Amanitin-containing mushroom poisoning is one of the most harmful and lethal types of mushroom poisoning events. Its basic medical and clinical medical knowledge has not been fully understood and mastered, so the basic and clinical diagnosis and treatment of amanitin-containing mushroom poisoning has always been a hot research field of acute mushroom poisoning. This article focuses on the new progress in the epidemiology, toxicological properties, poisoning mechanism, clinical diagnosis and treatment of amanitin-containing mushroom poisoning, in order to provide the basis for further study, diagnosis and treatment of amanitin-containing mushroom poisoning for basic researchers and clinical medical staff.
Poisoning is a frequent reason for patients to seek emergency medical attention, and in severe cases, it can result in severe cardiac disease or cardiac arrest. American Heart Association published the guideline for the management of patients with cardiac arrest or life-threatening toxicity due to poisoning in Circulation on September 18, 2023. Based on the literature, this article interprets the suggestions related to neurotoxic substances in this guideline, mainly involving the clinical management of benzodiazepines, opioids, cocaine, local anesthetics, and sympathomimetic substances poisoning. By interpreting the recommended points of the guide in detail, it is hoped that it will be helpful for the diagnosis and treatment of readers.
A 49-year-old male patient with compartment syndrome of the right leg caused by acute carbon monoxide poisoning was admitted on December 30, 2019. The patient had a 10-year history of chronic nephritis and began dialysis treatment due to renal failure 1 month ago. Emergency surgical decompression for compartment syndrome was performed after admission. Two weeks later, the patient was diagnosed as the novel coronavirus pneumonia caused by 2019 novel coronavirus (2019-nCoV) infection. Then, the patient was transferred to the isolation ward, where he was given anti-infection, anti-virus, expectorant, heat-clearing and detoxifying drugs, bedside dialysis, and nutrition support symptomatic treatment. After 2 weeks of treatment, the patient is getting better, with no fever, cough, wheezing, and other discomfort. Meanwhile, the sensory and motor functions of right lower limb recovered gradually. This case is rare, severe, and difficult to diagnose and treat. It is the first reported case of novel coronavirus pneumonia after orthopedic surgery.
Objective To explore the risk factors of nosocomial pulmonary infection in acute pesticide poisoning. Methods The clinical data of patients with acute pesticide poisoning hospitalized in the Emergency Department of the First Affiliated Hospital of Wannan Medical College and the Second Affiliated Hospital of Wannan Medical College between January 1, 2021 and September 30, 2023 were retrospectively analyzed. Patients were divided into pulmonary infection group and non-pulmonary infection group according to whether they had pulmonary infection during hospital. Multiple logistic regression was used to analyze the independent risk factors of nosocomial pulmonary infection in patients with acute pesticide poisoning, and a risk prediction model (nomogram) was constructed. The predictive efficacy of nomogram and independent predictors in nosocomial pulmonary infection were analyzed by using the receiver operating characteristic curve. Calibration curve and decision curve were used to evaluate the differentiation and clinical application value of the model. Results A total of 189 patients with acute pesticide poisoning were included in the study, with an average age of (58.12±18.45) years old, 98 males (51.85%) and 91 females (48.15%). There were 36 cases (19.05%) of pulmonary infection. Multiple logistic regression analysis showed that age [odds ratio (OR)=1.030, 95% confidence interval (CI) (1.001, 1.060), P=0.040], type 2 diabetes mellitus [OR=2.770, 95%CI (1.038, 7.393), P=0.042], ischemic cerebrovascular disease [OR=3.213, 95%CI (1.101, 9.376), P=0.033], white blood cell count [OR=1.080, 95%CI (1.013, 1.152), P=0.019], activities of daily living score [OR=0.981, 95%CI (0.965, 0.998), P=0.024] were independent predicting factors for nosocomial pulmonary infection in acute pesticide poisoning. The area under the curve of nosocomial pulmonary infection in patients with acute pesticide poisoning predicted by nomogram based on the above factors was 0.813 (P<0.001). The calibration curve showed that the prediction probability was consistent with the actual occurrence probability (P=0.912), and the decision curve showed that the nomogram had good clinical application value. Conclusions Age, activities of daily living score, type 2 diabetes mellitus, ischemic cerebrovascular disease, and white blood cell count are independent predictors of nosocomial pulmonary infection in acute pesticide poisoning. The nomogram constructed based on them has good differentiation and consistency, which can provide basis for early identification and intervention of clinical staff.
ObjectiveTo explore the effects of small dose and low pressure lavage on gastrointestinal hemorrhage induced by acute poisoning.
MethodsWe collected the clinical data of all the patients diagnosed as gastrointestinal hemorrhage induced by acute poisoning treated between January 2011 and December 2012. The patients were divided into two groups: control group and treatment group, according to the different treatments they underwent. The control group received traditional treatment only, while the treatment group received small dose and low pressure lavage as well as the traditional treatment. After recording the ages, poisoning dose, pretreatment time, shock and complications, we evaluated the risk of death by calculating ROCKALL scores.
ResultsThe differences of ages, sexes, and poisoning dose between these two groups were not significant. However, the death rate in high and middle risk patients of the treatment group was significantly lower than that of the control group (P<0.05).
ConclusionThe small dose and low pressure lavage can improve the prognosis of the gastrointestinal hemorrhage induced by acute intoxication.
