B\u1ec7nh nh\u00e2n nam, 17 tu\u1ed5i, \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o khoa c\u1ea5p c\u1ee9u trong t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n sau khi \u0111\u01b0\u1ee3c cha m\u1eb9 ph\u00e1t hi\u1ec7n \u1edf s\u00e2n tr\u01b0\u1edbc nh\u00e0 h\u00e0ng x\u00f3m. B\u1ec7nh nh\u00e2n t\u1ef1 khai \u0111\u00e3 s\u1eed d\u1ee5ng m\u1ed9t l\u01b0\u1ee3ng l\u1edbn r\u01b0\u1ee3u trong v\u00f2ng v\u00e0i gi\u1edd tr\u01b0\u1edbc \u1edf nh\u00e0 b\u1ea1n nh\u01b0ng kh\u00f4ng d\u00f9ng b\u1ea5t c\u1ee9 ch\u1ea5t g\u00e2y nghi\u1ec7n n\u00e0o. Kh\u00f4ng c\u00f3 \u00fd t\u01b0\u1edfng hay h\u00e0nh vi t\u1ef1 s\u00e1t. Kh\u00f4ng n\u00f4n, kh\u00f4ng ti\u00eau ch\u1ea3y, kh\u00f4ng kh\u00f3 th\u1edf.<\/p>\n
Theo l\u1eddi k\u1ec3 c\u1ee7a cha m\u1eb9, g\u1ea7n \u0111\u00e2y b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n “\u0111i\u00ean kh\u00f9ng” h\u01a1n v\u00e0 h\u00e0nh x\u1eed b\u1ea5t th\u01b0\u1eddng khi \u1edf nh\u00e0 c\u0169ng nh\u01b0 \u1edf tr\u01b0\u1eddng trong v\u00f2ng 6 th\u00e1ng tr\u1edf l\u1ea1i \u0111\u00e2y. \u0110i\u1ec3m s\u1ed1 c\u0169ng sa s\u00fat. B\u1ec7nh nh\u00e2n d\u00e0nh th\u1eddi gian \u1edf c\u00f9ng m\u1ed9t nh\u00f3m b\u1ea1n m\u1edbi v\u00e0 hai tu\u1ea7n tr\u01b0\u1edbc c\u00f2n tham gia \u0111\u00e1nh l\u1ed9n.<\/p>\n
Kh\u00e1m th\u1ea5y th\u00e2n nhi\u1ec7t l\u00e0 36,5 \u0111\u1ed9 C, huy\u1ebft \u00e1p 100\/62 mmHg, nh\u1ecbp th\u1edf 10 l\u1ea7n\/ph\u00fat, b\u00e3o ho\u00e0 oxy l\u00e0 98% (t\u1ef1 th\u1edf kh\u00ed tr\u1eddi). Ni\u00eam m\u1ea1c kh\u00f4ng kh\u00f4, kh\u00f4ng ch\u1ea3y n\u01b0\u1edbc d\u00e3i.<\/p>\n
Tri gi\u00e1c: k\u00edch th\u00edch, l\u00fa l\u1eabn, \u0111\u1ecbnh h\u01b0\u1edbng \u0111\u01b0\u1ee3c ng\u01b0\u1eddi nh\u01b0ng kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c kh\u00f4ng gian hay th\u1eddi gian. Ng\u00f4n ng\u1eef l\u1ed9n x\u1ed9n, mi\u1ec7ng c\u00f3 m\u00f9i r\u01b0\u1ee3u. \u0110\u1ed3ng t\u1eed hai b\u00ean nh\u01b0 \u0111\u1ea7u \u0111inh ghim, kh\u00f4ng c\u00f3 rung gi\u1eadt nh\u00e3n c\u1ea7u. K\u1ebft m\u1ea1c sung huy\u1ebft. C\u1ed5 m\u1ec1m. G\u1ecdi c\u00f3 l\u00e0m theo l\u1ec7nh nh\u01b0ng \u0111\u00e1p \u1ee9ng v\u1eadn \u0111\u1ed9ng ch\u1eadm v\u00e0 ph\u1ed1i h\u1ee3p \u0111\u1ed9ng t\u00e1c k\u00e9m. Kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u b\u00ean ngo\u00e0i c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u hay ban tr\u00ean da. Khi ng\u1ee7 nh\u1ecbp th\u1edf b\u1ec7nh nh\u00e2n gi\u1ea3m c\u00f2n 6 l\u1ea7n\/ph\u00fat.<\/p>\n
\u0110\u01b0\u1eddng m\u00e1u mao m\u1ea1ch \u0111\u1ea7u ng\u00f3n tay l\u00e0 4 mmol\/L (gi\u00e1 tr\u1ecb tham chi\u1ebfu 3,9-5,8).<\/p>\n
A. Lorazepam
\nB. Flumazenil
\nC. Naloxone
\nD. Fomepizole
\nE. Pralidoxime<\/p>\n
\u0110\u00e1p \u00e1n: s\u1ebd \u0111\u0103ng trong th\u1eddi gian s\u1edbm nh\u1ea5t.<\/p>\n
\u0110i\u1ec3m then ch\u1ed1t: \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u ph\u00f9 h\u1ee3p nh\u1ea5t \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n v\u1ecb th\u00e0nh ni\u00ean say r\u01b0\u1ee3u, ki\u1ec7t s\u1ee9c, suy h\u00f4 h\u1ea5p v\u00e0 \u0111\u1ed3ng t\u1eed co nh\u1ecf l\u00e0 naloxone.<\/p>\n
