每日一题_2022.11.25

A 70-year-old woman with depression and irritable bowel syndrome presented to the emergency department with a 3-day history of altered mental status, shortness of breath, nausea, and vomiting. She had recently been self-medicating worsening irritable bowel symptoms. Physical examination was notable for a respiratory rate of 22 breaths per minute, confusion, and mild, diffuse abdominal pain. Laboratory testing showed primary anion-gap metabolic acidosis and primary respiratory alkalosis. Toxicity of which of the following is the most likely cause of her acute symptoms and the findings seen in this non-contrast abdominal radiograph?

患者女，70岁，抑郁症、肠易激综合征，因精神状态改变、呼吸急促、恶心、呕吐 3d 急诊。她最近自我药疗使肠易激症状恶化。体格检查显示呼吸频率为22次/分钟、意识模糊和轻度弥漫性腹痛。实验室检查显示原发性阴离子间隙代谢性酸中毒和原发性呼吸性碱中毒。以下哪一项毒性是她急性症状的最可能原因，以及在无造影剂腹部 X 线片中观察到的结果？

A. Bismuth Salicylate 水杨酸铋

B. Calcium Carbonate 碳酸钙

C. Ferrous Sulfate 硫酸亚铁

D. Magnesium hydroxide 氢氧化镁

E. Simethicone 西甲硅油

答案解析：

正确答案是水杨酸铋。发现水杨酸盐水平升高至76 mg/dL（5.50 mmol/L；正常值，< 5 mg/dL[0.35 mmol/L]），并诊断为水杨酸铋毒性。由于接近铅的物质密度较高，大量铋似乎不透射线。给予碳酸氢钠输液及血液透析治疗水杨酸盐中毒后，患者症状减轻。

正确答案：A