Alpha-Chloralose?Toxicosis

https://journals.sagepub.com/doi/full/10.1177/1098612X221107787

Alpha-Chloralose

氯醛糖

氯醛縮葡萄糖

Abstract 摘要

Objectives 目的

The aim of this study was to describe the clinical picture in cats with alpha-chloralose (AC) intoxication and to confirm AC in serum from suspected cases of AC poisoning.

- 貓α氯醛糖的中毒臨床表現(xiàn)

- 血清α氯醛糖

Methods 方法

Suspected cases of AC poisoning were identified in patient records from a small animal university hospital from January 2014 to February 2020. Clinical signs of intoxication described in respective records were compiled, the cats were graded into four intoxication severity scores and hospitalisation time and mortality were recorded. Surplus serum from select cases in late 2019 and early 2020 was analysed to detect AC with a quantitative ultra-high performance liquid chromatography tandem mass spectrometry analysis, and the AC concentration was compared with the respective cat’s intoxication severity score.

2014年1月至2020年2月，
在一家小型動(dòng)物大學(xué)醫(yī)院的病歷中發(fā)現(xiàn)疑似α氯醛糖中毒的病例。

收集各自記錄中描述的中毒臨床癥狀，
將貓分為四個(gè)中毒嚴(yán)重程度評(píng)分，
并記錄住院時(shí)間和死亡率。

對(duì)2019年底和2020年初選定病例的剩余血清進(jìn)行分析，
采用定量超高高效液相色譜串聯(lián)質(zhì)譜分析（quantitative ultra-high performance liquid chromatography tandem mass spectrometry analysis）檢測(cè)α氯醛糖，
并將α氯醛糖濃度與各貓的中毒嚴(yán)重程度評(píng)分進(jìn)行比較。

Results 結(jié)果

Serum from 25 cats was available for analysis and AC poisoning was confirmed in all. Additionally, 78 cats with a clinical suspicion of AC intoxication were identified in the patient records, most of which presented from September to April. The most common signs of intoxication were ataxia, tremors, cranial nerve deficits and hyperaesthesia. The prevalence of clinical signs and intoxication severity differed from what has previously been reported, with our population presenting with less severe signs and no deaths due to intoxication. The majority had a hospitalisation time <48?h, irrespective of intoxication severity score.

25例貓血清分析，均為α氯醛糖中毒。

此外，
在病患記錄中發(fā)現(xiàn)了78例臨床懷疑α氯醛糖中毒的貓，
其中大多數(shù)是在9月至4月期間出現(xiàn)的。

中毒最常見(jiàn)的癥狀有
共濟(jì)失調(diào) ataxia、
震顫 tremors、
腦神經(jīng)缺陷 cranial nerve deficits?
和感覺(jué)過(guò)敏?hyperaesthesia。

臨床癥狀和中毒嚴(yán)重程度的流行程度與先前報(bào)道的不同，
此報(bào)道的群體出現(xiàn)的癥狀較輕，
沒(méi)有因中毒而死亡的病例。

無(wú)論中毒嚴(yán)重程度評(píng)分如何，
大多數(shù)病患住院時(shí)間<48小時(shí)。

Conclusions and relevance 結(jié)論和相關(guān)性

This study describes the clinical signs and prognosis in feline AC intoxication. There were no mortalities in confirmed cases, indicating that AC-poisoned cats have an excellent prognosis when treated in a timely manner. Recognition of AC intoxication as a differential diagnosis for acute onset of the described neurological signs in areas where AC exposure is possible may influence clinical decision-making and help avoid excessive diagnostic procedures. A severe clinical picture upon presentation could be misinterpreted as a grave prognosis and awareness about AC poisoning may avoid unnecessary euthanasia.

