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( )Tj
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( )Tj
0 0 0 1 k
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0.0833 Tw
(Les analyses semi-quantitatives doivent tre proscrites.)Tj
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0.85 0.3 0 rg
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( )Tj
/Cs12 cs 1 scn
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( )Tj
/F10 1 Tf
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0 g
( )Tj
0 0 0 1 k
-2.0707 -7.5391 TD
0.2432 Tw
(Le dosage sanguin est indiquŽ sÕil a une incidence sur la prise en charge)Tj
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0 Tw
(mŽdicale.)Tj
/F12 1 Tf
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0.85 0.3 0 rg
( )Tj
/Cs12 cs 1 scn
-4.7019 -14.6306 TD
( )Tj
/F10 1 Tf
10 0 0 10 88 680 Tm
0 g
( )Tj
0 0 0 1 k
-2.4707 -10.2414 TD
0.0726 Tw
(Les prŽlvements ˆ visŽe conservatoire doivent tre systŽmatiques ds la prise)Tj
0.0432 -1.2 TD
0.0833 Tw
(en charge du patient \(sŽrothque et urothque\).)Tj
-0.9638 -2.1022 TD
0.0735 Tw
(Les intoxications mŽdicamenteuses, volontaires ou accidentelles, sont une cause)Tj
0 -1.2 TD
0.096 Tw
(frŽquente dÕadmission dans les services dÕurgences. LÕŽventail des molŽcules en)Tj
T*
0.0311 Tw
(cause est en perpŽtuelle Žvolution. Parmi les mŽdicaments les plus frŽquemment)Tj
T*
0.1888 Tw
(en cause, les antidŽpresseurs tricycliques et les barbituriques sont maintenant)Tj
T*
0.1227 Tw
(supplantŽs par les inhibiteurs de la recapture de la sŽrotonine \(IRS\), les benzo-)Tj
T*
0.0773 Tw
(diazŽpines \(BZD\) et les cardiotropes. LÕapproche clinique des patients intoxiquŽs)Tj
T*
0.0887 Tw
(repose sur lÕanalyse de lÕanamnse de lÕintoxication, la recherche des signes cli-)Tj
T*
0.1793 Tw
(niques et biologiques constituant un toxidrome )Tj
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( )Tj
/Cs12 cs 1 scn
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/F10 1 Tf
0 g
-17.4731 21.9436 TD
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0 0 0 1 k
18.6946 -21.9436 TD
0.1793 Tw
(. La prise en charge dÕune)Tj
-22.6859 -1.2 TD
0.0843 Tw
(intoxication reste essentiellement symptomatique et repose avant tout sur cette)Tj
T*
0.0833 Tw
(approche clinique )Tj
/F4 1 Tf
0.85 0.3 0 rg
4.2913 24.3436 TD
0 Tw
( )Tj
/Cs12 cs 1 scn
3.7086 -24.3436 TD
(\(2\))Tj
/F10 1 Tf
0 g
-3.4086 24.3436 TD
( )Tj
0 0 0 1 k
4.6301 -24.3436 TD
(. )Tj
-9.2214 -1.8023 TD
0.1765 Tw
(Actuellement, pratiquement tous les toxiques peuvent tre identifiŽs et quan-)Tj
0 -1.2 TD
0 Tw
(tifiŽs )Tj
/F4 1 Tf
0.85 0.3 0 rg
4.7913 27.3459 TD
( )Tj
/Cs12 cs 1 scn
-2.4244 -27.3459 TD
(\(3\))Tj
/F10 1 Tf
0 g
2.7244 27.3459 TD
( )Tj
0 0 0 1 k
-1.5029 -27.3459 TD
0.0908 Tw
(. LÕutilitŽ de la recherche systŽmatique en urgence des toxiques lors de)Tj
-3.5884 -1.2 TD
0.0324 Tw
(la prise en charge de patients intoxiquŽs est controversŽe et la pertinence de ces)Tj