\u1ede b\u1ec7nh nh\u00e2n ng\u1ed9 \u0111\u1ed9c ethanol c\u1ea5p, r\u1ed1i lo\u1ea1n tr\u1ea1ng th\u00e1i t\u00e2m th\u1ea7n v\u00e0 suy h\u00f4 h\u1ea5p, c\u1ea7n ngh\u0129 \u0111\u1ebfn tr\u01b0\u1eddng h\u1ee3p ng\u1ed9 \u0111\u1ed9c c\u00e1c thu\u1ed1c kh\u00e1c d\u00f9 khi h\u1ecfi b\u1ec7nh ho\u1eb7c th\u0103m kh\u00e1m kh\u00f4ng khai th\u00e1c \u0111\u01b0\u1ee3c r\u00f5 r\u00e0ng. \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u ph\u00f9 h\u1ee3p nh\u1ea5t \u1edf b\u1ec7nh nh\u00e2n n\u00e0y c\u1ea7n h\u01b0\u1edbng t\u1edbi gi\u1ea3i quy\u1ebft t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p.<\/p>\n
T\u00ecnh tr\u1ea1ng ng\u1ed9 \u0111\u1ed9c opioid g\u00e2y suy h\u00f4 h\u1ea5p c\u00f3 th\u1ec3 nhanh ch\u00f3ng gi\u1ea3i quy\u1ebft b\u1eb1ng naloxone, \u0111\u00e2y l\u00e0 m\u1ed9t ch\u1ea5t \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 opioid. Naloxone c\u00f3 t\u00e1c d\u1ee5ng ng\u1eafn, n\u00ean c\u00f3 th\u1ec3 c\u1ea7n cho li\u1ec1u l\u1eb7p l\u1ea1i. Trong khi \u0111\u00f3, c\u1ea7n ti\u1ebfn h\u00e0nh c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u1ed9c ch\u1ea5t trong huy\u1ebft thanh v\u00e0 n\u01b0\u1edbc ti\u1ec3u. X\u00e9t nghi\u1ec7m salicylate v\u00e0 acetaminophen c\u00f3 vai tr\u00f2 quan tr\u1ecdng v\u00ec \u0111\u00e2y th\u01b0\u1eddng l\u00e0 c\u00e1c ch\u1ea5t c\u00f3 nguy c\u01a1 \u0111\u1ed9c t\u00ednh cao.<\/p>\n
N\u1ebfu b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng r\u01b0\u1ee3u c\u00f9ng v\u1edbi m\u1ed9t opioid d\u1ea1ng gi\u1ea3i ph\u00f3ng k\u00e9o d\u00e0i ho\u1eb7c t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i, r\u01b0\u1ee3u c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u1ed1c \u0111\u1ed9 gi\u1ea3i ph\u00f3ng opioid kh\u1ecfi d\u1ea1ng d\u01b0\u1ee3c ch\u1ea5t gi\u1ea3i ph\u00f3ng k\u00e9o d\u00e0i \u0111\u00e3 d\u00f9ng. Hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y \u0111\u00f4i khi \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 “ph\u00e1 li\u1ec1u” (dose dumping) v\u00e0 c\u00f3 th\u1ec3 g\u00e2y qu\u00e1 li\u1ec1u opioid, t\u1ee9c l\u00e0 m\u1ed9t li\u1ec1u l\u1edbn opioid \u0111\u00e1ng l\u1ebd \u0111\u01b0\u1ee3c h\u1ea5p th\u1ee5 trong th\u1eddi gian d\u00e0i nay l\u1ea1i \u0111\u01b0\u1ee3c h\u1ea5p thu m\u1ed9t c\u00e1ch nhanh ch\u00f3ng. Th\u00eam n\u1eefa, r\u01b0\u1ee3u c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 qu\u00e1 li\u1ec1u opioid do t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p.<\/p>\n
Lorazepam c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng cai r\u01b0\u1ee3u ho\u1eb7c ng\u1ed9 \u0111\u1ed9c c\u1ea5p cocaine. Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n n\u00e0y kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a c\u00e1c t\u00ecnh tr\u1ea1ng tr\u00ean, \u0111\u1ed3ng th\u1eddi s\u1eed d\u1ee5ng m\u1ed9t benzodiazepin \u0111\u01b0\u1ee3c cho l\u00e0 s\u1ebd l\u00e0m n\u1eb7ng t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p.<\/p>\n
Flumazenil \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c t\u00e1c d\u1ee5ng c\u1ee7a benzodiazepine. Tuy nhi\u00ean nhi\u1ec1u b\u1eb1ng ch\u1ee9ng cho th\u1ea5y thu\u1ed1c n\u00e0y gi\u1ea3i ch\u1ec9 quy\u1ebft suy h\u00f4 h\u1ea5p m\u1ed9t c\u00e1ch kh\u00f4ng \u1ed5n \u0111\u1ecbnh, v\u00e0 c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m ng\u01b0\u1ee1ng g\u00e2y co gi\u1eadt.<\/p>\n
