Division of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri.
Medical and Research Services, VA Greater Los Angeles Healthcare System, Los Angeles, California; UCLA Membrane Biology Laboratory, Division of Nephrology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
Am J Kidney Dis. 2022 Jun;79(6):877-889. doi: 10.1053/j.ajkd.2021.06.030. Epub 2021 Dec 9.
Poisoning is a common problem in the United States. Acid-base disturbances, electrolyte derangements, or acute kidney injury result from severe poisoning from toxic alcohols, salicylates, metformin, and acetaminophen. Lithium is highly sensitive to small changes in kidney function. These poisonings and drug overdoses often require the nephrologist's expertise in diagnosis and treatment, which may require correction of acidosis, administration of selective enzyme inhibitors, or timely hemodialysis. The clinical and laboratory abnormalities associated with the poisonings and drug overdoses can develop rapidly and lead to severe cellular dysfunction and death. Understanding the pathophysiology of the disturbances and their clinical and laboratory findings is essential for the nephrologist to rapidly recognize the poisonings and establish an effective treatment plan. This installment of AJKD's Core Curriculum in Nephrology presents illustrative cases of individual poisonings and drug overdoses and summarizes up to date information on their prevalence, clinical and laboratory findings, pathophysiology, diagnosis, and treatment.
中毒在美国是一个常见的问题。毒醇、水杨酸盐、二甲双胍和对乙酰氨基酚等严重中毒会导致酸碱平衡紊乱、电解质失调或急性肾损伤。锂对肾功能的微小变化非常敏感。这些中毒和药物过量通常需要肾病专家在诊断和治疗方面的专业知识，这可能需要纠正酸中毒、给予选择性酶抑制剂或及时进行血液透析。与中毒和药物过量相关的临床和实验室异常可能迅速发展，并导致严重的细胞功能障碍和死亡。了解这些紊乱的病理生理学及其临床和实验室发现对于肾病专家快速识别中毒并制定有效的治疗计划至关重要。AJKD 的肾脏病学核心课程的这一期介绍了个别中毒和药物过量的实例，并总结了其流行率、临床和实验室发现、病理生理学、诊断和治疗方面的最新信息。