Objective To explore the treatment methods for group Amanita exitialis poisoning, and summarize the treatment strategies for group Amanita exitialis poisoning. Methods A group of Amanita exitialis poisoning patients admitted to the Department of Emergency Medicine of the Affiliated Hospital of Yunnan University on July 31, 2023 were retrospectively included. We graded the patients’ condition and analyzed their clinical data, treatment methods, and blood purification selection modes. Results A total of 6 patients with Amanita exitialis poisoning were included, with an average age of 52 years. There were 2 patients with grade Ⅰ, 2 patients with grade Ⅱ, 1 patient with grade Ⅲ and 1 patient with grade Ⅳ. Grade Ⅰ patients choosed single one mode hemoperfusion (HP), grade Ⅱ patients choosed single multiple mode HP, grade Ⅲ patient choosed multiple mode HP combined with plasma exchange, and grade Ⅳ patient choosed multiple mode HP combined with plasma exchange, double plasma molecular adsorption system and continuous renal replacement therapy. After individualized comprehensive treatment, 5 patients were cured and discharged, and 1 patient died. Conclusions In the treatment of group Amanita exitialis poisoning, in addition to basic drug treatment, it is necessary to first consider factors such as the side effects of blood purification and the economic conditions of the patient. Then, according to the different disease grades of the patient, single or combined blood purification, single or multiple treatment modes can be choosed. Early selection of appropriate individualized blood purification modes can effectively buy time for poisoning patients.
Acute carbon monoxide poisoning is a common and frequently occurring disease in winter and spring in China, with high disability and mortality. Delayed encephalopathy is a serious sequela after the pseudo-convalescence. Its mechanism is complex, including environmental and genetic factors, hypoxia and energy metabolism disorder, cytotoxicity and oxygen free radical damage, immune disorder and inflammatory activation, neurotransmitter disorder, brain parenchymal changes, vascular and hemorheological abnormalities, calcium overload, and cell apoptosis. At present, methods for predicting delayed encephalopathy in acute carbon monoxide poisoning include detailed inquiry of medical history, laboratory examination of relevant indicators, electrophysiological examination, brain imaging examination, and evaluation scale prediction. This review summarizes the research status of the pathogenesis and early prediction methods of delayed encephalopathy in acute carbon monoxide poisoning, with a view to providing reference for future research directions.
Delayed encephalopathy due to acute carbon monoxide poisoning (DEACMP) is a serious complication of acute carbon monoxide poisoning. Patients with DEACMP often present with cognitive impairment, abnormal mental behavior, extrapyramidal system symptoms, pyramidal system symptoms, and may also have focal cortical dysfunction, which is closely related to the poor prognosis of the patients. Current research shows that the occurrence of DEACMP is related to multiple factors such as immune disorders, and glucocorticoids can exert certain therapeutic effects through immunosuppression. This article reviews the risk factors of DEACMP, the clinical research progress and possible mechanisms of glucocorticoid treatment for DEACMP, providing more references for the clinical treatment of DEACMP.
Objective To formulate an optimal treatment for patients with acute organophosphorus pesticide poisoning through the evidence-based approach. Methods Based on the clinical questions raised from a real-life patient of acute organophosphorus pesticide poisoning (OP poisoning) in Emergency ICU (EICU), we searched ACP journal club (1991-April, 2006), The Cochrane Library (Issue 1, 2006), MEDLINE (1966-May 2006) and Chinese Biological Medical Database(1978-May 2006) for systematic reviews , clinical randomized controlled trials, cohort and case-control studies using the keywords of “organophosphorus compounds, poisoning, insecticides, oximes, cholinesterase reactivators, and intermediate syndrome”. The quality of the included studies was assessed. Results One Cochrane systematic review and one meta-analysis were included. These two studies concluded that there was no clear evidence on the benefits of oximes for acute organophosphorus pesticide poisoning. Based on the current evidence, integrated with clinical expertise and the patients’ values, the oximes were not used for this patient, only low-dose atropine was administered with other supportive therapies. After one week of treatment, the patient was discharged since her vital signs were stable and clinical symptoms were relieved. Conclusions The appropriate management for acute organophosphorus pesticide poisoning has been formulated with the approach of evidence-based medicine. Large-scale, methodologically-sound trials are required.
Acute poisoning is characterized by a sudden and rapid onset, most poisons lack specific antidotes. Even with the full use of blood purification, mechanical ventilation, and various drugs, it is often difficult to change the fatal outcome of critically ill patients. In recent years, extracorporeal membrane oxygenation (ECMO) has gradually gained attention and exploratory application in the treatment of acute poisoning due to its significant cardiopulmonary function support, veno-venous ECMO is used for severe lung injury after poisoning, acute respiratory distress syndrome and respiratory failure due to ineffective mechanical ventilation, and it can also be used to assist the removal of residual poisons in the lungs. Veno-arterial ECMO is commonly employed in patients with circulatory failure following poisoning, fatal cardiac arrhythmias, and arrest of cardiac and respiratory. The application of veno-arterio-venous ECMO has also been reported. The mode of ECMO necessitates timely adjustments according to the evolving illness, while ongoing exploration of additional clinical indications is underway. This review analyzes and evaluates the application scope and effectiveness of ECMO in acute poisoning in recent years, with a view to better exploring and rationalizing the use of this technology.