本研究描述了貓α氯醛糖中毒的臨床癥狀和預(yù)后。

確診病例中沒(méi)有死亡病例，
這表明如果及時(shí)治療，
α氯醛糖中毒貓的預(yù)后很好。

在可能接觸α氯醛糖的地區(qū)，
將α氯醛糖中毒作為急性發(fā)作的神經(jīng)癥狀的鑒別診斷可能會(huì)影響臨床決策，
并有助于避免過(guò)度的診斷檢查。

嚴(yán)重的臨床表現(xiàn)可能被誤解會(huì)出現(xiàn)嚴(yán)重的預(yù)后，
對(duì)α氯醛糖中毒的認(rèn)識(shí)可以避免不必要的安樂(lè)死。

Introduction 引文

Alpha-chloralose (AC) is a compound with both excitatory and depressive effects on the central nervous system, in low and high doses, respectively. It is used as a rodenticide, avicide and as an anaesthetic for laboratory animals.1–10?AC-based rodenticides are approved in many countries and cause death by central nervous affection, leading to an inability to maintain homeostasis.1,2?For outdoor pets, accidental poisoning is a risk in areas where these products are used for pest control. Clinical signs of AC intoxication in several species have previously been reported,1–11?but publications on AC poisoning in companion animals are scarce.12–15?AC intoxication in the clinical setting is a presumptive diagnosis based on history, clinical signs and exclusion of other diseases with a similar presentation. Poisoning can be confirmed by demonstrating AC or its metabolites in blood or urine;1,6,11–13,16?however, the availability of commercial tests has so far been limited. As there is no antidote or otherwise specific treatment for AC intoxication, treatment is supportive and symptomatic, including monitoring and maintaining a normal body temperature, minimising external stimuli and, when indicated, anticonvulsants.1,5,9

α氯醛糖

? ? - 中樞神經(jīng)系統(tǒng)

? ? ? ? -?興奮性 - 低劑量
? ? ? ? - 抑制性 - 高劑量

? ? - 滅鼠劑?rodenticide
? ? - 殺鳥(niǎo)劑 avicide
? ? - 實(shí)驗(yàn)室動(dòng)物麻醉劑 ?an anaesthetic for laboratory animals

? ? - 戶外寵物意外攝入

? ? - 中毒確認(rèn)
? ? ? ? - 血液，尿液 -?α氯醛糖及其代謝產(chǎn)物

? ? - 無(wú)解毒劑/其他特異性治療

? ? - 支持性治療
? ? - 對(duì)癥性治療

? ? - 監(jiān)測(cè)?
? ? ? ? - 維持體溫
? ? ? ? - 減少外部刺激
? ? ? ? - 必要時(shí)使用抗驚厥藥物

Following the approval of use of AC rodenticides in Sweden in 2013, suspected cases of AC poisoning in outdoor cats have been anecdotally communicated within the veterinary community. In the autumn of 2019, there was a surge in suspected cases admitted to the University Animal Hospital, Small Animal Clinic (UDS) at the Swedish University of Agricultural Sciences in Uppsala and other small animal hospitals and clinics across the country. A collaboration between UDS and the Swedish National Veterinary Institute was initiated, leading to the development and validation of a novel quantitative ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC–MS/MS) analysis for the detection of AC in feline blood.16

The objectives of this study were to describe clinical signs of feline AC poisoning, confirm intoxication through chemical analysis of blood samples from admitted cats and to investigate the association between the severity of intoxication and AC serum concentrations.

Materials and methods

The UDS patient record database from January 2014 to February 2020 was reviewed to identify suspected cases of AC poisoning in client-owned cats presenting to the emergency clinic. The database did not include AC intoxication as a specific diagnosis, and the search was based on the following primary and/or secondary diagnoses: unspecified poisoning; rodenticide poisoning; signs of poisoning or intoxication; and signs of neurological disease. In most cases, the attending clinician had noted AC intoxication as the main differential diagnosis. Cats were included if the following criteria were fulfilled: (1) outdoor cat with possible exposure to AC according to history; (2) a clinical suspicion of AC intoxication; and (3) the presence of at least two signs of AC intoxication from a clinical case definition based on previous publications on AC poisoning.1,2,9,12–15?Signs included coma; stupor; somnolence; seizures; cranial nerve deficits, including vision impairment; ataxia; tremor; hyperaesthesia; hypothermia; bradycardia; bradypnoea or other respiratory alteration; hypotension and behavioural changes (see?supplementary material for definitions of signs). Cats were excluded if there was a history of trauma, no possible risk of exposure (ie, indoor cats) or a previous diagnosis of neurological disease.

