RESUMO
Las intoxicaciones en Chile siguen siendo un motivo importante de consulta en el servicio de urgencia (SU). Tanto intoxicaciones accidentales como intencionales constituyen una fuente de morbimortalidad y gasto de recursos monetarios no solo en Chile, si no que en todo el mundo. Debido a los múltiples compuestos que pueden producir una intoxicación grave, sigue siendo un desafío para el equipo de salud su enfrentamiento y manejo oportuno. Los médicos que tratan a estos pacientes deben ser sistemáticos y ordenados en su enfrentamiento, ya que la presentación clínica es variada y depende del agente ingerido, co-ingestas, si es aguda o crónica o concomitante con otras patologías (trauma, infecciones, etc.). El manejo está dirigido a las maniobras básicas de reanimación y soporte vital, prevención de absorción del tóxico y cuando corresponda, la administración del antídoto. La evaluación y tratamiento inicial serán abordados en esta revisión, temas específicos para diferentes drogas serán discutidos de forma separada. Objetivo: entregar las nociones básicas del enfrentamiento y manejo terapéutico inicial de un paciente intoxicado desde la perspectiva de la medicina de urgencias. Método: se realizó una revisión bibliográfica de la literatura científica, presentándose la evidencia actual del manejo e intervenciones terapéuticas utilizadas actualmente de un paciente intoxicado.
In Chile, poisonings are a frequent reason for emergency department visits. Accidental and intentional poisonings constitute an important source of worldwide morbidity, mortality and health care costs. Because of the heterogeneous presentations of poisonings, and the unknown exposure, it is always challenging for healthcare providers. Doctors who treat these patients must remember to be systematic and structured in their evaluation since the clinical presentation is not only determined by the exposure itself but also by co-ingestions, the time of presentation, whether the exposure is acute or chronic, and other concomitant health issues (trauma, hypothermia, comorbidities). The management focuses on basic resuscitation and life support, prevention of absorption of the toxin, and when appropriate, administering an antidote. Initial evaluation and treatment will be addressed in this review, and specific issues for different drugs will be discussed elsewhere. Objective: to describe the basic concepts to assess and manage the initial encounter of a poisoned patient from the perspective of emergency medicine. Methods: a bibliographic review of the scientific literature was carried out, presenting the current evidence of the management and therapeutic interventions currently used in an intoxicated patient.
RESUMO
@#Datura plants contain anticholinergic properties. Consumers may present with a spectrum of anticholinergic symptoms, including hallucination, agitation, tachycardia, delirium, hyperthermia, and dilated pupils. Prompt identification of the symptoms with appropriate treatment can be life-saving. Some patients might not be able to provide history and therefore recognition of toxidromes is imperative. Awareness should be built among the public who may be exposed to such fruits or plants.
RESUMO
PURPOSE: In the management of acute poisoning, the anion gap and the osmol gap are easily derived from serum laboratory findings and arterial blood gas analysis. The anion gap is known to be increased by the effects of the toxic material itself and secondary complications or by an exacerbation of an underlying illness. The osmol gap can be increased by the presence of osmotically active materials in the body, such as alcohol, glycols and mannitol. This study was proposed to investigate the significance of an increased anion gap in acutely poisoned patients and the effect of alcohol ingestion in increasing the osmol gap, which might help to understand the significance of an increased osmol gap in acutely poisoned patients. METHODS: A retrospective chart review of poisoned patients who had visited the emergency departments of the Anam and the Ansan hospitals of Korea University was used in this study. Serum laboratory findings and arterial blood gas analysis were used to measure the anion gap and the osmol gap. Patients were categorized into a non anion-gap group versus a high anion-gap group and a normal osmolgap group versus a high osmol-gap group. Frequency of toxidrome, blood pH and drinking history were included to evaluate the relations between the groups. RESULTS: Of 204 patients, 195 patients who completed the tests were included in the study. In the 99 patients with a high anion-gap, 38 (38.38%) patients showed development of toxidrome. In the 96 patients with a non anion-gap, only 15 (15.62%) patients showed toxidrome. Forty-six (80.7%) of the 57 patients with a high osmol-gap and 20 (22.2%) of the 90 patients with a normal osmol-gap had a history of drinking. CONCLUSION: In poisoned patients, the group with a higher anion gap showed a higher frequency of toxidrome. This suggests that in the management of a poisoning victim with an uncertain history, should a high anion gap be found, an intense observation and evaluation is necessary to identify the cause. An increase in the osmol gap in poisoned patients is generally considered to be from alcohol ingestion. Thus, for a patient with an increased osmol gap, measurement of the serum ethanol level should be done to exclude the effect of alcohol.