Sporer K A, Khayam-Bashi H
Department of Emergency Services, San Francisco General Hospital, University of California 94110, USA.
Am J Emerg Med. 1996 Sep;14(5):443-6. doi: 10.1016/S0735-6757(96)90146-1.
Is universal screening of acetaminophen (APAP) and salicylate (SAL) necessary in patients with a suicidal ingestion or an altered mental status and suspected ingestion? This descriptive, retrospective chart review in an emergency department in a large urban county hospital examined all patients who presented with a history of suicidal ingestion or an altered mental status with a strong suspicion of ingestion from January 1992 through October 1993. APAP and SAL serum levels were measured in 1,820 patients, and charts of patients with APAP serum levels of > 1 microgram/mL or SAL serum levels of > 1 mg/dL were reviewed. The patient's history of ingesting APAP or SAL was recorded, as well as the clinician's interpretation of that level. Sixteen charts were not available. APAP levels of > 1 microgram/mL were found in 175 (9.6%) patients, 120 (6.5%) of whom were APAP history-positive and 55 (3%) APAP history-negative. None of the APAP history-negative group required therapy with N-acetylcysteine. Eight (0.3%) of the APAP history-negative group had potentially toxic levels of > 50 micrograms/mL. SAL levels of > 1 mg/dL were found in 155 (8.5%) patients, 44 (2.5%) of whom were SAL history-positive and 111 (6%) SAL history-negative. Three patients were SAL history-negative but had a significant chronic SAL intoxication. All these patients presented with an altered mental status and had an anion gap of > 20 mEq/L. Universal screening found that 0.3% of suicidal ingestions had a potentially toxic APAP intoxication not suggested by history. This incidence of infrequent but potentially life: threatening overdose should prompt clinicians to screen all of their patients with a suspected ingestion. Salicylate screening found that 0.16% of suicidal ingestions had a toxic SAL intoxication not suggested by history, although such intoxication should be suggested by an elevated anion gap and an altered mental status. Since this less severe intoxication is less frequent and usually suggested by commonly obtained laboratory data, universal screening is not indicated, but a more selective approach to screening could be taken.
对于有自杀性服药或精神状态改变且怀疑有服药情况的患者，对乙酰氨基酚（APAP）和水杨酸盐（SAL）进行普遍筛查是否必要？这项在一家大型城市县医院急诊科进行的描述性回顾性图表审查，检查了1992年1月至1993年10月期间所有有自杀性服药史或精神状态改变且高度怀疑有服药情况的患者。对1820名患者测量了APAP和SAL血清水平，并审查了APAP血清水平>1微克/毫升或SAL血清水平>1毫克/分升的患者的病历。记录了患者服用APAP或SAL的病史，以及临床医生对该水平的解读。16份病历无法获取。在175名（9.6%）患者中发现APAP水平>1微克/毫升，其中120名（6.5%）有APAP病史阳性，55名（3%）有APAP病史阴性。APAP病史阴性组中无一例需要用N - 乙酰半胱氨酸治疗。APAP病史阴性组中有8名（0.3%）患者的APAP水平潜在中毒>50微克/毫升。在155名（8.5%）患者中发现SAL水平>1毫克/分升，其中44名（2.5%）有SAL病史阳性，111名（6%）有SAL病史阴性。3名患者有SAL病史阴性，但有明显的慢性SAL中毒。所有这些患者均表现为精神状态改变，阴离子间隙>20毫当量/升。普遍筛查发现，0.3%的自杀性服药患者有潜在中毒性APAP中毒，而病史未提示。这种不常见但可能危及生命的过量服药发生率应促使临床医生对所有怀疑有服药情况的患者进行筛查。水杨酸盐筛查发现，0.16%的自杀性服药患者有病史未提示的中毒性SAL中毒，尽管这种中毒情况应由阴离子间隙升高和精神状态改变提示。由于这种不太严重的中毒情况不太常见，且通常由常见的实验室数据提示，因此不建议进行普遍筛查，但可以采取更具选择性的筛查方法。