Fomepizole, m\u1ed9t thu\u1ed1c \u1ee9c ch\u1ebf alcohol dehydrogenase, l\u00e0 m\u1ed9t ch\u1ea5t gi\u1ea3i \u0111\u1ed9c trong ng\u1ed9 \u0111\u1ed9c ethylene glycol ho\u1eb7c methanol. Thu\u1ed1c \u1ee9c ch\u1ebf chuy\u1ec3n ho\u00e1 ethylene glycol ho\u1eb7c methanol th\u00e0nh c\u00e1c ch\u1ea5t \u0111\u1ed9c. Ethylene glycol v\u00e0 methanol c\u00f3 m\u1eb7t trong nhi\u1ec1u ho\u00e1 ch\u1ea5t, dung m\u00f4i v\u00e0 ch\u1ea5t ch\u1ed1ng \u0111\u00f4ng b\u0103ng c\u00f4ng nghi\u1ec7p, nh\u01b0ng \u00edt \u0111\u01b0\u1ee3c ng\u01b0\u1eddi v\u1ecb th\u00e0nh ni\u00ean v\u00e0 thanh ni\u00ean s\u1eed d\u1ee5ng l\u00e0m ch\u1ea5t k\u00edch th\u00edch.<\/p>\n
Pralidoxime l\u00e0 ch\u1ea5t gi\u1ea3i \u0111\u1ed9c trong ng\u1ed9 \u0111\u1ed9c phospho h\u1eefu c\u01a1. Phospho h\u1eefu c\u01a1 g\u00e2y h\u1ed9i ch\u1ee9ng ng\u1ed9 \u0111\u1ed9c \u0111\u01b0\u1ee3c t\u00f3m g\u1ecdn l\u1ea1i trong c\u1ee5m t\u1eeb DUMBBELS (\u0111\u1ea1i ti\u1ec7n – defecation, ti\u1ec3u ti\u1ec7n – urination, co \u0111\u1ed3ng t\u1eed – miosis, t\u0103ng ti\u1ebft ph\u1ebf qu\u1ea3n – bronchorrhea, co th\u1eaft ph\u1ebf qu\u1ea3n – bronchospasm, nh\u1ecbp tim ch\u1eadm – bradycardia, n\u00f4n m\u1eeda – emesis, ch\u1ea3y n\u01b0\u1edbc m\u1eaft – lacrimation, v\u00e0 ch\u1ea3y n\u01b0\u1edbc d\u00e3i – salivation).<\/p>\n
Legano L. Alcohol. Pediatr Rev 2007 Apr 3; 28:153.<\/p>\n
Sugarman JM and Paul RI. Flumazenil: a review. Pediatr Emerg Care 1994 Feb 1; 10:37.<\/p>\n
Kraut JA and Mullins ME. Toxic alcohols. N Engl J Med 2018 Jan 18; 378:270.<\/p>\n
Brent J. Fomepizole for ethylene glycol and methanol poisoning. N Engl J Med 2009 May 21; 360:2216.<\/p>\n
Nackers KA et al. Substance abuse, general principles. Pediatr Rev 2015 Dec; 36:535.<\/p>\n
Walden M et al. The effect of ethanol on the release of opioids from oral prolonged-release preparations. Drug Dev Ind Pharm 2007 Oct; 33:1101.<\/p>\n
Ngu\u1ed3n: NEJM<\/p>\n
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Case l\u00e2m s\u00e0ng B\u1ec7nh nh\u00e2n nam, 17 tu\u1ed5i, \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o khoa c\u1ea5p c\u1ee9u trong t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n sau khi \u0111\u01b0\u1ee3c cha m\u1eb9 ph\u00e1t hi\u1ec7n \u1edf s\u00e2n tr\u01b0\u1edbc nh\u00e0 h\u00e0ng x\u00f3m. B\u1ec7nh nh\u00e2n t\u1ef1 khai \u0111\u00e3 s\u1eed d\u1ee5ng m\u1ed9t l\u01b0\u1ee3ng l\u1edbn r\u01b0\u1ee3u trong v\u00f2ng v\u00e0i gi\u1edd tr\u01b0\u1edbc \u1edf nh\u00e0 b\u1ea1n nh\u01b0ng kh\u00f4ng […]\n","protected":false},"author":1,"featured_media":5483,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5482","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5482","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=5482"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5482\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/5483"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=5482"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=5482"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=5482"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}