Intoxicaciones agudas por alcohol, otras drogas y fármacos psicoactivos

  1. P. Díez Romero 1
  2. M. Gallego Alonso-Colmenares 1
  3. J. Fernández Herranz 1
  4. M. Ganzo Pión 1
  1. 1 Hospital General Universitario Gregorio Marañón
    info

    Hospital General Universitario Gregorio Marañón

    Madrid, España

    ROR https://ror.org/0111es613

Journal:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Year of publication: 2015

Issue Title: Urgencias (III): Urgencias neurológicas

Series: 11

Issue: 89

Pages: 5314-5323

Type: Article

DOI: 10.1016/J.MED.2015.10.016 DIALNET GOOGLE SCHOLAR

More publications in: Medicine: Programa de Formación Médica Continuada Acreditado

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Abstract

Initial management begins with the conventional system ABC (airway, breathing and circulation) and neurological assessment and management of complications (seizures, arrhythmias and electrolyte disorders). Subsequently, more specific to reduce the absorption, promote disposal and use of antidotes (if any) measures. The clinical manifestations of acute ethanol intoxication, relate directly with blood alcohol levels. Clinical management is based on general measures, thiamine must be used as prophylaxis for Wernicke encephalopathy. Several studies have shown that Metadoxine may be useful in treating acute alcohol intoxication. The clinical manifestations related to drug abuse are a common target, the condition of the central nervous system and hemodynamic instability. The handling is very similar, despite the variety of illicit substances: hydration, use of naloxone / flumazenil, checking vital signs. Psychotropic drugs are a very heterogeneous group, have a wide margin of safety (with exceptions). The use of activated charcoal should be performed at multiple doses, due to the long half life of this group, being ineffective measures to accelerate the elimination of the drug. Lithium is the drug within the group, sequels and organ damage can cause poisoning last once. The handling is related in case of serious poisoning, existing as only specific antidote flumazenil for benzodiazepine poisoning.

