误食走马芹致重度中毒

Severe poisoning caused by mistaken ingestion of European waterhemlock root(Radix Archangeliae Decurrentis)

1例61岁男性误食走马芹1 h后出现恶心、呕吐、意识不清伴四肢抽搐,实验室检查示白细胞计数(WBC)21.5×10^9/L,丙氨酸转氨酶(ALT)246-U/L,总胆红素(TBil)35.3-μmol/L,肌酸激酶-MB(CK-MB)20.8-μg/L,乳酸脱氢酶(LDH)525-U/L,血清肌酐(Scr)143-μmol/L,尿酸1-338-μmol/L,血氨45μmol/L。胸部CT示双肺多发磨玻璃密度影。诊断:急性重度走马芹中毒,中毒性脑病,吸入性肺炎,肺水肿。立即给予呼吸机辅助呼吸、镇痛镇静、抗感染、化痰平喘、抑制胃酸分泌、补液水化、促醒、保肝、营养心肌等救治措施,并行2次血液灌流。5 d后患者病情好转,实验室检查示WBC 12.0×10^9/L,ALT 94-U/L,TBil 28.2-μmol/L,CK-MB 2.7μg/L,LDH 452-U/L,Scr 61μmol/L,尿酸514μmol/L,血氨38.0μmol/L。转急诊内科继续治疗。

A 61-year-old man developed nausea,vomiting,unconsciousness,and limb convulsions after 1 hour of mistaken ingestion of European waterhemlock(Radix Archangeliae Decurrentis).Laboratory tests showed white blood cell count(WBC)21.5×10^9/L,alanine aminotransferase(ALT)246-U/L,total bilirubin(TBil)35.3-μmol/L,creatine kinase MB(CK-MB)20.8-μg/L,lactate dehydrogenase(LDH)525-U/L,serum creatinine(Scr)143-μmol/L,uric acid 1-338μmol/L,and blood ammonia 45-μmol/L.Chest compu-ted tomography showed multiple ground glass density lesions in bilateral lungs.The patient was diagnosed as having acute and severe European waterhemlock poisoning,toxic encephalopathy,aspiration pneumonia,and pulmonary edema.The treatments including ventilator assisted breathing,analgesia and sedation,anti-infection,expectorant and antiasthmatic,inhibition of gastric acid secretion,rehydration hydration,promotion of awakening,liver protection,and myocardial nutrition were given.In addition,the patient received 2 times of hemoperfusion.Five days later,the patient′s condition was improved.Laboratory tests showed WBC 12.0×10^9/L,ALT 94-U/L,TBil 28.2-μmol/L,CK-MB 2.7-μg/L,LDH 452-U/L,Scr 61μmol/L,uric acid 514-μmol/L,blood ammonia 38.0-μmol/L.Then the patient was transferred to the Department of Emergency Internal Medicine for further treatment.