For each cat, clinical signs of intoxication were noted as either absent or present based on the patient record. Signs noted by the caregiver were also included, regardless of whether the sign was seen at presentation or during stationary care. A score of the overall clinical severity of intoxication was assigned to each cat and mortalities were noted. Ambulatory cats with few or mild signs were given scores of 1 or 2 and non-ambulatory cats with several and/or more severe signs were scored as 3 or 4 (Table 1). The identification of cases, documentation of signs and scoring of each case was performed by one clinician.

Table 1 Description of clinical signs with respect to intoxication severity score assigned to cats with suspected alpha-chloralose poisoning in 2014–2020 admitted to the University Animal Hospital, Small Animal Clinic, Uppsala, Sweden

表1 2014-2020年瑞典烏普薩拉大學(xué)動(dòng)物醫(yī)院小動(dòng)物診所疑似α氯醛糖中毒貓的中毒嚴(yán)重程度評(píng)分臨床癥狀描述

Available surplus serum samples from 25 cats that had presented from October 2019 to February 2020 were analysed in order to detect AC. The cats were aged 5 months to 15 years (median 5 years). All but one (Maine Coon mixed-breed) were domestic shorthair or domestic longhair cats. Six cats were male castrated, seven male entire, nine female spayed and three female entire. There was no standardised treatment protocol, and treatment was dependent on the attending clinician. All patients in this group had been provided with supportive care with intravenous crystalloid fluids, warming when hypothermic and reduction of external stimuli (ie, dark and silent environment with minimal handling). Some patients had also been given a constant rate infusion (CRI) of intralipid (200 mg/ml; Fresenius Kabi) lipid emulsion to help bind circulating toxins, and patients with seizures had been treated with anticonvulsants as needed.

A novel validated UHPLC–MS/MS method with a lowest detection limit of 30?ng/ml was used.16?For each cat, the association between serum concentration of AC and intoxication severity score (1–4) was calculated using Spearman’s correlation. The duration of hospitalisation for each cat was noted and the median and range described for each severity score group. Outdoor cats admitted to the clinic with (n?=?9) and without (n?=?10) neurological signs but no clinical suspicion of AC poisoning were used as controls.

Results 結(jié)果

A total of 103 cases were extracted from patient records and 44 surplus serum samples from 25 cats with suspected AC poisoning were available for chemical analysis. AC was detected in all samples in a concentration range of 386–17,500?ng/ml and was not detected in any of the 19 controls. All samples had been stored at ?20°C prior to analysis.

In the 25 confirmed cases, the most common clinical signs were ataxia and tremor, described in all cats (n?=?25). Cranial nerve deficits (mainly vision impairment), hyperaesthesia, bradycardia, somnolence and behavioural changes were all described in ?60% of the cases (Table 2). Median duration of hospitalisation was 24?h (range 13–75) with no difference between severity scores. All but one cat (severity score 4) were hospitalised for <48?h, and all cats survived to discharge.

Table 2 Prevalence of clinical signs in 25 cats with confirmed alpha-chloralose poisoning admitted to the University Animal Hospital, Small Animal Clinic, Uppsala, Sweden in October 2019 and February 2020

表2 2019年10月至2020年2月，瑞典烏普薩拉大學(xué)動(dòng)物醫(yī)院小動(dòng)物診所收治的25例確診為α氯醛糖中毒的貓的臨床癥狀發(fā)生率

With regard to intoxication severity scores, five cats were scored as mild (1), five as moderate (2), 11 as severe (3) and four as very severe (4). The intoxication severity score correlated with the detected AC concentration (r?=?0.74;?P?<0.0001 [Figure 1]). When several samples from the same individual were analysed, the sample with the highest AC concentration was used in the comparison.

Seventy-eight additional suspected cases were extracted from the UDS patient medical record database. With regard to intoxication severity, 15 were classified as mild (1), 24 as moderate (2), 22 as severe (3) and 17 as very severe (4). The prevalence of clinical signs was, overall, in agreement with the confirmed cases of AC poisoning. However, seizures were notably more common in this group, with 22% of suspected case records noting seizures vs 8% of confirmed cases (see?Tables 2?and?3). There were no mortalities due to poisoning; however, nine of the cats in this group (11%) were euthanased at presentation, at the owners’ request.

