CHU Angers, Pôle Médecines Intensives et spécialisées, Centre antipoison et Toxicovigilance, Angers, France.
Clin Toxicol (Phila). 2013 May;51(4):243-8. doi: 10.3109/15563650.2013.782409. Epub 2013 Apr 9.
The objective of this study was to evaluate the effects of early digestive tract decontamination on the severity of acute-on-chronic lithium poisoning (acute poisoning in patients under long-term therapy).
This was an observational and retrospective study of acute-on-chronic lithium overdoses recorded by the Angers Poisons and Toxicovigilance Centre between February 2006 and September 2010. The cases of overdose were divided into two groups: those undergoing early decontamination (by sodium polystyrene sulphonate and/or whole bowel irrigation) and those in whom decontamination was delayed (> 12 h) or not performed. Severity was assessed using the Poisoning Severity Score (PSS).
Fifty-nine patients met the inclusion requirements, 15 of whom were decontaminated at an early stage. The mean age of the patients did not differ statistically between the two groups (49 vs. 44 years, p = 0.25). The estimated ingested doses in the early decontaminated and comparison groups were 12.75 and 12.73 g, respectively (p = 0.9), and the PSSs during the first 12 h were 0.8 and 0.69 (p = 0.32). Those patients who were early decontaminated had an overall lower PSS (1.07 vs. 1.79; p = 0.001), maintained a higher GCS (14.93 vs. 13.3; p = 0.038), and their highest measured serum lithium levels were much lower (2.39 vs. 4.08 meq/L; p = 0.001) than those in the comparison group. All patients who received early digestive tract decontamination subsequently recovered. Under multivariate analysis, undergoing early digestive tract decontamination was significantly associated with a lower risk of severe poisoning (OR, 0.21; 95% CI, 0.04-0.99; p = 0.049), regardless of the lithium dose ingested or the serum lithium level.
Our results thus highlight the usefulness of early digestive tract decontamination. This technique was statistically associated with a reduction in the severity of acute-on-chronic lithium poisoning at a given ingested dose and serum lithium level.
本研究旨在评估早期消化道去污对慢性锂中毒急性加重（长期治疗患者的急性中毒）严重程度的影响。
这是一项对昂热中毒和毒物监测中心 2006 年 2 月至 2010 年 9 月期间记录的慢性锂过量摄入的急性加重病例进行的观察性、回顾性研究。将过量病例分为两组：早期去污组（聚苯乙烯磺酸钠和/或全肠道灌洗）和延迟去污组（>12 小时）或未去污组。严重程度采用中毒严重程度评分（PSS）进行评估。
59 例患者符合纳入标准，其中 15 例早期去污。两组患者的平均年龄无统计学差异（49 岁比 44 岁，p=0.25）。早期去污组和对照组估计的摄入剂量分别为 12.75 和 12.73 g（p=0.9），前 12 小时的 PSS 分别为 0.8 和 0.69（p=0.32）。早期去污组患者的总体 PSS 较低（1.07 比 1.79；p=0.001），GCS 较高（14.93 比 13.3；p=0.038），测量的血清锂水平也较低（2.39 比 4.08 meq/L；p=0.001）。所有接受早期消化道去污的患者均恢复。多变量分析显示，早期消化道去污与严重中毒风险降低显著相关（OR，0.21；95%CI，0.04-0.99；p=0.049），与摄入的锂剂量或血清锂水平无关。
我们的研究结果强调了早期消化道去污的有效性。该技术与给定的摄入剂量和血清锂水平下的慢性锂中毒急性加重严重程度降低显著相关。
