Juurlink D N, McGuigan M A, Paton T W, Redelmeier D A
Department of Medicine, University of Toronto, Canada.
CMAJ. 2001 Jul 10;165(1):27-30.
Acutely poisoned patients sometimes require immediate treatment with an antidote, and delays in treatment can be fatal. We sought to determine the availability of 10 antidotes at acute care hospitals in Ontario.
Mailed questionnaire with repeated reminders to pharmacy directors at all acute care hospitals in Ontario.
Responses were obtained from 179 (97%) of 184 hospitals. Only 9% of the hospitals stocked an adequate supply of digoxin immune Fab antibody fragments, a life-saving antidote for patients with severe digoxin toxicity, whereas most of the hospitals stocked sufficient supplies of ipecac syrup (88%) and flumazenil (92%), arguably the least crucial antidotes in the survey. Only 1 hospital stocked adequate amounts of all 10 antidotes. Certain hospital characteristics were associated with adequate antidote stocking (increased annual emergency department volume, teaching hospital status and designation as a trauma centre). Conversely, antidote supplies were particularly deficient at small hospitals and, paradoxically, geographically isolated facilities (those most reliant on their own inventory). The cost of antidotes correlated only weakly with stocking rates, and many examples of excessive antidote stocking were identified.
Most acute care hospitals in Ontario do not stock even minimally adequate amounts of several emergency antidotes, possibly jeopardizing the survival of an acutely poisoned patient. Much of this problem could be rectified at no additional cost by reducing excessive stock of expensive antidotes and redistributing the resources to acquire deficient antidotes.
急性中毒患者有时需要立即使用解毒剂进行治疗，治疗延迟可能会致命。我们试图确定安大略省急症医院10种解毒剂的供应情况。
向安大略省所有急症医院的药房主任邮寄调查问卷，并多次提醒。
184家医院中有179家（97%）回复。只有9%的医院储备了足够的地高辛免疫Fab抗体片段，这是治疗严重地高辛中毒患者的一种救命解毒剂，而大多数医院储备了足够的吐根糖浆（88%）和氟马西尼（92%），可以说这是调查中最不重要的解毒剂。只有1家医院储备了足够数量的所有10种解毒剂。某些医院特征与解毒剂的充足储备有关（急诊科年就诊量增加、教学医院地位以及被指定为创伤中心）。相反，小型医院以及自相矛盾的是地理上孤立的机构（那些最依赖自身库存的机构）的解毒剂供应特别不足。解毒剂的成本与储备率的相关性较弱，并且发现了许多解毒剂储备过多的例子。
安大略省的大多数急症医院甚至没有储备最低限度足够数量的几种紧急解毒剂，这可能会危及急性中毒患者的生存。通过减少昂贵解毒剂的过多库存，并将资源重新分配以获取短缺的解毒剂，这个问题的很大一部分可以在不增加成本的情况下得到解决。
