Analyses capillaires au décours des intoxications par les nouveaux produits de synthèse

Richeval, Camille; Wiart, Jean-François; Phanithavong, Mélodie; Caous, Anne-Sylvie; Carton, Louise; Deheul, Sylvie; Humbert, Luc; Tournebize, Juliana; Kieffer, Pauline; Allorge, Delphine; Gaulier, Jean-Michel

doi:10.1016/j.therap.2018.09.031

Cited by 5 publications

(1 citation statement)

References 2 publications

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“…Rationale Although no published studies have addressed this issue, the available data suggest that analytical identification of recreational drugs is of limited value for patient management and generally cannot be performed routinely due to the mismatch between the emergency setting and the time required to obtain the results [181][182][183][184][185]. However, retrospective identification is useful to more clearly understand the observed symptoms and signs, and, as a result of the acquired knowledge, contributes to the improvement of care [183,186], medical treatment (particularly, in addiction medicine [187,188]) and implementation of preventive actions [189,190]. Epidemiologically, analytical identification contributes to the limited and not always up-to-date data [191], and provides support for an early warning system for emerging substances [183,192,192].…”

Section: Question 63: When Should An Antidote (When One Exists) Be Amentioning

confidence: 99%

Management of pharmaceutical and recreational drug poisoning

Mégarbane

Oberlin

Alvarez

et al. 2020

Ann. Intensive Care

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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.

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