Department of Pharmacy, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Clin Toxicol (Phila). 2011 Jun;49(5):391-401. doi: 10.3109/15563650.2011.580754.
Little is known about medication errors which occur with the antidotes ethanol and fomepizole, used for treatment of methanol and ethylene glycol poisoning. Study objectives were to describe and compare the frequency, type, outcome and underlying causes of medication errors associated with ethanol and fomepizole.
Patients aged ≥13 years were included if they were hospitalized in 1996-2005 for methanol or ethylene glycol poisoning and treated with ethanol or fomepizole. Charts from 10 hospitals were separately reviewed by two abstracters who recorded case details. A consensus panel of clinicians used the abstracted data to identify medication errors and classify error outcome. Fisher's exact test determined significant differences in the proportion of ethanol and fomepizole-treated cases with medication error and univariate logistic regression identified risk factors associated with harmful dosage errors.
There were 145 ethanol- and 44 fomepizole-treated cases. There was ≥1 medication error in 113/145 (78%) ethanol- and 20/44 (45%) fomepizole-treated cases (p = 0.0001) with more ethanol-related errors involving excessive dose, inadequate monitoring and inappropriate antidote duration. Harmful errors occurred in 19% of ethanol- and 7% of fomepizole-treated cases (p = 0.06) and were largely due to excessive antidote dose or delayed antidote initiation. Occurrence of harmful dosage error was reduced in cases with Poison Control Centre consultation, odds ratio (95% confidence interval) 0.39 (0.17, 0.91), hemodialysis 0.37 (0.16, 0.88), or fomepizole versus ethanol 0.24 (0.06, 1.04).
Fomepizole was less prone to medication error than ethanol. Error-related harm was most commonly due to excessive antidote dose or delayed antidote initiation.
对于乙醇和甲磺酸去铁胺这两种解毒剂用于甲醇和乙二醇中毒治疗时所产生的用药错误，我们知之甚少。本研究旨在描述并比较与乙醇和甲磺酸去铁胺相关的用药错误的频率、类型、结果和潜在原因。
1996 年至 2005 年期间，年龄≥13 岁的因甲醇或乙二醇中毒而住院，并接受乙醇或甲磺酸去铁胺治疗的患者纳入本研究。10 家医院的病历由 2 名摘要员分别进行审查，记录病例详情。一个临床医生共识小组使用摘要数据来识别用药错误，并对错误结果进行分类。Fisher 确切检验确定了乙醇和甲磺酸去铁胺治疗组中用药错误的比例差异，单变量逻辑回归确定了与有害剂量错误相关的危险因素。
共纳入 145 例乙醇治疗和 44 例甲磺酸去铁胺治疗的病例。145 例乙醇治疗组中有≥1 个用药错误的患者 113 例（78%），44 例甲磺酸去铁胺治疗组中有 20 例（45%）（p=0.0001），乙醇相关的错误更多地涉及剂量过大、监测不足和解毒剂持续时间不当。19%的乙醇治疗组和 7%的甲磺酸去铁胺治疗组发生了有害错误（p=0.06），主要原因是解毒剂剂量过大或解毒剂开始延迟。在接受中毒控制中心咨询、血液透析或使用甲磺酸去铁胺替代乙醇治疗的患者中，有害剂量错误的发生率降低，比值比（95%置信区间）分别为 0.39（0.17，0.91）、0.37（0.16，0.88）和 0.24（0.06，1.04）。
与乙醇相比，甲磺酸去铁胺较少发生用药错误。错误相关的危害最常见的原因是解毒剂剂量过大或解毒剂开始延迟。
