急性草酸二甲酯中毒致急性肾损伤四例

Four cases of acute renal injury caused by acute dimethyl oxalate poisoning

目的探讨草酸二甲酯(DMO)中毒致急性肾损伤的临床表现及非透析治疗的方法、疗效及预后。方法于2020年7月,对4例急性DMO中毒患者的职业资料、临床资料、实验室检查结果、治疗方法及病情转归等进行回顾性分析。结果急性事故后现场调查可见工作场所内有大量白色DMO晶体。4例患者同时、短期内接触DMO后急性起病,出现不同程度的乏力、腹胀、腰腹部绞痛及夜尿增多等症状。实验室检查均显示急性肾损伤,起病时患者血肌酐119~835μmol/L。早期予以休息、保护肾功能、水化碱化尿液等治疗,同时均给予百令胶囊治疗。4例患者症状缓解,肾功能完全恢复正常,临床预后良好。结论急性DMO中毒导致急性肾损伤主要以低比重尿、无菌性白细胞尿等肾小管间质病变为主,早期积极治疗,临床短期预后较好。

Objective To investigate the clinical features,non-dialysis treatment and prognosis of acute renal injury caused by acute dimethyl oxalate(DMO)poisoning.Methods Retrospective analysis was performed on the occupational data,clinical manifestation,laboratory examination,treatment methods and prognosis of 4 patients with acute DMO poisoning in July 2020.Results A large number of white DMO crystals were observed in the workplace.Four patients had acute onset,presenting symptoms such as fatigue,abdominal distension,abdominal cramps and nocturia to varying degrees.Laboratory tests all showed acute kidney injury.Serum creatinine of patients at the onset were 119-835μmol/L.Patients were given early treatment including rest,protection of renal function,hydration and alkalization of urine,Bailing capsule.Renal function of 4 patients returned to normal,and clinical prognosis was good.Conclusion Acute DMO poisoning leads to acute renal injury,mainly with renal tubulointerstitial lesions such as hypogravity uria and aseptic leucuria.Active treatment in the early stage has a good short-term clinical prognosis.