新光医院肾脏科主治医师(附件)PPT课件

PLANTPOISONINGinCriticalCare,林秉熙醫師新光醫院腎臟科主治醫師國立陽明大學醫學系講師,LinB.S.,.,2,KeyPoints(1),Therearealargevarietyofplantpoisonsinnaturewithonlyfewspecificantidotes.Acutegastroenteritisisafeatureofmostplantpoisonings.Organicbrainsyndromesarecommon.Supportivecareanddecontamination(gastro-intestinaltractandothers)arethemainstaysoftreatment.,LinB.S.,.,3,KeyPoints(2),Identificationoftheplantisimportantforanticipatingclinicalevents.Inplant-relatedcardiacglycosidetoxicity,antidigoxinFabfragmentsmaybeofuse.Mucosalirritation,renalfailure,andhypo-calcemiacharacterizeplant-relatedoxalatetoxicity.,LinB.S.,.,4,KeyPoints(3),Life-threateningmushroompoisoningstendtohaveadelayofatleast6hpriortotheonsetofsymptoms.Hepatic,renal,orcentralnervoussystemcomplicationsmaydevelop,dependingonthetypeofmushroomingested,LinB.S.,.,5,Hinderedplanttoxicology,Paucityofacutelyillpatients,prospectiveclinicaltrials,andgoodclinicalseriesinplanttoxicologyImmensenumberofuncharacterizedpotentialtoxinsintheplantkingdomImpreciseidentificationoftheoffendingspeciesIdentificationofthetoxinorquantitativebloodlevelsrarelyobtained,LinB.S.,.,6,Benignplantswithacuteillness,SimultaneousingestionofpesticidesAllergicresponse,LinB.S.,.,7,Commonclinicalsyndromes,AcutegastroenteritisAlmostuniversal,eventheonlyfeatureofpoisoningsOrganicbrainsyndromethesecondmostcommonmanifestationoftenseenalongwith,orfollowingthegastroenteritisalterationinmentalstatusmanifestedbydelirium,coma,orseizures,LinB.S.,.,8,GeneralManagement,Stablizedairway,breathingcannotbedetectedbyupto40%ofthepopulation.,LinB.S.,.,45,Cyanogenicplants(5),TreatmentofcyanidepoisoningPromptresuscitationVentilationwith100%oxygenSodiumthiosulfate,25%solution,150mg/kgivGastricdecontamination(larvage)Activatedcharcoaladministration,LinB.S.,.,46,ToxalbuminSyndrome,Castorbean(Ricinuscommunis蓖麻子)Jequiritybean(Abrusprecatorius相思子)Sandboxtree(Huracrepitans)Bellyachebush(Jatrophagossipifolia麻風樹屬)Blacklocust(Robiniapseudoacacia北美刺槐樹)Desertpotato(J.macrorhiza),LinB.S.,.,47,Toxalbumin-containingplants,Abrin,theactivetoxininthejequiritybean,andricin,foundinthecastorbean,areamongthemostpotentnaturaltoxinsknownwhenadministeredparenterally.Ingestionofthesebeansisusuallynotassociatedwithtoxicityunlesstheyarechewed.Extremelyantigenic,causingahypersensitivityreaction,LinB.S.,.,48,Toxalbumin-containingplants,Castorbeantoxicity:acute,severe,gastroenteritisJequiritybeancontainsglycyrrhizin,whichmaycausehyperaldosteronism.Abrinismoretoxicthanwithricin“aslittleasonejequiritybeanwhenchewedcanbelethaltoachild”,LinB.S.,.,49,Toxalbumin-containingplants,Toxiceffectsoftoxalbuminingesion:acute,persistentandseveregastroenteritisencephalopathy:stupor,seizures,andcomamultipleorgansystemfailureinsomecases,withpancreatitis,hepatotoxicity,hemolysis,renalfailure.Inaddition,aprimaryirritantdermatis,LinB.S.,.,50,Toxalbumin-containingplants,Treatment:StandardsupportivecareActivatedcharcoaladministrationTreatseverehemorrhagicgastroenteritisNospecificantidoteavailable,LinB.S.,.,51,ColchicineSyndrome,Autumncrocus(Colchicumautuminate)Glorylily(Gloriosasuperba),LinB.S.,.,52,Colchicinepoisoning,Truebotanicalcolchicinepoisoningisunusual.Theclinicalsyndrome:acutegastroenteritis,maybesevere&hemorrhagicascendingmotorparesis,bonemarrowdepression,rhabdomyolysis,renalfailure,DIC,andARDS,whichisusuallythecauseofdeathOrganicbrainsyndrome:seizuresanddelirium.,LinB.S.,.,53,Colchicinepoisoning,Atropine:antidotaltothegastrointestinaleffectsActivatedcharcoalshouldbeadministeredmultidosesofcharcoalduetoileusinmanypatientsAnticipaterhabdomyolysisandrenalfailurecirculatoryshockdirectnephrotoxiceffectsofthecolchicineCentralvenousorSwan-Ganzmonitoringifneeded,LinB.S.,.,54,Mushroompoisoning,Mushroom-inducedtoxicsyndromes:8groupsThreelife-threateningmushroomsyndromes:Hepatorenalsyndrome,centralnervoussystemabnormalities,renalfailurecausativeagents:cyclopeptides,monomethyl-hydrazine,orelline,andorellanine,LinB.S.,.,55,Mushroompoisoning,Specificmanagementprolongedmultiple-doseactivatedcharcoaltherapyhigh-dosepenicillinGmaybehepatoprotective?transplantationforfulminantamatoxin-inducedhepaticfailure?Monomethylhydrazinepoisoning:administrationofmethyleneblueforsignificantmethemoglobinemiatre