Endotracheal intubation in  -hydroxybutyric acid intoxication and overdose

Michael, Helen; Harrison, Magnus

doi:10.1136/emj.2004.021154

Cited by 5 publications

(3 citation statements)

References 2 publications

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“…The decision to provide airway management in a patient with poisoning requires careful consideration of a number of factors including altered mental status because of the presence of a sedating xenobiotic, presence of acidosis or severe electrolyte abnormalities, substance-induced respiratory compromise or hemodynamic instability, and drug-induced seizure [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Reasons for intubation in a poisoned patient may include central nervous system depression, agitated delirium, inability to cooperate with procedures, respiratory compromise, and acute lung injury.…”

Section: Introductionmentioning

confidence: 99%

Poisonings Associated with Intubation: US National Poison Data System Exposures 2000–2013

et al. 2015

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Patients may be intubated after exposure to a variety of substances because of respiratory failure, CNS sedation, pulmonary pathology, or cardiovascular instability. However, there is little data describing the types of substances that are associated with endotracheal intubation or the rates of intubation after these exposures. Evaluation of this association may inform future research on intubation after exposures to specific substances and guide poison prevention education. Our objective was to determine which exposures were commonly associated with intubation using the data from National Poison Data System (NPDS). The NPDS tracks data from potential exposures to substances reported to all American Association of Poison Control Centers. We performed a retrospective analysis of NPDS data from January 1st, 2000 to December 31st, 2013 to identify human exposures to substances that were associated with endotracheal intubation. Descriptive statistics were used to analyze the data. There were 93,474 single substance exposures and 228,507 multiple substance exposures that were associated with intubation. The most common exposures to substances that were associated with intubation were atypical antipsychotics (7.4 %) for single exposures and benzodiazepines (27.4 %) for multiple exposures. Within each age group, the most common known exposures to substances were for patients under 6 years, clonidine for single and multiple exposures; for patients aged 6-12 years, clonidine for single exposures and atypical antipsychotics for multiple exposures; for patients aged 13-19 years, atypical antipsychotics for single and multiple exposures; and for patients over 19 years, atypical antipsychotics for single exposures and benzodiazepines for multiple exposures. From 2000-2013, the exposures to substances most commonly associated with intubation varied by single versus multiple exposures and by age. This study helps clarify the exposures to substances that are associated with intubation reported to poison centers in the USA.

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Section: Introductionmentioning

confidence: 99%

Poisonings Associated with Intubation: US National Poison Data System Exposures 2000–2013

et al. 2015

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“…Patients commonly wake abruptly and may be combative or delirious for several hours 42 . Management is supportive, with intubation only required for prolonged coma, airway security or other complications 43–45 . Antidotes such as physostigmine are not beneficial 46 …”

Section: Discussionmentioning

confidence: 99%

Teenage toxins: Recreational poisoning in the adolescent

Gunja

2011

J Paediatrics Child Health

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Adolescents are experimenting with recreational drugs on a regular basis, particularly at social gatherings such as parties, raves and mass events. A combination of reduced fluid intake, physical activity and drug-induced hyperthermia leads to complications such as heat stroke, delirium and potentially death. The clinician needs to be aware of the variety of pharmacologically active substances available in the recreational marketplace in order to diagnose and manage these patients. Recreational misadventure, because of incorrect dosage or mixing multiple substances, is a common reason for teenagers presenting to hospital with toxidromes. Death from club drug overdose is more likely to be associated with suicidal intent, related risky behaviour and trauma, as well as the inherent toxicity of the drug itself. Although many teenagers are concerned about 'drink spiking' with club drugs, the most common agent causing drink spiking incidents is ethanol.

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“…Supervising Editor: Michael Hodgman, MD Poisoned patients may present with altered mental status necessitating ETI due to loss of airway reflexes, or because the predicted clinical course anticipates imminent inability to protect airway and the risk of aspiration [7][8][9][10][11]. Patients may also require airway protection for management of overdose-related seizure, severe agitation, or delirium [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Endotracheal Intubation in the Pharmaceutical-Poisoned Patient: a Narrative Review of the Literature

et al. 2020

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Introduction Endotracheal intubation (ETI) is an essential component of the supportive care provided to the critically ill patient with pharmaceutical poisoning; however, specific nuances surrounding intubation including techniques and complications in the context of pharmaceutical poisoning have not been well elucidated. Discussion A search of the available literature on ETI in pharmaceutical-poisoned patients was undertaken using Medline, ERIC, Cochrane database, and PsycINFO using the following MeSH and keyword terms: ("toxicology" OR "poisons" OR "drug overdose" OR "poisoning") AND ("intubation, intratracheal" OR "intubation, endotracheal" OR "airway management" OR "respiration, artificial"). A hand-search was also performed when the literature in the above search required additional conceptual clarification, including using the "Similar Articles" feature of PubMed, along with reviewing articles' reference lists that discussed intubation in the context of a poisoning scenario. Articles with any discussion around the ETI process in the context of a pharmaceutical poisoning were then included. Intubation may be performed in patients poisoned with pharmaceuticals in the context of both single and multiple organ dysfunction including central and peripheral nervous system, pulmonary, or cardiovascular toxicity with hemodynamic instability, or localized effects resulting in mechanical airway obstruction. Certain classes of poisonings may require modifications to the standard rapid sequence induction airway management algorithm. Conclusions ETI is a key component of the supportive care provided to the patient poisoned by a pharmaceutical agent. Clinicians should be aware of the spectrum of toxicities that can necessitate intubation, as well as airway management nuances that are specific to various poisoning presentations.

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Endotracheal intubation in -hydroxybutyric acid intoxication and overdose

Cited by 5 publications

References 2 publications

Poisonings Associated with Intubation: US National Poison Data System Exposures 2000–2013

Poisonings Associated with Intubation: US National Poison Data System Exposures 2000–2013

Teenage toxins: Recreational poisoning in the adolescent

Endotracheal Intubation in the Pharmaceutical-Poisoned Patient: a Narrative Review of the Literature

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