Hondebrink Laura, Rietjens Saskia J, Hunault Claudine C, Pereira Rob R, Kelleci Nuriye, Yasar Gulhan, Ghebreslasie Ariam, Lo-A-Foe Cindy, De Vries Irma, Meulenbelt Jan
National Poisons Information Center, University Medical Center Utrecht , the Netherlands.
Clin Toxicol (Phila). 2015 Mar;53(3):168-77. doi: 10.3109/15563650.2015.1004579. Epub 2015 Feb 4.
Methylphenidate intoxications mostly have a relatively mild course, although serious complications can occur.
We aimed to characterize methylphenidate exposures and reassess our current dose threshold for hospital referral (2 mg/kg).
In a prospective follow-up study, we analysed 364 consecutive methylphenidate exposures that were reported to the Dutch Poisons Information Center. Patients and/or physicians were surveyed by telephone using standardized questionnaires. Three physicians independently scored the observed severity of the intoxication of each patient as 'no/mild' (observation at home) or 'moderate/severe' (hospital referral necessary).
Unintentional exposures (40%) mostly occurred at home involving the patients' own medication or those from a family member. Compared to unintentionally exposed patients, intentionally exposed patients were exposed to relatively high methylphenidate doses (3.1 vs 1.6 mg/kg), more often used immediate release methylphenidate formulations (62 vs 34%) and more frequently had concomitant exposures (71 vs 17%). Severe symptoms like convulsions or coma were reported only in patients with concomitant exposures. Following exposure to methylphenidate only (i.e. no concomitant exposures), the most commonly reported symptoms were dry mucosa, headache, agitation, sleepiness and tachycardia. Our results show that the reported methylphenidate dose is predictive of the observed severity of the intoxication and can therefore aid in pre-hospital triage.
We increased our current dose threshold for hospital referral from 2 to 3 mg/kg. In addition, we will refer patients at lower doses when clinical symptoms indicate the need for hospital referral. Application of this new dose threshold optimizes triage, thereby reducing unnecessary hospital referral and thus costs, without jeopardising patient safety.
哌甲酯中毒大多病程相对较轻，不过也可能出现严重并发症。
我们旨在描述哌甲酯暴露情况，并重新评估当前的医院转诊剂量阈值（2毫克/千克）。
在一项前瞻性随访研究中，我们分析了向荷兰毒物信息中心报告的364例连续的哌甲酯暴露病例。通过电话使用标准化问卷对患者和/或医生进行调查。三名医生独立将每名患者中毒的观察严重程度评为“无/轻度”（在家观察）或“中度/重度”（需要转诊至医院）。
无意暴露（40%）大多发生在家中，涉及患者自己的药物或家庭成员的药物。与无意暴露的患者相比，有意暴露的患者接触的哌甲酯剂量相对较高（3.1对1.6毫克/千克），更常使用速释哌甲酯制剂（62%对34%），且更频繁地同时接触其他物质（71%对17%）。仅在同时接触其他物质的患者中报告了惊厥或昏迷等严重症状。仅接触哌甲酯（即无同时接触其他物质）后，最常报告的症状是黏膜干燥、头痛、烦躁、嗜睡和心动过速。我们的结果表明，报告的哌甲酯剂量可预测观察到的中毒严重程度，因此有助于院前分诊。
我们将当前的医院转诊剂量阈值从2毫克/千克提高到了3毫克/千克。此外，当临床症状表明需要转诊至医院时，我们将对较低剂量的患者进行转诊。应用这一新的剂量阈值可优化分诊，从而减少不必要的医院转诊及成本，同时不危及患者安全。
