Title: Antidote Safety in Pregnancy
题目：解毒剂的安全性与妊娠
Author 作者: Bryan Hayes

Most antidotes have not been adequately studied in pregancy and hold a Pregnancy Risk Category 'C' by the FDA. However, there are a few antidotes that hold a category 'D' or 'X' rating (contraindicated).
很多解毒剂在妊娠期的应用都没有经过足够的研究，被美国食物与药物管理局标记为妊娠危险分类‘C’。但有几个解毒剂被定为‘D’或‘X’（禁忌的）。
Ethanol (toxic alcohols) - Category C
乙醇（有毒的酒精）－分类 C
Reproduction studies have not been conducted with alcohol injection. Ethanol crosses the placenta, enters the fetal circulation, and has teratogenic effects in humans. When used as an antidote during the second or third trimester, Fetal Alcohol Syndrome AS is not likely to occur due to the short treatment period; use during the first trimester is controversial.
酒精注射对生育的影响还没有报导。乙醇可通过胎盘进入胎儿循环，在人身上有致崎作用。在妊娠中晚期作为解毒剂使用，由于应用时间段，不会造成胎儿酒精综合症。在妊娠早期的应用有争议。
Alternative (preferred) antidote: fomepizole.
可替代（推荐）的解毒剂：甲吡唑

Methylene blue (methemoglobinemia) - Category X
亚甲基兰（高铁血红蛋白血症）－分类 X
Use during amniocentesis has shown evidence of fetal abnormalities, but it has been used orally without similar adverse events. IV may be ok.
有证据显示经羊水穿刺给药可造成胎儿异常，但口服用药没有类式的不良后果。静脉用药可能可以。

Lorazepam and diazepam (seizures, nerve agents) - Category D
劳拉西泮和地西泮（癫痫，神经毒剂）－分类 D
Teratogenic effects have been observed in some animal studies and in humans. Lorazepam/diazepam and their metabolite cross the human placenta.
动物和人试验都发现有致崎作用，劳拉西泮和地西泮及它们的代谢物可通过人胎盘。

Potassium iodide (radioactive iodine) - Category D
碘化钾（放射活性碘）－ 分类 D
Iodide crosses the placenta (may cause hypothyroidism and goiter in fetus/newborn). Use for protection against thyroid cancer secondary to radioactive iodine exposure is considered acceptable based upon risk:benefit, keeping in mind the dose and duration.
碘通过胎盘（可造成胎儿／新生儿低甲或甲状腺肿大。根据风险效益分析，可以用来作为防止由于暴露放射碘而造成甲状腺癌。

Amyl nitrite (cyanide) - Category C (manufacturer contraindicates)
亚硝酸异戊酯（氰化物）－ 分类 C （厂商建议禁用）
Animal reproduction studies have not been conducted. Because amyl nitrate significantly decreases systemic blood pressure and therefore blood flow to the fetus, use is contraindicated in pregnancy (per manufacturer).
还没有动物的生育试验。由于亚硝酸异戊酯会明显地降低血压，减少胎儿血流，因此，妊娠期禁用（根据厂商建议）。
Other options exist to treat cyanide exposure including sodium nitrite, sodium thiosulfate, and hydroxocobalamin.
在治疗氰化物中毒时可有其它的选择：亚硝酸钠，硫代硫酸钠，和羟钴胺。

Penicillamine (chelator) - Category D
青霉胺（螯合剂）－ 分类 D
In most cases, the benefits of short-term use probably outweigh the risk, especially when accounting for the health and prognosis of the mother.
在很多情况下，短期的效益要超过风险，尤其要考虑到母亲的健康和预后时。

References 参考文献
Lexi-Comp Online, Lexi-Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; February 14, 2013.
1. General 常识:
      -- Should be considered in patients concerned for neurological infection with recent travel to endemic country
对最近到过流行区旅游并怀疑有神经系统感染的病人要考虑此病
-- Lab: JEV-specific IgM in serum (after 7 days of sx onset) or CSF (after 4 days of sx onset)
实验检查：日本脑炎病毒（JEV）－血清特异性IgM(起病后7天内)或CSF IgM（起病后4天内）
      -- Viral culture and other viral RNA amplifications tests are not sensitive
病毒培养和其它病毒RNA放大实验并不敏感
      -- Treatment is supportive
治疗主要是支持性
      -- In survivors, 30-50% have significant neurological, cognitive, psychological sequelae
在幸存病人中，30－50％会有明显的神经，认知，和心理方面的后遗症
2. Vaccine 疫苗
      -- One vaccine (Ixiaro) is available in the US    
美国有一个疫苗（Ixiaro）
      -- 2 doses, 28 days apart (96% develop immunity)
要接种两次，相隔28天（96％产生免疫力）
      -- No information on duration of protection
没有有关保护期的资料
      -- Recommended for travelers ≥ 1 month in endemic areas during JEV season
建议给在高发季节到流行区旅游超过1个月以上的旅游者
 
Bottom Line 要点:
Very rare but deadly disease with high mortality and post-infection sequelae.  Think about it in travelers to Asia during summer/fall seasons who have not been immunized.
罕见但具有高死亡率和感染后后遗症的恶性疾病。对在夏秋季到亚洲没有免疫过的旅游者要考虑日本脑炎。
  
References
http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/japanese-encephalitis.htm#2473