急性硒吸入中毒

Acute Selenium Poisoning by Inhalation

10.30027/CJOM.200904.0007

林純吉(Chun-Chi Lin)；吳明玲(Ming-Ling Wu)；鄧昭芳(Jou-Fang Deng)

亞硒酸鈉 ； 金屬燻煙 ； 化學性肺炎 ； 中毒性角膜病變 ； sodium selenite ； metal fume ； chemical pneumonitis ； toxic keratopathy

中華職業醫學雜誌

16卷2期（2009 / 04 / 01）

151 - 158

繁體中文

職業性硒中毒主要發生於吸入的途徑，美國職業安全衛生署規定工作場所空氣中硒化合物的容許暴露標準，平均一天暴露8小時，一週暴露四十小時的暴露容許濃度為0必毫克／立方公尺。急性硒中毒在醫學文獻上並不多見，本研究報告一例職業暴露的急性中毒個案。52歲男性，工作於某飼料加工廠約4-5年。某日在亞硒酸鈉的加熱過程中，吸入刺激性的大量煙霧，隨後產生頭暈、噁心、呼吸困難、不斷咳嗽、胸口悶、眼睛乾澀等症狀，身體有刺鼻的異味，實驗檢查發現有白血球數目增加及鉀離子過低。毒物學檢查方面，尿硒濃度：540 μg/g creatinine（參考值23-115 μg/g creatinine)，血清中硒濃度104ug/L（參考值70-190 ug/L）。診斷為刺激性硒燻煙吸入併化學性肺炎和角膜炎。住院治療11日後出院。暴露於硒的作業環境中，應注意吸入性傷害的預防，中毒後的臨床監測，主要觀察呼吸道和系統性症狀，若呼氣時聞到大蒜味，則通常意味過度暴露。實驗室檢查可由測定尿液及血液中硒的濃度來確定診斷。硒中毒目前無特殊解毒劑可供治療，支持性療法是最主要的治療方式。

Occupational selenium poisoning mainly occurs through inhalation. American Conference of Governmental and Industrial Hygienists' (ACGIH) threshold limit value expressed as a time-weighted average of selenium is 0.2 milligram per cubic meter. Acute selenium poisoning was rarely reported in the literature. We concerned on a case suffering acute selenium poisoning from occupational exposure. A 52 year-old male patient who worked in a livestock feed additive factory for 4-5 years inhaled large amount of selenium smoke during manufacturing procedure. He experienced dizziness, nausea, cough, chest tightness, and dyspnea. Pungent odor and conjunctivitis were noted in physical examination. Laboratory tests disclosed leucocytosis and hypokalemia. Toxicological tests revealed urine selenium level with a value of 540 ug/g creatinine (reference: 23-115 ug/g creatinine) and serum selenium level with a value of 104 ug/L (reference: 70-190 ug/L). Diagnosed as selenium fume inhalation complicated with chemical pneumonitis and toxic keratopathy, he received supportive treatment and was discharged on day 11. This case highlights prevent from inhalation is imperative when employees exposed to selenium in working environment. Close monitoring of cardiac and respiratory function is necessary for the poisoned. It suggests excessive exposure to selenium if garlic odor presents on the breath. Diagnosis could be confirmed by urine or blood selenium concentration. Whereas there is no antidote to selenium poisoning, supportive care is the mainstay of management of acute selenium poisoning.