Symptom >> Internal Medicine >> Respiratory Medicine

The breath smells of garlic

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Breathing gas is the smell of garlic: a symptom of organophosphorus pesticide poisoning. The important signs of organophosphorus pesticide poisoning are due to the increase of glandular secretion. The poisoned person has more secretions of garlic smell in the mouth and respiratory tract.

Cause

Cause

Organophosphorus pesticides can be poisoned by ingestion, inhalation or absorption through the skin. Most of the causes of poisoning in children are: eating food contaminated with organophosphorus pesticides (including fruits, vegetables, dairy products, food, and poisoned livestock, aquatic products, etc.); misuse of toys or pesticide containers contaminated with pesticides; inappropriate The use of organophosphorus pesticides to kill mosquitoes, flies, cockroaches, cockroaches, bedbugs, cockroaches and to treat skin diseases and deworming. Mothers do not wash their hands and change clothes after using pesticides to breastfeed their babies, using plastic bags packed with organophosphorus pesticides. Make a pad, or fill the pad with "wooden pants" instead of a pad with a sand-sprayed organic phosphorus pesticide; children can also inhale poisoning by playing near the field where organophosphorus pesticides are sprayed.

The conduction of cholinergic nerves (including motor nerves, sympathetic, parasympathetic preganglionic fibers, parasympathetic nerves, and partially sympathetic postganglionic fibers) from the human body, relying on the acetylcholine released at the junction with the cells. The activity of the effector organs is dominated; some parts of the central nervous system, such as the sensory motor area of the cerebral cortex, especially the transcranial cells of the pyramidal cells, caudate nucleus, and thalamus in the deep cortex, also involve acetylcholine. Cholinergic neurotransmission must produce an effect in combination with a cholinergic receptor. Cholinergic receptors are classified into muscarinic and nicotinic; the former is distributed in the myocardium, smooth muscle, gland and other effector organs innervated by cholinergic ganglia fibers, and the latter is distributed in autonomic ganglia and skeletal muscle. Inside the sports board. Under normal circumstances, upon completion of its physiological function, the released acetylcholine is rapidly decomposed by the acetylcholinesterase present in the tissue and loses its effect.

When organic phosphorus enters the human body, its phosphoryl group is tightly bound to the active part of the enzyme to form phosphoryl cholinesterase and lose the ability to decompose acetylcholine, so that acetylcholine accumulates in vivo and inhibits the activity of only acetylcholinesterase. Excessive excitation of the central nervous system and cholinergic nerves, and finally into inhibition and failure, showing a series of symptoms and signs:

1. Some of the parasympathetic nerves and some sympathetic ganglia fibers have cholinergic muscarinic receptor excitability, and there are symptoms such as smooth muscle contraction, increased glandular secretion, pupillary contraction, nausea, vomiting, abdominal pain, diarrhea, etc. .

2, motor nerves and muscle junction point cholinergic nicotinic receptors excitement, muscle fibrillation or convulsions (); severe poisoning or late poisoning, turned into nicotinic symptoms such as muscle weakness or muscle paralysis.

3, central nervous system cells interstitial cholinergic receptors excited, causing dysfunction, began to have headaches, dizziness, irritability, slang and other excitement symptoms, severe speech disorders, coma and respiratory central paralysis.

4, in the circulatory system, both heart rate slowdown, blood pressure drop and other muscarinic symptoms, but also blood pressure rise and heart rate and other nicotinic symptoms.

Examine

an examination

Related inspection

White blood cell count (WBC) urine routine

For suspicious cases, the contact history with organophosphorus pesticides must be thoroughly inquired. The food (nursing), shelter, clothing, contact and play sites of the children must be fully understood; the children should be examined for organophosphorus pesticide poisoning. Specific signs, such as pupil dilation (in the early stage of poisoning may not appear, late dilated pupils, occasionally poisoned children do not appear dilated pupils, or have a large dilated before the pupil shrinks), fasciculation, secretion increased as sweaty, Rogue, tearing, lung rales (acute pulmonary edema), erythema or blisters on the skin. Some organophosphorus pesticides have a special garlic odor or aroma. According to laboratory conditions, the following checks are made:

1. The presence of organophosphorus compounds can be demonstrated by examining the patient's vomit or gastric contents initially taken during gastric lavage, as well as respiratory secretions.

2, the determination of organic phosphorus decomposition products in urine, can be used as indicators of exposure to poison, and some can assist in early diagnosis.

3. Determination of blood cholinesterase activity, such as cholinesterase activity reduced to less than 80% of normal people, which is diagnostic, and based on this value can be estimated to be mild and as a reference for medication. The blood cholinesterase activity of mild patients decreased to 70% to 50% of normal people, moderate to 50% to 30%, and severe cases to 30% or less. In rural and rescue sites, the approximate results of cholinesterase activity can be determined within 20 minutes using a simple and applicable bromothymol blue paper colorimetric method.

Diagnosis

Differential diagnosis

Breathing gas is rancid smell: Breathing gas is rancid smell is due to the growth of bacteria under the purulent sputum, the protein in the purulent sputum decomposes, producing a foul odor. Atrophic rhinitis is a slow-developing nasal atrophic inflammation characterized by atrophy of the nasal mucosa, periosteum, and bone. Severe with a typical bad smell, called ozena. More often than adolescence, women are more common than men.

Breathing gas is alcoholic: Breathing gas is a symptom of alcoholism due to alcoholism. Alcoholism refers to mental and physical disorders caused by drinking. Alcoholic dependence refers to a series of withdrawal symptoms when a chronic alcoholic person stops drinking. In fact, alcohol dependent people are often in a poisoned state. The incidence of alcoholism in China is lower than that in Western countries, but its incidence has appeared to increase in recent years and should be taken seriously.

Breathing gas is a smell of urine: If the kidney is sick and causes kidney failure, these poisons cannot be excreted in time, and thus will stay in the blood, causing water and salt metabolism disorders and forming uremia. When the concentration of toxic substances in the blood increases, some volatile toxic substances are excreted from the respiratory qi of the lungs, so there is a smell of urine in the uremic patients' wards. For suspicious cases, the contact history with organophosphorus pesticides must be thoroughly inquired. The food (nursing), shelter, clothing, contact and play sites of the children must be fully understood; the children should be examined for organophosphorus pesticide poisoning. Specific signs, such as pupil dilation (in the early stage of poisoning may not appear, late dilated pupils, occasionally poisoned children do not appear dilated pupils, or have a large dilated before the pupil shrinks), fasciculation, secretion increased as sweaty, Rogue, tearing, lung rales (acute pulmonary edema), erythema or blisters on the skin. Some organophosphorus pesticides have a special garlic odor or aroma.

According to laboratory conditions, the following checks are made: