Toxicological analysis in agitated patients
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Published on: April 5, 2011
F Moritz1, J P Goullé, C Girault
1Medical Emergency Department, Hôpital Charles Nicolle, Centre Hospitalier Universitaire, 1 rue de Germont, F-76 031 Rouen Cedex, France. Fabienne.Moritz@chu-rouen.fr
Objective:
To assess the toxicological etiologies in agitated patients and to evaluate their initial clinical diagnosis in the light of toxicological results analysis.
Design:
Prospective clinical study.
Setting:
Emergency Department (ED) in a 2,650-bed University Hospital.
Patients:
Fifty-eight consecutively enrolled patients admitted to the ED in agitated states over a 6-month period.
Measurements And Results:
All patients underwent laboratory tests including blood glucose, ethanol and serum drug screening. Toxicology tests were conducted by fluorescence polarization immunoassay and confirmed by high performance liquid chromatography/diode array detector and gas chromatography-mass spectrometry. The physician's initial diagnosis was evaluated in the light of toxicological analysis results. Serum toxicological analysis revealed that 50/58 patients were under the influence of alcohol and/or a drug. Benzodiazepines (22/58), selective serotonin reuptake inhibitors (5/58) and opiates (4/58) were the most frequently observed. The initial clinical diagnosis was alcohol intoxication in 39 patients, although 1 patient was not under the influence of alcohol and 16 also had benzodiazepine in their sera. Moreover, the diagnosis of serotonin syndrome was overlooked in two patients.
Conclusion:
Most agitated patients were under the influence of alcohol and/or a drug. Benzodiazepine alone or in association with alcohol was surprisingly frequent. A serotonin syndrome may explain the agitation state.
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