Citation

Zilker T. Notarzt 2014; 30(5): 224-237.

Copyright

(Copyright © 2014)

DOI

10.1055/s-0033-1337035

PMID

unavailable

Abstract

Chemical accidents in adults give rise to hospital admission in only 5. Suicidal selfpoisonings are still a challenge for paramedics, emergency and hospital doctors. Natural toxins as amatoxins, cholchicine and snakebites can lead to severe intoxication. Sedatives, antidepressants and analgesics are the drugs which are often used for suicidal intent due to their availability. Quetiapine and paracetamol are the drugs which are ingested for attempted suicide/suicide mostly. The treatment of poisoning centers on the severity which can be judged by the poison severity score, the Reed classification or the GCS. Most intoxicated patients can be treated symptomatically or by intensive care measurements. Antidotal treatment however is needed for some specific poisonings. Exact sample drawing is essential for diagnostic and forensic purposes. There is no evidence based proof for the effectiveness of primary detoxification from the gastrointestinal tract like forced emesis, gastric lavage or the use of cathartics. Early after the ingestion of a harmful substance the administration of activated charcoal seems advisable. Hemodialysis can remove water soluble substances with a small volume of distribution. Multiple charcoal administration may exhibit some influence on secondary detoxification. Provision of evidence of the efficacy for newer antidotes like hydroxocobalamin in smoke inhalation, fomepizol for toxic alcohols and silibinin for amanita poisoning are emerging. Two recently recommended therapeutic principles have still to demonstrate their ability: Firstly the treatment of patients with calcium receptor antagonistic and beta-receptor antagonistic agents poisoning by high dose of insulin plus glucose, secondly the treatment for severe intoxication with cardiotoxic and psychotropic drugs with a lipid emulsion (Lipid rescue). It is essential for all doctors to contact a poison control center whenever they are confronted with an intoxicated patient. There they can get advice about which dose is toxic and about the newest therapeutic procedure. © Georg Thieme Verlag KG Stuttgart New York.

Language: de

Keywords

adult; human; hemodialysis; acute poisoning; intoxication; laxative; hospital admission; stomach lavage; psychotropic agent; poison center; activated carbon; intensive care; detoxification; glucose; insulin; hydroxocobalamin; charcoal; 4 methylpyrazole; Article; beta adrenergic receptor; lipid emulsion; acute intoxication; cardiotoxin; poison control center; silibinin; treatment of intoxication; volume of distribution