從UDS病患病歷數(shù)據(jù)庫(kù)中提取了另外78例疑似病例。

根據(jù)中毒嚴(yán)重程度，15例為輕度(1)，24例為中度(2)，22例為重度(3)，17例為極重度(4)。

總的來(lái)說(shuō)，臨床癥狀的發(fā)生率與確診的ACα氯醛糖中毒病例一致。

然而，抽搐發(fā)作在這一組中明顯更常見(jiàn)，
22%的疑似病例記錄顯示出現(xiàn)了抽搐發(fā)作，
而確診病例的比例為8%(見(jiàn)表2和3)。

然而，這組貓中有9例(11%)在主人的要求下被安樂(lè)死。

Of all cases (n?=?103), two presented in 2014, four in 2015, three in 2016, four in 2017, seven in 2018, 74 in 2019 (Figure 2) and nine in the first two months of 2020. In the years 2014–2019, 84/94 cats (89%) were admitted from September to April each year.

Table 3 Prevalence of clinical signs in 78 cats presenting with suspected alpha-chloralose poisoning admitted to University Animal Hospital, Small Animal Clinic, Uppsala, Sweden, between January 2014 and February 2020

Discussion 討論

The present study aimed to contribute to the knowledge about AC intoxication in cats by describing the clinical presentation of a large group of cats with suspected AC poisoning admitted to a small animal university hospital.

AC poisoning was confirmed in 25 cats where blood samples were available for chemical analysis. The prevalence of clinical signs differed somewhat from what was previously reported by Segev et al,12?who reported a series of AC intoxication in both dogs and cats. The most common clinical signs observed by Segev et al in 13 cats were hypothermia, seizures, coma, hyperaesthesia, miosis and tremor.12?The clinical presentation was overall more severe in the report by Segev et al,12?with 46% of patients presenting comatose, and seizures noted in 54% of cats. This could reflect a difference in the definition of coma between studies. Clinically, severe hyperaesthesia may be very similar to partial seizures, with an overlap in the appearance and interpretation of the two, both between studies and between clinicians in the present study.（在臨床上，嚴(yán)重的感覺(jué)過(guò)敏可能與部分性抽搐發(fā)作非常相似，在多個(gè)研究之間和本研究中多個(gè)臨床醫(yī)生之間，兩者在外在表現(xiàn)和判讀上都有重疊。）Furthermore, while Segev et al reported an overall mortality of 15%, there were no mortalities in the cats with confirmed AC poisoning in the present study. Increasing public awareness about AC poisoning in cats in Sweden in 2019 may have influenced caregivers to seek veterinary care for cats with few or minor signs. This may have decreased the mortality and severity of signs of intoxication in this population as a result of receiving supportive care early in the progression of intoxication. However, the duration of hospitalisation in surviving cats was similar between our study and that which has been previously reported.12

Bradycardia 心動(dòng)過(guò)緩 was not reported by Segev et al,12?but was noted in 80% of our cats with confirmed poisoning. Tremor and ataxia 震顫和共濟(jì)失調(diào), which were noted in all our cats with confirmed intoxication, was noted in 15% and 0%, respectively, in the study by Segev et al.12?At UDS, hypothermia 低體溫 has been considered a very common sign of AC poisoning. When normal endothermia is impaired, the ambient temperature will greatly influence body temperature. In mice, ambient temperatures below 15.6°C were shown to be associated with higher mortalities after AC bait ingestion.1,2?As most cats in the present study presented to the clinic in the colder months (September–April), hypothermia is potentially a lethal consequence of poisoning. However, only 40% of confirmed cats presented with hypothermia (ie, fewer than expected). In the report by Segev et al, hypothermia was the most common sign of intoxication, seen in 91% of the cats.12?It is possible that the normothermic cats in the present study were admitted prior to the development of hypothermia, and that it was prevented by the supportive care provided. Regardless, these findings illustrate the importance of not excluding AC poisoning based on normothermia.（基于正常體溫不能排除α氯醛糖中毒）

Cats are more sensitive to AC than both dogs and humans, with a minimum lethal dose of 100?mg/kg vs 600–1000?mg/kg for dogs and >1000?mg/kg for humans（貓對(duì)α氯醛糖比犬和人都更敏感，最低致死劑量為100?mg/kg，犬為600-1000?mg/kg，人為1000?mg/kg）.2,8,9?Hanriot and Richet (1893, cited in Balis and Monroe)2?reported the LD50?for cats and dogs to be 400–600?mg/kg orally, but injecting as little as 40?mg/kg could lead to convulsions（Hanriot和Richet(1893年，Balis和Monroe引用)2報(bào)告貓和犬口服的LD50為400 - 600 mg/kg，但注射僅40mg/kg就可能導(dǎo)致驚厥。）. In an experimental model, a 5?mg/kg/h CRI maintained a stable level of surgical anaesthesia（在實(shí)驗(yàn)?zāi)Ｐ椭校?mg/kg/h的CRI維持了穩(wěn)定的手術(shù)麻醉水平）.4?To our knowledge, there have been no publications on the amount of intake, or AC serum concentration, where the first signs of intoxication can be expected in cats.

In the present study, it was not possible to determine with certainty how the cats had been exposed to AC. Several caregivers reported known baiting with AC either on their own property or in the vicinity（α氯醛糖誘餌）. Many observed the onset of neurological signs shortly after the cat had eaten a rodent（貓捕食了嚙齒類(lèi)）. Ingested rodent carcasses（吞食嚙齒類(lèi)尸體） were occasionally detected radiographically in the stomach at the time of presentation and one of the confirmed poisoned cats vomited a mouse carcass at the clinic. Many bird species are also very sensitive to AC and secondary poisoning through ingestion of intoxicated birds cannot be excluded（許多鳥(niǎo)類(lèi)對(duì)α氯醛糖也非常敏感，不能排除通過(guò)攝入已中毒的鳥(niǎo)類(lèi)而繼發(fā)中毒的可能性。）.9?Cats are also known dietary neophobes（貓也是出了名的飲食恐新者。）. A pilot study on the use of AC as a poison for feral cat control showed that the AC-containing bait palatability was low, and the cats were very reluctant to eat it, even when it contained low concentrations of AC（一項(xiàng)關(guān)于使用α氯醛糖作為野貓對(duì)照中毒的初步研究表明，含有α氯醛糖的誘餌的適口性很低，野貓非常不愿意吃這種誘餌，即使誘餌中含有的α氯醛糖濃度低）.17??Cornwell reported that cats did not eat AC bait, even when fasted for 36?h（Cornwell報(bào)告說(shuō)，即使禁食了36小時(shí)，貓也不吃α氯醛糖的誘餌）.8?This could indicate that the cats in the present study were secondarily poisoned, rather than having eaten bait directly（這可能表明，本研究中的貓是二次中毒，而不是直接吃了誘餌。）. However, hazard analysis of AC deemed the risk for secondary poisoning to mammal predators as ‘negligible’（然而，α氯醛糖的公害分析認(rèn)為，對(duì)哺乳動(dòng)物捕食者的二次中毒風(fēng)險(xiǎn)是“可以忽略不計(jì)的”）.18?In summary, with the available data, it was not possible to know how the cats were exposed to AC（總之，根據(jù)現(xiàn)有的數(shù)據(jù)，不可能知道貓是如何接觸到α氯醛糖的。）.

Owing to its retrospective nature there are weaknesses in this study. Samples were obtained opportunistically, and blood sampling was performed at different points in time in relation to the progression of intoxication. This limitation likely influenced the measured concentrations in each sample. Our data show a clear correlation between clinical severity and AC concentration, which is expected with a dose-dependent toxin. Some individual differences between cats’ ability to metabolise and excrete the toxin may however, influence the clinical severity in relation to AC concentration. Although all signs of intoxication were registered, including those reliably reported from the caretaker, the study was dependent on the extent of the history-taking by the attending clinicians upon admission, as well as during stationary care. As the study population consisted of outdoor cats, some clinical signs may also have gone unobserved by the caregiver. Furthermore, the confirmed cases in this study were all sampled in 2019 and 2020, when the clinical records generally included more detailed descriptions about which signs were present or absent due to increased awareness. Earlier records (2014–2018) are often less elaborate, and some signs may therefore be under-reported in the unconfirmed cases. As a direct, quantitative method of AC detection was not used in the study by Segev et al,12?a comparison between differences in blood concentrations of AC – and its impact on the prevalence of clinical signs and intoxication severity – was not possible.

