老年人水杨酸中毒。认识和建议如何预防它。
文章的细节
-
引用
复制到剪贴板 -
杜纳斯C，库萨克BJ
老年人水杨酸中毒。认识和建议如何预防它。
药物老化。1992年1 - 2月;2(1):20-34。
- PubMed ID
-
1554971 (PubMed视图]
- 摘要
-
阿司匹林(乙酰水杨酸)及其水杨酸盐衍生物是有效的解热、镇痛和抗炎药物，尽管出现了更新、可能更安全的非甾体类抗炎药(NSAIDs)，但仍被老年人广泛使用。然而，没有一种新的非甾体抗炎药被证明比阿司匹林或水杨酸更有效。慢性水杨酸中毒最常见于老年人，可发生治疗剂量。老年患者的毒性增加通常是由于无意中过量服用。双重处方或额外使用非处方水杨酸盐是一些不知情的长期毒性的原因。根据一些研究，水杨酸的全身清除率(主要通过肝脏代谢)随着年龄的增长而减少，肾脏清除也是如此。这些变化在使用高剂量水杨酸治疗的老年人中更加重要，当代谢饱和时，肾脏排泄可获得更多不变的药物。面对肾脏损害，毒性风险增加。急性水杨酸中毒的诊断一般不构成诊断问题。患者通常有故意用药过量史，伴有换气过度、发热和恶心。 The diagnosis can be confirmed by measuring serum salicylate concentrations. Chronic intoxication often poses a diagnostic dilemma with atypical presentations mimicking other disease states such as diabetic ketoacidosis, delirium, cerebrovascular accident, myocardial infarction or cardiac failure. The diagnosis of salicylate intoxication should be borne in mind when an older patient presents with recent deterioration in activities of daily living with no known cause. Plasma salicylate concentrations should be measured if salicylate intoxication is suspected, even if there is no documented history of salicylate ingestion. The risk of salicylate nephrotoxicity is also increased with age, and upper gastrointestinal haemorrhage is associated with increased mortality in older age groups. Treatment of acute toxicity consists of prompt recognition of salicylate intoxication, use of activated charcoal, correction of acid-base abnormalities, general supportive measures, and if concentrations are extremely high, dialysis can be effectively used. Chronic toxicity, which can occur even with marginally high salicylate concentrations, is treated with drug withdrawal and supportive therapy. Chronic salicylate toxicity can be averted by prescription of conservative doses of drug, avoidance of concomitant use of different salicylate preparations, and therapeutic monitoring to guide dosage. Renal function should be monitored to detect nephrotoxicity from chronic salicylate therapy. Patients should be regularly screened for evidence of gastrointestinal bleeding.(ABSTRACT TRUNCATED AT 400 WORDS)
引用这篇文章的药物银行数据
- 药物