RESUMO
Most cases of acute arsenic poisoning occur through accidental or voluntary ingestion of pesticides or insecticides, and all body systems are affected. Arsenic can prolong the QT interval and lead to torsades of Pointes, a crucial type of arrhythmia characteristic of such QT interval prolongation. In our revision of the literature, there have been found only 5 cases of torsades of Pointes due to acute arsenic poisoning. Recently, there have been published four additional cases in patients with refractory or recurrent acute promyelocytic leukemia being treated with arsenic trioxide. In all nine cases, torsades of pointes appeared slowly after poisoning. Herein is described a case of acute arsenic poisoning which led to an early onset of torsades of Pointes, hypopotasemia and high levels of serum troponin I.
Assuntos
Intoxicação por Arsênico/sangue , Intoxicação por Arsênico/complicações , Torsades de Pointes/sangue , Torsades de Pointes/induzido quimicamente , Troponina I/sangue , Doença Aguda , Adulto , Humanos , MasculinoRESUMO
La mayoría de los casos de intoxicación aguda por arsénico se producen por la ingestión accidental o voluntaria de insecticidas o pesticidas, y sus manifestaciones clínicas reflejan afectación de todos los sistemas corporales. El arsénico puede prolongar el intervalo QT y causar torsades de Pointes, un tipo de arritmia con riesgo vital característica de la prolongación del intervalo QT. En una revisión de la literatura sólo hemos encontrado cinco casos de torsades de Pointes debidas a la intoxicación aguda por arsénico. Recientemente, se han publicado cuatro casos adicionales en pacientes con leucemia promielocítica aguda refractaria o recurrente tratados con trióxido de arsénico. En los nueve casos, las torsades de Pointes aparecieron tardíamente tras la intoxicación. Se describe un caso de intoxicación aguda por arsénico que tuvo torsades de Pointes precoces, hipopotasemia y altos niveles séricos de troponina I
Most cases of acute arsenic poisoning occur through accidental or voluntary ingestion of pesticides or insecticides, and all body systems are affected. Arsenic can prolong the QT interval and lead to torsades of Pointes, a crucial type of arrhythmia characteristic of such QT interval prolongation. In our revision of the literature, there have been found only 5 cases of torsades of Pointes due to acute arsenic poisoning. Recently, there have been published four additional cases in patients with refractory or recurrent acute promyelocytic leukemia being treated with arsenic trioxide. In all nine cases, torsades of pointes appeared slowly after poisoning. Herein is described a case of acute arsenic poisoning which led to an early onset of torsades of Pointes, hypopotasemia and high levels of serum troponin I
Assuntos
Masculino , Adulto , Humanos , Torsades de Pointes/etiologia , Intoxicação por Arsênico/diagnóstico , Intoxicação por Arsênico/fisiopatologia , Troponina I/sangue , Hipopotassemia/etiologia , Tentativa de SuicídioRESUMO
El aire venoso portal hepático es un signo radiológico raro habitualmente causado por una isquemia intestinal aguda. La tomografía computarizada de abdomen permite un fácil diagnóstico al mostrar ramificaciones radiotransparentes situadas dentro de los 2 cm adyacentes a la cápsula hepática. Se presentan dos casos de aire venoso portal hepático asociados a necrosis intestinal difusa. El primer caso tuvo un hematoma de la vaina de los rectos complicado con un síndrome compartimental abdominal, mientras que el segundo paciente sufrió una pancreatitis aguda asociada a una bacteriemia por Aeromonas hydrophila. Ambos pacientes fallecieron al poco del ingreso en el servicio de Medicina Intensiva por hipotensión arterial refractaria. Se discuten las implicaciones de estas observaciones tan extremadamente raras
Hepatic portal venous gas is a rare radiologic finding commonly caused by acute bowell ischemia. It is easily diagnosed at CT scan by the appearance of branching of radiolucency extending to within 2 cm of the liver capsule. Two cases of hepatic portal venous gas associated with diffuse intestinal necrosis are reported. A rectus sheath hematoma causing an abdominal compartment syndrome was present in the first case, whereas in the second case an acute pancreatitis associated with Aeromonas hydrophila bacteremia was observed. Both patients died shortly after admission to the Intensive Care Unit because of refractory arterial hypotension. The implications of these extremely rare observations are discussed
