Martínez Sánchez L, Almario Hernández A F, Escuredo Argullós L, Maçao P, Trenchs Sainz de la Maza V, Luaces Cubells C
Servicio de Urgencias de Pediatría, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, España.
Servicio de Urgencias de Pediatría, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, España.
An Pediatr (Barc). 2014 Oct;81(4):220-5. doi: 10.1016/j.anpedi.2013.12.002. Epub 2014 Jan 16.
Poisoning is an infrequent cause of consultation in a pediatric emergency department (PED), but it can be potentially serious. Pediatricians should know how to use the available antidotes properly.
To analyze the use of antidotes in a PED and to assess the suitability of their indications.
A retrospective review of antidote use in a PED between January 2008 and June 2012. Inclusion criteria were age younger than 18 years and consultation for suspicious poisoning by a substance that could be treated with an antidote. The adequacy of antidote indication was based on the recommendations of the Spanish Society of Pediatric Emergencies (SSPE).
A total of 1728 consultations for suspicious poisoning (0.4% of the total visits in the PED) were recorded. In 353 cases (20.4%) the involved poison could be treated with an antidote. Sixty-seven patients received an antidote (3.9% of consultations for suspicious poisoning), and a total of 69 administrations of an antidote were made: 100% oxygen (46), N-acetylcysteine (10), flumazenil (4), naloxone (3), deferoxamine (2), vitamin K (2), bicarbonate (1), and carnitine (1). In 3 cases there was no indication for administration: flumazenil without respiratory depression, and vitamin K following coumarin exposure. As side effects, agitation was noted after the use of flumazenil, and a decrease in the prothrombin time during infusion of N-acetylcysteine.
The administration of antidotes in this PED is uncommon and, mainly, in accordance with the SSPE recommendations, and without serious side effects. The use of flumazenil needs to be limited to the cases with a clear indication and without any contraindication.
中毒是儿科急诊科（PED）不常见的就诊原因，但可能具有潜在严重性。儿科医生应知晓如何正确使用现有的解毒剂。
分析儿科急诊科解毒剂的使用情况，并评估其用药指征的合理性。
对2008年1月至2012年6月期间某儿科急诊科解毒剂的使用情况进行回顾性研究。纳入标准为年龄小于18岁且因可使用解毒剂治疗的可疑中毒前来就诊。解毒剂用药指征的合理性依据西班牙儿科急诊学会（SSPE）的建议。
共记录了1728例可疑中毒就诊病例（占儿科急诊科总就诊人数的0.4%）。在353例病例（20.4%）中，所涉毒物可用解毒剂治疗。67例患者接受了解毒剂治疗（占可疑中毒就诊病例的3.9%），共进行了69次解毒剂给药：100%氧气（46次）、N - 乙酰半胱氨酸（10次）、氟马西尼（4次）、纳洛酮（3次）、去铁胺（2次）、维生素K（2次）、碳酸氢盐（1次）和肉碱（1次）。有3例给药无指征：氟马西尼用于无呼吸抑制的情况，维生素K用于香豆素暴露后。作为副作用，使用氟马西尼后出现躁动，输注N - 乙酰半胱氨酸期间凝血酶原时间缩短。
该儿科急诊科解毒剂的使用并不常见，且主要符合SSPE的建议，无严重副作用。氟马西尼的使用应限于有明确指征且无任何禁忌证的情况。
