Caused by excessive dosagepoisoning。Misuse or overdose and drug abuse can causeDrug poisoning。Common poisoning drugs include western medicine, traditional Chinese medicine and pesticide.
Foreign name
Drug Poisoning
Visiting department
Emergency Department
Common causes
Caused by misuse, overdose and drug abuse
common symptom
Dizziness, nausea, vomiting, lethargy, apathy, weakness, severe respiratory failure, etc
atlas
Science popularization in China
Committed to authoritative science communication
The certification expert of this term is
Jiang Donghui|Chief physician
Emergency Department of Wuxi Second People's Hospitalto examine
Dizziness, nausea, vomiting, lethargy, apathy, weakness, severe respiratory failure, etc
pathogeny
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The factors affecting drug poisoning are generally believed to be related to the following factors.
1. Drug management
With the development of the chemical pharmaceutical industry, if the management cannot keep up, the occurrence of drug poisoning will increase.
2. Prevention of regional diseases
For example, HCPX is widely used in schistosomiasis endemic areas in China, and the incidence of toxic neuropathy and neurosis is also high.
3. Genetic factors
It is an important cause of toxicity of some drugs.For example, glucose 6-phosphate dehydrogenase (G6PD) deficiency patients play an important role in hemolytic anemia caused by the use of quinine antimalarial drugs.In patients with pseudocholinesterase deficiency, after the same dose of muscle relaxant succinylcholine was used, the interval time between exhalation and inspiration was prolonged, and in severe cases, asphyxia was caused.The metabolism of alcohol in the body mainly depends on acetaldehyde dehydrogenase, and those who lack acetaldehyde dehydrogenase are prone to alcoholism.
4. Gender and age differences
The sensitivity of sex and age to drug toxicity varies greatly.For example, chloramphenicol can cause aplastic anemia, and the incidence rate of women is three times higher than that of men.Children should pay more attention to drug use, because children's drug metabolism is not fully developed, and they are highly sensitive to drug toxicity.If chloramphenicol can cause gray baby syndrome, the child may die several hours after symptoms appear.Children's kidneys excrete streptomycin slowly, and long-term use can cause deafness.The functions of heart, liver and kidney of the elderly are declining, and allergic reactions or poisoning are prone to occur.At the same dose of digoxin, the plasma half-life was prolonged and the incidence of digitalis poisoning was high.The renal excretion function of the elderly decreased, and the plasma concentration after intramuscular injection of penicillin was 13 times higher than that of the young.The dosage of barbiturate hypnotics used by the elderly should be adjusted because the metabolic activity of drugs in the liver of the elderly is reduced.There are many kinds of drugs used by the elderly, and the duration of drug use is long. The incidence of side effects of drugs is also high.
clinical manifestation
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The clinical manifestations are different according to different kinds of drugs.Clinical manifestations of common drug poisoning:
1. Chlorpromazine poisoning
The patient may have dizziness, lethargy, indifferent expression, weakness, and sometimes mental disorder, disorderly words and movements;It can also cause salivation, nausea, vomiting, abdominal pain, abdominal distension, jaundice, hepatomegaly, etc.Acute poisoning caused by excessive dose often causes palpitations, cold limbs, decreased blood pressure, even shock, dyspnea, narrowed pupils, coma and loss of reflexes.Proteins, red blood cells, white blood cells and casts may appear in urine.Long term and large dose application can cause granulocytopenia, thrombocytopenia, hemolytic anemia, and even aplastic anemia.There may also be facial paralysis, dysphonia and stuttering, muscle spasm around the orbit, and even hyperkeratosis.A few cause eye damage, resulting in vision loss, or even blindness.
2. Poisoning by phenobarbital, isobarbital, and secobarbital
The patient was initially excited, manic, convulsion, and then turned to depression, lethargy, confusion, slurred speech, deep sleep and even deep coma.In late stage, limbs are paralyzed, reflex disappears, urine and fecal incontinence, pupil shrinks, breathing is shallow and light, and even respiratory failure occurs.
3. Chloral hydrate poisoning
The patient has nausea, abdominal pain, severe liver and kidney function damage, oliguria, lethargy to coma, shallow and slow breathing, cyanosis of lips, respiratory muscle paralysis, loss of reflex, weak pulse, decreased blood pressure, arrhythmia and even cardiac arrest.
4. Digitalis poisoning
Digitalis drugs are mainly used to treat congestive heart failure, but their therapeutic dose is very close to the toxic dose. The elderly have poor tolerance and are prone to poisoning.When digitalis is poisoned, the patient has headache, dizziness, dizziness, yellow vision, anorexia, nausea, vomiting, diarrhea and various cardiac rhythm abnormalities such as ventricular premature contraction, paroxysmal atrial tachycardia, atrioventricular block. Some patients have atrial fibrillation, and suddenly the heart rhythm becomes regular. The ECG shows a typical digitalis poisoning pattern.
5. Atropine and scopolamine poisoning
The patient first had symptoms of dry skin and mucosa, thirst, dysphagia, facial flushing, pupil enlargement, blurred vision, tachycardia, urinary retention and other parasympathetic nerve depression.Severe patients have central excitation symptoms: increased speech, hallucinations, irritability, delirium, convulsions, etc;This was followed by depression, lethargy and coma.Those poisoned by scopolamine were more lethargic than excited.At this time, take the patient's urine and drop it into the cat's eye, which can cause pupil dilation, which is helpful for diagnosis.
6. Sodium salicylate and aspirin poisoning
Patients may suffer from nausea, vomiting, stomachache, dizziness, sweating, flushing, tinnitus, epistaxis, blurred vision, gastrointestinal bleeding, proteinuria, ketonuria, early respiratory alkalosis, followed by metabolic acidosis, dehydration, potassium loss, irritability, pulse speed, convulsions, comaRespiratory and peripheral circulatory failure.
diagnosis
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The diagnosis of drug poisoning, the inquiry of medical history and clinical examination are basically the same as those of general diseases, but the differential diagnosis of drug poisoning is more complicated.First of all, it is necessary to distinguish whether the patient's toxic symptoms are caused by the development of the disease or by medication, such as headache, dizziness, nausea, vomiting, etc.In case of sudden rash, it should be considered to be related to drugs or poisons.The doctor should specifically ask about the medication history, medication type, dosage and time, and be familiar with the adverse reactions of each drug, as well as the patient's family drug toxicity history.The incubation period of poisoning symptoms is of great reference significance for diagnosis, most of which are 1 to 2 days, and the maximum is 10 to 12 days.
treatment
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1. Treatment principle
Remove the cause, accelerate excretion, delay absorption, support therapy, symptomatic treatment.The special treatment is mainly to take antidote substances.
2. Antidote for common drugs
(1) Lead, manganeseIt can be detoxified with calcium sodium edetate.
(2) Arsenic, mercuryDetoxification can be carried out with dithiopropyl alcohol and sodium dithiopropyl sulfonate.
(3) Nitrite, benzeneA small amount of methylene blue can be injected intravenously.
(4) CyanideNitrite sodium thiosulfate therapy.
(5) OrganophosphorusAtropine, Jiefosidine.
(6) OpioidsNaloxone.
prevention
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1. Strengthen poison publicity
Popularize knowledge about poisoning prevention and first aid.
2. Strengthen poison management
Strictly observe the protection and management system of poisons, strengthen the storage of poisons, and prevent the leakage of poisons.
3. Prevent accidental ingestion of poisons or overdose
Containers of drugs and chemicals should be labeled separately, and the hospital should strictly check the system for drug use to avoid misuse or overdose.
