RESUMO
Paraquat®, or N,N'-dimethyl-4,4'-bipyridinium dichloride, is a bipyridyl compound used as a non-selective herbicide and desiccant that can cause acute poisoning through all routes of exposure. There is no known antidote, and the available treatments are based on avoiding its absorption and timely removing it, in adults and children. We describe a case series of 14 pediatric patients from the department of Cauca, Colombia, with acute intoxication after oral intake of paraquat. Patients were referred to a medium-high complexity hospital in southwestern Colombia and treated according to an institutional protocol for acute paraquat poisoning. Acute paraquat poisoning after oral ingestion is associated with a high mortality rate, even with timely medical attention, as the compound has no known antidote and quickly reaches systemic concentrations for fulminant poisoning. Based on the available literature, our center has proposed a clinical protocol including early standard management, immunosuppressive and antioxidant treatments, and systemic removal techniques. This protocol suggests an adequate approach to acute paraquat poisoning in the pediatric population.
El dicloruro de 1,1'-dimetil-4,4'-bipiridilo (Paraquat®) es un compuesto químico de la familia de las piridinas, utilizado como herbicida no selectivo y desecante. Este compuesto puede causar intoxicación aguda por todas las vías de exposición. En el momento, no hay un antídoto conocido y los tratamientos disponibles, incluidos los pediátricos, se basan en contrarrestar su absorción y propiciar su remoción oportuna. Se describe una serie de casos de 14 pacientes pediátricos, procedentes en su mayoría del departamento del Cauca, con intoxicación aguda por ingestión de paraquat. Los pacientes fueron remitidos y atendidos en un hospital de mediana a alta complejidad en el suroccidente colombiano, con un protocolo institucional para el manejo de la intoxicación aguda por el herbicida. La intoxicación aguda con paraquat por vía oral se asocia con una alta tasa de mortalidad, aún con atención médica oportuna, pues fácilmente se alcanzan concentraciones sistémicas para ser fulminante. Basado en la literatura disponible, el Hospital Universitario San José ha propuesto un protocolo clínico adecuado para la intoxicación aguda por paraquat en población pediátrica que incluye manejo estándar temprano, tratamiento inmunosupresor y antioxidante, y técnicas para su remoción sistémica.
Assuntos
Algoritmos , Herbicidas , Paraquat , Humanos , Paraquat/intoxicação , Criança , Feminino , Masculino , Pré-Escolar , Adolescente , Herbicidas/intoxicação , Intoxicação/terapia , Intoxicação/tratamento farmacológico , Colômbia , Doença Aguda , Lactente , Antioxidantes/uso terapêutico , Protocolos Clínicos , Antídotos/uso terapêuticoRESUMO
La intoxicacioÌn por paracetamol de causa no intencional en niños pequeños, e intencional en adolescentes es un motivo de consulta cada vez más frecuente en los servicios de urgencia. La gravedad y el pronoÌstico de esta intoxicacioÌn están dados por el riesgo de falla hepática. Ante la sospecha de ingesta de paracetamol, se debe conocer el tiempo transcurrido, la cantidad de ingesta del fármaco, estimar la toxicidad de la dosis ingerida para predecir hepatotoxicidad, determinar las medidas de contaminacioÌn necesarias, dosificar paracetamol en sangre y evaluar la necesidad de administración de antídoto. Se describe el caso de una adolescente que con intencioÌn suicida presentoÌ una intoxicacioÌn aguda por paracetamol con riesgo de daño hepático requiriendo decontaminación digestiva, administración de antídoto y abordaje interdisciplinario de sus problemas psicoemocionales.
Paracetamol intoxication due to an unintentional cause in young children, and intentional in adolescents, is an increasingly frequent cause for consultation in emergency services. The severity and prognosis of this poisoning is due to the risk of liver failure. Given the suspicion of paracetamol ingestion, the time passed since the ingestion, the amount of paracetamol ingested, the estimate of the dose ingested to predict hepatotoxicity, we must determine the necessary decontamination measures and the paracetamol dose in blood and evaluate the need to administer a paracetamol antidote. We describe the case of an adolescent who presented acute paracetamol poisoning with risk of liver damage resulting from a suicide attempt and who required digestive decontamination, antidote administration and an interdisciplinary approach to her psychological and emotional problems.
