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1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 26-32, feb. 2020. tab
Artigo em Espanhol | LILACS-Express | ID: ibc-ET2-3433

RESUMO

Objetivo: Investigar si existen diferencias clínicas y toxicológicas en pacientes intoxicados por anfetamina (ANF) y metanfetamina (MANF) atendidos en servicios de urgencias. Método: Estudio observacional retrospectivo de intoxicaciones por ANF y MANF con confirmación analítica en Baleares (2013-2018). Se compararon variables clínicas, toxicológicas y de manejo clínico entre grupos. Resultados: 1) Se incluyeron 120 pacientes, 86 (71,7%) grupo ANF y 34 (28,3%) grupo MANF. 2) La confirmación de derivados anfetamínicos se realizó por cromatografía de gases-espectrometría de masas en 787 muestras de orina previamente positivas mediante un método de cribado cualitativo. Se confirmaron 154 (19,6%) muestras. De ellas, 34 fueron excluidas. 3) Se encontraron diferencias significativas entre ANF y MANF en: edad (32,3 vs 28,4 años); sexo (72,1 vs 94,1% hombres); nacionalidad española (64,0 vs 29,4%); en motivos de admisión: alteración de conducta (15,1 vs 0%) y palpitaciones (1,2 vs 20,6%); y en características clínicas: agitación (27,9 vs 8,8%). No hubo diferencias de manejo clínico. El 76,6% de casos fueron polintoxicaciones, más comunes en ANF (82,6 vs 61,8%). En estos casos se detectó principalmente cocaína (63,0%), cannabis (48,9%), MDMA (38,0%) y alcohol (35,9%). La mayor asociación del cannabis con el grupo de ANF fue estadísticamente significativa (45,3 vs 17,6%). La causa de los falsos positivos se identificó en el 78,7% de muestras, siendo el MDMA (71,2%) la principal. Conclusiones: Se observaron diferencias entre ANF y MANF en cuanto a variables demográficas y motivo de asistencia; no obstante en esta serie hubo un alto porcentaje de polintoxicaciones


Objective: To determine whether clinical and toxicologic findings differed between cases of amphetamine (AMP) and methamphetamine (mAMP) poisoning attended in 2 Balearic Island hospital emergency departments. Methods: Retrospective observational study of AMP and mAMP cases with laboratory confirmation between 2013 and 2018. We compared clinical and toxicologic variables as well as clinical management between groups. Results: 1) A total of 120 cases were found: 86 (71.7%) with AMP poisoning and 34 (28.3%) with mAMP poisoning. 2) Drug poisoning was confirmed by gas chromatography associated with mass spectrometry (GC–MS) in 787 urine samples found to be positive during screening. One hundred fifty-four (19.6%) were confirmed by GC–MS. Thirtyfour of them did not meet the inclusion criteria. 3) Significant differences between AMP and mAMP cases were found for age (32.3 vs 28.4 y, respectively); sex (72.1% vs 94.1% men); and Spanish nationality (64.0% vs 29.4%). Reasons for admission and clinical features also differed: the reasons were aberrant behavior (15.1% in the AMP group vs 0% in the mAMP group) and palpitations (1.2% vs 20.6%); agitation was observed in 27.9% and 8.8%, respectively. Clinical management was similar in the 2 groups. Multiple drug poisoning was detected in 76.6% patients and was more common in patients in the AMP group (82.6% vs 61.8%). The additional drugs in these cases were mainly cocaine (63.0%), cannabis (48.9%), 3,4-methylenedioxy-N-methamphetamine (MDMA) (38.0%), and alcohol (35.9%). Cannabis was detected in a significantly higher proportion in the AMP group (45.3%) than in the mAMP group (17.6%). False positives were found in 78.7% of the samples. The culprit drug was most often MDMA (71.2%). Conclusions: AMP poisonings were associated with age over 30 years, Spanish nationality, aberrant behavior, agitation, multiple drug findings, and the use of cannabis. Poisonings caused by mAMP abuse were associated with age under 30 years, non-Spanish nationality, palpitations, and single-drug use

