Glauser F L, Smith W R
Arch Intern Med. 1975 Nov;135(11):1468-73.
The following abnormalities were observed during the first 24 hours of admission for 162 drug overdosage (OD) episodes in 152 patients: abnormal chest x-ray films; increased A-aO2 gradient; elevated white blood cell (WBC) counts; elevated serum enzyme levels; gross myoglobinuria; skin lesions suggestive of pressure necrosis; and abnormal electrocardiograms. Many sputum cultures were positive for single or multiple potentially pathogenic organisms. These correlations existed: all patients with OD duration of less than 12 hours were hyperthermic; as temperatures increased so did WBC counts; hyperthermic patients had higher creatine phosphokinase (CPK) values than those with hypothermia or normothermia; patients with skin lesions had higher temperatures and CPK values and longer OD duration; serum enzme levels increased with increasing OD duration; patients with CPK levels greater than 10,000 mU/ml had myoglobinuria; and patients with the most abnormal chest x-ray films had higher temperatures and larger A-aO2 gradients. Incidence of pneumonitis is low, even with abnormal chest radiograms, leukocytosis, hyperthermia, and positive sputum cultures. Abnormal temperatures and leukocytosis are probably secondary to stress, hypoxemia, acidosis, and specific drug ingestion rather than infection.
在152例患者的162次药物过量（OD）事件入院后的最初24小时内观察到以下异常情况：胸部X光片异常；肺泡-动脉血氧分压差（A-aO2梯度）增加；白细胞（WBC）计数升高；血清酶水平升高；肉眼可见的肌红蛋白尿；提示压迫性坏死的皮肤病变；以及心电图异常。许多痰培养显示单一或多种潜在致病微生物呈阳性。存在以下相关性：所有OD持续时间少于12小时的患者均有发热；随着体温升高，WBC计数也升高；发热患者的肌酸磷酸激酶（CPK）值高于体温过低或正常体温的患者；有皮肤病变的患者体温和CPK值更高，OD持续时间更长；血清酶水平随着OD持续时间的增加而升高；CPK水平大于10,000 mU/ml的患者有肌红蛋白尿；胸部X光片异常最严重的患者体温更高，A-aO2梯度更大。即使有胸部X光片异常、白细胞增多、发热和痰培养阳性，肺炎的发生率也很低。体温异常和白细胞增多可能继发于应激、低氧血症、酸中毒和特定药物摄入，而非感染。
