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药物中毒

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“食物中毒”:你喜欢吃鱼吗?
原作者: Hong Kim,葛赟 译,肖锋校对 发布日期:2015-01-28

Title: “Food poisoning”: How do you like your fish?
题目:“食物中毒”:你喜欢吃鱼吗?
Author 作者: Hong Kim
翻译:葛赟 校对:肖锋

 

Food poisoning can occur with many different food groups/items, as well as how the food is prepared, handled or stored.
很多不同类型的食物都可能出现中毒,同时也与它们的制作,处理或储存过程有关。
There are three specific “food poisonings” associated with fish consumption can cause serious toxicity/illness beyond GI symptoms: Ciguatera, Scrombroid, tetrodotoxin (puffer fish)
有三种特殊的与鱼有关食物毒素,食入会引起胃肠道症状严重的中毒/疾病:
蚌肉毒,鲭鱼,河豚毒素(河豚)。

Ciguatera 蚌肉毒
•Endemic to warm tropical water and bottom reef dwelling large carnivorous fish: grouper, red snapper, barracuda, amberjack, parrot fish, etc. (> 500 species).
•主要生活在温热带水中和水底暗礁的大型肉食性鱼:鲈科鱼,红鲷鱼,梭鱼类,琥珀鱼,鹦嘴鱼等(>500个鱼种)
•Toxin: ciguatoxin: opens voltage gated Na channel
•毒素:蚌肉毒:使电压调控Na2+通道开放
Symptoms 症状:
1GI symptoms: n/v/d and abdominal pain
胃肠道症状:恶心,呕吐,腹泻和腹痛
2Hot/cold reversal
冷热交替
3Paresthesia of tongue/lip >> extremities
舌和嘴唇感觉异常超过四肢末端
4Dental pain: “loose teeth”
牙痛:“牙齿松动”
May progress to develop…
病情也许会不断进展
•T wave changes, bradycardia, hypotension
•心电图T波改变,心动过缓,低血压
•Respiratory paralysis and pulmonary edema
•呼吸麻痹和肺水肿
Treatment: supportive care and mannitol in presence of severe neurologic symptoms (limited evidence).
治疗:支持治疗,如出现严重神经系统症状时给予甘露醇(有限地证据)
 
Scrombroid鲭鱼
•Endemic in (dark meat) fish living in temperate or tropical water: amberjack, skipjack, tuna, mackerel, albacore, mahi mahi, etc.
•区域性:主要生活在温热带水中(鱼肉为黑色),琥珀鱼,飞鱼类,鲔鱼,鲭鱼,长鳍金枪鱼等
•Associated with poor refrigeration/storage after catching fish.
•与捕捉以后冷冻、储存条件不适有关
•Histidine in tissue is converted to histamine by bacteria on the fish skin.
•在鱼皮上的细菌将组织内组胺酸分解成组胺
 
Symptoms 症状:
•GI symptoms: n/v/d and abdominal pain
•胃肠道症状:恶心,呕吐,腹泻和腹痛
•Upper body flushing
•上半身潮红
•Puritis, urticarial and perioral swelling can occur
•瘙痒,单纯性荨麻疹样,和口周水肿
•Palpitation and mild hypotension
•心悸和轻度低血压
 
Tx: H1/H2 blockers and supportive care
治疗:H1/H2拮抗剂和支持治疗
Serious reactions: treat like allergic/anaphylactic reaction
严重反应:治疗方法同变态/过敏反应
Tetrodotoxin 河豚毒素
•Ingestion of improperly prepared puffer fish sushi (or bite from blue ring octopus)
•食用了用错误方法制作的河豚鱼生鱼片(或者被篮圈八爪鱼咬过)
•Toxin: tetrodotoxin: blocks voltage gated Na channel.
•毒素:河豚毒素:阻滞了电压门控的Na2+通道
•Highest concentration in liver and ovary.
•在肝中和卵巢中浓度最高
 
Symptoms 症状:
•GI: n/v/d
•胃肠道:恶心,呕吐及腹泻
•Progressive paresthesia and weakness (bulbar-> extremities), ataxia
•不断恶化的感觉异常和虚弱(中心-> 外周),共济失调
•Ascending paralysis and respiratory distress/paralysis
•上行性麻痹和呼吸窘迫/麻痹
•Dysrythmia and hypotension
•心律失常和低血压
•Mental status preserved.
•没有神志改变
 
Treatment: supportive care and intubated if needed.
治疗:支持治疗和必要时气管插管