Stevens D C, Campbell J P, Carter J E, Watson W A
University of Missouri-Kansas City.
J Toxicol Clin Toxicol. 1994;32(1):31-9. doi: 10.3109/15563659409000428.
There is little information on the prevalence and clinical presentation of acid-base abnormalities associated with cocaine toxicity. To address these issues, arterial blood gas results were evaluated in 156 cocaine-associated emergency department patient visits. Arterial blood gas results were obtained as part of the patient's clinical assessment. The majority of patients (52%) had a normal pH (7.35 to 7.45). Thirty-three percent of patients were acidotic, with a pH between 6.4 and 7.35. In 33 patients the acidosis was metabolic, with a HCO3- of 14 +/- 6 mmol/L. The acidosis was primarily respiratory in 18 patients, with evidence of hypoventilation. Hypoventilation was generally secondary to chest trauma or decreased mental status. Alkalosis (pH > 7.45) was observed in 15% of patients, and was usually respiratory, as evidenced by tachypnea and a low PCO2. These results indicate that metabolic and respiratory acid-base abnormalities are common during cocaine toxicity. Acidosis and alkalosis were associated with numerous patient presentations, including chest pain, shortness of breath, decreased mental status, trauma, and seizures. Acid-base abnormalities do not appear to be associated with a specific route of cocaine self-administration. Patients with a history of potential cocaine toxicity should be evaluated for acid-base abnormalities.
关于与可卡因中毒相关的酸碱异常的患病率和临床表现的信息很少。为了解决这些问题，我们对156例因可卡因相关疾病就诊于急诊科的患者的动脉血气结果进行了评估。动脉血气结果是作为患者临床评估的一部分获得的。大多数患者（52%）的pH值正常（7.35至7.45）。33%的患者存在酸中毒，pH值在6.4至7.35之间。33例患者的酸中毒为代谢性，碳酸氢根（HCO3-）为14±6 mmol/L。18例患者的酸中毒主要为呼吸性，有通气不足的证据。通气不足通常继发于胸部创伤或精神状态下降。15%的患者出现碱中毒（pH>7.45），通常为呼吸性碱中毒，表现为呼吸急促和低二氧化碳分压（PCO2）。这些结果表明，在可卡因中毒期间，代谢性和呼吸性酸碱异常很常见。酸中毒和碱中毒与多种患者表现相关，包括胸痛、呼吸急促、精神状态下降、创伤和癫痫发作。酸碱异常似乎与可卡因自我给药的特定途径无关。有可卡因中毒潜在病史的患者应评估是否存在酸碱异常。
