Bond G R
Division of Emergency Medicine, University of Virginia, Charlottesville, USA.
Emerg Med Clin North Am. 1995 May;13(2):343-55.
More than 1 million children in the United States ingest poisons each year. The vast majority of these exposures result in no harm to the child. The task of the emergency physician is to discern which children are at risk and treat those children with appropriately aggressive therapy while minimizing intervention for the rest. In pediatric exposure cases, the toxin is usually identified. A careful toxic differential diagnosis will lead to a list of likely poisons in symptomatic patients without an identified exposure. The cornerstone of treatment remains the evaluation of the ingestion episode, careful assessment of the patient, and the application of basic supportive medical care. In the ED, when it has been determined that gastrointestinal decontamination is indicated on the basis of the substance and quantity ingested, activated charcoal is the decontamination agent of choice if the substance ingested is absorbed by activated charcoal. Gastric emptying should be restricted to those circumstances when the substance ingested is not bound to activated charcoal or the rare event when a child presents to the ED within 1 hour of ingestion with significant CNS depression. Whole bowel irrigation is a recently described technique to enhance the passage of drugs already beyond the pylorus. The indications for its use are poorly defined. Laboratory tests are generally overordered after pediatric ingestions. Appropriate use of the laboratory includes an assessment of basic serum chemistry studies in symptomatic patients, confirmation of suspected toxins, and the determination of the need for specific antidotal therapy. General "drug screens" are expensive and rarely contribute to patient care. Use of specific therapies, including antidotes and enhanced elimination techniques, should be limited to those cases when expectation that a defined benefit outweighs the risk of the procedure is reasonable. The indications for the use of these interventions in children may be different from those for adults.
美国每年有超过100万儿童摄入毒物。这些接触绝大多数对儿童无害。急诊医生的任务是辨别哪些儿童处于危险之中，并对这些儿童进行适当积极的治疗，同时尽量减少对其他儿童的干预。在儿科中毒病例中，毒素通常是可以识别的。仔细的中毒鉴别诊断将为有症状但未明确接触毒物的患者列出可能的毒物清单。治疗的基石仍然是对摄入情况的评估、对患者的仔细评估以及基本支持性医疗护理的应用。在急诊科，如果根据摄入的物质和数量确定需要进行胃肠道去污，且摄入的物质可被活性炭吸附，那么活性炭就是首选的去污剂。洗胃应仅限于摄入的物质不被活性炭吸附的情况，或儿童在摄入后1小时内出现严重中枢神经系统抑制这种罕见情况。全肠道灌洗是一种最近描述的技术，用于促进已通过幽门的药物排出。其使用指征尚不明确。儿科中毒后实验室检查通常开得过多。实验室检查的合理使用包括对有症状患者进行基本血清化学研究评估、确认疑似毒素以及确定是否需要特定的解毒治疗。一般的“药物筛查”费用高昂，很少对患者护理有帮助。特定治疗方法的使用，包括解毒剂和强化清除技术，应仅限于预期明确的益处大于该操作风险的合理情况。这些干预措施在儿童中的使用指征可能与成人不同。