2.
Rev Esp Salud Publica ; 942020 Jan 16.
Artigo em Espanhol | MEDLINE | ID: mdl-31942868

RESUMO

OBJECTIVE: There are few epidemiological studies on acute poisonings from pesticides, industrials and household products in Spain. The objective of this work is to describe the epidemiological and clinical profile of acute poisonings by chemical products in our country, and analyze their annual evolution. METHODS: The Spanish Toxicovigilance System (SETv) is a prospective registry that includes 32 Emergency Departments and Intensive Care Units in Spain. An observational descriptive study of acute poisoning by chemical agents (excluding pharmacological products and illicit drugs) was carried out, within 1999-2014. Statistical analysis was performed using Chi-square or exact Fisher's tests. Non-parametric continuous variables were compared using the Mann-Whitney U test. P-value less than 0.05 were considered significant. RESULTS: The 10,548 cases studied had a mean age of 38.41 (±22.07) years, being significantly higher in women (p=0.0001). 67.7% of the poisonings occurred at home, and the most frequent routes of exposure were respiratory (48.3%), digestive (35.3%) and ocular (13.1%). The most frequent toxic groups were toxic gases (31%), caustics (25.6%) and irritant gases (12.1%). Of the patients that required treatment (76.2%), antidotes were used in 27.2%. 20.6% of the patients were admitted at Hospital, with a median stay of 32 (±151.94) days, with significant differences for pesticides and solvents (p=0.02). Sequelae were presented at discharge in 2.1% of patients. Mortality was 1.4% (146 patients) with a mean age of 62.08 years (±19.58) (p=0.0001). CONCLUSIONS: The reduction of chemical poisonings should be prevented in the domestic environment, taking into account the sources of exposure to carbon monoxide and the handling of household cleaning products, both caustic liquids and the generation of irritating gases when mixed.

3.
Emergencias ; 32(1): 26-32, 2020 Feb.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31909909

RESUMO

OBJECTIVES: To determine whether clinical and toxicologic findings differed between cases of amphetamine (AMP) and methamphetamine (mAMP) poisoning attended in 2 Balearic Island hospital emergency departments. MATERIAL AND METHODS: Retrospective observational study of AMP and mAMP cases with laboratory confirmation between 2013 and 2018. We compared clinical and toxicologic variables as well as clinical management between groups. RESULTS: 1) A total of 120 cases were found: 86 (71.7%) with AMP poisoning and 34 (28.3%) with mAMP poisoning. 2) Drug poisoning was confirmed by gas chromatography associated with mass spectrometry (GC-MS) in 787 urine samples found to be positive during screening. One hundred fifty-four (19.6%) were confirmed by GC-MS. Thirtyfour of them did not meet the inclusion criteria. 3) Significant differences between AMP and mAMP cases were found for age (32.3 vs 28.4 y, respectively); sex (72.1% vs 94.1% men); and Spanish nationality (64.0% vs 29.4%). Reasons for admission and clinical features also differed: the reasons were aberrant behavior (15.1% in the AMP group vs 0% in the mAMP group) and palpitations (1.2% vs 20.6%); agitation was observed in 27.9% and 8.8%, respectively. Clinical management was similar in the 2 groups. Multiple drug poisoning was detected in 76.6% patients and was more common in patients in the AMP group (82.6% vs 61.8%). The additional drugs in these cases were mainly cocaine (63.0%), cannabis (48.9%), 3,4-methylenedioxy-N-methamphetamine (MDMA) (38.0%), and alcohol (35.9%). Cannabis was detected in a significantly higher proportion in the AMP group (45.3%) than in the mAMP group (17.6%). False positives were found in 78.7% of the samples. The culprit drug was most often MDMA (71.2%). CONCLUSION: AMP poisonings were associated with age over 30 years, Spanish nationality, aberrant behavior, agitation, multiple drug findings, and the use of cannabis. Poisonings caused by mAMP abuse were associated with age under 30 years, non-Spanish nationality, palpitations, and single-drug use.

4.
Emergencias ; 31(2): 107-110, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30963738

RESUMO

OBJECTIVES: To review changes occurring over time in cases of medication overdose attended by an emergency department. MATERIAL AND METHODS: Retrospective review of epidemiologic and care variables related to drug poisonings in a university teaching hospital in 2007 and 2017. We used multivariate analysis to compare the 2 years. RESULTS: A total of 750 cases were included; 438 (58.4%) were from 2007. Fewer cases were seen in 2017 even though the total numbers of emergencies and poisonings had risen (P<.001). Fewer cases were suicides or suicide attempts in 2017 (P<.001), and digestive tract decontamination and antidotes were used less often (P<.001 and P=.007, respectively). Admissions (P=.004) and voluntary self-discharges or patient losses were also down in 2017 (P=.03). However, multidrug poisonings increased (P=.001), especially in the context of recreational drug use by men. Benzodiazepine overdoses accounted for most of such cases (65.1%). CONCLUSION: Medication overdoses seem to be decreasing, although the proportion of men overdosing is rising. Suicide attempts, the abuse of specific medications, and admissions also seem to be decreasing.