A intoxicação não intencional por paracetamol em crianças pequenas e a intoxicação intencional em adolescentes é um motivo cada vez mais comum de consulta em serviços de emergência. A gravidade e o prognoÌstico desse envenenamento são dados pelo risco de insuficiência hepática. Quando há suspeita de ingestão de paracetamol, o tempo decorrido desde que é ingerido, a quantidade de paracetamol ingerida, a estimação da dose ingerida para predizer hepatotoxicidade, utilizamse para determinar as medidas de contaminação necessárias, dosar paracetamol no sangue e avaliar a ne- cessidade de administração de antídoto. Descrevemos o caso de uma adolescente com intenção suicida que apresentou intoxicação aguda por paracetamol com risco de lesão hepática com necessidade de descontaminação digestiva, administração de antídoto e abordagem interdisciplinar de seus problemas psicoemocionais.
Assuntos
Humanos , Feminino , Criança , Intoxicação/tratamento farmacológico , Carvão Vegetal/uso terapêutico , Acetaminofen/intoxicaçãoRESUMO
Introducción: El uso de productos de limpieza, a expensa de los desinfectantes se ha incrementado por la población mundial como consecuencia de la COVID-19. El manejo frecuente de estas sustancias químicas por las personas puede ocasionar cuadros de intoxicaciones agudas. Esta situación se evidencia en los reportes emitidos por los centros antitóxicos del orbe, donde consta el aumento en el número de consultas toxicológicas. Objetivo: Describir el tratamiento de las intoxicaciones agudas por desinfectantes durante la COVID-19. Métodos: Se realizó una revisión bibliográfica acerca del tratamiento de las intoxicaciones agudas por desinfectantes durante la COVID-19. Se incluyeron artículos escritos en español, inglés y portugués. Además, se abordaron aspectos relacionados con las intoxicaciones agudas por el uso de desinfectantes, el cuadro clínico, así como elementos del diagnóstico y tratamiento de las intoxicaciones agudas por estas sustancias químicas. Conclusiones: Las intoxicaciones agudas por hipoclorito de sodio y geles hidroalcohólicos son las más frecuentes en la población durante la COVID-19 en proporción con el uso de estos productos químicos. La atención médica precoz, eficaz y oportuna disminuirá la posibilidad de aparición de complicaciones. El tratamiento de estás intoxicaciones agudas está en relación con los síntomas y signos que presentan los pacientes al ser recibidos en los servicios de urgencia(AU)
Introduction: The use of cleaning products, at the expense of disinfectants, has increased by the world population as a consequence of COVID-19. Frequent handling of these chemical substances by people can cause acute poisoning. This situation is evidenced in the reports issued by the world's anti-toxic centers, where the increase in the number of toxicological consultations is recorded. Objective: To describe the treatment of acute poisoning by disinfectants during COVID-19. Methods: A literature review on the treatment of acute poisoning by disinfectants during COVID-19 was carried out. Articles written in Spanish, English and Portuguese were included. In addition, aspects related to acute poisoning due to the use of disinfectants, the clinical condition, as well as elements of the diagnosis and treatment of acute poisoning by these chemical substances were addressed. Conclusions: Acute poisoning by sodium hypochlorite and hydroalcoholic gels are the most frequent in the population during COVID-19 in proportion to the use of these chemical products. Early, effective and timely medical care will reduce the possibility of complications. The treatment of these acute intoxications is related to the symptoms and signs presented by patients when they are received in the emergency services(AU)
Assuntos
Humanos , Masculino , Feminino , Intoxicação/tratamento farmacológico , Hipoclorito de Sódio/efeitos adversos , Desinfetantes/intoxicação , Higienizadores de Mão/efeitos adversos , COVID-19RESUMO
In the present study, we aimed to compare the detoxifying effects of two fat emulsions containing either long-chain triglyceride or a mixture of medium-chain and long-chain triglycerides in the propafenone-poisoned rat model. Rats were randomly divided into 3 groups according to the fat emulsions used: long-chain triglyceride-based fat emulsion (LL) group; medium-chain and long-chain triglyceride-based fat emulsion (ML) group; normal saline (NS) group. Propafenone was continuously pumped (velocity=70 mg/kg per h) until the mean blood pressure dropped to 50% of basal level. Then, LL/ML fat emulsions or NS was intravenously infused instantly with a loading-dose (1.5 mL/kg) and a maintenance dose (0.25 mL/kg per min) for 1 h. Subsequently, the propafenone was added to plasma (3.5 µg/mL) in vitro, mixed with three doses of LL or ML (1, 2, or 4%). Finally, after centrifugation, the concentration of propafenone was measured. Rats treated with LL exhibited accelerated recovery, characterized by higher blood pressure and heart rate. Rats in both the LL and ML groups demonstrated decreased propafenone in plasma (time-points: 15, 25, and 60 min). However, rats that received LL showed lower propafenone in myocardial tissue at the end of detoxification treatment. Rats in the ML group had the lowest value of pH, the minimum content of HCO3-, and the highest production of lactic acid at the end. In the in vitro experiments, propafenone decreased more dramatically in the LL group compared to the ML group. Long-chain triglyceride fat emulsion had a better effect on treating propafenone poisoning in rats.
