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Dtsch Med Wochenschr 2016; 141(19): 1376-1383
DOI: 10.1055/s-0042-109586
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Akute Bewusstseinsstörungen
© Georg Thieme Verlag KG Stuttgart · New York

Bewusstseinsstörungen aus toxikologischer Sicht

Consciousness disorders from toxicological view
Lukas Bündgens
1   Medizinische Klinik III (Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin), Universitätsklinikum, RWTH Aachen
,
Frank Tacke
1   Medizinische Klinik III (Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin), Universitätsklinikum, RWTH Aachen
,
Christian Trautwein
1   Medizinische Klinik III (Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin), Universitätsklinikum, RWTH Aachen
,
Alexander Koch
1   Medizinische Klinik III (Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin), Universitätsklinikum, RWTH Aachen
› Author Affiliations
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Publication History

Publication Date:
19 September 2016 (online)

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Zusammenfassung

Bewusstseinsstörungen durch absichtliche und unabsichtliche Vergiftungen sind ein häufiger Aufnahmegrund in Notaufnahmestationen deutscher Krankenhäuser. Zu den Erstmaßnahmen zählen die Sicherung von Vitalfunktionen und Atemweg, gefolgt von einer fokussierten Diagnostik bezüglich der Intoxikationsursache. Die Giftnotrufzentralen (GIZ) in Deutschland können wichtige Informationen zu spezifischen therapeutischen Maßnahmen liefern. Wichtige toxikologische Ursachen von Bewusstseinsstörungen sind Vergiftungen mit Opiaten, Benzodiazepinen, trizyklischen Antidepressiva, Alkohol, Methanol und Ethylenglykol, Kohlenmonoxid und Salicylaten. Im Vordergrund der Therapie stehen supportive Maßnahmen sowie die primäre und sekundäre Giftelimination. Für bestimmte Toxine gibt es eine spezifische Antidottherapie. Bei schweren Vergiftungen mit eingeschränkten Vitalfunktionen sollten Überwachung und Therapie auf einer Intensivstation erfolgen.

Abstract

Poisoning with impaired mental state is a frequent cause for hospital admission. The initial management includes assessment of vital functions and airway management followed by focussed diagnostics. Poison Emergency Centers can provide valuable assistance in acute intoxications. Clinically important agents causing mental state alterations include opiates, benzodiazepines, tricyclic antidepressants, alcohol, methanol and ethylene glycol, carbon monoxide and salicylates. Most important therapeutic measures comprise supportive care, decontamination or elimination. For certain toxins specific antidotes are available. In presence of severe intoxications and impaired vital functions, the patient should be transferred to the intensive care unit (ICU).

Schlüsselwörter

Intoxikation - Vergiftung - Bewusstseinsstörung - Antidot - Intensivstation - Giftelimination

Keywords

poisoning - mental state alteration - intoxication - antidote - ICU
 

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