5.
Emergencias (Sant Vicenç dels Horts) ; 31(2): 107-110, abr. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182527

RESUMO

Objetivo: Análisis de la evolución temporal de las intoxicaciones medicamentosas (IM) atendidas en urgencias hospitalarias. Método: Estudio retrospectivo, con análisis multivariante de variables epidemiológicas y asistenciales de IM, comparando la casuística de los años 2007 con 2017, en un hospital universitario. Resultados: Se incluyeron 750 casos, 58,4% del 2007. En 2017, disminuyeron la causa suicida (p < 0,001), el empleo de descontaminación digestiva (p < 0,001) y antídotos (p = 0,007), y los ingresos (p = 0,004), altas voluntaria o fugas (p = 0,03). Se incrementó por el contrario la intoxicación múltiple (p = 0,001), especialmente en varones y en contexto recreativo. Las benzodiacepinas fueron los fármacos más implicados en las IM (65,1%). Conclusiones: Existe una tendencia al descenso de las IM atendidas, con incremento en varones, menos intencionalidad suicida, menos uso de terapéuticas específicas y menos admisiones hospitalarias


Objective: To review changes occurring over time in cases of medication overdose attended by an emergency department. Methods: Retrospective review of epidemiologic and care variables related to drug poisonings in a university teaching hospital in 2007 and 2017. We used multivariate analysis to compare the 2 years. Results: A total of 750 cases were included; 438 (58.4%) were from 2007. Fewer cases were seen in 2017 even though the total numbers of emergencies and poisonings had risen (P<.001). Fewer cases were suicides or suicide attempts in 2017 (P<.001), and digestive tract decontamination and antidotes were used less often (P<.001 and P=.007, respectively). Admissions (P=.004) and voluntary self-discharges or patient losses were also down in 2017 (P=.03). However, multidrug poisonings increased (P=.001), especially in the context of recreational drug use by men. Benzodiazepine overdoses accounted for most of such cases (65.1%). Conclusions: Medication overdoses seem to be decreasing, although the proportion of men overdosing is rising. Suicide attempts, the abuse of specific medications, and admissions also seem to be decreasing


Assuntos
Humanos , Masculino , Feminino , Adulto , Overdose de Drogas/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Envenenamento/epidemiologia , Registros/estatística & dados numéricos , Estudos Retrospectivos , Análise Multivariada , Hospitais Universitários/estatística & dados numéricos
11.
Emergencias (St. Vicenç dels Horts) ; 28(1): 38-40, feb. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-148465

RESUMO

El objetivo de este estudio es la detección de parámetros analíticos asociados a la mortalidad en los pacientes con diabetes mellitus tipo 2 (DM2) con tratamiento crónico con metformina que acuden a urgencias por un cuadro clínico agudo con presencia de acidosis láctica. Se trata de un estudio observacional-analítico retrospectivo realizado en un hospital de tercer nivel. Se recogieron datos clínicos y analíticos en una serie de pacientes con acidosis láctica, estratificada por gravedad, y tratamiento con metformina para DM2. Se compararon los resultados en función de la mortalidad o supervivencia del episodio. De 16 pacientes estudiados, con una edad media de 70 años (rango de 60 a 77), el 75% presentó sintomatología gastrointestinal los 5 días previos a su ingreso. La mortalidad total observada fue del 19%, que se asoció a la presencia de sepsis al ingreso, leucocitosis con neutrofilia, plaquetopenia, elevación de proteína C reactiva (PCR), valores altos de procalcitonina y la comorbilidad con una o más patologías crónicas. Las cifras sé- ricas de metformina no se correlacionaron significativamente con la mortalidad. Se concluye que en pacientes con acidosis láctica y tratamiento con metformina pueden ser factores asociados a la mortalidad la presencia de criterios de sepsis, neutrofilia con plaquetopenia, elevación de PCR y de procalcitonina y la existencia de una o más patologías comórbidas (AU)


