6. Amphetamine-based substance poisoning

Amphetamine compounds mainly include amphetamine, methamphetamine, and dimethylenedioxide, which are strong central stimulants. The therapeutic dose of this type of drug is close to the dose of poisoning, and poisoning is prone to occur.

1. Methods for confirming poisonous drugs

1) A history of overdose or misuse of amphetamine drugs.

2) Acute poisoning is mainly manifested in the central nervous system.

3) The presence of amphetamine drugs is detected in blood, urine and stomach contents.

2. Acute poisoning manifestations

Excited, mentally active, fast but inaccurate movements, anxiety, tension, panic, attack tendency, tremor, disordered consciousness, dizziness.

Severe poisoning can be seen with delirium, mania, hallucination, paranoid schizophrenia, tachycardia, enhanced breathing, high or low blood pressure, high fever, sweating, coma, arrhythmia, intracranial hemorrhage, circulatory failure, and even death.

3. Treatment measures

Symptom-oriented supportive treatment is the main focus.

1) If the patient is oral poisoned and does not have convulsions, he will induce vomiting, and the patient will be treated with a charcoal suspension. If the patient suffers from convulsions, he will first control the convulsions and then perform gastric lavage.

2) Oral ammonium chloride or vitamin C is given to acidify urine to promote the excretion of toxic substances.

3) Patients with extreme excitement and mania are given haloperidol.

4) Those with hypertension and central nervous system excitation were given chlorpromazine; those with vasodilators such as sodium nitroprusside were given for significant hypertension.

5) Use diazepam or short-acting barbiturates to control central excitation and convulsions.

7. Acute ethanol poisoning

1. Methods for confirming poisonous drugs

1) A clear history of excessive alcohol or alcoholic beverages.

2) Exhaust gas or vomit has an alcoholic smell.

3) Based on the above two items, detect blood or exhaled gas alcohol to detect the ethanol concentration exceeding 11 mmol/L.

2. Acute poisoning manifestations

1) Excitement period

Eye congestion, flushing or pale face, dizziness, euphoria, laughter and crying, easy to be emotional, carefree, sometimes naive, sometimes rude, or talk about turbulently, or fall asleep silently, etc.

2) Ataxia period

After excitement, the patient's movements gradually became clumsy, his body was unstable, his gait was staggering, his mind was confused, his speech was incoherent, and his pronunciation was unclear.

3) Sleeping period

Sleeping, breathing slowly and snoring, pale face, wet and cold skin, accelerated heart rate, blood pressure, body temperature drop, or vomiting, large, urinary incontinence, and occasionally cerebral edema. If the brain is suppressed, respiratory failure and circulatory failure occur, and even death.

After children take the poisoning dose, there is generally no excitation stage. High fever, shock, and increased intracranial pressure may occur.

3. Treatment measures

1) Due to rapid absorption of alcohol, vomiting, gastric lavage and activated carbon are not suitable for patients with pure alcohol poisoning.

2) In severe cases, intravenously, 100ml of 50% glucose injection and 20U of insulin are injected; at the same time, intramuscularly, 100mg of vitamin B1, vitamin B6 and niacin are injected to accelerate the oxidation of ethanol in the body and promote soberness. In the future, according to the condition, you can repeat injections every 6 to 8 hours. Appropriate supplementation of vitamin C is conducive to alcohol oxidation and metabolism.

3) The alcohol-promoting metabolite metadocin is an activator of acetaldehyde dehydrogenase and can antagonize the decrease in the activity of ethanol dehydrogenase caused by chronic alcohol poisoning; accelerate the excretion of ethanol and its metabolites acetaldehyde and ketone bodies through the urine, which is an alcohol-promoting drug. It is given intravenously 0.9g each time.

5) Sedatives should be used with caution in acute alcohol poisoning. For those with irritability and overexcitation, small doses of benzodiazepines can be used; for those with convulsions, diazepam, 10% chloral hydrate, etc. Do not use morphine and barbiturates to prevent aggravate respiratory depression.

6) Hemodialysis can be used for patients with severe condition or regular treatment of worsening condition.

4. The principle of action, selection and clinical application of commonly used antidotes and antagonists

Naloxone can relieve the central inhibition of alcohol poisoning, promote the transformation of ethanol in the body, shorten the coma time, and have a wake-up effect.

8. Clenbuterol poisoning

Bobsy is a powerful β2 receptor agonist, which can cause sympathetic nerve excitation, and the treatment amount is used to relax bronchial smooth muscle, and the body stays for a long time. The chemical properties of this drug are stable and will be decomposed until it is heated to 172℃. Patients can cause poisoning by eating animal viscera or meat containing Bobsy.

1. Methods for confirming poisonous drugs

1) Eat animal offal or meat containing botulinum before the onset of the disease.

