Recognizing and Caring for the Intoxicated Patient in an Outpatient Clinic

Donroe, Joseph H.; Tetrault, Jeanette M.

doi:10.1016/j.mcna.2016.12.012

Cited by 9 publications

(2 citation statements)

References 26 publications

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“…Due to the time lapse from admission until subspecialty consultation, the window of opportunity for informative BAC testing (<6 to 12 h since drinking) (Andresen‐Streichert et al, 2017, 2018; Bean et al, 2001) had often passed. Although the topic has been well reviewed (Donroe & Tetrault, 2017), studies are limited examining the rates of patients within the window of positive BAC at outpatient visits. Anecdotal evidence suggests that individuals tend to abstain from alcohol in the preceding 12 to 24 h prior to outpatient visits, likely accounting for the low rates of BAC positivity in this study.…”

Section: Discussionmentioning

confidence: 99%

Positive blood phosphatidylethanol concentration is associated with unfavorable waitlist‐related outcomes for patients medically appropriate for liver transplantation

Faulkner

White

Manatsathit

et al. 2022

Alcoholism Clin & Exp Res

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Background Excessive alcohol use is a leading etiology of liver disease and indication for liver transplantation. Accurate measurement of alcohol use remains a challenge in the management of patients in the pre‐, peri‐, and post‐liver transplant settings. Blood 16:0‐18:1 phosphatidylethanol (PEth) concentration is a sensitive and specific biomarker of binge and moderate, chronic alcohol use. As PEth has the longest detection window of available blood‐based direct alcohol biomarkers for moderate to heavy drinking, it shows promise as an indicator of patterns and chronicity of drinking. However, the utility of PEth in clinical liver transplantation is understudied. This study examines the association of PEth results with liver transplantation waitlist‐focused patient outcomes. Methods Retrospective data for all patients tested for PEth for a one‐year period at a tertiary care medical center with an active liver transplantation program were abstracted. Indications for PEth testing, liver transplantation waitlist‐related outcomes (e.g., listing and delisting) following testing and associations of PEth results with other parameters were analyzed. Results Over a one‐year period, 153 PEth tests were performed on 109 individuals. The most frequent indications for PEth testing were as an objective indicator of alcohol use patterns (86.3%) and to assess alcohol as a putative etiology of liver injury (13.7%). Of the 109 patients, 56 were medically appropriate for liver transplantation. Medically acceptable candidates with unfavorable transplantation waitlist‐related outcomes (delisting, deferment of transplant evaluation, deferment of listing until completion of recommended alcohol rehabilitation, and being deemed not a transplant candidate) were at least 3.41 times more likely to have a positive PEth test than those with favorable transplantation waitlist‐related outcomes (odds ratio 3.41, confidence interval 3.41 to ∞, p = 0.001). Conclusion This single‐center study reporting a comprehensive account of PEth utilization at a liver transplant center demonstrates that liver transplantation waitlist‐related outcomes are associated with PEth test results. Patients with positive PEth tests were more likely to have unfavorable transplant waitlist‐related outcomes. PEth testing has not been validated as a predictor of relapse to drinking in post‐transplant patients and because its utility in the pre‐transplant setting is unclear its use could lead to disparities in the selection of patients for liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Positive blood phosphatidylethanol concentration is associated with unfavorable waitlist‐related outcomes for patients medically appropriate for liver transplantation

Faulkner

White

Manatsathit

et al. 2022

Alcoholism Clin & Exp Res

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“…Habituellement, en questionnant la personne, les accompagnants ou le personnel préhospitalier d'urgence, il est possible d'identifier les substances en cause (médication, drogue de rue, produit domestique, etc. ), leur voie d'administration et la dose réelle ou estimée (3,8,9). Si les substances ingérées sont des médicaments, la question visant à savoir si les comprimés sont à libération retardée sera également abordée, puisque leur absorption gastro-intestinale pourrait être prolongée et avoir un impact sur la durée d'observation recommandée (4,6).…”

Section: La Nature Et Les Circonstances De L'intoxicationunclassified

Un appel au Centre antipoison du Québec : l’évaluation initiale de la personne intoxiquée à l’urgence

Leblanc,

Ayotte,

Dufour

2023

soinsurgence

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Dans le cadre de leur travail, les infirmières qui pratiquent dans les urgences du Québec effectuent régulièrement des appels au centre antipoison du Québec (CAPQ) afin d’être guidées dans l’évaluation des personnes intoxiquées. Ces situations peuvent rapidement devenir complexes considérant les nombreuses substances potentiellement en cause, l’absence d’histoire claire et parfois même l’état critique de la personne. Lors de ces situations souvent déstabilisantes, il est important que l’infirmière d’urgence puisse identifier rapidement dans sa collecte de données les informations nécessaires qui seront utiles à communiquer avec l’infirmière du CAPQ. En ce sens, cet article vise à expliquer les différents éléments de la collecte de données en toxicologie et se veut un guide pour bien préparer l’infirmière d’urgence avant son appel au CAPQ.

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