Assuntos
Emulsões Gordurosas Intravenosas/administração & dosagem , Intoxicação/tratamento farmacológico , Propafenona/intoxicação , Triglicerídeos/administração & dosagem , Animais , Modelos Animais de Doenças , Masculino , Ratos , Ratos Sprague-DawleyRESUMO
In the present study, we aimed to compare the detoxifying effects of two fat emulsions containing either long-chain triglyceride or a mixture of medium-chain and long-chain triglycerides in the propafenone-poisoned rat model. Rats were randomly divided into 3 groups according to the fat emulsions used: long-chain triglyceride-based fat emulsion (LL) group; medium-chain and long-chain triglyceride-based fat emulsion (ML) group; normal saline (NS) group. Propafenone was continuously pumped (velocity=70 mg/kg per h) until the mean blood pressure dropped to 50% of basal level. Then, LL/ML fat emulsions or NS was intravenously infused instantly with a loading-dose (1.5 mL/kg) and a maintenance dose (0.25 mL/kg per min) for 1 h. Subsequently, the propafenone was added to plasma (3.5 μg/mL) in vitro, mixed with three doses of LL or ML (1, 2, or 4%). Finally, after centrifugation, the concentration of propafenone was measured. Rats treated with LL exhibited accelerated recovery, characterized by higher blood pressure and heart rate. Rats in both the LL and ML groups demonstrated decreased propafenone in plasma (time-points: 15, 25, and 60 min). However, rats that received LL showed lower propafenone in myocardial tissue at the end of detoxification treatment. Rats in the ML group had the lowest value of pH, the minimum content of HCO3-, and the highest production of lactic acid at the end. In the in vitro experiments, propafenone decreased more dramatically in the LL group compared to the ML group. Long-chain triglyceride fat emulsion had a better effect on treating propafenone poisoning in rats.
Assuntos
Animais , Masculino , Ratos , Intoxicação/tratamento farmacológico , Triglicerídeos/administração & dosagem , Propafenona/intoxicação , Emulsões Gordurosas Intravenosas/administração & dosagem , Ratos Sprague-Dawley , Modelos Animais de DoençasRESUMO
El paraquat (PQ) pertenece al grupo de herbicidas de los bipiridilos. Su presentación es en forma líquida o en granulado, usándose con una concentración al 5 %, para uso en jardinería y al 20 % para uso agrícola. En la intoxicación en humanos el órgano blanco es el pulmón. Los pacientes desarrollan insuficiencia respiratoria que puede explicarse por una inicial actividad que involucra un gran estrés oxidativo, con presencia de radicales libres de oxígeno y peroxidación lipídica, con sus consecuentes daños, además de infiltración por polimorfonucleares que con su reacción de liberación empeoran la neumonitis. Puede haber mejoría de la neumonitis y el daño en algunos órganos, pero pronto la aparición de fibrosis pulmonar lleva a falta de respuesta a la administración de oxígeno y a la muerte por insuficiencia respiratoria en algunos días a semanas. De acuerdo con la cantidad ingerida varía la evolución de la severidad del cuadro clínico. Se presentan dos pacientes pediátricos con intoxicación por PQ, a quienes se les inició tratamiento inmunosupresor después de 48 horas de la exposición. Uno de los pacientes se intoxicó de manera no intencional y otro por suicidio. Los dos pacientes recibieron tratamiento similar, sin embargo, el paciente con intención suicida falleció días después de la exposición. Se hace una revisión de la literatura sobre el tratamiento administrado.
Paraquat (PQ) belongs to the bipyridyls herbicides. Its presentation is liquid or granulated, being used at concentrations of 5 %, in gardening and 20 % in agricultural use. In human poisoning, the target organ is the lung. The patients develop respiratory insufficiency that can be explained by an initial activity that involves a great oxidative stress, with the presence of oxygen free radicals and lipid peroxidation, with its consequent damages, in addition to polymorphonuclear infiltration that with its liberation reaction worsen pneumonitis. There may be improvement of pneumonitis, but the appearance of pulmonary fibrosis will lead to a lack of response to the administration of oxygen and death due to respiratory failure in a few days to a few weeks. According to the amount ingested, the evolution of the severity of the clinical picture varies. We present two pediatric patients with PQ poisoning, who were started on immunosuppressant treatment after 48 hours of exposure. One of the patients was poisoned incidentally and the other one by suicide. The two patients received similar treatment, however, the patient with suicidal intention died days after the exposure. A review of the literature on the treatment offered is made.
