Arsenic poisoning in children
Introduction
Introduction to arsenic poisoning in children Arsenic is metallic and its toxicity is extremely low, but its compounds such as oxides, salts and organic compounds are toxic. The compounds that cause arsenic poisoning are mainly arsenic trioxide (commonly known as arsenic), arsenic pentoxide. , arsine, arsenic disulfide (realgar), arsenic trisulfide ( orpiment). The toxicity of trivalent arsenic compounds is stronger than that of pentavalent arsenic. In China, most of the arsenic poisoning is caused by excessive arsenic in drinking water. Pediatric arsenic poisoning is generally caused by excessive dose of arsenic-containing drugs, and can also be caused by inadvertent consumption of arsenic-containing poisonous mice and insecticides. Mother poisoning can cause fetal and milk poisoning. basic knowledge Sickness ratio: 0.001%-0.002% Susceptible people: children Mode of infection: non-infectious Complications: dehydration shock myocarditis coma
Cause
Causes of arsenic poisoning in children
(1) Causes of the disease
Due to the use of drugs containing too much arsenic, eating arsenic-containing insecticides or rodents and fruits contaminated with arsenic, caused by vegetables, mother poisoning can cause fetal and milk poisoning.
(two) pathogenesis
Arsenic is a kind of protoplast, which has a great affinity for the sulfhydryl group of the protein. It can inhibit many sulfur-containing enzymes that play an important role in the metabolic process, causing obstacles in cell respiration and oxidation, interfering with energy metabolism of cells, and damaging capillaries. The blood vessel wall increases permeability.
Soluble arsenic compounds can be absorbed through the digestive tract, respiratory tract and skin. They are distributed throughout the body with blood. The acute poisoning is mainly distributed in the liver and kidney. It is easy to accumulate in hair and nails. It is excreted by urine and feces. The molecular structure of arsenic ions and enzyme protein in the body. The combination of sulfhydryl and hydroxyl groups makes the enzyme inactive, interferes with normal metabolism, causes cell death, damages nerve cells, heart, liver and kidney, and directly damages arterioles and capillary walls, causing organ congestion, bleeding, etc. .
Arsenic hydrogen is the strongest hemolytic poison, which enters the human body through the respiratory tract. After a high concentration of arsine hydrogen enters the human blood circulation, it combines with hemoglobin to form hemoglobin peroxide, which reduces the reduced glutathione in red blood cells and causes acute blood vessels. Internal hemolysis, a large number of hemolysis leading to acute renal failure, in addition, may be associated with liver, heart, brain, lung and other organ damage, inhaled air arsine concentration of 50mg / m3, 1h can be fatal, 30mg / m3 severe poisoning .
Prevention
Prevention of arsenic poisoning in children
When producing arsenic compounds, it should be sealed, recycled, and enhanced to store arsenic compounds, especially arsenic trioxide (arsenic). Its appearance is similar to that of flour and salt. It should be kept by a person to prevent accidental misuse and poisoning.
Complication
Pediatric arsenic poisoning complications Complications dehydration shock myocarditis coma
Dehydration, acidosis and even shock; accompanied by heart, liver, brain, lung and other damage, toxic myocarditis, severe respiratory, circulatory, liver, kidney and other functional failures and central neuropathy, convulsions, coma and other critical signs, The mortality rate is very high.
Symptom
Symptoms of arsenic poisoning in children Common symptoms Abdominal pain, hair loss, thrombocytopenia, hemolytic, dyspnea, dizziness, dehydration, nausea, multiple neuritis
Common gastrointestinal symptoms in the early stage of acute arsenic poisoning, dry mouth, throat, pain, burning, tightness, hoarseness, nausea, vomiting, difficulty in swallowing, abdominal pain and diarrhea, vomit first stomach content, followed by blood Mucus and bile, sometimes mixed with unabsorbed arsenic smear, spit may have a garlic-like odor, severely resembles cholera, begins to drain a large amount of watery stools, and later becomes bloody or rice bran watery, mixed with bloodshot, soon Dehydration, acidosis and shock, but also headache, dizziness, irritability, convulsions, toxic myocarditis, multiple myocarditis, etc., a small number of nosebleeds and skin bleeding, serious sick children can breathe within 24h to several days after poisoning, Circulatory, liver, kidney and other functional failures and central neuropathy, dyspnea, convulsions, coma and other critical signs, a few cases of shock within 20min ~ 48h of shock, and even death, and gastrointestinal symptoms are not significant, patients may have blood The onset of , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Then weak, weak, until completely paralyzed or not paralyzed, wrist sag, foot sag and tendon reflex disappeared; or difficulty swallowing, pronunciation and breathing disorders, due to vasomotor dysfunction, sometimes skin flushing or erythema, chronic Poisoning patients are often weak, loss of appetite, occasional nausea, vomiting, constipation or diarrhea, sclera light yellow staining, kidney pain, severe yellow staining of skin mucosa, white blood cells and thrombocytopenia, anemia, red blood cells and bone marrow cell formation disorders, And hair loss, stomatitis, rhinitis, nasal septum ulcer, perforation, skin pigmentation, palm and heel skin hyperkeratosis, nail tarnish and flat, thin and brittle, white stripes appear, X-ray examination see gastrointestinal There are substances that X-rays cannot penetrate.
Examine
Pediatric arsenic poisoning examination
In case of suspected poisoning, urine and arsenic should be measured, urinary arsenic and arsenic increased significantly.
1. Urine examination of urinary biliary positive, urine routine protein and red, white blood cells.
Urinary arsenic was found to increase urinary arsenic. After acute arsenic poisoning for several hours to 12 hours, urinary arsenic increased significantly >2.67 mol/L (0.2 mg/L, normal urinary arsenic <2.66 mol/L).
2. The normal value of arsenic is 0.025~0.1mg/10g, and after 30h or 2 weeks of oral poisoning, arsenic is >1.33mol/100g (0.1mg/100g).
3. Vomiting arsenic is positive.
4. Blood examination blood test can appear white blood cells, thrombocytopenia, anemia, hemoglobin <60g / L, reticulocytes significantly increased; transaminase increased, bilirubin and urea nitrogen, creatinine increased, blood arsenic increased: blood arsenic >0.1mg/100ml is diagnostic, but blood arsenic has little diagnostic value for arsenic poisoning because the biological half-life of arsenic is only 60h.
5. Bone marrow examination can cause erythrocyte and bone marrow cell formation disorders.
6. Neuroelectromyography shows neurogenic damage, the affected muscles have denervated potential, and the sensory and motor nerve conduction velocity slows down.
7. Electrocardiogram examination of abnormal ECG, common T wave and ST segment changes, suggesting myocardial damage; various arrhythmias may occur.
Diagnosis
Diagnostic identification of arsenic poisoning in children
The diagnosis can be confirmed based on clinical manifestations and laboratory findings.
Severe cases are very similar to cholera, should pay attention to identification; myocardial and central nervous system damage should pay attention to myocarditis and encephalitis, encephalopathy identification.
