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首页> 外文期刊>Prescrire international >Acute poisoning following ingestion of medicines: initial management. How to treat life-threatening complications and to evaluate the risk of delayed effects and psychological distress.
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Acute poisoning following ingestion of medicines: initial management. How to treat life-threatening complications and to evaluate the risk of delayed effects and psychological distress.

机译：食入后急性中毒：初步管理。如何治疗威胁生命的并发症，以及评估延迟效应和心理困扰的风险。

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摘要

Acute poisoning following ingestion of medications, both intentional and unintentional, is frequent and more or less severe. It is often unclear whether a toxic dose has been ingested. This review examines the initial management of patients with suspected acute poisoning, based on a review of the literature using the standard Prescrire methodology. We examined clinical practice guidelines, which are mostly based on observational, pharmacological and toxicological data, as well as empirical data. Few comparative trials are available. In life-threatening situations, the first priority is to call an emergency response mobile unit and to implement life-support techniques, i.e., resuscitation for cardiorespiratory arrest; respiratory support if necessary; and the left lateral head-down position and glucose injection if the patient is unconscious. Prompt, initial measures may also include: anticonvulsant injection for status epilepticus (diazepam, for example); a sedative for extreme agitation (diazepam or clorazepate if there is no risk of respiratory depression; otherwise haloperidol); atropine for severe bradycardia; elevating the legs for hypotension; and naloxone in case of respiratory depression due to opioids. Drug poisoning can be life-threatening.The extent of the risk should be assessed by questioning the patient and close contacts, examining the immediate environment, and carrying out a clinical examination to identify a major toxic condition. The severity of poisoning is assessed by gathering all information about the patient, the drug(s) ingested, the circumstances of ingestion, and any other substances ingested at the same time. A poison control centre may be called to assist with diagnosis, to predict the clinical consequences, and to guide patient management. Activated charcoal can reduce the gastrointestinal absorption of some drugs. It should be given as soon as possible, preferably within 2 hours after ingestion of a drug known to be adsorbed by activated charcoal, provided the patient is fully conscious and capable of swallowing safely. Gastric lavage carries a risk of serious adverse effects. It is only justified in the rare cases in which the patient's life is at risk following ingestion of a drug that is not adsorbed by activated charcoal. Ipecac syrup should not be used under any circumstances. Purging and gastric lavage are not part of initial management. Few antidotes are suitable for use in the early stages of poisoning. Acetylcysteine can be used for some cases of paracetamol poisoning, and naloxone for some types of opioid poisoning. Paracetamol poisoning can cause life-threatening hepatocellular necrosis. Activated charcoal should be administered as soon as possible. Acetylcysteine protects the liver when administered within 24 hours after paracetamol ingestion. Paracetamol serum assay can be useful for guiding patient management. In practice, acetylcysteine should be given when access to emergency medical intervention is not feasible within 8 to 10 hours after paracetamol ingestion. Intravenous naloxone is useful for respiratory depression due to opioid poisoning, but its duration of action is often shorter than that of opioids, making continuous monitoring necessary. Hospital monitoring is warranted in case of potentially severe poisoning; this includes patients at increased risk, patients having taken a potentially lethal substance at a toxic or unknown dose. Some pharmacological substances and formulations can have delayed effects. In case of self-poisoning, the risk of short-term relapse should be evaluated, even when the patient's condition is not life-threatening. Hospital admission should be proposed, or sometimes imposed, until the acute risk of suicide has subsided. In practice, when faced with acute drug poisoning, the first step is to implement life-support measures, to gather and communicate prognostic information and details of any treatments to the ambulance crew or hospital team.
机译：故意和非故意摄入药物后的急性中毒是经常发生的或多或少严重的。经常不清楚是否已经摄入了毒性剂量。这篇综述基于对使用标准Prescrire方法的文献的综述，对疑似急性中毒的患者的初始治疗进行了检查。我们检查了临床实践指南，这些指南主要基于观察，药理和毒理学数据以及经验数据。很少有比较试验。在危及生命的情况下，首要任务是呼叫应急响应移动单元并实施生命支持技术，即进行心肺骤停复苏。必要时提供呼吸支持;如果患者失去知觉，则应朝左外侧头朝下放置并注射葡萄糖。迅速的初步措施还包括：癫痫持续状态的抗惊厥注射（例如地西p）;极度镇静的镇静剂（如果没有呼吸抑制的危险，则为地西am或氯硝西ate;否则为氟哌啶醇）;阿托品用于严重心动过缓;抬高腿以降低血压;如果因阿片类药物导致呼吸抑制，则使用纳洛酮。药物中毒可能会危及生命。应通过询问患者和亲密接触者，检查周围环境并进行临床检查以确定主要毒性状况来评估风险程度。中毒的严重程度通过收集有关患者，所摄入的药物，摄入情况以及同时摄入的任何其他物质的所有信息来评估。可以呼叫中毒控制中心来协助诊断，预测临床后果并指导患者管理。活性炭可以减少某些药物在胃肠道的吸收。如果患者完全清醒并且能够安全吞咽，应尽快服用，最好在摄入已知会被活性炭吸附的药物后2小时内服用。洗胃有严重不良反应的风险。仅在极少数情况下才有道理，在这种情况下，摄入不被活性炭吸附的药物会危及患者的生命。在任何情况下都不应使用吐根糖浆。清洗和洗胃不是初始治疗的一部分。很少有解毒剂适合在中毒的早期使用。乙酰半胱氨酸可用于扑热息痛中毒的某些情况，纳洛酮可用于某些类型的阿片类药物中毒。扑热息痛中毒可导致危及生命的肝细胞坏死。活性炭应尽快服用。乙酰氨基酚摄入后24小时内给予乙酰半胱氨酸可保护肝脏。扑热息痛血清测定法可用于指导患者管理。实际上，当对乙酰氨基酚摄入后8到10个小时内无法进行紧急医疗干预时，应给予乙酰半胱氨酸。静脉内纳洛酮可用于阿片类药物中毒引起的呼吸抑制，但其作用时间通常比阿片类药物的作用时间短，因此需要进行连续监测。如果可能发生严重中毒，应保证对医院进行监控;这包括风险增加的患者，以毒性或未知剂量服用了潜在致死性物质的患者。一些药理学物质和制剂可能会延迟作用。如果发生中毒，即使患者的病情不危及生命，也应评估短期复发的风险。应提议或有时实行住院治疗，直到自杀的急性风险减轻。实际上，当面对急性药物中毒时，第一步是实施生命支持措施，收集救护人员或医院团队的预后信息和任何治疗方法的详细信息。

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