severe poisoning
Introduction
Introduction Poisoning refers to diseases or deaths caused by excessive or large exposure to chemical poisons (such as lead, iron, zinc, mercury, arsenic, etc.), which cause structural and functional damage and metabolic disorders. Poisoning can cause nausea, vomiting, stomatitis, abdominal pain, diarrhea, hemorrhagic gastroenteritis (or constipation), skin, mucous membrane bleeding, tachycardia and other arrhythmias, elevated blood pressure, liver and kidney damage, hair loss , multiple neuropathic symptoms. Such as headache, lethargy, confusion, hallucinations, convulsions, tremors, convulsions, coma and so on. Severe cases of difficulty breathing, respiratory failure, shock, etc., can die within a few days.
Cause
Cause
1, acute lead poisoning, mostly due to accidental exposure to lead acetate, lead carbonate, lead chromate, tetraethyl lead and breathing dust or soot, steam and skin absorption or oral solvent.
2, iron poisoning, in the iron smelting, alloying and welding process, due to poor ventilation can be inhaled iron oxide dust; can also be due to the treatment of anemia oral iron overdose or accidental iron salt intake of iron.
3. Zinc poisoning, smelting of zinc and its alloys, and manganese, copper, silver, iron, cadmium, lead, arsenic, etc. can produce zinc oxide soot in smelting. Zinc chloride heating can form zinc chloride fumes. In the dye manufacturing and rubber plastics, leather, medicine, textile, ceramics and other industries, there are also opportunities to contact zinc dust and solutions.
4, phenol poisoning, phenol mainly phenol and cresol (coal phenol), coal soap containing 50% of the soap solution, namely coal phenol soap solution (lais to children), have corrosion and mild anabolic effect. It can denature and precipitate cell proteins; it has direct toxic effects on various cells. Mainly inhibits the respiratory, vascular arterial center and body temperature center.
5, mercury poisoning, mercury and its compounds mercury nitrate, thunder mercury, thimerosal, chlorinated high mercury, mercury, mercury chloride, commonly used in chemical, pharmaceutical, pesticides.
6, ammonia poisoning, ammonia is a colorless and irritating alkaline gas. It is mainly used in the refrigeration of leather, dyes, fertilizers, pharmaceuticals and other industries, often inhaled by accidents. When the concentration of ammonia in the air reaches 500-700 mg/m, severe respiratory symptoms can be found. When it reaches 3500-7500mg/m, lightning death can occur.
7, arsenic poisoning, acute poisoning is mainly caused by oral misconception, in addition to individual intentional suicide, more deliberate poisoning, which often causes group poisoning accidents. Inhalation of too much dust in industrial production can also cause poisoning, but it is rare. Arsenic is a kind of cytoplasmic cytotoxicity, which has a strong affinity with the thiol group of protease in the body. It is easy to combine with the sulfhydryl group of pyruvate oxidase to form an enzyme-arsenic complex, which makes the enzyme inactive, affecting cell oxidation and metabolism, leading to cells. Death, damage to the nerves, digestion, respiratory system and organs such as heart, liver, kidney, etc., in addition, can directly damage the capillaries, make it expand and relax, increase permeability, can also paralyze the vasomotor center, leading to capillaries Expansion, wall smooth muscle paralysis.
Examine
an examination
Related inspection
Pupil check blood pressure
1. Clinical manifestations of iron poisoning:
(1) Oral administration of a large number of ferrous salts such as ferrous sulfate and ferric ammonium citrate may cause nausea and severe vomiting after several minutes; the spit is brown or bloody. Severe abdominal pain and diarrhea, discharge a lot of watery or tar-like stools. Severe cases include dehydration, rapid pulse rate, decreased blood pressure, difficulty breathing, pale complexion, cyanotic lips, irritability, cold limbs, and even circulatory failure and coma. At the same time, toxic liver disease can occur, liver, tenderness, mild jaundice, etc.; proteinuria, tubular urine, occasionally hematuria. Oral trivalent iron such as ferric chloride has more gastrointestinal irritation symptoms than ferrous salts.
(2) Metal soot heat may occur 4 to 8 hours after inhalation of iron soot.
(3) Local damage: Ferric chloride and ferric chloride have irritating and corrosive effects on skin and mucous membrane. Can cause conjunctivitis, corneal opacity. Acute pain after skin wounds can cause erosion and necrosis.
2. Clinical manifestations of zinc poisoning:
(1) Metal soot heat: 2 to 8 hours after inhalation of a large amount of zinc oxide dust (usually after work). At the beginning of the mouth, the metal taste, dry throat, thirst, fatigue, chest tightness, cough, followed by chills, high fever, body temperature can reach 39 ° C or higher. With dizziness, headache, joint pain, nausea, vomiting and so on. The fever usually lasts for several hours, and it is hot after a lot of sweating. The entire course of the disease does not exceed 24 hours. Physical examination showed conjunctival, pharyngeal congestion, increased heart rate, and the lungs were audible and dry. Auxiliary examination may have elevated peripheral blood leukocytes. Proteins, sugars, porphyrins and casts appear transiently in the urine. X-ray examination showed no special findings or only increased lung texture.
