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一例“体填者”苯二氮䓬中毒时出现的极度心动过缓

Extreme bradycardia in a case of benzodiazepine intoxication in a "body stuffer" (Bradicardia extrema en un caso de intoxicación por benzodiacepinas en un "body stuffer").

作者信息

La Rota Jaime, Nemeguén Camilo, Narváez Laura, Motta Jose, Calderón Juan

机构信息

Clinical Toxicologist - Antioquia University Clinical Toxicologist Hospital Santa Clara, Colombia.

Fundación Universitaria Medicina Juan N. Corpas, Specialist in Clinical Toxicology from Universidad del Rosario, Clinical Toxicologist in Sub Red Centro Oriente, Hospital Santa Clara, Clínica de Marly in Bogotá and Clínica Los Nogales. Member of the Latin American and Caribbean Toxicology Network RETOXLAC. Professor of Clinical Toxicology undergraduate and postgraduate Universidad Javeriana, Universidad del Rosario, Universidad Nacional, Universidad de La Sabana, Universidad del Bosque, Colombia.

出版信息

Toxicol Rep. 2024 Sep 25;13:101738. doi: 10.1016/j.toxrep.2024.101738. eCollection 2024 Dec.

Abstract

Transport intoxication in the form of body stuffing, a dangerous practice involving the ingestion or insertion of psychoactive substances into the body to evade detection during drug trafficking, represents a major medical problem that requires immediate attention in the emergency department. Unlike body packing, where substances are encapsulated and swallowed for later extraction, body stuffing involves direct ingestion without wrapping, which greatly increases the risk of serious intoxication and even death. Benzodiazepines, due to their high demand on the black market, are among the most common drugs used in body stuffing. The management of this type of poisoning in the emergency department presents a significant clinical challenge due to the variability in clinical presentation, which can range from drowsiness and confusion to respiratory depression and coma.Rapid and accurate assessment is critical for effective management.The initial focus is on patient stabilization and life support as needed, which may include administration of naloxone to reverse opioid effects, mechanical ventilation for respiratory depression, and management of seizures if they occur.An appropriate approach in the emergency department is crucial to improve the prognosis and quality of life of patients affected by this type of poisoning. Timely intervention and expert management can prevent serious complications and even death. We present the case of a patient with benzodiazepine intoxication with an atypical presentation due to clonazepam transport with bradycardia and its management in an institution in Bogotá-Colombia.

摘要

以体内填塞形式出现的运输性中毒是一种危险行为,涉及在毒品贩运过程中摄入或向体内插入精神活性物质以逃避检测,这是一个重大的医学问题,需要急诊科立即予以关注。与体内包裹不同,体内包裹是将物质封装后吞下以便日后取出,而体内填塞是直接吞食且无包裹,这大大增加了严重中毒甚至死亡的风险。苯二氮䓬类药物因其在黑市上的高需求,是体内填塞中最常用的毒品之一。由于临床表现的变异性,从嗜睡、意识模糊到呼吸抑制和昏迷不等,急诊科对这类中毒的处理面临重大临床挑战。快速准确的评估对有效处理至关重要。初始重点是根据需要稳定患者病情并提供生命支持,这可能包括给予纳洛酮以逆转阿片类药物的作用、对呼吸抑制进行机械通气以及处理癫痫发作(如果发生的话)。在急诊科采取适当的处理方法对于改善这类中毒患者的预后和生活质量至关重要。及时干预和专业处理可预防严重并发症甚至死亡。我们介绍了一名因携带氯硝西泮导致心动过缓而出现非典型表现的苯二氮䓬类药物中毒患者的病例及其在哥伦比亚波哥大一家机构的处理情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a0e/11567097/7088f8dcadc8/ga1.jpg

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