Beautiful girl suddenly weak, the culprit is...

On this day, the ward admitted a 29-year-old female patient, the main complaint is "difficult to swallow, speech ambiguity for 8 days, aggravated with the whole body weakness for 5 days."8 days beforewas admitted to hospital, the patient suddenly appeared in the throat of the foreign body feelingShe felt that she had just "colded" her throat and took some cold medicine herselfthat evening, when she was drinking water, she found that some of the water had come out of the mouth and could not be swallowed smoothly, and that she had found it difficult to chew when she ate meat for dinner, but she still felt it was a symptom of a cold and did not take it to her heartthe next 5 days, the patient's symptoms gradually aggravated, even their own saliva can not be swallowed, can only continue to take a tissue to catch the saliva flow of the mouth;the patient and their families only became aware of the bad, immediately went to the local hospital, and because the symptoms continue to worsen, transferred to the provincial hospitalthe day of admission, the resident checked the patient, found:body check bodydouble eyelids drooping, eye movement is not affected;the emergency department perfected the fatigue test, the New Sins Ming test, the results are positivesummarize the characteristics of medical history and physical examination as follows:combined with a brief medical history and physical results, the resident doctor formulated a preliminary diagnosis - severe muscle weaknessHowever, a few contradictions, so that "severe muscle weakness" this diagnosis is a lot of doubt:(1) patients are urgent, in 8 days faster progress to the whole body, does not meet the severe muscle weakness of this autoimmune disease subacute or chronic disease way
;(3) patients with muscle weakness symptoms after rest did not significantly improve, and severe muscle weakness has volatility, "morning light twilight weight" characteristicsmust have something else to do!, the doctor again looked at the patient, and repeatedly asked about the medical history, the patient only to quibble to tell the truthoriginally, the patient is a beautiful woman, is micro-plastic DIY people - in the first week of the disease, she self-skin injection sin-bottom purchased "botulinum toxin" and "bouric acid" to "thin face" "plump lips."three months ago, she had her own 3IU botulinum undercutins in her jaw and cheeks, and felt good about herself, and this time she planned to DO a diyThis time, however, the patient mistook 100 IU/bottles of Botox and injected it into the face onceAfter the patient's injection, he had difficulty opening his mouth and returned to normal on the 2nd day;then on the patient's medical history and check the body summary:to this, the initial diagnosis of botulinum toxin poisoning, basically clearTake a look at the results of myeion maps for further clear diagnosis!picture disfigured for the image of repeated neuroelectric stimulation (20 Hz) of the patient's right-hand musclecan be seen from the graph, under the high-frequency current stimulation of 29Hz, the amplitude of muscle fiber waveform gradually increased until it stabilized, showing the characteristics of "high frequency increment", and more clearly defined the direction of diagnosis of the front membrane lesions of the nerve muscle jointthe patient's condition continues to worsen, although the diagnosis has been made clearOn the 2nd day after admission, the patient began to have difficulty breathing and gradually aggravated, the afternoon blood gas analysis found that PaCO2 reached 50mmHg, so when the patient was transferred to the neurology ward for noninvasive ventilator-assisted ventilation treatmentbecause the combination of botulinum toxin and nerve endings is irreversible, botulinum toxin poisoning should be treated within 24 h of symptoms in antitoxin treatment and plasma free toxins;so, doctors focus on the main treatment of this patient in three areas: auxiliary ventilation, rehabilitation training and a large amount of rehydration to promote toxin metabolism Rehabilitation training mainly includes breathing muscle, mouth, mouth and throat muscle, limb rehabilitation three groups the most tired breathing muscles were first recovered On the second day of the start of rehabilitation training, the patient's conscious breathing effort was significantly better than before, and asked to change to continuous noninvasive ventilator-assisted ventilation for intermittent ventilation The break-off time gradually increased, and the 16th day of rehabilitation training completely removed the patient from the non-invasive ventilator the muscle strength of the torso muscle stoic limb sour recovery is relatively slow From the initial can not be vertical neck, can not complete the rotation of all directions of the neck, can not maintain the sitting position, double upper arm flat lift can not maintain more than 10s, after nearly 1 month of rehabilitation, reached the neck can slowly move, can sit alone by the bed, forearm can hold the mobile phone, write the state patient was transferred to a local rehabilitation hospital for further treatment after 40 days in hospital Through regular visits, we learned that patients can walk alone around 1 and a half months after the onset of the disease, 2 months after the torso and limbs muscle strength recovery is better, can be more stable free movement But at this time the earliest symptoms of the throat muscle recovery is still relatively slow, until about 4 months after the onset of the disease to remove the gastric tube, eat rice paste and other soft food then, let's take this example to a simple understanding of botulinum toxin poisoning characteristics! Botox toxicity characteristics
A Unlike poisoning caused by other substances, botulinum toxin poisoning usually appears symptoms of
poisoning after several days of exposure to botulinum toxin (usually 2 h to 8 d, mostly 12 to 72 h); Infants before the age of one year may be poisoned with botulinum toxin due to the formation of intestinal flora, while adult foodborne botulinum toxin poisoning is mainly caused by the use of spoiled meat or meat products, and C The symptoms of acute, symmetrical, downward retardation paralysis are mainly manifested The progress order of downward retardation paralysis is as follows: eyelid drooping, blurred vision, re-vision, vision- of vision, vision- impairment, sound impairment, difficulty pronunciation, difficulty swallowing, head-up weakness, upper limb weakness, respiratory muscle weakness, lower limb weakness (limb muscle weakness mostly from the near end of the limb to the far end of the development) Some patients may have autonomic neurological dysfunction such as tears, reduced saliva secretion, erect hypotension, and gastrointestinal system symptoms such as abdominal pain, diarrhea, nausea and vomiting; E antitoxin treatment should be given within 24 h after symptoms appear, followed by supportive treatment of the disease, including auxiliary ventilation, rehabilitation training, and reinforcement
of rehydration; author: Irene Source: , Journal of Neurology, Medicine