In the present study, mortality and duration of hospitalisation was not dependent on the severity of clinical signs, indicating that intoxication severity is not indicative of prognosis. Our data suggest that cats with AC poisoning will rarely succumb when given proper supportive care in a timely manner.

在本研究中，死亡率和住院時(shí)間與臨床癥狀的嚴(yán)重程度無(wú)關(guān)，這表明中毒嚴(yán)重程度并不能預(yù)示預(yù)后如何。

我們的數(shù)據(jù)表明，如果及時(shí)給予適當(dāng)?shù)闹С中宰o(hù)理，α氯醛糖中毒的貓很少會(huì)出現(xiàn)死亡。

Conclusions 結(jié)論

This study provides a clinical description of AC intoxication in cats, describing 25 confirmed and 78 suspected cases of AC poisoning. Cats with AC intoxication have an excellent prognosis for complete recovery, providing that supportive care is given in a timely manner. When admitting an outdoor cat with acute onset of described neurological signs, no history of trauma and possible AC exposure, intoxication should be included in the list of differential diagnoses. This may influence both clinical decision-making, diagnostic work-up and client communication. A severe clinical picture upon presentation could be misinterpreted as a grave prognosis and both clinical and client awareness about AC poisoning may avoid unnecessary euthanasia.

本研究提供了貓α氯醛糖中毒的臨床描述，描述了25例確診病例和78例疑似α氯醛糖中毒病例。貓α氯醛糖中毒有很好的預(yù)后完全恢復(fù)，提供及時(shí)的支持護(hù)理。當(dāng)收治有急性神經(jīng)癥狀、無(wú)外傷史和可能接觸α氯醛糖的戶外貓時(shí)，中毒應(yīng)列入鑒別診斷列表中。這可能會(huì)影響臨床決策、診斷檢查和與寵主溝通。嚴(yán)重的臨床表現(xiàn)可能被誤解為嚴(yán)重的預(yù)后，臨床環(huán)境和寵主對(duì)α氯醛糖中毒的認(rèn)識(shí)可以避免不必要的安樂(lè)死。

Acknowledgments

Preliminary results from this study were communicated to the Swedish Chemicals Agency. We would like to thank them for taking our data into consideration, resulting in rapid action and a ban of layman use of AC rodenticides in Sweden in December of 2019.19?Following the ban, the number of cases decreased rapidly and substantially.

Ethical approval

The work described in this manuscript involved the use of non-experimental (owned or unowned) animals. Established internationally recognised high standards (‘best practice’) of veterinary clinical care for the individual patient were always followed and/or this work involved the use of cadavers. Ethical approval from a committee was therefore not specifically required for publication in?JFMS. Although not required, where ethical approval was still obtained, it is stated in the manuscript.

Informed consent

Informed consent (verbal or written) was obtained from the owner or legal custodian of all animal(s) described in this work (experimental or non-experimental animals, including cadavers) for all procedure(s) undertaken (prospective or retrospective studies). No animals or people are identifiable within this publication, and therefore additional informed consent for publication was not required.

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The Swedish Environmental Protection Agency and Djurv?nnernas F?rening, Stockholm, funded the chemical analyses in this study.

ORCID iD

Cecilia Tegner?https://orcid.org/0000-0003-4015-1228

Footnote

Accepted:?25 May 2022

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• Definitions of clinical signs.

Summary

The following file is available online:

Definitions of clinical signs.

Resources 資源

File?(sj-docx-1-jfm-10.1177_1098612x221107787.docx)

Clinical definitions 臨床定義

Coma?- non-ambulatory, obtunded, unconscious and unresponsive including to nociceptive stimuli.

