老年人水杨酸盐中毒。对如何预防的认识和建议。
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杜纳斯C，库萨克BJ
老年人水杨酸盐中毒。对如何预防的认识和建议。
药物老化。1992 Jan-Feb;2(1):20-34。
- PubMed ID
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1554971 (PubMed视图］
- 摘要
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阿司匹林(乙酰水杨酸)及其水杨酸衍生物是有效的解热、镇痛和抗炎药，尽管出现了新的、可能更安全的非甾体类抗炎药(NSAIDs)，但它们仍然被老年人广泛使用。然而，没有一种新型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往往是由于无意的过量用药。双处方或额外使用非处方水杨酸盐是不知情的长期毒性的一些原因。根据一些研究，水杨酸酯的全身清除(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。在代谢饱和时使用高剂量水杨酸盐治疗的老年人中，这些变化越来越重要，因为肾脏排泄有更多不变的药物可用。在肾损害的情况下，毒性的风险增加。急性水杨酸中毒的诊断一般不构成诊断问题。患者通常有故意过量用药史、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)
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