T*
0.0966 Tw
(prescriptions nÕest pas avŽrŽe ˆ ce jour. Par ailleurs, du fait de contraintes Žco-)Tj
T*
0.1602 Tw
(nomiques \(tarification ˆ lÕactivitŽ ou T2A\), le choix de la prescription de telles)Tj
T*
0.0833 Tw
(analyses toxicologiques devra tre pertinent et motivŽ.)Tj
0 -1.8023 TD
0.139 Tw
(Les situations o lÕindication dÕune thŽrapeutique spŽcifique, lÕŽvaluation de la)Tj
0 -1.2 TD
0.0698 Tw
(gravitŽ ou du pronostic sont liŽes aux rŽsultats des investigations toxicologiques)Tj
T*
0.0833 Tw
(restent rares )Tj
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0.85 0.3 0 rg
5.3913 36.3482 TD
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( )Tj
/Cs12 cs 1 scn
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0 g
-0.0286 36.3482 TD
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0.85 0.3 0 rg
( )Tj
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/Cs12 cs 1 scn
0.0008 Tw
[(1. MŽthodes )-82.7(dÕanalyses)]TJ
/F10 1 Tf
10 0 0 10 117 680 Tm
0 g
0 Tw
( )Tj
0 0 0 1 k
-6.2913 -42.0527 TD
0.0278 Tw
(De nombreuses techniques, de plus en plus performantes, existent, mais les pos-)Tj
0 -1.2 TD
0.1762 Tw
(sibilitŽs dÕidentification et de quantification de chaque toxique vont dŽpendre)Tj
T*
0.1697 Tw
(des mŽthodes disponibles dans le laboratoire de toxicologie )Tj
/F4 1 Tf
0.85 0.3 0 rg
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( )Tj
/Cs12 cs 1 scn
20.3773 -44.4527 TD
(\(5-8\))Tj
/F10 1 Tf
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-20.1773 44.4527 TD
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0 0 0 1 k
22.2874 -44.4527 TD
0.1697 Tw
(. Le clinicien)Tj
-29.0787 -1.2 TD
0.0816 Tw
(doit conna”tre celles qui lui sont accessibles, leurs limites et leurs contraintes de)Tj
T*
0.035 Tw
(temps afin de ne pas les prescrire inutilement. Actuellement, nous avons 2 types)Tj
T*
0.1394 Tw
[(dÕanalyses )139.4(: le dŽpistage \(rŽsultats qualitatifs ou semi-quantitatifs\) et le dosage)]TJ
T*
0.4035 Tw
[(\(rŽsultats quantitatifs\). Le Ç )403.5(screening )403.5(È toxicologique associe gŽnŽralement)]TJ
T*
0.0833 Tw
(plusieurs mŽthodes de dŽpistage et de dosage. )Tj
0 -1.8023 TD
0.2017 Tw
(La mŽthode qui permet de tout dŽtecter, rapidement et pour un faible cožt)Tj
0 -1.2 TD
0.0833 Tw
(nÕexiste pas encore.)Tj
0 -1.8023 TD
0.1309 Tw
[(Ð )130.9( )130.9(ColorimŽtrique )130.9(: Une substance mise en contact avec un rŽactif produit une)]TJ
0 -1.2 TD
0.0833 Tw
[(rŽaction colorŽe )83.3(:)]TJ
0.9921 -1.5023 TD
[(¥ )83.3( )83.3(rŽaction de Forrest pour les phŽnothiazines )83.3(;)]TJ
T*
[(¥ )83.3( )83.3(rŽaction de Trinder pour les salicylŽs \(dŽpistage et dosage\) )83.3(;)]TJ
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(URGENCES)Tj
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ET
EMC
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( )Tj
0 0 0 1 k
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0 Tw
( )Tj
0 0 0 1 k
-6.4992 -6.0368 TD
