■故意服用多种药物过量是青春期经常遇到的自我伤害方法。治疗包括支持治疗,解毒剂(如果有的话)和去污技术,目的是减少胃肠道系统的药物吸收,以最大程度地减少毒性。然而,目前使用的去污技术,如洗胃(GL),活性炭或全肠冲洗,有一个可疑的有效性。目前仅在轶事病例中描述了用于大量摄入药物或形成药物的内窥镜胃去污(EGD)治疗。在这里,我们描述了在接受EGD治疗的青少年患者中故意药物过量的管理以及该疗法对药物药代动力学的影响。
■一名15岁男孩在昏迷状态(格拉斯哥昏迷量表:7-8)下接受儿科重症监护病房,阿司匹林,比索洛尔,氟西汀,呋塞米,阿普唑仑,和普瑞巴林药片.立即进行快速顺序插管,然后对患者进行对症治疗和GL治疗,同时去除最少的胃物质。考虑到药物的类型,从口头假设开始的时间和假设的未知数量,尝试EGD的目的是去除药物的潜在聚集体。在EGD之前和之后采集系列血样以测量药物的血浆水平。发现了一种药牛,并立即用EGD取出。药物监测结果表明,喹硫平超过了文献报道的毒性水平,表明它可能是我们患者认为的较高剂量的药物。PICU的逗留很顺利,患者在拔管后被转移到精神科病房。
■我们的案例表明,GL在减轻多药吸收方面是无效的,尤其是潜在诱导药效的药物。此外,根据我们的血浆药物监测,我们认为,早期EGD应考虑在所有情况下,大量服用药丸,可以形成生药的缓释药物或在无法排除危及生命的剂量的情况下。
UNASSIGNED: Intentional multiple drugs overdose is an often-encountered method of self-harm in adolescence. Treatments include supportive therapy, antidotes (when available) and decontamination techniques with the aim of reducing drugs absorption by the gastrointestinal system to minimize toxicity. Nevertheless, the decontamination techniques currently used, such as gastric lavage (GL), activated charcoal or whole-bowel irrigation, have a questionable effectiveness. Endoscopic gastric decontamination (EGD) treatment for massive ingestion of drugs or formation of pharmacobezoars is currently described only in anecdotal cases. Here we describe the management of an intentional drug overdose in an adolescent patient treated with EGD and the effects of this therapy on drugs pharmacokinetics.
UNASSIGNED: A 15-year-old boy was admitted in an unconscious state (Glasgow Coma Scale: 7-8) to the pediatric intensive care unit after assuming an unspecified amount of quetiapine, aspirin, bisoprolol, fluoxetine, furosemide, alprazolam, and pregabalin pills. Rapid sequence intubation was immediately performed and then the patient was treated with symptomatic therapy and GL with minimal removal of gastric material. Accounting for the type of drugs, the time elapsed from oral assumption and the unknown quantity assumed, EGD was attempted with aim of removing potential aggregate of the drugs. Serial blood samples were taken before and after EGD to measure the plasma level of the drugs. A pharmacobezoar was found and was immediately removed with EGD. The results of the drug monitoring showed that quetiapine exceeded the toxic level reported in literature indicating that it may have been the drug assumed in higher quantity by our patient. PICU stay was uneventful, and the patient was transferred to the psychiatric ward after extubation.
UNASSIGNED: Our case shows how GL is not effective in mitigating multidrug absorption especially drugs potentially inducing pharmacobezoars. Furthermore, based on our plasma drug monitoring, we believe that early EGD should be considered in all cases of massive pill intake, prolonged release drugs that can form pharmacobezoars or in cases where a life-threatening dose cannot be excluded.