Assuntos
Humanos , Pré-Escolar , Criança , Paraquat/intoxicação , Intoxicação/tratamento farmacológico , México/epidemiologiaRESUMO
Introducción: La recepción masiva de intoxicados en los hospitales, derivados de emergencias químicas, se sustenta en postulados teóricos generales de estas emergencias, los siniestros con víctimas en masa y la teoría de los sistemas. Debe tributar al ciclo de reducción de riesgos de desastres. Objetivo: Diseñar una concepción teórica de la recepción masiva de intoxicados derivados de emergencias químicas, para los hospitales, que tribute a las fases de la etapa de respuesta del ciclo de reducción de riesgos de desastres. Métodos: Se realizó una investigación en sistemas y servicios de salud, entre los años 2005 y 2017. Se revisaron y analizaron fuentes bibliométricas e infométricas y se consultaron expertos en el proceso de concreción del resultado, por método de consenso para determinar la pertinencia. Resultados: Se concibió la recepción masiva de intoxicados en los hospitales como un sistema, que asumió cuatro subsistemas: el preparativo, ejecutivo y recuperativo como fundamentales, y el de aseguramiento, para garantizar el funcionamiento de estos. Todos están relacionados entre sí, con dependencia significativa entre ellos. Se caracteriza por ser: flexible, objetivo, participativo, oportuno, aceptable, adecuado y selectivo. Conclusiones: El enfoque sistémico de la recepción masiva de intoxicados en los hospitales como consecuencia de las emergencias químicas, constituye un referente de gran valor teórico para su comprensión integral como fenómeno complejo, su estructura está conformada por cuatro subsistemas: el preparativo, ejecutivo, recuperativo y el de aseguramiento, y tributa a las fases de la etapa de respuesta del ciclo de reducción de riesgos de desastres(AU)
ABSTRACT Introduction: The mass reception of intoxicated people in hospitals, resulting from chemical emergencies, is based on general theoretical postulates of chemical emergencies, mass casualty events and systems theory, which must contribute to the disaster risk reduction. Objective: To design a hospital theoretical conception for mass reception of intoxicated people resulting from chemical emergencies. This conception should contribute to the response phases of the disaster risk reduction. Methods: This is a research on health systems and services conducted from 2005 to 2017. We reviewed and analyzed bibliometric and infometric sources and we consulted experts. To determine the relevance, we focused on the process of result concretion and consensus method. Results: The mass reception of intoxicated patients in hospitals was conceived as a system of four subsystems. The basic are preparatory, executive and recuperative subsystems. The assurance subsystem guarantees the operation. All subsystems relate to each other with significant dependence between them. This system is flexible, objective, participatory, timely, acceptable, adequate and selective. Conclusions: The systemic approach of the mass reception of intoxicated patients in hospitals resulting from chemical emergencies constitutes a valuable theoretical reference for its basic comprehension as a complex phenomenon. Four subsystems structures it: preparatory, executive, recuperative and assurance. It contributes to the response phases of the cycle for disaster risk reduction(AU)
Assuntos
Humanos , Masculino , Feminino , Intoxicação/tratamento farmacológico , Desastres , Incidentes com Feridos em Massa , Emergências , Pesquisa em Sistemas de Saúde PúblicaRESUMO
Pteridium spp., popularmente conhecida como samambaia, comumente encontrada em solos ácidos, arenosos e de baixa fertilidade. A intoxicação ocorre quando os animais passam por privação alimentar ou ingestão acidental. O objetivo deste estudo é relatar a ocorrência de dois casos de intoxicação crônica por samambaia em bovinos na região nordeste do estado do Rio Grande do Sul, Brasil. Ambos os casos cursaram com sinais clínicos de disfagia, halitose, salivação e presença de tumores na orofaringe. A baixa oferta e qualidade de forragem, superlotação das áreas de pasto, manejo inadequado das pastagens, a presença de Pteridium arachnoideum, os sinais clínicos em conjunto com os achados de necropsia e o exame histopatológico confirmaram o diagnóstico de intoxicação crônica.(AU)
Pteridium spp., commonly known as fern, is commonly found in acidic, sandy and low fertility soils. Poisoning occurs when animals go through food deprivation or accidental ingestion. The objective of this study is to report the occurrence of two cases of chronic intoxication in cattle in the northeast region of the state of Rio Grande do Sul, Brazil. Both cases had clinical signs of dysphagia, halitosis, salivation and the presence of tumors in the oropharynx. Low supply and quality of forage, overcrowding of pasture areas, inadequate pasture management, presence of Pteridium arachnoideum, clinical signs, necropsy and histopathological of lesions confirmed the diagnosis of chronic intoxication.(AU)