Benzalkonium chloride intoxication caused by intravenous self-injection.

Masato Miyauchi, Makiko Hayashida, Hiroyuki Yokota
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Abstract

Background: Benzalkonium chloride (BZK) is widely used as a germicide in hospitals and other places. Although several cases of accidental oral intake of BZK have been reported, there have been few reported cases of BZK toxicity due to intravenous injection.

Case report: A male nurse in his 40 s injected 15 mL of 10% BZK (Osvan S) directly into his left antebrachial vein while at home, as a suicide attempt. The patient was admitted to our hospital 1 hour later. Acute respiratory distress syndrome (ARDS) was diagnosed by blood gas analysis, chest X-ray, and CT scan. Due to extracorporeal blood purification therapy, including hemoperfusion and plasma exchange, serum BZK became undetectable. However, the ARDS was not improved. Extracorporeal blood purification therapy consisting of continuous hemodiafiltration (CHDF) was continued to treat the ARDS. After performing CHDF for the next 36 hours, improvement of both the PaO2/FiO2 ratio and chest X-ray findings was noted. Tracheal extubation was performed on day 9 and no further complications occurred after this period, he was discharged on day 21.

Conclusion: Extracorporeal blood purification therapy is probably effective for treatment of BZK intoxication by intravenous injection.

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静脉自注致苯扎氯铵中毒。
背景:苯扎氯铵(Benzalkonium chloride, BZK)作为杀菌剂广泛应用于医院等场所。虽然有几例意外口服BZK的报道,但由于静脉注射BZK毒性的报道很少。病例报告:一名40多岁的男护士在家中将10% BZK (Osvan s) 15 mL直接注射到左前臂静脉,企图自杀。1小时后,患者住进我院。经血气分析、胸片及CT扫描诊断为急性呼吸窘迫综合征(ARDS)。由于体外血液净化治疗,包括血液灌流和血浆交换,血清BZK无法检测到。但ARDS无明显改善。持续血液滤过(CHDF)的体外血液净化治疗继续治疗ARDS。在接下来的36小时进行CHDF后,PaO2/FiO2比率和胸部x线检查结果均有所改善。第9天拔管,术后无并发症,第21天出院。结论:体外血液净化疗法是治疗静脉注射BZK中毒的有效方法。
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