2) Symptoms related to sympathetic nerve excitation such as palpitations, tachycardia, excessive sweating, muscle tremor, etc.

3) Crenbuterol is present in blood, urine, and stomach contents.

2. Acute poisoning manifestations

The severity of the poisoning is related to the amount of food intake.

Mild poisoning shows palpitations, eyelid muscle tremors. Severe poisoning shows nausea, vomiting, skeletal muscle tremors in the limbs, electrocardiogram shows sinus tachycardia, ventricular premature beats, and low amplitude of ST and T waves.

3. Treatment measures

1) Mild poisoning, stop eating, lie flat, drink more water, and improve after lying quietly.

2) Severe poisoning, induce vomiting, gastric lavage, and diarrhea; monitor blood potassium and supplement potassium in an appropriate amount; oral or intravenous infusion receptor blockers such as propranolol, metoprolol, esmolol, etc.

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Acute infectious diarrhea in children

Diagnosis and treatment standards

Diarrhea is a group of diseases characterized by increased stool frequency and changes in stool traits caused by multiple factors. Acute infectious diarrhea refers to diarrhea disease caused by pathogenic microorganism infection within 2 weeks. Acute infectious diarrhea has a high incidence and is widely prevalent, which seriously endangers children's health. In recent years, with the widespread application of oral rehydration salt in developing countries, the breastfeeding rate has increased, and nutrition and health care measures have improved, the mortality rate of the disease has been significantly reduced, but it is still one of the main causes of death in common children in my country and children under 5 years old. At present, there are still problems such as unreasonable application of antibacterial drugs and excessive transvenous rehydration during the treatment process. To this end, the National Health Commission and the State Administration of Traditional Chinese Medicine organized experts from relevant disciplines to formulate them in light of the national conditions of our country to further improve the diagnosis and treatment level of acute infectious diarrhea in my country.

1. The main pathogen

Pathogens include viruses, bacteria, fungi and parasites, among which virus infections, especially rotavirus infections, are the most common.

2. Clinical manifestations

Co-clinical manifestations.

1. Gastrointestinal symptoms. Changes in stool properties, such as thin and paste stools, watery stools, mucus stools, pus and bloody stools; the number of stools increases, more than 3 times a day, or even 10 to 20 times a day; nausea, vomiting, abdominal pain, abdominal distension, loss of appetite, etc.

2. Systemic symptoms. Such as fever, irritability, mental depression, drowsiness, even convulsions, coma, shock, may be accompanied by symptoms of involvement in other organ systems such as the heart, brain, liver, and kidneys.

3. Water, electrolytes and acid-base balance disorders, including varying degrees of dehydration, metabolic acidosis, hypokalemia, hyponatremia or hypernatremia, and may also include hypocalcemia and hypomagnesemia.

Dehydration. The degree of dehydration is evaluated based on the loss of body fluid, mental state, skin elasticity, mucosa, fontanelle, eye socket, across, urine volume, pulse and blood pressure. The degree of dehydration is divided into mild, moderate, and severe. According to the serum sodium level, it is divided into isotonic dehydration, hypotonic dehydration and hypertonic dehydration. The two were common in the past.

Metabolic acidosis is manifested as deep breathing, frequent vomiting, mental depression, lethargy, and even coma.

Low sodium and hypernatremia. It may cause nausea, vomiting, mental depression, fatigue, and severe cases may cause consciousness disorders, convulsion attacks, etc.

Hypokalemia. Such as mental loss, weakness, abdominal distension, heart rhythm disorder, etc.

Hypocalcemia and hypomagnesemia. The main manifestations are hand and foot twitching and convulsions, which are more likely to occur in children with malnutrition. When the above symptoms occur during or after correction of dehydration and acidosis, hypocalcemia should be considered. Hypomagnesemia should be considered when calcium supplementation treatment is ineffective.

Clinical characteristics of acute infectious diarrhea caused by common pathogens.

Three, auxiliary examination

Feces routine.

It is a routine examination for acute infectious diarrhea. When Vibrio cholerae is infected, Vibrio with meteor-like movement can be seen by dark field microscopy. When Amoeba Protozoa is infected, an amoeba trophoblast containing red blood cells can be seen under the microscope. When fungal infection, spores and mycelium can be seen in the stool smear.

Fecal bacteria culture.

People with mucus, pus, bloody stool or stool microscopy have more white blood cells, fecal bacteria culture should be performed; children with normal immune function with acute watery stool do not need to undergo routine fecal culture.

Other pathogenic testing methods.

Such as enzyme immunoassay, direct immunofluorescence analysis, nucleic acid amplification technology or molecular sequence analysis and detection, etc.

Blood culture.

Blood culture examination should be performed in the following situations: suspected sepsis or intestinal fever; symptoms of systemic infection and poisoning; primary or secondary immune function; infants under 3 months old; certain high-risk factors such as hemolytic anemia, traveling to the intestinal fever epidemic area or contacting tourists from the epidemic area and suffering from fever diseases of unknown causes.

other.

