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소아의 카보퓨란 집단 중독에서의 임상 양상과 콜린에스터라제 농도

Clinical characteristics and cholinesterase levels in children with carbofuran poisoning

대한응급의학회지 2020년 31권 2호 p.228 ~ 235
윤신애 ( Yoon Shin-Ae ) - Chungbuk National University College of Medicine Chungbuk National University Hospital Department of Pediatrics

우성일 ( Woo Sung-Il ) - Chungbuk National University College of Medicine Chungbuk National University Hospital Department of Pediatrics

Abstract


Objective: Acute group poisoning caused by food ingestion occurred in an elementary school in Korea. We aimed to describe the clinical characteristics, emergency treatment, outcomes, and the cholinesterase level of children with carbofuran poisoning.

Method: We recruited 32 children who were transferred to hospitals, and they underwent physical examination and laboratory investigations with detailed history-taking performed at one week after carbofuran poisoning. A questionnaire about presenting symptoms, the transport process, treatment, and the clinical course was conducted with their parent’s agreement. We compared the level of cholinesterase in red blood cells (RBCs) of the child patients without poisoning.

Results: The most common presenting symptoms were hypersalivation (84.4%), dizziness (68.8%), nausea (65.6%), and tremor of the limbs (56.3%). Among them, nine children were transported from the initial hospital to a higher level emergency medical center. Both cholinesterase measurements and atropine injection were done only at a provincial emergency medical center. One child who required ventilator care and was admitted to the intensive care unit showed a low serum cholinesterase level until one week. Six children had symptoms that lasted until a week. Patients showed a significantly lower RBC cholinesterase level than did the children without poisoning (11974 [95% CI 10257-13997] vs 13025 [95% CI 12157-13552] IU/gHb) (P=0.017).

Conclusion: The clinical features and cholinesterase activity of children with carbamate poisoning may be different from those of adults with carbamate poisoning. RBC acetylcholinestrase was significantly lower than that of healthy children until a week after carbofuran poisoning. Cholinersterase could be decreased for a long time, against our expectations, and it is a biomarker of exposure to carbofuran in children by serial monitoring.

키워드

Carbamate; Poisoning; Child; Cholinesterase
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