گزارش یک مورد درمان موفقیت آمیز بدنبال مسمومیت با قرص برنج

ﻣﻘﺪﻣﻪ: ﻣﺴﻤﻮﻣﯿﺖ ﺣﺎد ﯾﮏ ﻣﺸﮑﻞ ﺑﺰرگ ﺟﻬﺎﻧﯽ و ﯾﮑﯽ از ﻋﻠﻞ ﻋﻤﺪه ﻣﺮگ و ﻣﯿﺮ اﺳﺖ. آﻟﻮﻣﯿﻨﯿﻮم ﻓﺴﻔﯿﺪ alp ﮐﻪ در اﯾﺮان ﺑﻪ ﻗﺮص ﺑﺮﻧﺞ ﻣﻌﺮوف اﺳﺖ ﮐﺸﻨﺪﮔﯽ ﺑﺴﯿﺎر ﺑﺎﻻﯾﯽ دارد. ﻣﺴﻤﻮﻣﯿﺖ ﺑﺎ alp اﻧﺘﯽدوت ﺧﺎﺻﯽ ﻧﺪارد. ﺑﺎ اﯾﻦ ﺣﺎل، ﻣﻄﺎﻟﻌﺎت ﻗﺒﻠﯽ ﺑﺮﺧﯽ از روشﻫﺎی درﻣﺎﻧﯽ ﻣﺎﻧﻨﺪ ﺷﺴﺘﺸﻮی ﻣﻌﺪه ﺑﺎ ﺑﯽﮐﺮﺑﻨﺎت ﺳﺪﯾﻢ و ﻣﺼﺮف زﻏﺎل را ﭘﯿﺸﻨﻬﺎد ﮐﺮدهاﻧﺪ. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﻪ ﮔﺰارش ﯾﮏ ﻣﻮرد درﻣﺎن ﻣﻮﻓﻘﯿﺖ اﻣﯿﺰ ﻣﺴﻤﻮﻣﯿﺖ ﻧﺎﺷﯽ از ﻗﺮص ﺑﺮﻧﺞ ﭘﺮداﺧﺘﻪ اﺳﺖ. ﻣﻌﺮﻓﯽ ﺑﯿﻤﺎر: ﺑﯿﻤﺎر ﺧﺎﻧﻢ ﺷﺼﺖ ﺳﺎﻟﻪ ﺑﺎ درد ﺷﺪﯾﺪ ﺷﮑﻢ ﺑﻪ اورژاﻧﺲ ﺑﯿﻤﺎرﺳﺘﺎن ﭘﯿﻤﺎﻧﯿﻪ ﺟﻬﺮم ﻣﺮاﺟﻌﻪ ﻧﻤﻮد. در ﻣﻌﺎﯾﻨﺎت ﺑﺎﻟﯿﻨﯽ ﺑﯿﻤﺎر ﻣﺸﺨﺺ ﺷﺪ ﮐﻪ ﺑﯿﻤﺎر ﺑﻪ دﻟﯿﻞ ﻣﺼﺮف ﻗﺮص ﺑﺮﻧﺞ ﺑﺎ درد ﺷﮑﻢ ﻫﻤﺮاه ﺑﺎ ﺗﻬﻮع اﺳﺘﻔﺮاغ ﺑﺪون ﻫﻤﺎﭼﻮری ﻣﻮاﺟﻬﻪ ﺷﺪه اﺳﺖ. در ﻫﻨﮕﺎم ﻣﺮاﺟﻌﻪ ﺑﯿﻤﺎر ﺑﻪ ﻃﻮر ﮐﺎﻣﻞ ﻫﻮﺷﯿﺎر ﺑﻮد و ﻋﻼﯾﻢ ﺣﯿﺎﺗﯽ 110/70 o2sat: 92 _pr: 86_rr: 20_ bp ﺛﺒﺖ ﺷﺪ. ﺑﯿﻤﺎر اﺑﺘﺪا npo ﺷﺪ و ﻟﻮﻟﻪ ﺑﯿﻨﯽ- ﻣﻌﺪه ای ﺑﺮای ﺑﯿﻤﺎر ﮔﺬاﺳﺘﻪ ﺷﺪ و ﺑﻪ ای ﺳﯿﻮ ﻣﻨﺘﻘﻞ ﺷﺪ. 150 ﺳﯽﺳﯽ ﻧﺮﻣﺎل ﺳﺎﻟﯿﻦ ﺑﺎ روﻏﻦ زﯾﺘﻮن از ﻃﺮﯾﻖ ng ﺑﻪ ﻣﺮﯾﺾ داده ﺷﺪ. آﻣﭙﻮل ﭘﻨﺘﻮﭘﺮازول، وﯾﺘﺎﻣﯿﻦ ﺳﯽ،آﻣﭙﻮل اﻧﺪاﺳﺘﺮون، 8 واﺣﺪ اﻧﺴﻮﻟﯿﻦ رﮔﻮﻻر ﺑﻪ ﻫﻤﺮاه دﮐﺴﺘﺮوز واﺗﺮ dw 5% و ﯾﮏ ﮔﺮم ﺳﻔﺘﺮﯾﺎﮐﺴﻮن و ﮐﻠﺴﯿﻢ ﮔﻠﻮﮐﻮﻧﺎت ﺑﻪ ﺑﯿﻤﺎر ﺗﺰرﯾﻖ ﺷﺪ و ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﯿﺰان آﻟﺒﻮﻣﯿﻦ2/8 ﺑﯿﻤﺎر، دو وﯾﺎل آﻟﺒﻮﻣﯿﻦ ﺑﻪ ﺻﻮرت ورﯾﺪی stat و ﺳﭙﺲ ﯾﮏ وﯾﺎل ﻫﺮ 8 ﺳﺎﻋﺖ و ده ﻗﺮص nac ﺑﻪ ﺻﻮرت ﺧﻮراﮐﯽ ﺑﺮای ﺑﯿﻤﺎر درﺧﻮاﺳﺖ ﺷﺪ. ﺑﻪ دﻟﯿﻞ دﻫﯿﺪره ﺑﻮدن ﺑﯿﻤﺎر 3000 ﺳﯽﺳﯽ ﺳﺮم ﻗﻨﺪی - ﻧﻤﮑﯽ ﻫﻤﺮاه ﺑﺎ 40 ﻣﯿﻠﯽ اﮐﯽ واﻻن ﭘﺘﺎﺳﯿﻢ ﮐﻠﺮﯾﺪ ﺑﻪ ﺑﯿﻤﺎر ﺗﺰرﯾﻖ ﺷﺪ. ﺑﺮای ﺑﯿﻤﺎر ﮐﺎﺗﺘﺮ ادراری ﮔﺬاﺷﺘﻪ ﺷﺪ ﮐﻪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ آزﻣﺎﯾﺸﺎت اوﻟﯿﻪ hco3:12/2 _pco2:36/2 _ ph:7/136، 300 ﺳﯽﺳﯽ ﺳﺪﯾﻢ ﺑﯽ ﮐﺮﺑﻨﺎت در 500 ﺳﯽﺳﯽ ﻧﺮﻣﺎل ﺳﺎﻟﯿﻦ در ﻃﯽ دو ﺳﺎﻋﺖ و ﻫﻢ ﭼﻨﯿﻦ 60 ﺳﯽﺳﯽ ﺳﺪﯾﻢ ﺑﯽﮐﺮﺑﻨﺎت در ﻟﯿﺘﺮ ﺑﻪ ﺑﯿﻤﺎر داده ﺷﺪ. در اداﻣﻪ ng ﺑﯿﻤﺎر ﺧﺎرج و ﻃﺒﻖ دﺳﺘﻮر ﻣﺘﺨﺼﺺ ای ﺳﯿﻮ و ﻣﺮاﻗﺒﺖﻫﺎی وﯾﮋه ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ازﻣﺎﯾﺶ vbg ﯾﮏ وﯾﺎل ﺳﺪﯾﻢ ﺑﯽ ﮐﺮﺑﻨﺎت ﺑﺮای ﺑﯿﻤﺎر ﺷﺮوع ﺷﺪ. ﺑﺎ ﺑﻬﺒﻮد وﺿﻌﯿﺖ، ﺑﯿﻤﺎر ﺑﻪ ﺑﺨﺶ ﻣﻨﺘﻘﻞ ﺷﺪ. ﻧﺘﯿﺠﻪ ﮔﯿﺮی: در ﺑﯿﻤﺎران ﺑﺎ ﻣﺴﻤﻮﻣﯿﺖ ﻧﺎﺷﯽ از ﻗﺮص ﺑﺮﻧﺞ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻋﺪم وﺟﻮد اﻧﺘﯽﺑﺎدی اﺧﺘﺼﺎﺻﯽ در درﻣﺎن اﯾﻦ ﮔﺮوه از ﺑﯿﻤﺎران ﻧﯿﺎز ﺑﻪ ﺗﺸﺨﯿﺺ ﺳﺮﯾﻊ و درﻣﺎنﻫﺎی ﺣﻤﺎﯾﺘﯽ ﻣﯽﺑﺎﺷﺪ. ﻧﺘﺎﯾﺞ اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن داد ﮐﻪ ﺗﺨﻠﯿﻪ ﺳﺮﯾﻊ و رﻗﯿﻖ ﺳﺎزی ﻣﺤﺘﻮﯾﺎت ﻣﻌﺪه، ﺗﺠﻮﯾﺰ روﻏﻦ زﯾﺘﻮن، ﺑﯽ ﮐﺮﺑﻨﺎت، ﺗﺜﺒﯿﺖ ﭘﺘﺎﻧﺴﯿﻞ ﻏﺸﺎء ﺳﻠﻮﻟﯽ و ﺳﺎﯾﺮ اﻗﺪاﻣﺎت درﻣﺎﻧﯽ ﻣﯽﺗﻮاﻧﻨﺪ ﺑﻪ ﺧﻮﺑﯽ زﻧﺪﮔﯽ ﺑﯿﻤﺎران را ﻧﺠﺎت دﻫﻨﺪ.

a case report of successful treatment following rice pill poisoning in a 60-year-old woman

introduction: acute poisoning is a major global problem and one of the leading causes of death. aluminum phosphide (alp), which is known as rice pellet in iran, has a very high lethality. alp poisoning has no specific antidote. however, previous studies have suggested some treatments such as gastric lavage with sodium bicarbonate and charcoal consumption. the present study reported a case of successful treatment of rice pill poisoning.introduction of the patient: the patient, a 60-year-old woman, referred to the emergency room of motahhari hospital due to abdominal pain. clinical examination of the patient revealed that the patient had experienced abdominal pain due to vomiting without hematuria due to taking rice pills. the patient was fully conscious at the time of admission and vital signs bp 110/70 _rr 20_pr 86_o2sat 92 were recorded. the patient was first npo and a nasopharyngeal tube was inserted. 150 cc of normal saline with olive oil was given to the patient via ng. pantoprazole_vitamin c ampoule, indasterone ampoule, 8 units of regular insulin with 50% dextrose water and one gram of ceftriaxone and calcium gluconate were injected into the patient.conclusion: in patients with rice pill poisoning due to the lack of specific antibodies in the treatment of this group of patients need rapid diagnosis and supportive therapies. the results of this study showed that rapid emptying and dilution of gastric contents, administration of olive oil, bicarbonate, stabilization of cell membrane potential and other therapeutic measures can save the lives of patients.