Two Cases of Acute BASTA Poisoning with Discordant Clinical Courses at Similar Lethal Doses

固殺草中毒引起之回溯型失憶與循環衰竭：二病例報告與文獻回顧

林詩怡(Shih-Yi Lin) ； 郭慧亮(Huey-Liang Kuo)

《Acta Nephrologica》 22卷2期 (2008/06) Pp. 124-127

摘要

固殺草是台灣常見的除草劑。近年來隨著固殺草在農藥市場的佔有率增加，因誤食固殺草或自殺的中毒案例也逐漸增加。然而，台灣固殺草中毒案例的正式報告甚少，且大多僅描述臨床變化；我們提出同時服用固殺草且皆超過致死劑量的兩中毒案例，他們不僅表現固殺草中毒的典型特徵－腸胃道與神經學症狀，也都具有嚴重固殺草中毒導致之循環衰竭，雖然兩案例接受相似的治療，卻有完全相異的臨床反應與結果，我們根據此二案例的臨床表現與文獻的回顧，不僅描述固殺草中毒的臨床特徵，同時我們也討論固殺草其神經與循環系統毒性之治療，根據文獻“固殺章乏神經輿循環毒性告為可逆多數案例僅需支持洽療即可完聖復原，而嚴重循環衰竭的病例可考慮以血液淨化的治療方式。

關鍵字

固殺草 ； 神經毒性 ； 農藥中毒 ； 循環系統衰竭

並列摘要

Accidental or suicidal ingestion of glufosinate ammonium-containing herbicides is not uncommon in Taiwan. This poisoning is characterized by initial gastrointestinal symptoms, followed by various delayed neurological symptoms. In severe cases, patients die of refractory circulators failure. Two female patients (48 and 82 years old) ingested BASTA together in a suicide attempt, roughly estimated at 400 mn1 and 300 ml, respectively. On arrival, they both manifested typical characteristics of BASTA intoxication, involving initial nausea and vomiting followed by seizure and coma. Despite similar treatments, the daughter died of circulatory failure while the mother survived. During recovery, the mother manifested anterograde and transient retrograde amnesia. She was discharyged with fair physical and neurological performance. This case report indicates that the clinical outcomes of BASTA intoxication are not associated with ingested doses, age and initial symptoms. The neurological sequelae and circulatory failure were transient and not necessarily terminal. Hemopurification may be needed to treat the severe circulatory failure of BASTA intoxication.

並列關鍵字

glufosinate ammonium ； neurotoxicity ； poisoning ； herbicide ； cardiovascular toxicity