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DOI: 10.1055/s-2001-17890
Akute Vergiftungen in der internistischen Intensivmedizin
Cases of acute poisoning admitted to a medical intensive care unitPublication History
Publication Date:
18 October 2001 (online)
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Hintergrund und Fragestellung: Aufgrund der geringen Information zur Epidemiologie akuter Vergiftungen wurden die Daten aller intoxikierten Patienten, die auf der internistischen Intensivstation der Johann Wolfgang Goethe-Universität Frankfurt am Main von Januar 1993 bis Dezember 1999 behandelt wurden, ausgewertet.
Patienten und Methodik: Insgesamt waren dies 147 (80 Frauen, 67 Männer, Altersdurchschnitt 41 Jahre, 2,3 %) von 6211 Patienten.
Ergebnisse: Zur Aufnahme führten die Notwendigkeit zur Beatmung und die Überwachung der Vitalfunktionen. 52 % der Patienten (n = 76) wurden wegen eines Suizidversuchs, vorwiegend mit Antidepressiva (n = 19), Paracetamol (n = 16) oder Benzodiazepinen (n = 9) aufgenommen. Von diesen 76 Patienten verstarben zwei (2,6 %). 48 % der Patienten (n = 71) wurden nach akzidentellen Vergiftungen, überwiegend mit Heroin (n = 19), Alkohol (n = 18) und Digitalis (n = 12), behandelt. Bei 11 Patienten lagen Vergiftungen mit Herbiziden, Tiergiften, Industrie- bzw. Haushaltschemikalien vor. In dieser Gruppe verstarben drei drogenabhängige Patienten (4,2 %). Abhängig von der Vergiftungsform wurden unterschiedliche Therapiestrategien (Kohle, Antidota, extrakorporale Entgiftung) eingesetzt.
Folgerung: Die Zahl der akut intoxikierten Patienten, die intensivmedizinisch behandelt werden mussten, war sehr niedrig bedingt durch eine exzellente Versorgung in der prähospitalen Phase und in der Notaufnahme. Die Letalität lag im Rahmen der aus der Literatur bekannten Daten.
Cases of acute poisoning admitted to a medical intensive care unit
Background and objective: Because of the paucity of information on the epidemiology of acute poisoning requiring intensive medical care, all such patients treated on the medical intensive care unit of the university hospital in Frankfurt am Main, Germany, between January 1993 and December 1999, were retrospectively evaluated.
Patients and methods: Of the total of 6211 patients, 147 (80 women, 67 men, mean age 41 years, 2,3 %) were treated for acute intoxication in the intensive care unit.
Results: Reasons for admission to the intensive care unit were the need for ventilator treatment or intensive monitoring of vital functions. 52 % of the patients (n = 76) had attempted suicide, most of them using anti-depressive drugs (n = 19), paracetamol (n = 16), or benzodiazepines (n = 9). Two patients (2,6 %) died. 48 % of the patients (n = 71) were admitted because of accidental poisoning. Leading toxic agents in this group were heroin (n = 19), alcohol (n = 18) and digitalis (n = 12). 11 patients had taken herbicides, animal poisons or chemicals used at work or for house cleaning. In this cohort, three i. v. drug abusers (4,2 %) had died. Depending on the agents used, a variety of treatments (charcoal, antidots, extracorporal therapy) were undertaken.
Conclusion: Due to excellent care in the prehospital phase and in the emergency room the number of patients requiring treatment on the intensive care unit was rather low. The mortality was in the range of other reports.
