Case 1:
Ms. Wang, who lives in Fengtai, Beijing, used both toilet cleaner and 84 disinfectant when cleaning the bathroom, and then suddenly fainted and finally died due to ineffective rescue.
Interpretation:
1. The active ingredient of 84 disinfectant solution is sodium hypochlorite. The main ingredient of toilet cleaner is hydrochloric acid, which has a strong pungent odor, and most toilet cleaners are added with fragrance in order to cover up the unpleasant smell.
2. After 84 disinfectant and toilet cleaner are mixed, sodium hypochlorite and hydrochloric acid undergo a chemical reaction to produce chlorine gas, which invades the human body through the respiratory tract, which can cause damage to the mucous membrane of the upper respiratory tract, cause dyspnea, etc., and can be fatal in severe cases.
Remind:
1. 84 disinfectant should be stored below 25°C in the dark, and must be diluted before use; It should be used and dispensed, not diluted with hot water above 50°.
2. The general dilution concentration of 84 disinfectant is 2 to 5 parts per thousand, that is, 2 to 5 ml of 84 disinfectant solution is placed in 1000 ml of water. The soak time is 10 to 30 minutes, and after disinfection, it should be rinsed with clean water before use.
3. The bleaching effect and corrosiveness of 84 disinfectant are strong, so it is best not to use it for disinfection of clothes, and it is best not to disinfect foods such as vegetables and fruits with 84 disinfectant.
Case 2:
An 18-year-old girl in Jiangmen, Guangdong Province, died mysteriously after taking two drugs at the same time, roxithromycin and compound methoxamine capsules, due to a cold.
Interpretation:
1. Compound methoxnamine capsules contain: methoxamine (β-adrenergic receptor agonist), narcodine (peripheral cough suppressant), chlorpheniramine (first-generation antihistamine, can cause drowsiness), aminophylline (25mg/capsule), used for bronchial asthma and wheezing bronchitis, and other respiratory diseases caused by cough, sputum, wheezing and other symptoms, children under 8 years old are prohibited.
2. Roxithromycin: It is a macrolide antibacterial drug, which can inhibit the activity of CYP3A4 and CYP1A2. When roxithromycin is combined with aminophylline, roxithromycin can inhibit the metabolism of aminophylline, increase the blood concentration of aminophylline, and in severe cases, it can lead to aminophylline poisoning. Aminophylline is mainly metabolized by CYP1A2, and the activity of CYP1A2 varies greatly among individuals, and people with low enzyme activity are more likely to interact.
Remind:
1. Chinese patent medicines containing aminophylline: (1) Shunqi sputum tablets, containing aminophylline and chlorpheniramine; (2) Zhubeiding Asthma Pills, containing aminophylline and promethazine; (3) Anti-asthma and anti-inflammatory capsules, ginger bile cough and asthma tablets, containing aminophylline and ammonium chloride.
2. Antimicrobial drugs that can cause aminophylline poisoning: (1) macrolides (erythromycin, clarithromycin, roxithromycin); (2) quinolones (norfloxacin, ofloxacin, ciprofloxacin); (3) tetracyclines (minocycline, doxycycline); (4) Lincoamide (clindamycin, lincomycin).
3. The interaction between two special antibacterial drugs: azithromycin, moxifloxacin and aminophylline has no clinical significance and can be used together.
Case 3:
The patient is a 22-year-old male from Beijing. In the past, due to cold and fever, 12 tablets of acetaminophen sustained-release tablets (specification: 0.65g) were taken orally within 2 days. On the third day, he developed liver failure and died after resuscitation.
Interpretation:
1. Acetaminophen: The maximum daily dose for adults is 2g, and the maximum dose for children each time: 15mg/kg. The interval between doses ≥ 4 hours, and no more than 4 times in 24 hours.
2. Many combination cold medicines contain acetaminophen. If you take two cold medicines at the same time, or take fever reducers and painkillers at the same time, it is likely to cause an overdose of acetaminophen, causing acute liver damage, and in severe cases, liver failure and even death.
3. According to the 2012 U.S. survey, acetaminophen causes acute liver failure accounts for 46% of acute liver failure. The time of liver damage caused by excessive intake of acetaminophen is 48~72 hours after the treatment.
