[논문]WHO 분류 1 등급 EPN, Phosphamidone, Terbufos 유기인계 중독환자의 임상 양상

문종구; 문정미; 이미진; 전병조

doi:10.22537/jksct.16.1.1

WHO 분류 1 등급 EPN, Phosphamidone, Terbufos 유기인계 중독환자의 임상 양상
Different Clinical Courses for Poisoning with WHO Hazard Class Ia Organophosphates EPN, Phosphamidon, and Terbufos in Humans 원문보기

대한임상독성학회지 = Journal of the Korean society of clinical toxicology, v.16 no.1, 2018년, pp.1 - 8

문종구 (전남대학교병원 응급의학과) , 문정미 (전남대학교병원 응급의학과) , 이미진 (경북대학교병원 응급의학과) , 전병조 (전남대학교병원 응급의학과)

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Purpose: Extremely hazardous pesticides are classified as World Health Organization (WHO) hazard class Ia. However, data describing the clinical course of WHO class Ia OP (organophosphate) poisonings in humans are very scarce. Here, we compare the clinical features of patients who ingested hazard class Ia OPs. Methods: This retrospective observational case study included 75 patients with a history of ingesting ethyl p-nitrophenol thio-benzene phosphonate (EPN), phosphamidon, or terbufos. The patients were divided according to the chemical formulation of the ingested OP. Data regarding mortality and the development of complications were collected and compared among groups. Results: There were no differences in the baseline characteristics and severity scores at presentation between the three groups. No fatalities were observed in the terbufos group. The fatality rates in the EPN and phosphamidon groups were 11.8% and 28.6%, respectively. Patients poisoned with EPN developed respiratory failure later than those poisoned with phosphamidon and also tended to require longer mechanical ventilatory support than phosphamidon patients. The main cause of death was pneumonia in the EPN group and hypotensive shock in the phosphamidon group. Death occurred later in the EPN group than in the phosphamidon group. Conclusion: Even though all three drugs are classified as WHO class Ia OPs (extremely hazardous pesticides), their clinical courses and the related causes of death in humans varied. Their treatment protocols and predicted outcomes should therefore also be different based on the chemical formulation of the OP.

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문제 정의

This study describes the various clinical courses that were observed in patients who were poisoned by one of three WHO hazard class Ia OPs. In particular, we showed the various initial characteristics that were observed in patients who were poisoned with three WHO hazard class Ia OPs and died.

제안 방법

This study has several limitations. The first limitation of our study is that the number of enrolled patients was too small to draw definitive conclusions. Prospective studies involving a larger number of patients are needed.
The following information was collected during the medical chart review: age, gender, OP formulation ingested, time interval from ingestion to arrival at the ED, the amount of ingested OP, score on the Glasgow Coma Scale (GCS) at presentation, Acute Physiology and Chronic Health Evaluation (APACHE) II score at presentation, poisoning severity score (PSS) at presentation, BChE and red blood cell (RBC) AChE levels at presentation, laboratory results, the time interval from ingestion to administration of gastric lavage and activated charcoal, the development of respiratory failure, the duration of mechanical ventilation support, the development of seizures, hypotension or metabolic acidosis, and the survival outcome. We did not collect the ingested amount because the ingested amount does not reflect the real absorbed amount because the patient may have vomited and, in the case of terbufos, because it is sold as a granule formulation, whereas the other two OPs are sold as a liquid formulation.
This investigation was a two-institution, retrospective, observational case series study that was performed using chart reviews. The study design was approved by the Institutional Review Board at Chonnam National University Hospital (IRB No CNUH-2016-270).

대상 데이터

The exclusion criteria included co-ingestion with another drug (n=20), unknown time of OP ingestion (n=5), patients who were transferred before establishing a final outcome (n=11) or discharged against medical advice (n=3), a treatment based on a different protocol using pralidoxime (PAM) and atropine (n=9), a history of lung disease (n=3) or a history of other preexisting comorbid conditions (n=2). After applying the exclusion criteria, the 75 remaining patients were included in the subsequent analyses.
The patients were stratified based on the chemical formulation of the OP they ingested. The observed OPs included terbufos (terbufos group), EPN (EPN group), or phosphamidon (phosphamidon group).
To reduce bias from prehospital deaths as much as possible, we included patients who were dead on arrival at the ED. The record review identified 128 patients who met these criteria. The exclusion criteria included co-ingestion with another drug (n=20), unknown time of OP ingestion (n=5), patients who were transferred before establishing a final outcome (n=11) or discharged against medical advice (n=3), a treatment based on a different protocol using pralidoxime (PAM) and atropine (n=9), a history of lung disease (n=3) or a history of other preexisting comorbid conditions (n=2).

데이터처리

Either a Fisher’s exact test or a Chi-square test was performed to compare categorical variables.

이론/모형

Continuous variables were compared using the Kruskal-Wallis H test. The post hoc comparisons were conducted using the Mann-Whitney test with a Bonferroni adjustment. Either a Fisher’s exact test or a Chi-square test was performed to compare categorical variables.

성능/효과

In conclusion, the clinical courses and causes of death following poisoning with EPN, phosphamidon, or terbufos are diverse in human, even though all three are classified as WHO hazard class Ia OP formulations. Thus, the treatment protocol, including intensive supportive care and the prediction of outcomes for EPN, phosphamidone or terbufos poisoning, should differ based on the chemical formulation of the OP.
In this study, the fatality rate in the phosphamidon group appeared to be higher than the rate in the EPN group (28.6% in phosphamidon group vs. 11.8% in EPN group; p=0.¹¹⁶⁾. The lack of a statistical difference in fatality rates in this study may be because of its small sample size.

참고문헌 (21)

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WHO 분류 1 등급 EPN, Phosphamidone, Terbufos 유기인계 중독환자의 임상 양상
Different Clinical Courses for Poisoning with WHO Hazard Class Ia Organophosphates EPN, Phosphamidon, and Terbufos in Humans 원문보기

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WHO 분류 1 등급 EPN, Phosphamidone, Terbufos 유기인계 중독환자의 임상 양상 Different Clinical Courses for Poisoning with WHO Hazard Class Ia Organophosphates EPN, Phosphamidon, and Terbufos in Humans 원문보기

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WHO 분류 1 등급 EPN, Phosphamidone, Terbufos 유기인계 중독환자의 임상 양상
Different Clinical Courses for Poisoning with WHO Hazard Class Ia Organophosphates EPN, Phosphamidon, and Terbufos in Humans 원문보기

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