Primena intravenske emulzije masti u lečenju kardiocirkulatornih poremećaja prouzrokovanih trovanjem glifosat-surfaktant herbicidom

  • Jasmina Jović-Stošić National Poison Control Centre, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Vesna Putić Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia, Sector for Pharmacy, Military Medical Academy, Belgrade, Serbia
  • Nataša Perković-Vukčević National Poison Control Centre, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Gordana Babić National Poison Control Centre, Military Medical Academy, Belgrade, Serbia
  • Snežana Djordjević National Poison Control Centre, Military Medical Academy, Belgrade, Serbia
  • Zoran Šegrt National Poison Control Centre, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
DOI: https://doi.org/10.2298/6975
Ključne reči: herbicides||, ||herbicidi, poisoning||, ||trovanje, fat emulsions, intravenous||, ||masne emulzije, intravenske, cardiovascular system||, ||kardiovaskularni sistem, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod. Glifosat je prvi herbicid namenjen za uništavanje korova na genetski modifikovanim usevima. Sam glifosat je malo toksičan, ali komercijalni proizvodi sadrže i surfaktante koji povećavaju njegovu otrovnost. Za lečenje trovanja ovim preparatima ne postoji specifičan antidot, a u novije vreme se ispituje mogućnost primene intravenskih lipidnih emulzija (ILE). Prikaz bolesnika. Bolesnik, star 50 godina, primljen je 3 časa nakon samotrovanja preparatom koji sadrži glifosat i surfaktant polioksietilenamin. Na prijemu je bio u stanju kome, bez spontanog disanja, hipotenzivan 80/50 mmHg, sa tahikardijom širokih kompleksa na elektrokardiogramu. Analize arterijske krvi pokazale su postojanje acidoze (pH 7.07). Primenjena je konvencionalna terapija koja je uključivala mehaničku ventilaciju, intravensku primenu tečnosti, bikarbonata i dopaminsku stimulaciju. Kako nije dovela do popravljanja hemodinamskih poremećaja, primenjen je Intralipid® 20%, 100 mL u bolusu, a zatim 400 mL u infuziji tokom 20 minuta. Pre isteka infuzije došlo je do postepenog porasta krvnog pritiska, a u roku od 2 sata i uspostavljanja sinusnog ritma. Zaključak. Prikaz ovog bolesnika potvrđuje  da bi primena intravenskih emulzija masti mogla biti dodatna terapijska opcija u lečenju kardiocirkulatornih poremećaja prouzrokovanih trovanjem komercijalnim preparatima herbicida glifosata.

 

 

 

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Objavljeno
2017/02/01
Broj časopisa
Vol. 73 Br. 4 (2016)
Rubrika
Prikaz bolesnika