(2) Chemical pneumonia: Zinc chloride smoke is strongly irritating, and symptoms of bronchial pneumonia such as cough, shortness of breath, chest pressure, post-sternal pain, hemoptysis, etc. appear soon after inhalation. In severe cases, there may be symptoms of pulmonary edema such as difficulty breathing, cyanosis, slightly foamy sputum, and even suffocation due to bronchial mucosal shedding.
(3) Digestive system damage: It is caused by the acid diet or the accidental consumption of zinc salt in the galvanized container. There may be manifestations of acute gastroenteritis such as nausea, vomiting, abdominal pain, diarrhea, etc., severe cases can cause dehydration and shock. Corrosive zinc salts such as zinc chloride can cause burning and pain in the mouth and upper abdomen, pain, urgency and bloody stools. In severe cases, gastrointestinal perforation can cause peritonitis and circulatory failure. It can also be associated with laryngeal edema and central nervous system symptoms.
3. Diagnosis of phenol poisoning:
(1) Toxic inhalation and oral history;
(2) local manifestations: dermatitis caused by skin contact; oral, mouth, throat, esophagus and stomach burning, thirst, nausea and vomiting, abdominal pain, diarrhea, bloody stools. Penetration of phenol in the eye, causing conjunctivitis, keratitis, blindness;
(3) systemic poisoning performance: headache, dizziness, chest tightness, fatigue, slow breathing, body temperature, blood pressure, convulsions, coma, breathing, circulatory failure;
(4) 24-hour urinary phenol > 20-50 mg and help diagnosis.
4. Clinical manifestations of cadmium poisoning:
(1) Inhalation acute poisoning: Inhalation of high-concentration cadmium smoke can immediately cause eye and throat irritation, and the mouth has a metallic taste. Generally, after a period of several hours to 24 hours, there may be symptoms such as sore throat, cough, chest tightness accompanied by pain, gradual increase in difficulty in breathing, fatigue, headache, chills, fever, and muscle and joint pain. Severe cases gradually worsen within 1 to 3 days, acute chemical bronchopneumonia and pulmonary edema occur, and severe cough, massive sputum, difficulty breathing, cyanosis, high fever, can cause respiratory and circulatory failure. The lungs can smell dry and wet. The x-ray film shows that both lungs are scattered in patchy shadows. It usually recovers after two weeks. Occasionally combined with liver and kidney failure. Pulmonary fibrosis can occur in a small number of cases, leaving residual ventilatory dysfunction.
(2) Oral acute poisoning: after taking oral cadmium, symptoms such as nausea, vomiting, salivation, abdominal pain, diarrhea, and urgency after several minutes to several hours may occur, and severe cases may be accompanied by fatigue, headache, sweating, dizziness, sensory disturbance, Muscle soreness, convulsions and other performance. Can collapse due to loss of water. After treatment, it usually recovers within 2 to 3 days.
5. Poisoning symptoms of mercury poisoning:
Acute poisoning by inhalation of mercury vapor through the respiratory tract is characterized by shortness of breath, cough, chills, fever, dyspnea, post-sternal pain, and pharyngeal edema; oral soluble mercury salts can cause burning sensation in the oral mucosa, increased saliva, metallic odor, and sternal rear Upper abdominal pain, vomiting, diarrhea, blood in the stool, pharyngeal edema, and even suffocation, peripheral circulatory failure, and necrotizing nephropathy.
6, the judgment of ammonia poisoning:
There is a history of exposure to ammonia and ammonia, which is easy to judge based on the following symptoms.
(1) Inhalation poisoning: mouth, clothes, nose have a spicy feeling, cough, tears, runny, chest pain, chest tightness, shortness of breath, ammonia smell; even skin erosion, edema, necrosis, pulmonary edema, throat, difficulty breathing, etc. .
(2) Skin contact: visible skin redness, blisters, erosion, keratitis, etc.
7. Clinical manifestations of arsenic poisoning:
(1) Early oral poisoning is characterized by acute gastroenteritis, metallic taste in the mouth, burning sensation in the throat and esophagus, nausea, vomiting, severe abdominal pain and diarrhea. The stool is rice-like and sometimes bloody. Heavy and heavy. Severe vomiting and diarrhea can lead to dehydration and loss of salt, causing thirst, oliguria, fatigue, dizziness, gastrocnemius tendon, etc., in severe cases, shock.
