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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2020

01-12-2020 | Paracetamol | Review

Management of pharmaceutical and recreational drug poisoning

Authors: Bruno Mégarbane, Mathieu Oberlin, Jean-Claude Alvarez, Frederic Balen, Sébastien Beaune, Régis Bédry, Anthony Chauvin, Isabelle Claudet, Vincent Danel, Guillaume Debaty, Arnaud Delahaye, Nicolas Deye, Jean-Michel Gaulier, Francis Grossenbacher, Philippe Hantson, Frédéric Jacobs, Karim Jaffal, Magali Labadie, Laurence Labat, Jérôme Langrand, Frédéric Lapostolle, Philippe Le Conte, Maxime Maignan, Patrick Nisse, Philippe Sauder, Christine Tournoud, Dominique Vodovar, Sebastian Voicu, Pierre-Géraud Claret, Charles Cerf

Published in: Annals of Intensive Care | Issue 1/2020

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Abstract

Background

Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis.

Methods

A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d’Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology.

Results

The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature.

Conclusions

The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.
Appendix
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Metadata
Title
Management of pharmaceutical and recreational drug poisoning
Authors
Bruno Mégarbane
Mathieu Oberlin
Jean-Claude Alvarez
Frederic Balen
Sébastien Beaune
Régis Bédry
Anthony Chauvin
Isabelle Claudet
Vincent Danel
Guillaume Debaty
Arnaud Delahaye
Nicolas Deye
Jean-Michel Gaulier
Francis Grossenbacher
Philippe Hantson
Frédéric Jacobs
Karim Jaffal
Magali Labadie
Laurence Labat
Jérôme Langrand
Frédéric Lapostolle
Philippe Le Conte
Maxime Maignan
Patrick Nisse
Philippe Sauder
Christine Tournoud
Dominique Vodovar
Sebastian Voicu
Pierre-Géraud Claret
Charles Cerf
Publication date
01-12-2020
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2020
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-020-00762-9

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