，NPi保持在0/0，随后，它增加了。此外,即使在停用阿托品之后,意识,撕裂,流涎并没有恶化,指示从OP恢复。在HD26上，血清乙酰胆碱酯酶（AChE）水平首次高于可测量水平，随着NPi的增加。在这种情况下,根据体征评估OP的持续性具有挑战性,因为阿托品和PAM治疗改善了这些体征.NPi水平的改善与中毒的改善相吻合，这表明NPi对评估OP的持续时间很有用。与AChE相比，NPi是无创和敏感的，用于评估OP的持久性，可用于允许更早停止药物治疗并指导适当的治疗持续时间。