Remind:
1. The U.S. Food and Drug Administration (FDA) prohibits over-the-counter combination cold medicines for children under 2 years of age, and does not recommend over-the-counter combination cold medicines for children under 4 years of age.
2. Proprietary Chinese medicines containing acetaminophen: (1) Cold Ling capsules and granules, containing acetaminophen and chlorpheniramine; (2) Jingan capsules, containing acetaminophen, amantadine, chlorpheniramine; (3) Cold clear tablets, capsules and granules, containing acetaminophen, chlorpheniramine, morpholinoguanidine; (4) Baby flower cold tablets, containing acetaminophen and chlorpheniramine; (5) Vitamin C Yinqiao tablets and granules, containing acetaminophen, vitamin C, chlorpheniramine; (6) New compound Daqing leaves, containing acetaminophen, amobarbital, caffeine and vitamin C; (7) Zhiganjia capsules, containing acetaminophen, morpholinoguanidine, and chlorpheniramine.
Case 4:
After 60-year-old Uncle Wang suffered heat stroke in Ningbo, he drank two sticks of Huoxiang Zhengqi Water and took two cephalosporins. As a result, his face was flushed and his blood pressure dropped, and he was taken to the hospital for rescue.
Interpretation:
1. Huoxiang Zhengqi water contains 40~50% ethanol.
2. Alcohol is metabolized in the body to produce acetaldehyde, and cephalosporins will inhibit the metabolism of acetaldehyde in the body, resulting in acetaldehyde accumulation, causing poisoning, and in severe cases, it can induce acute liver damage, apnea and even death.
Remind:
1. Common alcohol-containing drugs: compound licorice oral liquid, cold cough syrup, Danhong Huayu oral liquid, Sophie cough syrup, gynecological Baifeng oral liquid, golden throat health spray, Xianlubei drops, levocarnitine oral liquid, cyclosporine A oral solution, etc.
2. Common drugs that can cause disulfiram-like reactions: most cephalosporin antibiotics, metronidazole, tinidazole, secnidazole, dysentery, glibenclamide, etc., can inhibit the metabolism of ethanol, causing "disulfiram-like reaction", headache, dizziness, nausea, vomiting, palpitation, chest tightness, dyspnea, blood pressure drop and a series of symptoms.
3. There is a process of metabolism of ethanol, acetaldehyde and drugs in the body, and it takes a certain amount of time for the recovery of acetaldehyde dehydrogenase activity, so people who drink alcohol should abstain from alcohol 2 days before taking the drug and not release the ban until 7 days after stopping the drug.
Case 5:
In order to lower blood pressure, an old man in Hubei took 2 tablets of blood pressure medicine, and then ate half a pomelo. Half an hour later, I felt terrible dizziness, my heart beat very fast, and I even fainted halfway to the hospital.
Interpretation:
The bioactive ingredients contained in grapefruit: first, it can promote the rapid entry of the drug into the bloodstream, which is equivalent to increasing the dosage; Second, it can inhibit the metabolic elimination of antihypertensive drugs and increase the concentration of drugs. When grapefruit is taken with antihypertensive drugs (such as nifedipine), it will increase the efficacy of the drug several times to dozens of times, causing dizziness and nausea, which is more dangerous.
Remind:
1. Statins that lower blood lipids: such as simvastatin, atorvastatin, lovastatin, etc., if you eat a large amount of grapefruit or drink grapefruit juice at the same time while taking such drugs, the drug will accumulate in the body, increase the risk of adverse reactions such as liver injury and rhabdomyolysis, and even cause acute kidney failure.
2. Rosuvastatin: neither an inhibitor of cytochrome P450 isoenzymes nor an enzyme inducer, grapefruit juice has not been found to have an effect on the pharmacokinetics of rosuvastatin.
3. Health supplement red yeast rice: contains statin analogues, and grapefruit should not be eaten.
4. Diping antihypertensive drugs: The results of studies have shown that grapefruit can significantly increase the bioavailability of calcium channel blockers (Diping antihypertensive drugs), and patients who are taking Diping antihypertensive drugs should avoid grapefruit as much as possible.
