피하기종,기종격을 동반한 제초제 중독 1례 = PARAQUAT INTOXICATION WITH SUBCUTANEOUS EMPHYSEMA AND PNEUMOMEDIASTINUM:CASE REPORT 1

다국어 초록 (Multilingual Abstract)

Paraquat(1,1-dimethyl-4,4-bipyridium dichloride) is lethal herbicide and it is thought to act by turning into superoxide and peroxide free radical in the presence of reducing agents. Among the multiple organ failure, the pulmonary complication is always fatal. We present the case of a patient with subcutaneous emphysema and pneumomediastinum without pneumothorax on 6days later after acute paraquat ingestion.
A 28 years old female patient was admitted ED at 10:40 on September 8, 1995(Day 1) after ingestion of 10cc-15cc of paraquat (20% solution) at 20:00 on yesterday. By the sodium dithionite test, the presence of paraquat was negative in the urine. She was alert without oropharyngeal ulceration and had stable vital signs. Her hepatic function was moderately deteriorated (SGOT/SGPT 389/867, ALP 233, TB 5.7) and the others laboratory findings were normal limits. She was transferred to ICU and treatment was according to a our protocole(Table 1). On day 6, she complainted numbness on the right lateral neck and respiratory difficulty. The chest X-ray showed subcutaneous emphysema, pneumomediastinum and pneumomediastinum without pneumothorax. Day after day, the size of subcutaneous emphysema and pneumomediastinum were decreased on chest x-ray and it was not found inflammatory signs. The chest CT showed pulmonary fibrosis on the both lower lung field(onday 10) and the esophagography showed no specific findings without dye leakage(on day 14). On day 16, The high resolution chest CT was showed diffuse pulmonary opacity with cystic lesions and peribronchovascular air densities were found with pericardial emphysema and pneumomediastinum. At 4:30 a.m. on day 18, the respiratory arrest was developed and she was expired at 4:35 a.m. under DNR.