小结
定义
病史和体格检查
关键诊断因素
- 婴儿用药错误
- 目睹摄入或发现儿童拿着空瓶或药丸
- 故意摄入史
- 物质滥用既往史
- 拟交感神经药物中毒综合征
- 抗毒蕈碱中毒综合征
- 阿片类药物中毒综合征
- 镇静催眠药中毒综合征
- 胆碱能综合征
其他诊断因素
- 恶心、呕吐或腹泻
- 意识状态改变
- 发热或体温过高
- 口腔和口咽沾染或灼伤
- 高血压或低血压
- 通气过度或通气不足
- 惊厥
- 失明或视力下降
- 听力下降或耳鸣
- 皮肤发红
- 低血糖症状和体征
- 黄疸
- 反射亢进和肌阵挛
- 肌肉强直
- 眼球震颤
- 共济失调
- 喘鸣
危险因素
- 家中的药物
- 容易拿到药物或家用化学品
- 低龄
- 异食癖
- 情绪压力
- 抑郁史或其他精神病史
- 女性
- 酒精使用障碍的家族史
诊断性检查
首要检查
- 血清电解质
- 血清尿素
- 血清肌酐
- 指尖血或血清葡萄糖
- 毛细血管血气或动脉血气分析（ABG）
- 阴离子间隙
- 血清乳酸
- 血清酮体或丙酮
- INR
- 肝功能检查 (LFT)
- 血清对乙酰氨基酚水平
- 血清水杨酸盐水平
- 尿液药物筛查
- 尿液分析
- 心电图 (ECG)
- 妊娠试验
- 血清肌酸激酶
- 腹部 X 线检查
- 胸部 X 线检查
需考虑的检查
- 乙醇水平
- 血清甲醇和乙二醇
- 血清地高辛水平
- 血清抗惊厥药水平
- 血清铁水平
- 血清锂、茶碱或全血重金属水平
- 尿液药物综合筛查
- 纳洛酮治疗试验
- 碳酸氢钠的治疗试验
- 阿托品和解磷定的治疗试验
- 氟马西尼的治疗试验
- 奥曲肽的治疗试验
- 毒扁豆碱的治疗试验
治疗流程
无症状
有症状和/或高风险摄入和/或药物水平升高
撰稿人
作者
David L. Eldridge, MD
Associate Professor
Clerkship Director
Department of Pediatrics
Brody School of Medicine at East Carolina University
Greenville
NC
利益声明
DLE has received research grants and been a site investigator for an ongoing clinical trial from GlaxoSmithKline and a closed clinical trial from Cempra Pharmaceuticals. DLE is an author of one reference cited in this topic.
Matthew R. Ledoux, MD
Associate Professor of Pediatrics
Vice Chair of Pediatrics
Co-Medical Director, Maynard Children’s Hospital, Vidant Medical Center
Division Chief, Division of Pediatric Critical Care and Hospital Medicine
Department of Pediatrics
Brody School of Medicine at East Carolina University
Greenville
NC
利益声明
MRL declares that he has no competing interests.
鸣谢
Dr David Eldridge and Dr Matthew Ledoux would like to gratefully acknowledge Dr Cynthia K. Aaron and Dr Keenan M. Bora, previous contributors to this topic.
利益声明
CKA and KMB declare that they have no competing interests.
同行评议者
Laurie Prescott, MD, FRCP
Emeritus Professor of Clinical Pharmacology
Faculty of Medicine
University of Edinburgh
Edinburgh
UK
利益声明
LP declares that he has no competing interests.
Mark Mannenbach, MD
Consultant in Pediatric Emergency Medicine
Assistant Professor of Pediatric and Adolescent Medicine
Mayo Clinic College of Medicine
Rochester
MN
利益声明
MM declares that he has no competing interests.
Colin A. Graham, MBChB, MPH, MD, FRCSEd, FRCSGlasg, FIMCRCSEd, FCCP, FCEM, FHKCEM, FHKAM
Editor
European Journal of Emergency Medicine
Professor of Emergency Medicine
Chinese University of Hong Kong
Hong Kong
People's Republic of China
利益声明
CAG is the editor of the European Journal of Emergency Medicine and receives an annual honorarium from Wolters Kluwer Health, the journal's publishers.
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