For example, blood routine, blood biochemistry, blood gas analysis and electrocardiogram. In addition to detecting blood sugar and electrolytes, children with convulsions can complete cerebrospinal fluid, head CT or MRI examinations as appropriate. Those with acute abdominal symptoms should undergo abdominal ultrasound and/or abdominal erectile slabs and other examinations.

Four, diagnosis

Within 2 weeks of the course of the disease, the stool traits change and the number of stools increases more than usual, acute diarrhea can be diagnosed. Acute infectious diarrhea disease should be considered first. Based on the stool traits and microscopic examinations, the cause can be estimated based on the onset season, age and prevalence, and etiology examinations can help clarify the pathogen. Blood gas analysis and blood biochemistry should be improved at the same time to evaluate whether there is dehydration and its degree, nature, as well as whether there is acid-base imbalance and electrolyte disorders.

5. Differential diagnosis

Water samples are identified.

1. Diseases that lead to digestive and absorption dysfunction of the small intestine. Such as lactase deficiency, glucose-galactose malabsorption, chlorination-depleting diarrhea, primary bile acid malabsorption, etc., the stool pH, reducing sugar tests, potassium, sodium and chloride ion determination, gene detection and other examination methods can be selected according to the characteristics of different diseases to identify them.

2. Enteric diseases induced by food protein. The most common allergens are milk protein, soy, eggs, etc. The symptoms usually occur within 1 year old, manifested as vomiting, diarrhea, and watery stools after several days of intake of suspicious food, which may be accompanied by anemia, hypoproteinemia, vitamin K deficiency, etc. Avoiding suspicious food symptoms to relieve, and the recurrence of symptoms after intake of suspicious foods can be considered. Food stimulation tests and small intestinal mucosa biopsy are helpful for diagnosis.

Identification of pus, blood and stool.

It is often caused by infection with various invasive pathogens and is difficult to distinguish based on clinical manifestations alone. Tests for stool pathogens should be carried out. It also needs to be distinguished from the following diseases.

1. Acute necrotizing intestinal colitis. Severe symptoms of poisoning, high fever, vomiting, initial watery stool, then turn to dark red, jam-like or red bean soup-like bloody stool, severe abdominal distension, often accompanied by shock. Abdominal flat films and abdominal B-ultrasound can show local inflation and dilation of the small intestine, widening intestinal space, and accumulation of gas in the intestinal wall.

2. Food protein-induced rectalitis. It is more common in babies within 6 months of breastfeeding. It is mainly manifested as diarrhea, with varying stools, loose or loose stools, common mucus and bloody stools. The children are generally in good condition and have no positive abdominal palpation. The symptoms of avoiding suspicious food have improved. Those who have repeated symptoms after eating suspicious food should be highly suspicious. Food stimulation tests can help confirm the diagnosis.

3. Intestinal colitis syndrome induced by food protein. Common allergens are milk protein, eggs, soybeans, etc. Vomiting and diarrhea are common clinical manifestations, with watery stools or loose stools. If the lesions affect the colon, bloody stools may occur. In children with acute attacks, vomiting occurs within 4 hours after ingesting food, diarrhea may occur within 24 hours after ingesting food, and in severe cases, dehydration may occur in varying degrees. It is easy to misdiagnose as acute infectious diarrhea. Avoid suspicious food symptoms to relieve, and the recurrence of symptoms after ingesting suspicious foods can be considered. Food stimulation tests can help diagnose.

4. Inflammatory bowel disease. It is a group of nonspecific chronic intestinal inflammatory diseases whose causes are still unknown, including ulcerative colitis and Crohn's disease. It is mainly manifested as diarrhea, mostly mucus bloody stools, accompanied by abdominal pain, weight loss, fever, anemia, growth and development delay, and some are accompanied by parenteral symptoms such as arthritis, iridocyclitis, and erythema nodular erythema. The initial cases are easily misdiagnosed as acute infectious diarrhea, and require a comprehensive history, physical examination, endoscopy, imaging and pathological examinations to clarify the diagnosis.

6. Severity assessment and admission criteria

Assessment of the severity of the disease.

1. The main symptoms are gastrointestinal symptoms, without dehydration or obvious systemic poisoning.

2 Medium size. Gastrointestinal symptoms are severe, with mild or moderate dehydration and systemic poisoning.

3. Severe gastrointestinal symptoms, severe dehydration and obvious symptoms of systemic poisoning.

Admission criteria.

Children with oral rehydration failed, accompanied by moderate to severe dehydration, electrolyte disorders, acidosis and systemic infections, severe symptoms of poisoning, shock, and external organs or systemic involvement should be hospitalized for treatment.
Chapter completed!