Whipple J K, Quebbeman E J, Lewis K S, Gottlieb M S, Ausman R K
Department of General Surgery, Medical College of Wisconsin, Milwaukee 53226.
Ann Pharmacother. 1994 Apr;28(4):446-50. doi: 10.1177/106002809402800403.
To describe the clinical presentation of narcotic overdose in hospitalized patients and to differentiate this circumstance from other conditions often misdiagnosed as overdose.
Case series.
Two acute-care teaching hospitals.
Forty-three hospitalized patients who received naloxone for a clinically suspected narcotic overdose.
Two investigators independently evaluated each incident to determine whether the patient had a narcotic overdose. The patients were judged to have had an overdose if caregivers documented an immediate improvement in mental status, respiratory rate, or blood pressure after naloxone administration.
The clinical presentation of a narcotic overdose in hospitalized patients was defined. Conditions misdiagnosed as an overdose were determined.
Symptoms improved rapidly with the administration of naloxone in 28 incidents (65 percent) and were designated overdose. In 15 other instances there was no improvement in symptoms; these patients were designated nonoverdose. Only half of the overdose patients had a respiratory rate < 8 breaths/min immediately prior to naloxone administration. Only two of the overdose patients had the classic triad of symptoms (respiratory depression, coma, and pinpoint pupils). Other overdose patients had only one or two of the classic signs. The clinical presentation of narcotic overdoses in hospitalized patients did not include respiratory depression, hypotension, or coma in the majority of patients. All overdose patients showed a decrease in mental status. The majority of nonoverdose patients had pulmonary conditions that were misdiagnosed as a narcotic overdose.
Narcotic overdoses in hospitalized patients seldom fit the classic description. The lack of respiratory depression does not mean the absence of a narcotic overdose. Patients who receive narcotics and develop a significant decrease in mental status should be evaluated for a possible overdose. Pulmonary, neurologic, cardiovascular, and electrolyte abnormalities often are misdiagnosed as a narcotic overdose in hospitalized patients.
描述住院患者麻醉药品过量的临床表现，并将这种情况与其他常被误诊为过量的病症相鉴别。
病例系列研究。
两家急症护理教学医院。
43例因临床怀疑麻醉药品过量而接受纳洛酮治疗的住院患者。
两名研究人员独立评估每起事件，以确定患者是否存在麻醉药品过量。如果护理人员记录了纳洛酮给药后患者精神状态、呼吸频率或血压立即改善，则判定患者发生了过量。
定义住院患者麻醉药品过量的临床表现。确定被误诊为过量的病症。
28例事件（65%）中，纳洛酮给药后症状迅速改善，被判定为过量。在其他15例中，症状未改善；这些患者被判定为未发生过量。仅一半过量患者在纳洛酮给药前呼吸频率<8次/分钟。只有两名过量患者出现了典型的三联征症状（呼吸抑制、昏迷和针尖样瞳孔）。其他过量患者只有一两种典型体征。住院患者麻醉药品过量的临床表现大多数患者并不包括呼吸抑制、低血压或昏迷。所有过量患者均出现精神状态下降。大多数未发生过量的患者患有肺部疾病，被误诊为麻醉药品过量。
住院患者的麻醉药品过量很少符合典型描述。呼吸抑制的缺乏并不意味着不存在麻醉药品过量。接受麻醉药品且精神状态显著下降的患者应评估是否可能发生过量。肺部、神经、心血管和电解质异常在住院患者中常被误诊为麻醉药品过量。
