Wiley J F
Section of General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.
Pediatr Clin North Am. 1991 Jun;38(3):725-37. doi: 10.1016/s0031-3955(16)38127-5.
The comprehensive drug screen has serious limitations when used as the sole study for diagnosing intoxication. A careful history and physical examination in the poisoned patient can provide important clues that point to possible toxins. Ancillary studies help differentiate the most likely poison and guide treatment. Fortunately, most poison victims do well with supportive care alone. However, the clinician should be aware of agents that can cause significant harm to patients if not detected and treated quickly. Iron and carbon monoxide are good examples of lethal agents that need a high index of clinical suspicion for early recognition and require specific therapy to ensure a good outcome. Patients who overdose with clonidine, calcium-channel blockers, beta-adrenergic blockers, or albuterol must be managed expectantly and according to their clinical presentation because rapid laboratory verification is not available for these poisons. In all situations, the clinician must integrate information from history, physical examination, and laboratory to render the best care.
当用作诊断中毒的唯一研究手段时，全面药物筛查存在严重局限性。对中毒患者进行仔细的病史询问和体格检查可提供指向可能毒素的重要线索。辅助检查有助于鉴别最可能的毒物并指导治疗。幸运的是，大多数中毒受害者仅通过支持性治疗就能康复。然而，临床医生应意识到，如果某些毒物未被及时发现和治疗，可能会对患者造成重大伤害。铁和一氧化碳就是需要高度临床怀疑才能早期识别且需要特定治疗以确保良好预后的致死性毒物的典型例子。服用可乐定、钙通道阻滞剂、β肾上腺素能阻滞剂或沙丁胺醇过量的患者必须根据其临床表现进行预期处理，因为针对这些毒物尚无快速的实验室检测方法。在所有情况下，临床医生都必须整合病史、体格检查和实验室检查的信息，以提供最佳治疗。