Bibliographic References

  • Observatorio español de las drogas y las toxicomanías. Informe anual 2011. Disponible en http://www.pnsd.msc.es/Categoria2/ob-serva/pdf/oed2011.pdf
  • Azkunaga B, Mintegi S, del Arco Arco L, Bizkarra I. Cambios epidemio-lógico en las intoxicaciones atendidas en los servicios de urgencias pediá-tricos españoles entre 2001 y 2010: incremento de las intoxicaciones etí-licas. Emergencias. 2012;24:376-9.
  • Azkunaga B, Mintegi S, Bizkarra I, Fernández J; Intoxications Working Group of the Spanish Society of Pediatric Emergencies. Toxicology surveillance system of the Spanish Society of Paediatric Emergencies: first-year analysis. Eur J Emerg Med. 2011;18:285-7.
  • González Hernández J, Laín Terés N. Actitud general en las intoxicaciones agudas. En: Julián Jiménez A, editor. Manual de pro-tocolos y actuación en Urgencias. 2ª ed. Madrid: Nilo Gráficas; 2005. p. 813-20.
  • Origüen Sabater J, de Miguel B. Manual de diagnóstico y tera-péutica médica. 7ª ed. Madrid: Hospital Universitario 12 de Octu-bre; 2012. p. 10276-284.
  • Andersen AH. Experimental studies on the pharmacology of activated charcoal: I. Adsorption power of charcoal in aqueous solutions. Acta Pharmacol. 1946;2:69-78.
  • Burillo-Putze G, Munné P, Dueñas A, Trujillo MM, Jiménez A, Adrián MJ, et al. Intoxicaciones agudas: perfil epidemiológico y clí-nico, y análisis de las técnicas de descontaminación digestiva utiliza-das en los servicios de urgencias españoles en el año 2006 -Estudio HISPATOX. Emergencias. 2008;20:15-26.
  • Jones AW. Aspects of in-vivo pharmacokinetics of etanol. Alcohol Clin Exp Res. 2000;24:400-2.
  • Oneta CM, Simanowski UA, Martínez M, Allali-Hassani A, Parés X, Ho-mann N, et al. First pass metabolism of ethanol is strinkgly influenced by speed of gastric emptying. Gut. 1998;43:612-9.
  • Guerri C. Cómo actúa el alcohol en nuestro cerebro. Trastornos Adictivos. 2000;2(1):14-25.
  • Janicak PG, Piszczor J. Alcohol-related syndrome. En: Flaberty JA, Chan-non RA, Davis 3M, editors. Psychiatry: diagnosis and therapy. East Norwalk: Appleton and Lange; 1988.p. 166-81.
  • Mardel S, Phair I, O'Dwyer F, Henry JA. Intravenous pyridoxine in acute ethanol intoxication. Hum Exp Toxicol. 1994;13:321-3.
  • Díaz Martínez MC, Díaz Martínez A, Villamil Salcedo V, Cruz Fuentes C. Efficacy of metadoxina in the management of acute al-cohol intoxication. J Inter Med Res. 2002;30(1):44-51.
  • Albertson TE, Dawson A, de Latorre F, Hoffman RS, Hollander JE, Jae-ger A. Use of naloxone in cases of suspected opioid-induced respiratory failure. Ann Emerg Med. 2001;Suppl37:83-4.
  • Weber JE, Hollander JE, Murphy SA, Braunwald E, Gibson CM. Cocai-ne induced myocardial infarction is associated with reduced microvascu-lar perfusion. Acad Emerg Med. 2003;10:428-9.
  • Galicia M, Nogué S, Sanjurjo E, Miró O. Consultas urgentes derivadas del consumo de éxtasis (3,4-metilenodioximetanfetamina) y derivados anfetamínicos: perfil epidemiológico, clínico y evolutivo. Rev Clin Esp. 2010;210:371-8.
  • Hill SL, Thomas SH. Clinical toxicology of newer recreational drugs. Clin Toxicol (Phila). 2011;49:705-19.
  • Varela M, Nogué S, Orós M, Miró O. Gamma hydroxybutirate use for sexual assault. Emerg Med. 2004;21:255-6.
  • Zvosec DL, Smith SW, Litonjua R, Westfal RE. Physostigmine for gamma-hydroxybutyrate coma: inefficacy, adverse events, and review. Clin Toxicol (Phila). 2007;45:261-5.
  • Rosenberg MF, Anthony JC. Early clinical manifestations of cannabis de-pendence in a community sample. Drug Alcohol Depend. 2001;64:123-31.
  • Iglesias ML, Epelde F, Espinosa J, Mariñosa M. Consumo de bebidas energizantes con alcohol, una mezcla arriesgada. Med Clin (Barc). 2013;141:133-9.
  • Pajarón M, Ckaver G, Nogué S, Munné P. Metahemoglobinemia secun-daria al uso recreacional de poppers. Med Clin (Barc). 2003;20:121:358.
  • Riquelme A, Burillo-Putze G, Jiménez A, Hardisson A. Epidemiología global de la Intoxicación Aguda en un Área de Salud. Aten Primaria. 2001;28:506.
  • Mintzer MZ, Stoller KB, Griffiths RR. A controlled study of flumazenil-precipitated withdrawal in chronic low-dose benzo-diacepine users. Psychopharmacology (Berl). 1999;147:200-9.
  • Singh N. Serial electrocardiographic changes as a predictor of cardiovas-cular toxicity in acute tricyclic antidepressant overdose. Am J Ther. 2002;9:75-9.
  • Teece C. Gastric lavage in tricyclic antidepressant overdose. Emerg Med J. 2003;20:64.
  • Mason PJ, Morris VA, Balcezak TJ. Serotonin syndrome. Presentation of 2 cases and review of the literature. Medicine. 2000;79:201-9.
  • Domínguez Ortega L, Medina Ortiz O, Cabrera García Armenter S. In-toxicación con litio. An Med Interna (Madrid). 2006;23(9):441-5.
  • Davis LL, Ryan W, Adinoff B, Petty F. Comprehensive review of the psychiatric uses of valproate. J Clin Psychopharmacol. 2000;20Suppl1:1-7.
  • Sweetman S. Carbamazepine. En: Brayheld A, editor. Martin-dale: The Complete Drug Reference. London: Pharmaceutical Press; 2009. p. 2336.
Data source: Dialnet