新光医院肾脏科主治医师（附件）.ppt

Lin B.S. IJV cannulation PLANT POISONINGin Critical Care 林秉熙 醫師 新光醫院腎臟科主治醫師 國立陽明大學醫學系講師 Key Points (1) There are a large variety of plant poisons in nature with only few specific antidotes. Acute gastroenteritis is a feature of most plant poisonings. Organic brain syndromes are common. Supportive care and decontamination (gastro-intestinal tract and others) are the mainstays of treatment. Key Points (2) Identification of the plant is important for anticipating clinical events. In plant-related cardiac glycoside toxicity, antidigoxin Fab fragments may be of use. Mucosal irritation, renal failure, and hypo-calcemia characterize plant-related oxalate toxicity. Key Points (3) Life-threatening mushroom poisonings tend to have a delay of at least 6 h prior to the onset of symptoms. Hepatic, renal, or central nervous system complications may develop, depending on the type of mushroom ingested Hindered plant toxicology Paucity of acutely ill patients, prospective clinical trials, and good clinical series in plant toxicology Immense number of uncharacterized potential toxins in the plant kingdom Imprecise identification of the offending species Identification of the toxin or quantitative blood levels rarely obtained Benign plants with acute illness Simultaneous ingestion of pesticides Allergic response Common clinical syndromes Acute gastroenteritis Almost universal, even the only feature of poisonings Organic brain syndrome the second most common manifestation often seen along with, or following the gastroenteritis alteration in mental status manifested by delirium, coma, or seizures General Management Stablized airway, breathing circulation Naloxone dextrose for altered mentation Gastrointestinal decontamination with lavage and activated charcoal Identifying the plant Consultation with regional poison control center Specific antidote if available Specific Plant Syndromes (1) ANTICHOLINERGIC SYNDROME PYRROLIZIDINE ALKALOIDS CARDIAC GLYCOSIDE OXALATE SYNDROME SOLANI