多剂量活性炭在急性自我中毒:一个随机对照试验
Michael Eddleston1, Edmund Juszczak, Nick A Buckley
1Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. eddlestonm@yahoo.com
Lancet (London, England)
|February 19, 2008
概括
常规多剂量活性炭并没有降低亚太农村地区故意自我中毒的死亡率. 对于这些地区的农药和植物摄入,迫切需要有效,负担得起的治疗方法.
科学领域:
- 毒理学 毒理学 毒理学
- 临床毒理学 临床毒理学
- 公共卫生 公共卫生
背景情况:
- 与工业化国家相比,发展中国家的故意自我中毒病例死亡率要高得多.
- 这种差异在很大程度上归因于农村地区使用高度有毒的农药和植物.
- 该研究调查了活性炭作为减少死亡率的潜在干预措施.
研究的目的:
- 评估多剂量活性炭在农村发展中国家的环境中减少故意自我中毒导致的死亡率的有效性.
- 为了比较没有木炭,单剂量活性炭和多剂量活性炭治疗的结果.
主要方法:
- 在斯里兰卡三家医院进行了一项开放的随机对照试验.
- 4632名患者被随机分配,每隔4小时接受不使用木炭,一次50克剂量或六次50克剂量的活性炭.
- 主要结局指标是死亡率,并根据治疗意图进行分析.
主要成果:
- 没有木炭 (6.8%),单剂量 (6.3%) 和多剂量 (6.3%) 活性炭组之间的死亡率没有显著差异.
- 根据所摄入的毒素类型,入院时的疾病严重程度或呈现时间,没有观察到结果的显著差异.
- 与没有木炭组相比,多剂量组的调整后死亡率比率为0.96 (95% CI 0.70-1.33).
结论:
- 对于亚太农村地区的故意自我中毒,不能推常规使用多剂量活性炭.
- 对早期使用活性炭的进一步研究可能是有益的.
- 迫切需要在这些地区开发有效和负担得起的杀虫剂和植物摄入治疗方法.
相关概念视频
01:14Prevention of Further Absorption of Poison
In cases of acute poisoning, the primary objective is to prevent further absorption of the toxic substance into the body. Immediate interventions using various decontamination techniques targeting the gastrointestinal (GI) tract can achieve this. Decontamination is crucial to prevent poison from entering the systemic circulation, which involves washing affected areas with water and mild soap and removing contaminated clothing. Once external decontamination is done, attention must be turned to...
01:26Pharmaceutical Poisoning: Treatment Strategies
Treatment strategies for poisoning are a critical aspect of emergency medicine, focusing on preventing the absorption of toxins and enhancing their elimination. When a poisoning incident occurs, the first response is to halt exposure and decontaminate the patient, particularly through gastrointestinal (GI) methods if the poison was ingested.Gastrointestinal Decontamination Techniques:Activated charcoal is the cornerstone of GI decontamination. It works through adsorption, binding the toxin to...
01:26Anticholinesterase Agents: Poisoning and Treatment
Anticholinesterases, also known as cholinesterase inhibitors, work by blocking the breakdown of acetylcholine, leading to its accumulation in the synaptic cleft. This accumulation indirectly enhances both muscarinic and nicotinic actions. These agents are classified as reversible or irreversible based on their mechanism of action.
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is slower than the...
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is slower than the...
01:26Enhanced Elimination of Poison
Poison can be effectively removed from the gastrointestinal (GI) tract through various decontamination procedures.
Antidotes serve a crucial role in counteracting the effects of poison by inhibiting enzymes responsible for producing harmful drug metabolites. In some cases, these toxic metabolites can be neutralized by endogenous cosubstrates, which are maintained at specific concentrations to prevent interaction with cellular macromolecules and subsequent cell death.
Renal excretion is the...
Antidotes serve a crucial role in counteracting the effects of poison by inhibiting enzymes responsible for producing harmful drug metabolites. In some cases, these toxic metabolites can be neutralized by endogenous cosubstrates, which are maintained at specific concentrations to prevent interaction with cellular macromolecules and subsequent cell death.
Renal excretion is the...
01:11Bioavailability Study Design: Single Versus Multiple Dose Studies
Bioavailability studies are essential for understanding how a drug is absorbed, distributed, metabolized, and excreted in the body. These studies assess the extent and rate at which the active pharmaceutical agent becomes available at the site of action. The design of bioavailability studies can involve single-dose or multiple-dose regimens, each with distinct advantages and limitations.Single-dose studies are the preferred approach due to their simplicity and reduced drug exposure for...
01:26Pharmaceutical Poisoning: Potential Scenarios
Pharmaceutical poisoning can occur through various channels, impacting an estimated 2 million hospitalized patients in the U.S. annually with serious adverse drug responses. These scenarios encompass both therapeutic uses, such as drug toxicity, where even standard dosages can lead to severe central nervous system depression, and non-therapeutic exposures, including accidental ingestion by children, and environmental and occupational exposures.Unintentional poisonings often involve exploratory...