RESUMEN
Serotonin syndrome is a potentially fatal condition caused by drugs that affect serotonin metabolism or act as serotonin receptor agonists. Monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors are the medications most commonly associated with serotonin syndrome. Serotonin syndrome can be mild and of short duration, but a prolonged course, life-threatening complications, and death are possible. Detection of serotonin syndrome is not difficult if the diagnostic criteria are understood and properly used, but the syndrome has no confirmatory tests and other drug-induced syndromes can, to a degree, mimic serotonin syndrome. The treatment is symptomatic and supportive. Antidotal therapies are available, but the evidence for their effectiveness is limited. If serotonin syndrome is promptly identified and aggressively treated, the patient should fully recover.
Asunto(s)
Causas de Muerte , Inhibidores de la Monoaminooxidasa/efectos adversos , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Síndrome de la Serotonina/inducido químicamente , Síndrome de la Serotonina/mortalidad , Enfermedad Crítica , Relación Dosis-Respuesta a Droga , Urgencias Médicas , Femenino , Humanos , Masculino , Inhibidores de la Monoaminooxidasa/administración & dosificación , Medición de Riesgo , Síndrome de la Serotonina/fisiopatología , Síndrome de la Serotonina/terapia , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Análisis de SupervivenciaRESUMEN
Overdoses of ß-blockers and calcium channel blockers can produce significant morbidity and mortality, and conventional therapies often do not work as treatments for these poisonings. High-dose insulin/glucose therapy has been successful in reversing the cardiotoxic effects of these drugs in cases where the standard therapies have failed, and it appears to be relatively safe. Many successes have been well documented, but the clinical experience consists of case reports, the mechanisms of action are not completely understood, and guidelines for use of the therapy are empirically derived and not standardized. Regardless of these limitations, high-dose insulin/glucose therapy can be effective, it is often recommended by clinical toxicologists and poison control centers, and critical care nurses should be familiar with when and how the therapy is used.
Asunto(s)
Antagonistas Adrenérgicos beta/envenenamiento , Bloqueadores de los Canales de Calcio/envenenamiento , Cardiotoxinas/efectos adversos , Enfermería de Cuidados Críticos/métodos , Glucosa/uso terapéutico , Insulina/uso terapéutico , Intoxicación/tratamiento farmacológico , Antagonistas Adrenérgicos beta/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Bloqueadores de los Canales de Calcio/efectos adversos , Relación Dosis-Respuesta a Droga , Educación Continua en Enfermería , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Intravenous lipid emulsion is an accepted therapy for the treatment of severe cardiac toxic effects caused by local anesthetics. Lipid emulsion therapy has also been used successfully to treat cardiac arrest and intractable arrhythmias caused by overdoses of antiepileptic drugs, cardiovascular drugs, and psychotropic medications, but experience with intravenous lipids as antidotal therapy in these clinical situations is limited. However, intravenous lipids are relatively safe, widely available, and easy to administer, and many published case reports document their dramatic effectiveness. Patients who have not responded to standard therapies have been quickly revived by administration of intravenous lipids. Use of lipids most likely will increase, and critical care nurses should be familiar with lipid therapy.