■氯丙嗪,最古老的抗精神病药物之一,仍然广泛使用,并且仍然服用过量。我们旨在研究氯丙嗪过量的临床效果,并确定所报告的剂量与重症监护病房入院或气管插管之间是否存在关系。
■我们对1987年至2023年期间因氯丙嗪过量(报告剂量超过300mg)而进入我们毒理学三级转诊医院的患者进行了回顾性分析。我们提取了人口统计信息,摄入的细节,临床效果和并发症(格拉斯哥昏迷量表,低血压[收缩压低于90mmHg],谵妄,心律失常),逗留时间,重症监护室入院,和气管插管.
■有218例氯丙嗪过量,在过去的36年里,演讲的频率在下降。演示时的平均年龄为32岁(四分位距:25-40岁),女性为143岁(61%)。报告的中位剂量为1,250mg(四分位距;700-2,500mg)。大多数报告(135;62%)涉及报告的其他药物的共同摄入,通常是苯二氮卓类药物,扑热息痛或抗精神病药。与报告的共同摄入组相比,有76(35%)氯丙嗪单独摄入,其中报告的中位剂量为1,650mg(四分位距:763-3,000mg)略高,报告的中位剂量为1,200mg(四分位距:700-2,100mg)。在所有的演讲中,36人(27%)的格拉斯哥昏迷评分低于9,50人(23%)被送入重症监护室,32例(15%)接受气管内插管。插管的患者(2,000mg;四分位距:1,388-3,375mg)和未插管的患者(1,200mg;四分位距:644-2,050mg;P<0.001)之间的中位报告剂量存在显着差异,以及入住重症监护病房和未入住重症监护病房的患者(P<0.0001)。插管的七个单独的氯丙嗪的中位报告剂量为2,500mg(四分位范围:2,000-8,000mg,范围:1,800-20,000毫克)。十八名(百分之八)病人出现谵妄,八人(4%)有低血压,三个人癫痫发作,有一次死亡.
■近四分之一的病例被送进重症监护病房,其中超过一半的病例被插管。虽然病人入院或插管的决定是基于临床需要,报告的摄入剂量与气管插管的要求之间存在显著关联.2013年后,出现频率和报告剂量均有所下降。该研究的主要局限性是回顾性设计,没有对摄入的分析确认。
■我们发现氯丙嗪过量最常见的作用是中枢神经系统抑制,气管插管与更大的报告剂量有关,特别是在单次服用氯丙嗪时。
UNASSIGNED: Chlorpromazine, one of the oldest antipsychotic medications, remains widely available and is still taken in overdose. We aimed to investigate the clinical effects of
chlorpromazine overdose and determine if there is a relationship between the reported dose ingested and intensive care unit admission or endotracheal intubation.
UNASSIGNED: We performed a retrospective analysis of patients admitted to our toxicology tertiary referral hospital with chlorpromazine overdose (reported dose ingested greater than 300 mg) between 1987 and 2023. We extracted demographic information, details of ingestion, clinical effects and complications (Glasgow Coma Scale, hypotension [systolic blood pressure less than 90 mmHg], delirium, dysrhythmias), length of stay, intensive care unit admission, and endotracheal intubation.
UNASSIGNED: There were 218
chlorpromazine overdose cases, with presentations decreasing in frequency over the 36 years. The median age at presentation was 32 years (interquartile range: 25-40 years) and 143 (61 per cent) were female. The median reported dose ingested was 1,250 mg (interquartile range; 700-2,500 mg). The majority of presentations (135; 62 per cent) involved reported co-ingestion of other medications, typically benzodiazepines, paracetamol or antipsychotics. There were 76 (35 per cent)
chlorpromazine alone ingestions in which there was a slightly higher median reported dose ingested of 1,650 mg (interquartile range: 763-3,000 mg) compared to the reported co-ingestion group, median reported dose ingested of 1,200 mg (interquartile range: 700-2,100 mg). Of all presentations, 36 (27 per cent) had a Glasgow Coma Scale less than 9, 50 (23 per cent) were admitted to the intensive care unit, and 32 (15 per cent) were endotracheally intubated. There was a significant difference in the median reported dose ingested between patients intubated (2,000 mg; interquartile range: 1,388-3,375 mg) and those not intubated (1,200 mg; interquartile range: 644-2,050mg; P < 0.001), and between those admitted to the intensive care unit and not admitted to the intensive care unit (P < 0.0001). The median reported dose ingested in seven
chlorpromazine alone presentations who were intubated was 2,500 mg (interquartile range: 2,000-8,000 mg, range: 1,800-20,000 mg). Eighteen (8 per cent) patients developed delirium, eight (4 per cent) had hypotension, three had seizures, and there was one death.
UNASSIGNED: Almost one quarter of cases were admitted to the intensive care unit and over half of these were intubated. Whist the decision to admit to an intensive care unit or intubate a patient is based on clinical need, there was a significant association between reported dose ingested and requirement for endotracheal intubation. Both the frequency of presentation and reported dose ingested declined after 2013. The major limitations of the study were a retrospective design and no analytical confirmation of ingestion.
UNASSIGNED: We found that the most common effect of chlorpromazine overdose was central nervous system depression and that endotracheal intubation was associated with larger reported doses ingested, particularly in single chlorpromazine ingestions.