To identify analytical factors associated with mortality in patients with type-2 diabetes under long-term treatment with metformin who come to the emergency department with acute symptoms of lactic acidosis. Retrospective observational analysis of patient records in a referral hospital. We collected clinical data and laboratory results for a series of metformin-treated patients with type-2 diabetes who developed lactic acidosis, stratified by severity. Factors related to the episode were analyzed for associations with mortality or survival. Of 16 patients studied (mean age 70 years; range, 60-77 years), 75% had gastrointestinal symptoms in the 5 days before they came to the emergency department. Mortality (19%) was associated with sepsis on arrival; elevated white blood cell counts, particularly neutrophil counts; low platelet counts; high C-reactive protein (CRP) and procalcitonin levels; and 1 or more chronic concomitant diseases. Metformin concentration was not significantly associated with mortality. Signs of sepsis, high neutrophil counts with low platelet counts, elevated CRP and procalcitonin levels, and the presence of 1 or more concomitant diseases may be risk factors for death in metformin-treated patients with lactic acidosis (AU)


Assuntos
Humanos , Diabetes Mellitus Tipo 2/complicações , Acidose Láctica/mortalidade , Diabetes Mellitus Tipo 2/tratamento farmacológico , Metformina/uso terapêutico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/métodos , Estudos Retrospectivos
12.
Med. clín (Ed. impr.) ; 146(3): 108-111, feb. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-147821

RESUMO

Introducción y objetivo: La sensibilidad química múltiple (.SQM) es un trastorno multisistémico de etiología controvertida que afecta a algunos sujetos al exponerse a productos químicos a concentraciones no perjudiciales. El objetivo de este trabajo es describir las características epidemiológicas, clínicas y psicológicas de una muestra de pacientes con SQM, para un posterior tratamiento grupal específico. Pacientes y método: Estudio descriptivo de los pacientes diagnosticados de SQM en una unidad de toxicología, mediante la administración del cuestionario Quick Environmental Exposure and Sensitivity Inventory, junto con la entrevista estructurada SCID-II, la escala de ansiedad HAS y el test de personalidad tipo A, PCTA. Resultados: Se incluyeron 73 pacientes, con una edad media de 52,6 años (rango 33-77; DE 9,29), siendo 66 mujeres (90,4%). El 53% estaban clasificados como grado i-ii y ii. Sesenta y un pacientes (83%) presentaron algún tipo de comorbilidad, fundamentalmente dolor crónico, fibromialgia y fatiga crónica, con niveles de ansiedad mayores (puntuación media 19,2), predominio de rasgos de personalidad fóbico-evitativo y patrón de conducta tipo A (31,1%). Conclusiones: La SQM afecta principalmente a mujeres de mediana edad, con comorbilidades (dolor crónico, fibromialgia y fatiga crónica), elevada ansiedad y conductas de evitación. Este análisis previo debería ayudar a ofrecer un abordaje psicoterapéutico específico a estos pacientes (AU)


Introduction and objective: Multiple chemical sensitivity (MCS) is a multisystem disorder of controversial etiology, affecting some subjects when exposed to chemicals at no harmful concentrations. The objective of this paper is to describe the epidemiological, clinical and psychological features of a sample of patients with MCS for further specific group treatment. Patiens and method: Descriptive study of patients diagnosed with MCS in a toxicology unit. We administered the Quick Environmental Exposure and Sensitivity Inventory, the structured interview SCID-II, the anxiety scale HAS and the type A personality test, PCTA. Results: Seventy-three patients were included. The mean age was 52,6 years (range 33-77; SD 9.29). Sixty-six were females (90.4%). Fifty-three percent were classified as i-ii and ii grade. Sixty-one patients (83%) presented some type of comorbidity, mainly chronic pain, fibromyalgia and chronic fatigue. They exhibited higher levels of anxiety (average score of 19.2), prevalence of phobic-avoidant traits of personality and type A behavior in 31.1%. Conclusions: MCS affects middle-aged women with comorbidities (chronic pain, fibromyalgia and chronic fatigue) and high anxiety and avoidance behaviors. This preliminary analysis should help provide a specific therapeutic approach to these patients (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Sensibilidade Química Múltipla/complicações , Sensibilidade Química Múltipla/epidemiologia , Sensibilidade Química Múltipla/psicologia , Exposição a Produtos Químicos , Testes de Personalidade/estatística & dados numéricos , Inquéritos e Questionários , Ansiedade/epidemiologia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Escala de Ansiedade Manifesta/estatística & dados numéricos , Escala de Ansiedade Manifesta/normas , Comorbidade
13.
Emergencias ; 28(1): 38-40, 2016 02.
Artigo em Espanhol | MEDLINE | ID: mdl-29094825