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[(¥ )25.3( )25.3(rŽaction de Ludwig-Hoffmann pour le mŽprobamate \(dŽpistage et dosage\) )25.3(;)]TJ
0 -1.5018 TD
0.0833 Tw
[(¥ )83.3( )83.3(rŽaction avec le dithionite pour le paraquat \(dŽpistage et dosage\).)]TJ
-0.9921 -1.5018 TD
0.2659 Tw
[(Avantages )265.9(: mŽthode rapide, peu cožteuse. InconvŽnients )265.9(: prŽsence dÕinter-)]TJ
0 -1.2 TD
0.0306 Tw
(fŽrences, manque de sensibilitŽ, souvent utilisŽe pour indiquer la prŽsence dÕune)Tj
T*
0.0833 Tw
(classe de mŽdicaments.)Tj
0 -1.8018 TD
0.0099 Tw
[(Ð )9.9( )9.9(SpectrophotomŽtrie UV )9.9(: lÕidentification du toxique se fait sur la dŽtermination)]TJ
0 -1.2 TD
0.0881 Tw
(du spectre UV de la molŽcule. Elle peut tre rŽalisŽe sur la molŽcule elle-mme)Tj
T*
0.0833 Tw
(ou aprs couplage de la molŽcule avec un autre composŽ chimique.)Tj
0 -1.5018 TD
0.147 Tw
[(Avantages )147(: mŽthode rapide, peu cožteuse. InconvŽnients )147(: prŽsence dÕinterfŽ-)]TJ
0 -1.2 TD
0 Tw
(rences.)Tj
0 -1.8018 TD
0.0896 Tw
[(Ð )89.6( )89.6(Immunologiques )89.6(: fondŽes sur la rŽaction dÕun antigne \(molŽcule ou famille)]TJ
0 -1.2 TD
0.3421 Tw
(chimique\) avec un anticorps spŽcifique de la molŽcule recherchŽe )Tj
/F4 1 Tf
0.85 0.3 0 rg
7.7913 21.3458 TD
0 Tw
( )Tj
/Cs12 cs 1 scn
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(\(9\))Tj
/F10 1 Tf
0 g
-23.0942 21.3458 TD
( )Tj
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0.3421 Tw
(. On)Tj
-32.4069 -1.2 TD
0 Tw
(distingue :)Tj
0.9921 -1.5017 TD
0.0701 Tw
[(¥ )70.1( )70.1(les mŽthodes en phase homogne sans Žtape de sŽparation )70.1(: Enzyme Mul-)]TJ
0 -1.2 TD
0.1573 Tw
(tiplied Immunoassay Technique \(EMIT\), Clone Enzyme Donor Immuno Assay)Tj
T*
0.0607 Tw
(\(CEDIA\), Fluorescence Polarization Immuno Assay \(FPIA\), Kinetic Interaction of)Tj
T*
0.0833 Tw
[(Microparticles in Solution \(KIMS\) )83.3(;)]TJ
0 -1.5018 TD
0.0406 Tw
[(¥ )40.6( )40.6(des techniques en phase hŽtŽrogne, nŽcessitant une phase de sŽparation )40.6(:)]TJ
0 -1.2 TD
0.0537 Tw
(les immuno-essais tels que Radio Immuno Assay \(RIA\), Enzyme Immuno Assay)Tj
T*
0.0833 Tw
(\(EIA\), Enzyme Linked Immuno Sorbent Assay \(ELISA\).)Tj
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[(Avantages )134.8(: mŽthodes souvent rapides. InconvŽnients )134.8(: )134.8(sensibilitŽ variable, exis-)]TJ
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0 -1.5659 TD
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0 -1.2 TD
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[(Ð )99.8( )99.8(La torche ˆ plasma ˆ couplage inductif couplŽe ˆ un spectromtre de masse)]TJ
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[(Ð )45.8( )45.8(LÕŽlectrophorse capillaire \(EC\) est une technique complŽmentaire des mŽtho-)]TJ
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T*
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T*
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-9.4306 -1.2 TD
