Pediatric nitrite poisoning
Introduction
Introduction to nitrite poisoning in children Nitrite poisoning refers to poisoning caused by eating salted meat products with high nitrate or nitrite content, kimchi and spoiled vegetables, or misuse of industrial sodium nitrite as salt. It can also be seen in drinking. Containing nitrate or nitrite bitter water, after the steamer water, nitrite can oxidize the normal oxygen-carrying methemoglobin in the blood into methemoglobin, thus losing oxygen carrying capacity and causing tissue hypoxia. The incidence of nitrite poisoning is acute, and the poisoning is characterized by hypoxic symptoms such as the lips, the tip of the tongue and the fingertips. Severe poisoning can be coma, convulsions, respiratory muscle paralysis, etc. If the rescue is not timely, it can die within 2 hours. This disease is also known as methemoglobinemia, divided into congenital and acquired two major categories. Congenital is caused by defects in erythrocyte-reduced methemoglobin, which is caused by poisoning. Hyper-hemoglobinemia caused by poisoning, including intestinal-induced sputum caused by vegetables, nitrite, sulfonamides, phenacetin, aniline, nitrobenzene and other drugs or chemical poisoning. basic knowledge The proportion of sickness: 0.01% Susceptible people: children Mode of infection: non-infectious Complications: coma
Cause
Causes of nitrite poisoning in children
(1) Causes of the disease
Nitrite is an industrial raw material, and can also be used for food processing. It is a white particle crystal or powder. Its appearance and shape are very similar to salt and sugar. It is often easily poisoned by poisoning. The main causes of nitrite poisoning in daily life are:
1. Inadvertently: Take nitrite as a salt.
2. Ingestion of spoiled vegetables: excessive intake of nitrite-producing vegetables, such as Chinese cabbage, green vegetables, leeks, spinach, etc., or edible salted or nitrite-containing cured meat products, kimchi and not Marinated pickles.
3. Drugs: such as sulfonamides, phenacetin and the like.
4. Drinking bitter well water: Drinking bitter well water with high nitrate or nitrite content, steaming pot water can also cause poisoning.
(two) pathogenesis
Hemoglobin is ferrous iron, which can carry oxygen. 1g hemoglobin can carry 1.34ml of oxygen. When nitrite is poisoned, it is a strong oxidant. After being absorbed by the body, nitrite ions can quickly make hemoglobin ferrous iron. Oxidation to ferric iron, hemoglobin is oxidized to methemoglobin, thereby preventing the oxygen and oxygen release functions of normal hemoglobin, causing tissue hypoxia, leading to organ dysfunction, methemoglobin itself is brownish black, no more than 0.2g in normal human body %, when the blood content is as high as 1.5g%, the skin mucous membrane appears cyanosis. If 20% hemoglobin becomes methemoglobin, clinical hypoxia symptoms occur. If 40% is converted to methemoglobin, the symptoms are serious, and different poisons Can also cause damage to other organs of the body, such as nitrite to expand blood vessels; aniline, nitro can cause hemolysis, etc., thus losing oxygen carrying capacity, when the blood hemhemoglobin > 1.5g%, the skin appears cyanosis, oxidized drugs also Can make hemoglobin into methemoglobin, such as blood methemoglobin up to 20%, clinical hypoxia, up to 40%, severe hypoxia Nitrite can also cause blood vessels to relax in the slippery muscles and cause blood pressure to drop.
Prevention
Prevention of nitrite poisoning in children
1. Fasting and deteriorating, rotten vegetables, cooked vegetables should not be stored for too long, do not eat too much leafy vegetables at a time.
2. Pickles should generally be more than 20 days.
3. Do not use bitter water, steaming pot water to cook rice.
4. Strengthen the management of drugs, and do not abuse drugs.
Complication
Pediatric nitrite poisoning complications Complications
Severe symptoms can occur convulsions, coma.
Symptom
Symptoms of nitrite poisoning in children Common symptoms: fatigue, irritability, diarrhea, nausea, loss of bloating, abdominal distension, shortness of breath, shortness of breath, difficulty in blood pressure
1. Incubation period: 1~3h, the elderly can reach 20h.
2. Acute onset: Sudden onset of skin and mucous membranes showing varying degrees of blue-purple, manifested as hypoglycemia such as lips, tip of tongue, fingertips, cyanosis, etc., without corresponding breathing difficulties, severe headache, dizziness, fatigue, chest tightness, shortness of breath , palpitations, nausea, vomiting, abdominal pain, diarrhea, bloating, etc.
3. Severe poisoning: severe poisoning of poisoning can cause irritability, mental dysfunction, unresponsiveness, loss of consciousness, convulsions, coma, blood pressure, respiratory failure, etc. If the rescue is not timely, it can die within 2 hours.
Examine
Examination of nitrite poisoning in children
Blood methemoglobin content determination, blood sampling is purple-black, shaking in the air does not change color, it will turn red after 5~6h, add 1% sodium cyanide 3 drops into the blood, turn red in 1min, use The spectrophotometer checks that there is an absorption band at 618-630 wavelength, and the absorption band disappears after adding ammonium sulfide or potassium cyanide.
X-ray chest X-ray and ECG examination if necessary.
Diagnosis
Diagnosis and diagnosis of nitrite poisoning in children
The onset is urgent, cyanosis is not proportional to hypoxia, and there is a history of diet and exposure to chemicals, combined with laboratory tests to confirm the diagnosis.
Different from respiratory diseases and acute heart failure, this disease has a history of diet and exposure to chemicals, and hair loss is not proportional to hypoxia. Sudden onset and laboratory tests can help identify.
