4회의 면역 억제제 펄스 치료로 생존한 치명적 농도의 파라캇 중독 1예
Successful Management of Fatal Paraquat Poisoning with Four Courses of Steroid and Cyclophosphamide Pulse
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초록
저자들은 치명적인 혈중 파라캇 농도(10.4 µg/mL)를 보여주면서 다발성장기부전 및 폐 섬유화에 의한 저산소증이 병발하여 생존 가능성이 극히 희박했던 중증 파라캇 중독 환자에서 골수기능억제가 나타날 정도까지 선제적이고 적극적으로 4차례의 스테로이드와 시클로포스파미드 펄스 면역 억제치료를 반복하였고, 치료 경과 중 면역 억제제로 인한 심각한 골수기능억제와 감염 등의 합병증이 발생하였으나 포기하지 않고 적극적인 치료를 시행하여 환자를 생존시켰기에 문헌고찰과 함께 보고하는 바이다.
Abstract
Although severe paraquat poisoning is fatal, intensive immunosuppression can be successful in selected patients. We report the case of a 33-yr-old patient who was poisoned by paraquat and developed multi-organ failure, progressive hypoxemia, and pulmonary fibrosis. The patient was successfully treated with four courses of immunosuppressive pulse therapy. The patient presented to the hospital 2.5 hours after ingesting 2 mouthfuls of paraquat. The serum level of paraquat was 10.40 µg/mL at 3 hours and 3.36 µg/mL at 10 hours after ingestion, which is predictive of a fatal outcome. The first course of steroid and cyclophosphamide pulse therapy was initiated after hemoperfusion. During the hospital course, the patient showed progressive hypoxemia with pulmonary fibrosis. Accordingly, three additional courses of immunosuppressive pulse therapy were administered to prevent pulmonary injury. This treatment inevitably led to bone marrow suppression, which was recovered with supportive care. The patient fully recovered after repeated immunosuppressive pulse therapy without residual hypoxemia and was successfully discharged from the hospital. (Korean J Med 2012;83:373-377)
참고문헌 (10)
- Kim GW, "1st ed, In Clinical Toxicology.1st ed" (2006), Koonja Pulblishing Inc.
- Joo MH, "Two cases of successful management of paraquat poisoning with pulmonary fibrosis", Korean J Med, 60, pp.490~495 (2001)
- Gil HW, "Association between plasma paraquat level and outcome of paraquat poisoning in 375 paraquat poisoning patients", Clin Toxicol, 46, pp.515~518 (2008)
- Proudfoot AT, "Paraquat poisoning: significance of plasma-paraquat concentrations", Lancet, 2, pp.330~332 (1979)
- Suzuki K, "Evaluation of severity indexes of patients with paraquat poisoning", Hum Exp Toxicol, 10, pp.21~23 (1991)
- Jones AL, "Multiple logistic regression analysis of plasma paraquatconcentrations as a predictor of outcome in 375 cases of paraquat poisoning", QJM, 92, pp.573~578 (1999)
- Hong SY, "Significance of plasma paraquat concentration in paraquat poisoning", Korean J Med, 48, pp.480~485 (1995)
- Koo JR, "Rapid analysis of plasma paraquat using sodium dithionite as a predictor of outcome in acute paraquat poisoning", Am J Med Sci, 338, pp.373~377 (2009)
- "Time-related lethal blood concentrations from acute human poisoning of chemicals (the MEMO database) part 2: the monographs: no. 25" (1997)[URL]
- Koo JR, "Failure of continuous venovenous hemofiltration to prevent death in paraquat poisoning", Am J Kidney Dis, 39, pp.55~59 (2002)