Literatur
- 1 AACT and EAPCCT . Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. J Toxicol Clin Toxicol. 1999; 37 731-751
- 2 Caballero V alles PJ, Dorado P S, Brusint O B, Jerez B B, Medina S M. The epidemiological surveillance of acute poisoning in 1997. A study of 1140 cases from the area south of the Madrid Community. Rev Clin Esp. 1999; 199 424-430
- 3 Crombie I K, McLoone P. Does the availability of prescribed drugs affect rates of self poisoning?. Br J Gen Pract. 1998; 48 1505-1506
- 4 Fürst S, Habscheid W. Acute poisoning in patients of a medical intensive care unit. Dtsch Med Wochenschr. 1993; 118 849-853
- 5 Hall A K, Curry C. Changing epidemiology and management of deliberate self poisoning in Christchurch. N Z Med J. 1994; 107 396-399
- 6 Henderson A, Wright M, Pond S M. Experience with 732 acute overdose patients admitted to an intensive care unit over six years. Med J Aust. 1993; 158 28-30
- 7 Johns M W. Self-poisoning with barbiturates in England and Wales during 1959 - 74. Br Med J. 1977; 1 1128-1130
- 8 Juarez-Aragon G, Castanon-Gonzalez J A, Perez-Morales A J, Montoya C abrera MA. Clinical and epidemiological characteristics of severe poisoning in an adult population admitted to an intensive care unit. Gac Med Mex. 1999; 135 669-675
- 9 Lapatto-Reiniluoto O, Kivisto K T, Pohjola-Sintonen S, Luomanmaki K, Neuvonen P J. A prospective study of acute poisonings in Finnish hospital patients. Hum Exp Toxicol. 1998; 17 307-311
- 10 Lawson A A, Mitchell I. Patients with acute poisoning seen in a general medical unit (1960 - 71). Br Med J. 1972; 4 153-156
- 11 Matthew H, Proudfoot A T, Brown S S, Aitken R C. Acute poisoning: organization and work-load of a treatment centre. Br Med J. 1969; 3 489-493
- 12 Nogue S, Marruecos L, Nolla J, Monteis J, Ferrer A, Civeira E. The profile evolution of acute severe poisoning in Spain. Toxicol Lett. 1992; 64 - 65 725-727
- 13 Persson H E, Sjoberg G K, Haines J A, Pronczuk D G. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol. 1998; 36 205-213
- 14 Phillips S, Brent J, Kulig K, Heiligenstein J, Birkett M. The Antidepressant Study Group . Fluoxetine versus tricyclic antidepressants: a prospective multicenter study of antidepressant drug overdoses. J Emerg Med. 1997; 15 439-445
- 15 Platt S, Hawton K, Kreitman N, Fagg J, Foster J. Recent clinical and epidemiological trends in parasuicide in Edinburgh and Oxford: a tale of two cities. Psychol Med. 1988; 18 405-418
- 16 Proudfoot A T. Clinical toxicology-past, present and future. Hum Toxicol. 1988; 7 481-487
- 17 Schuster H P, Weilemann L S. Results of treatment of internal medicine intensive care cases. Med Klin. 1981; 76 419-422
- 18 Stürer A, Weilemann L S. Fünf Jahre Vergiftungsdokumentation ADAM-Entwicklungen und Tendenzen für den Intensivmediziner. Intensivmed. 2000; 37 417
- 19 Tay S Y, Tai D Y, Seow E, Wang Y T. Patients admitted to an intensive care unit for poisoning. Ann Acad Med Singapore. 1998; 27 347-352
- 20 Vernon D D, Gleich M C. Poisoning and drug overdose. Crit Care Clin. 1997; 13 647-667
- 21 Verstraete A G, Buylaert W A. Survey of patients with acute poisoning seen in the Emergency Department of the University Hospital of Gent between 1983 and 1990. Eur J Emerg Med. 1995; 2 217-223
- 22 Viertel A, Sachunsky I, Wolf G, Blaser C. Treatment of diphenhydramine intoxication with haemoperfusion. Nephrol Dial Transplant. 1994; 9 1336-1338
- 23 Weilemann L S. Primary and secondary poison elimination. Internist. 2000; 41 1071-1076
- 24 Weilemann L S, Hilgers H J, Reckmann A. Current aspects of para-suicidal poisoning. Med Klin. 1996; 91 355-358
- 25 Weir P, Ardagh M. The epidemiology of deliberate self poisoning presenting to Christchurch Hospital Emergency Department. N Z Med J. 1998; 111 127-129
- 26 Zimmerman J E, Knaus W A, Judson J A. et al . Patient selection for intensive care: a comparison of New Zealand and United States hospitals. Crit Care Med. 1988; 16 318-326
Korrespondenz
Privatdozent Dr. med. Hans- Reinhard Brodt
Medizinische Klinik III/Infektiologie, J.
W. Goethe Universität
Theodor Stern Kai 7
60590 Frankfurt am Main
Phone: 49/69/6301 6608
Fax: 49/69/6301 6378
Email: reinhard@brodt.net