昏迷?- 不能行動(dòng)，遲鈍，無(wú)意識(shí)和無(wú)反應(yīng)，包括對(duì)傷害性刺激無(wú)反應(yīng)。

Stupor?- non-ambulatory, obtunded, unresponsive to external stimuli except nociceptive stimuli. May have some degree of consciousness.

木僵/昏睡 - 不能行動(dòng)，遲鈍，對(duì)外部刺激無(wú)反應(yīng)，除了對(duì)傷害性刺激有反應(yīng)?？赡苡幸欢ǔ潭鹊囊庾R(shí)反應(yīng)。

Somnolence?- impaired reactions to external stimuli and reduced awareness.、

嗜睡?- 對(duì)外部刺激的反應(yīng)變差和意識(shí)水平下降。

Seizures?- tonic/clonic or tonic epileptiform seizures in unconscious, non-ambulatory patient.

抽搐發(fā)作 - 昏迷、不可行動(dòng)的病患的強(qiáng)直性/陣攣性或強(qiáng)直性癲癇樣抽搐發(fā)作。

Cranial nerve affection?- including miosis, mydriasis, anisocoria, impairment of pupil light reflex, dazzle or menace, facial nerve paralysis, vestibular syndromes, ptyalism, Horner’s syndrome etc.

腦神經(jīng)的影響 - 包括瞳孔縮小、瞳孔散大、瞳孔大小不一、瞳孔對(duì)光反射障礙、炫目或威脅反應(yīng)變差、面神經(jīng)麻痹、前庭綜合征、過(guò)度流涎、霍納氏綜合征等。

Vision impairment - signs indicating reduced/impaired ability to process visual stimuli. These patients are also noted as cranial nerve affection.

視覺(jué)障礙?- 表明處理視覺(jué)刺激的能力下降或受損的跡象。這些病患還會(huì)出現(xiàn)腦神經(jīng)的影響的相關(guān)癥狀。

Ataxia?- decreased ability to coordinate movements, including proprioceptive, cerebellar and vestibular ataxia.

共濟(jì)失調(diào)?- 協(xié)調(diào)運(yùn)動(dòng)的能力下降，包括本體感覺(jué)性、小腦性共濟(jì)失調(diào)和前庭性共濟(jì)失調(diào)。

Hypotension?- average systolic pressure ≤100 mmHg or mean arterial pressure ≤80 mmHg.

低血壓 - 平均收縮壓≤100mmHg 或 平均動(dòng)脈壓≤80mmHg。

Hypothermia?- body temperature ≤37℃.

低體溫 - 體溫≤37℃.

Bradycardia?- heart rate ≤140/min.

心動(dòng)過(guò)緩 - 心率≤140次/min。

Bradypnea?- respiratory rate ≤15/min.

呼吸過(guò)緩?-?呼吸速率 ≤15次/min.

Other respiratory alteration - choppy breathing pattern, intermittent apnoea or other abnormal breathing patterns.

其他呼吸改變 - 深起伏的呼吸模式，間歇性呼吸暫?；蚱渌惓：粑Ｊ?。

Hyperesthesia?- exaggerated reactions to external stimuli such as sound, light or touch.

感覺(jué)過(guò)敏 -?對(duì)聲音、光線或觸覺(jué)等外界刺激的過(guò)度反應(yīng)。

Tremor?- rhythmic oscillating movement generalised or localised, especially involving ears, whiskers and muzzle.

震顫?- 有節(jié)奏的振蕩運(yùn)動(dòng)，全身或局部，特別是涉及耳朵，胡須和吻部。

Behavioural changes?- in patients with normal consciousness. Includes signs of hallucinations, extreme polyphagia, desorientation, euphoria, dysphoria, hypervigilance, compulsive behaviour or aggression in a patient who is normally calm/timid

行為改變 -?在意識(shí)正常的病患身上。包括幻覺(jué)、極度食欲亢進(jìn)、定向障礙、興奮、不安、高度警惕、強(qiáng)迫行為或攻擊的跡象，通常是平靜/膽小的病患

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