我们都可能听说过一些关于含有二甘醇(DEG)的咳嗽糖浆的令人沮丧的故事,这些糖浆可能是致命的。 DEG是一种臭名昭著的不良化学品,主要用于生产消费品和药品。 DEG因其甜味和适宜于制药制剂,是替代药物级甘油或丙二醇的极佳选择。 自从冈比亚惨案和马森吉尔事件以来,这一事件一直出现在新闻中。 DEG中毒的特点是急性肾功能衰竭(ARF)。 多年来,DEG已加入多种药物,包括咳嗽糖浆、退烧剂、注射剂等。

尽管在警报后召回掺假的药品批量,但召回时已经造成了损失,因此保健当局禁止在食品和药品中使用。 卫生当局及时收到世卫组织关于DEG集体中毒的警告。 尽管许多国家发生了许多悲惨事件和死亡事件,但仍然没有关于在药物制剂中使用DEG的法律。 科学知识的发展和全球范围的严格管制,以制止大规模中毒,使药物能够极大地造福于人类,而不是危害人类。

二甘醇(DEG)是一种粘稠的,几乎无味的液体,具有甜味,无色,吸湿。 除了用于各种工业产品之外,它还与许多可追溯到1937年的众所周知的集体中毒有关。 尽管有DEG的毒性以及与之相关的致命毒物流行,但尚未发布一份全面的评论。 通过系统检索OVID MEDLINE和ISI科学网,对DEG文献进行了综述。 从书籍章节、相关新闻文章和在线内容中收集了更多的细节。

本综述旨在概述DEG中毒的所有重要因素,包括流行病学、毒动力学、毒性机制、临床特征、DEG毒性、诊断和治疗。 在药物制剂中使用DEG代替其他成分时,发生了十几起DEG中毒的文献记载。 这些流行病主要影响到不发达国家和发展中国家,这些国家获得先进医疗的机会很少,质量控制标准也不够。 摄取后,DEG会迅速分布在全身,大部分会分布在血液流动良好的部位。 代谢的主要部位是肝脏,其母体及其代谢物2-羟基乙氧基乙酸(HEAA)通过肾脏迅速被清除。 研究表明,DEG代谢产物HEAA是引起肾脏和神经毒性的主要原因,尽管目前还没有完全了解其毒性的确切机制。

DEG中毒的临床疗效分为以下三个阶段: 第一阶段的特点是胃肠道症状、中毒症状和代谢性酸中毒的发病。 中毒严重时,患者可能会进入代谢性酸中毒更严重的第二阶段,并出现肾损伤症状。 如果患者得不到正确的支援性治疗,那么第二阶段可能会致命。 一旦稳定下来,病人可能进入最后阶段,这有时是致命的,涉及各种迟发性神经病变。

造成人类发病和死亡所需的DEG剂量尚不明确。 它们可能低估了毒性,因为它们主要基于大规模中毒流行病的报告。 成年人的平均估计致死剂量被定义为~1毫升/千克纯DEG。 正确的气道管理和对酸碱异常的关注构成了治疗的最初过程。 应尽快使用福美唑或乙醇来阻止有毒代谢物HEAA的产生。 血液透析也是必要的,辅助通气也是必要的。 摄入DEG可引起严重的并发症,其中有些可能致命。 然而,及时给予支持性护理和及时使用乙醇或福美唑可改善预后。

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