■本研究旨在描述泰国蟾蜍中毒患者的临床特征和结局。
■我们在5年期间(2012-2016年)对来自Ramathibodi毒物中心毒性暴露监测系统的蟾蜍中毒患者进行了回顾性研究。
■我们研究了36例蟾蜍毒素中毒的患者。中位年龄为31岁。大多数患者是男性(66.7%),并且摄入了蟾蜍肉(50%)。最常见的表现是胃肠道(GI)症状,中位发病时间为摄入后2小时。12例患者出现心动过缓;7例出现休克,1例出现心脏骤停。在所有患者的初始心电图中,最常见的异常是窦性心动过缓。两名患者在急诊室管理期间(ER到达后15分钟内或摄入后4.5小时内)早期出现心脏骤停。入院期间,一名患者出现窦性心动过缓,和两个发展缓慢性心律失常;然而,三人都很稳定。在任何患者中均未检测到快速性心律失常,例如室性心动过速。一些患者(11.1%)出现高钾血症。7例患者中有5例检测到血清地高辛,范围从0.43到>8ng/mL。大多数患者(75%)入院;住院时间中位数为2d(范围0.5-5d)。总死亡率为8.3%,死亡的三名患者都吃了蟾蜍肉和/或鸡蛋,并出现了心脏骤停。所有患者均接受有/无症状的支持性治疗,包括胃肠道净化,正性肌力药物,心脏起搏,和高钾血症的管理。一名患者因高钾血症接受静脉注射钙,但在钙后未出现心律失常。一名患者接受地高辛特异性抗体片段(DsFab),之后,他在临床上有所改善并出院。
■蟾蜍中毒通常会引起胃肠道症状和心动过缓。然而,在严重的情况下,死亡发生。未观察到快速性心律失常。支持,对症治疗可能是这种中毒的主要疗法,特别是如果DsFab不可用。
UNASSIGNED: This study was performed to describe the clinical characteristics and outcomes of patients with toad poisoning in Thailand.
UNASSIGNED: We carried out a retrospective study of patients with toad poisoning from the Ramathibodi Poison Center Toxic Exposure Surveillance System during a 5-year period (2012-2016).
UNASSIGNED: We studied 36 patients poisoned by toad toxin. The median age was 31 years. Most patients were male (66.7%) and had ingested toad meat (50%). The most common presentation was gastrointestinal (GI) symptoms with a median onset of 2 h after ingestion. Twelve patients presented with bradycardia; seven presented with shock and one with cardiac arrest. In the initial EKGs of all patients, the most common abnormality was sinus bradycardia.Two patients developed cardiac arrest early during management in the emergency room (within 15 minutes after ER arrival or within 4.5 h after ingestion). During admission, one patient developed sinus bradycardia, and two developed bradyarrhythmia; however, all three were stable. No tachyarrhythmias such as ventricular tachycardia were detected in any patient. Some patients (11.1%) presented with hyperkalemia. Serum digoxin was detected in five of seven patients tested, ranging from 0.43 to >8 ng/mL. Most patients (75%) were admitted to the hospital; the median duration of hospitalization was 2 d (range 0.5-5 d). The overall mortality rate was 8.3%, and all three patients that died ate toad meat and/or eggs and developed cardiac arrest. All patients received supportive with/without symptomatic care including GI decontamination, inotropic drugs, cardiac pacing, and management of hyperkalemia. One patient received intravenous calcium for hyperkalemia but did not develop dysrhythmia after calcium administration. One patient received digoxin-specific antibody fragments (DsFab), after which he clinically improved and was discharged.
UNASSIGNED: Toad poisoning commonly caused GI symptoms and bradycardia. However, in severe cases, death occurred. Tachyarrhythmia was not observed. Supportive, symptomatic care might be the main therapies for this poisoning, especially if DsFab is not available.