RESUMO

EN: To identify analytical factors associated with mortality in patients with type-2 diabetes under long-term treatment with metformin who come to the emergency department with acute symptoms of lactic acidosis. Retrospective observational analysis of patient records in a referral hospital. We collected clinical data and laboratory results for a series of metformin-treated patients with type-2 diabetes who developed lactic acidosis, stratified by severity. Factors related to the episode were analyzed for associations with mortality or survival. Of 16 patients studied (mean age 70 years; range, 60-77 years), 75% had gastrointestinal symptoms in the 5 days before they came to the emergency department. Mortality (19%) was associated with sepsis on arrival; elevated white blood cell counts, particularly neutrophil counts; low platelet counts; high C-reactive protein (CRP) and procalcitonin levels; and 1 or more chronic concomitant diseases. Metformin concentration was not significantly associated with mortality. Signs of sepsis, high neutrophil counts with low platelet counts, elevated CRP and procalcitonin levels, and the presence of 1 or more concomitant diseases may be risk factors for death in metformin-treated patients with lactic acidosis.

15.
Med Clin (Barc) ; 146(3): 108-11, 2016 Feb 05.
Artigo em Espanhol | MEDLINE | ID: mdl-26654553

RESUMO

INTRODUCTION AND OBJECTIVE: Multiple chemical sensitivity (MCS) is a multisystem disorder of controversial etiology, affecting some subjects when exposed to chemicals at no harmful concentrations. The objective of this paper is to describe the epidemiological, clinical and psychological features of a sample of patients with MCS for further specific group treatment. PATIENS AND METHOD: Descriptive study of patients diagnosed with MCS in a toxicology unit. We administered the Quick Environmental Exposure and Sensitivity Inventory, the structured interview SCID-II, the anxiety scale HAS and the type A personality test, PCTA. RESULTS: Seventy-three patients were included. The mean age was 52,6 years (range 33-77; SD 9.29). Sixty-six were females (90.4%). Fifty-three percent were classified as i-ii and ii grade. Sixty-one patients (83%) presented some type of comorbidity, mainly chronic pain, fibromyalgia and chronic fatigue. They exhibited higher levels of anxiety (average score of 19.2), prevalence of phobic-avoidant traits of personality and type A behavior in 31.1%. CONCLUSIONS: MCS affects middle-aged women with comorbidities (chronic pain, fibromyalgia and chronic fatigue) and high anxiety and avoidance behaviors. This preliminary analysis should help provide a specific therapeutic approach to these patients.


Assuntos
Sensibilidade Química Múltipla/epidemiologia , Determinação da Personalidade , Adulto , Distribuição por Idade , Idoso , Ansiedade/epidemiologia , Candidíase Vulvovaginal/epidemiologia , Dor Crônica/epidemiologia , Comorbidade , Síndrome de Fadiga Crônica/epidemiologia , Feminino , Fibromialgia/epidemiologia , Hábitos , Humanos , Entrevista Psicológica , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Sensibilidade Química Múltipla/psicologia , Polimedicação , Índice de Gravidade de Doença , Distribuição por Sexo
16.
Med Clin (Barc) ; 129(13): 501-3, 2007 Oct 13.
Artigo em Espanhol | MEDLINE | ID: mdl-17980119

RESUMO

BACKGROUND AND OBJECTIVE: Rumack's nomogram is usually used to indicate the treatment with N-acetilcysteine in the paracetamol poisoning, but it has several limitations. Paracetamol half-life elimination (t1/2) is approximately of 2 h with therapeutic doses and it increases to more than 4 h in patients with hepatotoxicity. The aim of this study was to determine the usefulness of estimated paracetamol t1/2 as greater than or inferior to 4 h by using a simple ratio in relation to the development of hepatotoxicity. PATIENTS AND METHOD: 21 patients with paracetamol overdose were admitted to Son Dureta Hospital (Palma de Mallorca) and Clínic Hospital (Barcelona) over 13 months. The estimated t1/2 is calculated using the quotient between 2 plasma paracetamol concentrations separated by 2 or more hours. RESULTS: We found a significant difference (p < 0.005) between the group with hepatotoxicity (n = 3; t1/2 = 8,5 h; range: 3,6 - 8,7 h); and without hepatotoxicity (n = 18; t1/2 = 2,4 h; (range: 1,6 - 4,3 h). We observed an agreement between positive ratio and a t1/2 > 4 h, and negative ratio with t1/2 < 4 h, bearing in mind that the quotient is obtained through mathematical equations. CONCLUSIONS: Rumack's nomogram should be complemented with t1/2 estimation in all cases of paracetamol poisoning, especially with those patients for whom we are not able to determine the time of ingestion at presentation or if there has been a multiple-timepoint ingestion.


