Ethylene Glycol Intoxication-A Challenge for Emergency Physicians

乙二醇中毒－急診醫師的挑戰

郭峻廷(Chun-Ting Kuo) ； 陳進明(Chin-Ming Chen)

《Journal of Emergency Medicine, Taiwan》 7卷1期 (2005/03) Pp. 30-34

摘要

急性神智改變是急診醫師的一大挑戰。急性發生的狀況常不容易取得病史，有時連理學都想當困難的檢查。乙二醇是工業常用到的機溶劑，日常生活中並不常見。多數的中毒個案為誤食。本文報告一位八十歲男性，曾在入院前一年因為硬腦膜下出血接受過手術，之後便有痴呆的現象，有隨意取物進食的習慣。入院當天，家屬發現病患倒臥在地上，神智不清，立即送醫。到醫院後，經檢查並未發現有腦部的病灶，血液學以及生化學檢查，還有初步的毒物篩檢都呈現陰性反應。之後因為病患漸出現呼吸困難現象，由酸血症以及高陰離子隙的變化，懷疑是無法測得的乙二醇中毒，而給予酒精以及血液透析治療。經過四次的血液透析治療，病人逐漸康復，神智也恢復正常。對於一個原本就不是很容易溝通的病患，懷疑有中毒的可能性，同時無法找出中毒的種類時，動脈血氧分析是一必要的篩檢檢驗。

關鍵字

急性神智改變 ； 乙二醇中毒 ； 嚴重酸血症 ； 血液透析 ； 酒精治療

並列摘要

Patients arriving with abruptly altered mental status are challenging for emergency physicians. One reason is because it is difficult to obtain detailed and correct history and sometimes even physical examinations can not be perform without the cooperation of the patients. To our knowledge, ethylene glycol is mainly an industrial solvent. Most cases involve mistakenly swallowing the substance, which diminishes the clues for diagnosis. We present an 80-year-old man who had a craniotomy 1 year before visiting our emergency department due to subdural hematoma. Dementia and bizarre behavior, like pica, was noted. When he was sent to the hospital, he was lying on the ground with an altered state of consciousness. Toxicology screen revealed negative findings. He was found to have a deep and rapid respiratory pattern. High osmolar and high anion gas metabolic acidosis were found. Alcohol and four applications of hemodialysis were given. After which, he restored consciousness and metabolic acidosis was resolved. From this case, we learned that the toxicology screen is the too basic to detect a patient with suggested ethylene toxicity. To rule out the possibility of ethylene toxicity, arterial blood gas is a good tool to determine abnormal signs in the blood.

並列關鍵字

altered consciousness ； ethylene glycol intoxication ； metabolic acidosis ； hemodialysis ； alcohol antidote