Zusammenfassung
Intoxikationen zählen beim Erwachsenen zu den häufigsten Todesursachen und bedingen 5–10 % aller Notarzteinsätze. Gerade unter dem Meldebild „Unklare Bewusstlosigkeit“ verbirgt sich nicht selten ein intoxikierter Patient, bzw. ist eine Vergiftung differenzialdiagnostisch abzugrenzen. Die Erstdiagnose und -behandlung hat sich in den letzten Jahren nur wenig geändert. Weiterhin gelten Merkregeln, wie die „6 W-Fragen“ in der Diagnostik oder die „5-Finger-Regel“ in der Therapie, anhand derer dieser Artikel strukturiert ist. Das Grundprinzip lautet nach wie vor, dass eine symptomatische Therapie stets vor der spezifischen Vergiftungsbehandlung stehen muss.
Abstract
Intoxication is a common source of morbidity and mortality in adults as well as children. It accounts for 5–10 % of all emergency calls and emergency department visits. The screening of patients with altered consciousness for signs of intoxication is therefore mandatory.
The diagnostics and treatment of intoxicated patients have not changed significantly over the past few years. Supportive care continues to be the most important aspect of treatment and should precede specific antitoxin treatments.
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Literatur
McCaig LF, Burt CW (1999) Poisoning-related visits to emergency departments in the United States, 1993–1996. J Toxicol Clin Toxicol 37(7):817–826
Litovitz TL, Klein-Schwartz W, Rodgers GCJ (2002) 2001 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 20:391-452
Tibbalis J (1989) Epidemiology of acute poisoning. Med Int 61:2496
Dyckmans M (2011) Drogen- und Suchtbericht. Die Drogenbeauftragte der Bundesregierung Bundesministerium für Gesundheit Berlin (Hrsg). http://drogenbeauftragte.de/fileadmin/dateien/Publikationen/Drogen_Sucht/Forschungsberichte/Bericht_Drogen-_und_Suchtbericht_2011.pdf. Zugegriffen: 20 Juli 2013
Eyer F, Zilker T (2013) Drogenintoxikationen. Notfall Rettungsmed 15:569–576
Pil K, Verstraete A (2008) Current developments in drug testing in oral fluid. Ther Drug Monit 30:196–202
Lillsunde P (2008) Analytical techniques for drug detection in oral fluids. Ther Drug Monit 30:181–187
Siebig S, Schoelmerich J, Wrede CE (2009) Toxikologisches Screening in der Notaufnahme: Managementvorteile durch eine Point-of-Care Testung? DGINA, Weimar
Sivilotti MLA (2013) Initial management of the critically ill adult with an unknown overdose. Edited by Traub SJ. http://www.uptodate.com/contents/initial-management-of-the-critically-ill-adult-with-an-unknown-overdose. Zugegriffen: 20 Juli 2013
Bruennler T, Langgartner J, Wrede CE et al (2008) Intoxikierte Patienten in der Notaufnahme – werden es mehr, werden sie jünger? DIVI, Hamburg, Intensivmed I/FPV04/09
Tate JR, Nixon PF (1987) Measurement of Michaelis constant for human erythrocyte transketolase and thiamin diphosphate. Anal Biochem 160(1):78–87
Hoffman RS, Goldfrank LR (1995) The poisoned patient with altered consciousness. Controversies in the use of a ‚coma cocktail’. JAMA 274(7):562–569
Chyka PA, Seger D, Krenzelok EP, Vale JA (2005) Position paper: single-dose activated charcoal. Clin Toxicol (Phila) 43(2):61–87
Tenenbein M (1997) Position statement: whole bowel irrigation. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol 35(7):753–762
Cooper GM, Le Couteur DG, Richardson D, Buckley NA (2005) A randomized clinical trial of activated charcoal for the routine management of oral drug overdose. QJM 98(9):655–660
Merigian KS, Blaho KE (2002) Single-dose oral activated charcoal in the treatment of the self-poisoned patient: a prospective, randomized, controlled trial. Am J Ther 9(4):301–308
(o A) (1999) Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol 37(6):731–751
Tenenbein M (1997) Position statement: whole bowel irrigation. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol 35(7):752–762
Krenzelok EP (2002) New development in the therapy of intoxications. Toxicol Lett 127:299–305
Hendrickson RG, Kusin S (2013) Gastrointestinal decontamination of poisoned adults. Edited by Traub SJ. http://www.uptodate.com/contents/gastrointestinal-decontamination-of-poisoned-adults. Zugegriffen: 20 Juli 2013
Merigian KS, Woodard M, Hedges JR et al (1990) Prospective evaluation of gastric emptying in the self-poisoned patient. Am J Emerg Med 8(6):479
Bradberry SM (2000) Mechanisms of toxicity, clinical features, and management of acute chlorophenoxy herbicide poisoning: a review. J Toxicol Clin Toxicol 38(2):137–144
Brent J (2009) Fomepizole for ethylene glycol and methanol poisoning. N Engl J Med 360(21):2216–2223
Brent J (2010) Fomepizole for the treatment of pediatric ethylene and diethylene glycol, butoxyethanol, and methanol poisonings. Clinc Toxicol (Phila) 48(5):401–406
Brett AS, Rothschild N, Gray R, Perry M (1987) Predicting the clinical course in intentional drug overdose. Implications for use of the intensive care unit. Arch Intern Med 147(1):133–137
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Pemmerl, S. Erstdiagnose und Erstbehandlungen von Vergiftungen. Med Klin Intensivmed Notfmed 108, 459–464 (2013). https://doi.org/10.1007/s00063-013-0223-5
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DOI: https://doi.org/10.1007/s00063-013-0223-5