葡萄催芽劑中毒

奪命晚餐 4人暴斃 死狀詭異
「沒見過這麼離奇的案子」

2011年 7月7日 蘋果日報  

情殺奪4命 南投神祕中毒大逆轉

2011年 8月23日 蘋果日報  

ETHYLENE CHLOROHYDRIN

Ethylene chlorohydrin, a cellulose ester solvent, is a colorless liquid with an odor resembling a mixture of ethyl alcohol and ether. Ethylene chlorohydrin is used as a solvent in industry. 

In agriculture, it is used to speed up sprouting of potatoes, to treat seeds to inhibit biological activity, and to hasten grape germination.

CLINICAL EFFECTS

SEVERE
Nausea, vomiting, coma, seizures, tachycardia, GI bleeding, metabolic acidosis, hypotension, and respiratory failure. Reported deaths have been due to metabolic acidosis and respiratory failure.

MILD/MODERATE
Nausea, vomiting, tachycardia, tachypnea, weakness, lethargy, transient confusion, sore throat or mouth pain, dizziness, transient hypertension, hypokalemia and transient renal insufficiency.

ONSET
Toxic effects generally develop within 2 hours after exposure.

VITAL SIGNS
Tachypnea, hypotension, and irregular pulse.

CARDIOVASCULAR
Circulatory shock and sinus tachycardia.

RESPIRATORY
Respiratory tract irritation, cough, and respiratory failure, non-cardiogenic pulmonary edema, capillary engorgement, and interstitial hemorrhages of the lungs.

NEUROLOGIC
Incoordination, vertigo, confusion, paresthesias, spastic contracture of the hands, seizures, cerebral edema, giddiness, headache, CNS depression, weak or absent reflexes, paralysis, and mental disturbances.

GASTROINTESTINAL
Nausea and vomiting.

HEPATIC
Liver glutathione depletion, inactivation of drug-metabolizing enzymes, hemorrhage, liver damage, and hepatic necrosis.

ACID-BASE
Metabolic acidosis.

PATIENT DISPOSITION

All symptomatic patients should be admitted to the hospital.
Symptoms may occur within 3 hours of exposure. Symptomatic patients should be monitored for at least 48 hours for level of consciousness, respirations, seizures, and BP.

ORAL/PARENTERAL EXPOSURE

Do NOT induce emesis

GASTRIC LAVAGE
Consider after ingestion of a potentially life-threatening amount of poison if it can be performed soon after ingestion (generally within 1 hour).

ACTIVATED CHARCOAL

SEIZURES
Administer a benzodiazepine IV.
Consider phenobarbital or propofol if seizures recur after diazepam 30 mg (adults) or 10 mg (children > 5 years).
Monitor for hypotension, dysrhythmias, respiratory depression, and need for endotracheal intubation. Evaluate for hypoglycemia, electrolyte disturbances, hypoxia.

ACUTE LUNG INJURY
Maintain ventilation and oxygenation and evaluate with frequent ABG or pulse oximetry monitoring.

HYPOTENSION
Infuse 10 to 20 mL/kg isotonic fluid. If hypotension persists, administer dopamine or norepinephrine

EXPERIMENTAL THERAPY

ETHANOL THERAPY

Ethanol (ETOH) partially inhibits the formation of toxic metabolites.

LOADING DOSE:
Administer 10 mL/kg of 10% ETOH in D5W over 30 minutes.

MAINTENANCE DOSE
Administer 1 to 2 mL/kg/hr of 10% ETOH in D5W by IV infusion. Aim at achieving and maintaining 100 to 130 mg/mL blood ethanol levels.

N-ACETYLCYSTEINE (NAC)

N-Acetylcysteine (NAC) may be helpful to promote resynthesis of glutathione in liver cells and increase conjugation and detoxification.

ORAL NAC DOSING
loading dose of 140 mg/kg followed by 70 mg/kg administered every 4 hours.

IV NAC DOSING
150 mg/kg NAC in 200 ml of D5W administered over 15 minutes followed by 50 mg/kg in 500 ml D5W over the next 4 hours. Finally, 100 mg/kg NAC in 1000 ml D5W over the next 16 hours. 

Reference: 

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Last Modified: May 13, 2011