(2) nervous system damage, dizziness, headache, numbness of the mouth, body aches, etc.; severe cases of toxic encephalopathy, manifested as agitation, paralysis, convulsions and coma, can die due to respiratory paralysis. After 3 to 20 days of treatment, some patients may have multiple neuritis and mental disorders, muscle pain, numbness and weakness of the limbs; acupuncture-like abnormalities are prominent manifestations of arsenic-toxic peripheral neuropathy, from the distal end to the proximal end. Centripetal symmetry extends.
(3) Most cases are accompanied by toxic heart, liver and kidney damage, which usually occurs 3 to 7 days after poisoning.
(4) The symptoms of poisoning in small doses of repeated ingestion are similar, but the onset is slow and the symptoms of poisoning are mild.
(5) Inhalation poisoning through the respiratory tract, mainly manifested as respiratory and nervous system symptoms, manifested by cough, chest pain, dyspnea, headache, dizziness, general weakness and irritability; severe convulsions and coma, nausea, vomiting and abdominal pain Symptoms are relatively mild and occur later; severe cases can die from respiratory and vasomotor palsy.
Diagnosis
Differential diagnosis
Serious differential diagnosis of poisoning:
1, iron poisoning: iron poisoning (ironpoisoning) is not uncommon, mostly due to excessive consumption of ferrous sulfate. Infants can be seriously poisoned or even die due to oral administration of ferrous sulfate 40mg ~ 1.5g; larger children have 10 to 15 sugar-coated ferrous pills (0.3g per pill) due to misuse, but also due to cooking in iron pan Acidic fruit causes iron poisoning. Excessive injection of iron can cause severe poisoning.
2. Zinc poisoning: Zinc is an essential trace element in the human body. The normal human body contains 2 to 2.5 g of zinc. However, excessive intake of zinc can also cause poisoning. Acute zinc poisoning is mostly caused by air and water sources, or accidentally caused by a large number of zinc compounds, such as zinc sulfate, zinc acetate, zinc chloride, zinc oxide and the like. The main symptoms are gastrointestinal dysfunction, such as nausea and diarrhea. Inhalation of large amounts of zinc vapor can cause acute metal fumes. Chronic zinc poisoning is rare.
3. Phenol poisoning: Phenol, also known as hydroxybenzene, phenol or carbolic acid, is white needle-like crystal with an unpleasant aroma. Phenol poisoning refers to the strong cracking and corrosion of phenol on skin and mucous membranes, which is absorbed by the skin mucosa and distributed to various tissues, and penetrates into the cells to cause systemic poisoning symptoms. The initial stage of poisoning is pale, wrinkled, softened, and painful; it turns red, brownish black, and is necrotic in severe cases. Acute skin poisoning can cause acute poisoning, headache, dizziness, fatigue, difficulty breathing and other symptoms. Phenol is splashed into the eye and can cause conjunctival, corneal burns or even necrosis if not rinsed with water. Oral phenol can cause burning sensation in the mouth, throat, sternum, severe abdominal pain, vomiting and diarrhea. Long-term inhalation of low concentrations of phenol can cause gastrointestinal symptoms such as nausea, vomiting, loss of appetite and diarrhea. Phenol may also cause allergic dermatitis and eczema.
4. Cadmium poisoning: poisoning caused by cadmium and cadmium compounds. There are acute and chronic poisoning points. Inhalation of cadmium-containing gas can cause respiratory symptoms? Oral intake of cadmium can cause liver and kidney symptoms.
5. Mercury poisoning: Mercury is a silver-white liquid metal that evaporates at room temperature. Mercury poisoning is more common in chronic conditions, mainly in production activities, caused by long-term inhalation of mercury vapor and mercury compound dust. Psycho-neural abnormalities, gingivitis, and tremor are the main symptoms. Acute mercury poisoning occurs when high-dose mercury vapor inhalation or ingestion of mercury compounds occurs. Those who are allergic to mercury may be poisoned even if they are partially coated with a mercury oil base.
6. Ammonia poisoning: Ammonia is a colorless, strongly irritating gas. Soluble in water to form ammonia, can be used as chemical fertilizer. Ammonia can be liquefied by pressurizing at room temperature to form liquid ammonia for transportation. Ammonia is an important chemical raw material. It is widely used in petroleum smelting, fertilizer manufacturing, synthetic fiber and leather. In the manufacturing of medicine, plastics, dyes, etc. In the production, transportation, storage and use of ammonia, if the pipeline, valves, storage tanks, etc. are damaged, leakage of ammonia gas may cause poisoning.
7, arsenic poisoning: often called arsenic poisoning, mostly due to misuse or excessive drug poisoning. Inhalation of powder, smoke or contaminated skin poisoning during production and processing is also common. Arsenic trioxide can be killed by inhalation of 5 to 50 mg orally, 60 to 100 mg.