Case 6:
Ms. Wang from Taiwan suffered from allergic redness and swelling on her thighs and the back of her hands after spraying mosquito repellent and applying sunscreen, as well as fainting.
Interpretation:
1. The main components of mosquito repellent are DEET and alcohol. DEET itself has no insecticidal effect, mainly relying on its natural volatilization or the volatile odor of the carrier, so that blood-sucking insects avoid and difficult to approach the human body after smelling. When DEET is used in large amounts and absorbed more, it may cause side effects such as dermatitis and cardiovascular disease.
2. Sunscreen contains benzophenone, which can be absorbed through the skin and has a certain degree of sensitization, which may cause contact sensitization and photosensitization. A large mixture of DEET, alcohol, benzophenone, plus high temperature, promotes skin absorption and increases the risk of allergic reactions.
Remind:
1. When using sunscreen and insect repellent, it is necessary to master the correct method. The best methods are: first, apply sunscreen first, with an interval of more than half an hour, and then spray mosquito repellent after the skin is absorbed; Second, sunscreen and mosquito repellent should not be used in the same area.
2. People with severe allergies are usually allergic, and normal application by ordinary people is unlikely to cause toxic reactions.
Be careful with the following mashups as well:
Interpretation:
The iodine contained in iodine wine reacts with the mercury in the red potion to form mercury iodide, which settles on the surface of the skin, and mercury itself is toxic and harmful to the body.
Remind:
1. The main chemical component of cinnabar is mercury sulfide.
2. Take Chinese patent medicines containing cinnabar, such as Jie Detoxification and Throat Pills, Meihua Dian Tongue Pills, etc., and avoid combining them with iodine lozenges.
3. External use of cinnabar-containing proprietary Chinese medicines, such as bone-setting Qili San, Safflower Qili San, Qili ointment, Zijin ingot, Zijin San, Bing Boron San, injury treatment ointment, Sai Milan cream, etc., should not be used in conjunction with iodine disinfectants.
4. Oral Chinese patent medicines containing cinnabar, such as Niuhuang Qingxin Pill, Angong Niuhuang Pill, Baizi Yangxin Pill, Tranquility and Brain Pills, Kidney and Brain Pills, etc., should not be used together with Western medicines such as bromide and iodide drugs, such as tribromine mixture, pasteurization mixture, potassium iodide mixture, compound iodine solution, etc.
Interpretation:
Vitamin C is an acidic substance, and sulfonamides (such as cotrimoxazole) and their metabolites are prone to form sulfonamide crystal salts in an acidic environment, which can form urinary stones and cause kidney damage.
Remind:
1. When vitamin C is combined with alkaline drugs, such as sodium bicarbonate, rhubarb, soda, aminophylline, etc., not only can vitamin C be ineffective, but also alkaline drugs will weaken their own pharmacological effects due to neutralization.
2. Vitamin C is highly reductive and easily oxidized. Copper ions and iron ions can accelerate the oxidation of vitamin C, so vitamin C should not be taken at the same time as drugs containing copper and iron ions, so as not to affect the efficacy of vitamin C.
3. In the case of iron deficiency, vitamin C can increase iron absorption. For example, vitamin C is taken with ferrous sulfate, which is beneficial to the absorption of ferrous sulfate.
Interpretation:
Ginkgo biloba preparation can competitively bind to the membrane receptor of platelet-activating factor (PAF) and antagonize the action of PAF, thereby inhibiting the aggregation and adhesion of platelets.
Ginkgo biloba capsules, ginkgo lozenges and other drugs have high levels of flavonoids and ginkgolides, and taking them with aspirin may increase the risk of bleeding. If you've just had surgery, you're at higher risk of bleeding.
Remind:
Medication explanation: When Ginkgo biloba preparation is combined with antiplatelet drugs or anticoagulants, if there is bleeding, bruising, new headache or visual changes, you should seek medical attention in time.
It is said that 1+1=2, but sometimes 1+1=dangerous, please keep in mind the deadly drug mix-and-match!
Source: People's Daily Science Popularization