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Akute Intoxikationen: Marker für Screening, Diagnose und Therapiesteuerung

  • G. HacklEmail author
Leitthema
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Zusammenfassung

Akute Intoxikationen machen einen wesentlichen Anteil des Patientenkollektivs auf internistischen Intensivstationen aus. Mischintoxikationen und Arzneimittelintoxikationen stehen dabei im Vordergrund. Ziel dieses Artikels ist es, Marker für Screening, Diagnose und Therapiesteuerung bei akuten Intoxikationen auf der Intensivstation näher zu beschreiben. Zur Erstellung dieser Arbeit wurde eine Literaturrecherche durchgeführt und ein Review anhand von Leitlinien, Case Reports, Expertenmeinungen und wissenschaftlichen Publikationen verfasst. Toxidrome stellen eine sinnvolle Einteilung von klinischen Charakteristika bei initialer Unkenntnis der verursachenden Substanz dar. Speziell im Intensivbereich sollte immer versucht werden, das ursächliche Toxin anhand von Enzymimmunassays sowie durch Chromatographie und Massenspektrometrie zu identifizieren und quantifizieren. Die intensivmedizinische Behandlung von Patienten mit akuten Intoxikationen umfasst neben den Maßnahmen zur Überwachung und Sicherung der Vitalfunktionen auch Methoden zur primären und sekundären Giftelimination. Die Indikation zum Einsatz von extrakorporalen Verfahren sollte genau abgewogen werden und das Verfahren anhand von Proteinbindung und Molekülgröße gewählt werden. Zunehmend finden auch die Lipidemulsionstherapie, die Hochdosisinsulintherapie sowie die hyperbare Oxygenierung Verwendung.

Schlüsselwörter

Toxikologie Pharmakologische und toxikologische Prozesse Vergiftung Intensivstationen Screening 

Acute intoxications: markers for screening, diagnosis and therapy monitoring

Abstract

Acute poisonings account for a significant proportion of the patient population presenting to intensive care units, whereby mixed drug overdoses and prescription drug overdoses predominate. The aim of this article was to describe indications for screening, diagnosis and therapy monitoring in acute overdoses in the intensive care unit. To conduct this work, a literature search was carried out and a review was written based on guidelines, case reports, expert opinions and scientific publications. Toxidromes are a useful tool for classification of clinical characteristics when the causative agent is initially unknown. Especially in critical care medicine, identifying and quantifying of the causative toxin by enzyme immunoassays, chromatography and mass spectrometry should be attempted. Intensive care treatment of patients with acute overdoses includes not only monitoring and support of vital functions but also methods for primary and secondary elimination of toxins. The indication for the use of extracorporeal procedures should be carefully evaluated and the method should be chosen based on protein binding and molecular size. Lipid emulsion therapy, high-dose insulin euglycaemia therapy and hyperbaric oxygenation are also increasingly used.

Keywords

Toxicology Pharmacological and toxicological processes Poisoning Intensive care units Screening  

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

G. Hackl gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Allgemeine Intensivstation, Universitätsklinik für Innere MedizinMedizinische Universität GrazGrazÖsterreich

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