Spiller Henry A, Bosse George M, Beuhler Michael, Gray Ted, Baker S David
Kentucky Regional Poison Center of Kosair Children's Hospital, Louisville, Kentucky 40232-5070, USA.
J Emerg Med. 2010 Apr;38(3):332-6. doi: 10.1016/j.jemermed.2007.11.081. Epub 2008 Jul 26.
The incidence of seizures after unintentional bupropion ingestion in children aged < 6 years has been reported as 0.2%. However, in many poison centers, > 80% of these patients are referred to the Emergency Department (ED) for evaluation.
To evaluate if all unintentional pediatric bupropion ingestions require referral to a health care facility (HCF), or what fraction of these could be managed safely at home.
A retrospective chart review was conducted of all bupropion ingestions in children aged < 6 years for 2000-2006 from four regional poison centers. Exclusion criteria were lack of follow-up or multiple drug ingestion.
Of 407 patients, 209 (51%) were male. Mean age was 2.2 years (SD +/- 1.0). There were 329 patients (81%) seen in a HCF, of which 143 (35%) were hospitalized; 77 patients (19%) were observed at home. Symptoms occurred in 73 patients (18%): sinus tachycardia (n = 50), nausea/vomiting (n = 32), hyperactivity (n = 17), seizure (n = 3), hallucinations (n = 2), and hypertension (n = 2). The mean heart rate of patients with sinus tachycardia (n = 50, 12.3%) was 137 beats/min (SD +/- 13), with a range of 112-172 beats/min. Mean dosage of those with tachycardia was 24 mg/kg. In the 2 patients with hypertension, the maximum recorded blood pressures were 145/80 mm Hg (2-year-old boy) and 137/90 mm Hg (2-year-old girl), with heart rates of 122 and 125 beats/min, respectively. Dose ingested and patient weight was known for 218 patients. Mean dosage ingested was 12.2 mg/kg, with a range of 2.6-64 mg/kg. Eighty-eight percent of patients with a known dosage ingested < 20 mg/kg.
A high percentage of children continue to be seen in a HCF. Concern from the higher incidence of severe effects seen with intentional adult exposures may be one of the reasons for this cautious approach.
Unintentional pediatric bupropion ingestions resulted in clinical effects that rarely required any HCF intervention. Isolated unintentional bupropion ingestion of <or= 10 mg/kg may not require referral to a health care facility.
据报道，6岁以下儿童意外摄入安非他酮后癫痫发作的发生率为0.2%。然而，在许多中毒控制中心，超过80%的此类患者被转诊至急诊科进行评估。
评估所有儿童意外摄入安非他酮的情况是否都需要转诊至医疗机构（HCF），或者其中有多少比例可以在家中安全处理。
对2000年至2006年来自四个地区中毒控制中心的所有6岁以下儿童安非他酮摄入病例进行回顾性病历审查。排除标准为缺乏随访或多药摄入。
407例患者中，209例（51%）为男性。平均年龄为2.2岁（标准差±1.0）。329例患者（81%）在医疗机构就诊，其中143例（35%）住院；77例患者（19%）在家中观察。73例患者（18%）出现症状：窦性心动过速（n = 50）、恶心/呕吐（n = 32）、多动（n = 17）、癫痫发作（n = 3）、幻觉（n = 2）和高血压（n = 2）。窦性心动过速患者（n = 50，12.3%）的平均心率为137次/分钟（标准差±13），范围为112 - 172次/分钟。心动过速患者的平均剂量为24毫克/千克。2例高血压患者的最高记录血压分别为145/80毫米汞柱（2岁男孩）和137/90毫米汞柱（2岁女孩），心率分别为122次/分钟和125次/分钟。已知218例患者的摄入剂量和体重。平均摄入剂量为12.2毫克/千克，范围为2.6 - 64毫克/千克。已知剂量的患者中88%摄入剂量<20毫克/千克。
仍有很高比例的儿童在医疗机构就诊。对成人故意暴露后严重后果较高发生率的担忧可能是这种谨慎做法的原因之一。
儿童意外摄入安非他酮导致的临床效应很少需要任何医疗机构的干预。单独意外摄入安非他酮≤10毫克/千克可能不需要转诊至医疗机构。