Assuntos
Acetaminofen/metabolismo , Acetaminofen/envenenamento , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Nomogramas , Adulto , Overdose de Drogas , Feminino , Meia-Vida , Humanos , Masculino , Valor Preditivo dos Testes
17.
Med. clín (Ed. impr.) ; 129(13): 501-503, oct. 2007. tab
Artigo em Espanhol | IBECS | ID: ibc-72205

RESUMO

FUNDAMENTO Y OBJETIVO: El nomograma de Rumack seutiliza para indicar el tratamiento con el antídoto Nacetilcisteínaen la intoxicación por paracetamol, perotiene varias limitaciones de uso. La semivida de eliminación(t1/2) del paracetamol, que con dosis terapéuticases de unas 2 h, se incrementa hasta más de4 h en caso de hepatotoxicidad. El objetivo de estetrabajo ha sido validar la predicción de hepatotoxicidada partir de la estimación de la t1/2 como superior oinferior a 4 h obtenida mediante un simple cociente.PACIENTES Y MÉTODO: Se ha estudiado a 21 pacientescon sobredosificación de paracetamol que acudierona los Hospitales de Son Dureta de Palma de Mallorcay Clínic de Barcelona durante un período de 13meses. La estimación de la t1/2 se realizó medianteun cociente entre 2 determinaciones consecutivasde paracetamol en plasma, separadas por un intervalode tiempo de 2 h o más.RESULTADOS: Se observó una diferencia significativa(p < 0,005) en la t1/2 entre el grupo con hepatotoxicidad(n = 3; t1/2 mediana de 8,5 h; extremos: 3,6-8,7 h) y el grupo sin hepatotoxicidad (n = 18; t1/2mediana de 2,4 h; extremos: 1,6-4,3 h). Se hallóuna coincidencia entre cociente positivo y t1/2 superiora 4 h, y entre cociente negativo y t1/2 inferior a4 h, teniendo en cuenta que el cociente se obtuvoa través de ecuaciones matemáticas.CONCLUSIONES: Se propone que se complemente elnomograma de Rumack con la estimación de la t1/2en todos los casos de intoxicación por paracetamol enque se planteen dudas respecto a la indicación detratamiento con antídoto, y en aquellos en los que sedesconozca el tiempo transcurrido desde la ingestao cuando ésta haya sido fraccionada


Rumack’s nomogram isusually used to indicate the treatment with N-acetilcysteinein the paracetamol poisoning, but it hasseveral limitations. Paracetamol half-life elimination(t1/2) is approximately of 2 h with therapeutic dosesand it increases to more than 4 h in patients with hepatotoxicity.The aim of this study was to determinethe usefulness of estimated paracetamol t1/2 as greaterthan or inferior to 4 h by using a simple ratio inrelation to the development of hepatotoxicity.PATIENTS AND METHOD: 21 patients with paracetamoloverdose were admitted to Son Dureta Hospital (Palmade Mallorca) and Clínic Hospital (Barcelona)over 13 months. The estimated t1/2 is calculatedusing the quotient between 2 plasma paracetamolconcentrations separated by 2 or more hours.RESULTS: We found a significant difference (p < 0.005)between the group with hepatotoxicity (n = 3; t1/2 =8,5 h; range: 3,6 – 8,7 h); and without hepatotoxicity(n = 18; t1/2 = 2,4 h; (range: 1,6 – 4,3 h). Weobserved an agreement between positive ratio and at1/2 > 4 h, and negative ratio with t1/2 < 4 h, bearingin mind that the quotient is obtained through mathematicalequations.CONCLUSIONS: Rumack’s nomogram should be complementedwith t1/2 estimation in all cases of paracetamolpoisoning, especially with those patientsfor whom we are not able to determine the time ofingestion at presentation or if there has been amultiple-timepoint ingestion (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Insuficiência Hepática/induzido quimicamente , Acetaminofen/síntese química , Acetaminofen/farmacologia , Acetaminofen/toxicidade , Acetilcisteína/toxicidade , Acetilcisteína/uso terapêutico , Sensibilidade e Especificidade , Testes de Toxicidade/métodos , /diagnóstico , Antídotos/uso terapêutico
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