Department of Medicine/Nephrology, Mount Sinai Beth Israel/Icahn School of Medicine, New York, NY.
Department of Medicine/Nephrology, Mount Sinai Beth Israel/Icahn School of Medicine, New York, NY.
Adv Chronic Kidney Dis. 2020 Jan;27(1):5-10. doi: 10.1053/j.ackd.2019.12.001.
Management of the poisoned patient begins with supportive care, assessment of organ function and dysfunction, and consideration of known or suspected poisons. The possibility of multiple ingestions should be considered with intentional exposures or suicide attempts. Enteric decontamination involves treatment to prevent the absorption of toxins from the gastrointestinal system and includes the use of activated charcoal. Poisoned patients may benefit from the use if antidotes are available, or enhanced elimination as with salicylate ion trapping during urinary alkalinization. The use of intravenous lipid therapy is of clinical benefit in poisoning from bupivacaine, amitriptyline, and bupropion. Hemodialysis is the most inexpensive, widely available, and most commonly used method of extracorporeal drug removal in the treatment of poisoning. Chelators with different chemical properties can bind toxic metals, providing an essential mechanism for detoxification, and may be used in combination with extracorporeal therapies such as DFO with HD for aluminum or iron, and DMSA or DMPS with HD to treat arsenic or mercury intoxication. The use of displacers with hemodialysis can be considered to augment clearance of protein-bound toxins.
中毒患者的治疗从支持性护理开始，评估器官功能和功能障碍，并考虑已知或疑似的毒物。对于故意暴露或自杀企图，应考虑多种摄入的可能性。肠道去污包括治疗以防止从胃肠道系统吸收毒素，包括使用活性炭。如果有解毒剂可用，中毒患者可能会受益于解毒剂的使用，或者通过尿液碱化期间水杨酸盐离子捕获增强排泄，如在水杨酸盐中毒中。静脉内脂质治疗在布比卡因、阿米替林和安非他酮中毒中具有临床益处。血液透析是治疗中毒时最廉价、最广泛可用和最常用的体外药物清除方法。具有不同化学性质的螯合剂可以结合有毒金属，为解毒提供了一个重要的机制，并且可以与体外治疗联合使用，例如用 HD 治疗铝或铁的去铁胺，用 HD 治疗砷或汞中毒的二巯丁二酸或二巯丁二钠。可以考虑使用血液透析中的置换剂来增强蛋白结合毒素的清除。