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0 Tw
( )Tj
/Cs12 cs 1 scn
3.4125 -51.7967 TD
(\(26\))Tj
/F10 1 Tf
0 g
-3.1125 51.7967 TD
( )Tj
0 0 0 1 k
4.8898 -51.7967 TD
0.4343 Tw
(. Un rŽsultat nŽgatif)Tj
-24.7811 -1.2 TD
0.0833 Tw
(nÕexclut pas le diagnostic dÕintoxication.)Tj
0 -2.0326 TD
0.0582 Tw
(Les antidŽpresseurs de type IMAO, ISRS ou quadricycliques ne sont pas dŽtectŽs)Tj
0 -1.2 TD
0.0833 Tw
[(par les tests immunochimiques Ç )83.3(antidŽpresseurs tricycliques )83.3(È \(ADT\).)]TJ
0 -2.0326 TD
-0.0501 Tw
(Les mŽthodes complŽmentaires chromatographiques, tel que le systme Remedi)Tj
6 0 0 6 256 680 Tm
0 g
0 Tw
( )Tj
5.628 0 0 7.5 391.136 100.681 Tm
0 0 0 1 k
(¨)Tj
10 0 0 10 258 680 Tm
0 g
( )Tj
0 0 0 1 k
13.9135 -58.2619 TD
(,)Tj
-34.3048 -1.2 TD
0.0887 Tw
(permettent de complŽter les mŽthodes de dŽpistage de routine \(tel le classique)Tj
/F11 1 Tf
9 0 0 9 260 680 Tm
0.85 0.3 0 rg
0 Tw
( )Tj
/Cs12 cs 1 scn
-22.8792 -6.6334 TD
0.0832 Tw
(Tableau 1 Ð )Tj
/F10 1 Tf
0 g
23.2126 6.6334 TD
0 Tw
( )Tj
0 0 0 1 k
-17.3601 -6.6334 TD
0.0832 Tw
(Limites des mŽthodes de dŽpistage aux urgences )Tj
ET
/Cs12 cs 1 scn
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BT
/F11 1 Tf
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1 g
0 Tw
( )Tj
0 0 0 0 k
-24.5312 -9.8794 TD
0.0834 Tw
(MŽthode de dŽpistage)Tj
2.4326 -1.125 TD
0 Tw
[(de )-83.4(Ç classe È)]TJ
ET
/Cs12 cs 1 scn
169.714 613.299 230.2 -28.2 re
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BT
8 0 0 8 271.467 596.465 Tm
0 0 0 0 k
(Limites)Tj
/F10 1 Tf
0 g
-0.4334 10.4419 TD
( )Tj
0 0 0 1 k
-26.2391 -15.1669 TD
0.0834 Tw
(AntidŽpresseurs tricycliques)Tj
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[(\(immuno analyse )83.4(: IA\))]TJ
14.4534 2.8874 TD
[(Faux positifs )83.4(: carbamazŽpine, phŽnothiazines, buflomŽdil)]TJ
0 -2.4 TD
[(Faux nŽgatifs )83.4(: antidŽpresseurs tŽtracycliques \(amoxapine, )]TJ
0 -1.1249 TD
(miansŽrine, maprotiline\), inhibiteur de la recapture de la )Tj
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0 Tw
(sŽrotonine)Tj
-14.4534 -2.4 TD
0.0834 Tw
[(BenzodiazŽpines \(IA\))-5583(Faux nŽgatifs )83.4(: seuil de dŽtection trop ŽlevŽ )83.4(: alprazolam)]TJ
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(ApparentŽs \(zolpidem, zopiclone\))Tj
-14.4534 -4.1625 TD
(OpiacŽs \(IA\))Tj
14.4534 1.7625 TD
-0.0215 Tw
[(Faux positifs \(pour une recherche de stupŽfiants\) )-21.5(: sirop antitussif )]TJ
0 -1.125 TD
0.0834 Tw
(\(pholcodine, dextromŽtorphane, codŽine\))Tj
0 -2.4 TD
0.0341 Tw
[(Faux nŽgatifs )34.1(: mŽthadone, buprŽnorphine, dextropropoxyphne)]TJ
-14.4534 -3.525 TD
0.0834 Tw
(AmphŽtamines \(IA\))Tj
14.4534 1.125 TD
0.0227 Tw
[(Faux positifs )22.7(: dŽcongestionant nasal \(ŽphŽdrine, phŽnylŽphrine\) )]TJ
0 -1.125 TD
0.0834 Tw
(Ð anorexigne \(clobenzorex, fenfluramine\) Ð benzathine Ð )Tj
T*
(cyamŽmazine Ð ofloxacine - heptaminol)Tj
-14.4534 -2.4 TD
[(PhŽnothiazines \(colorimŽtrie\))-2083(Faux positifs)]TJ
/F9 1 Tf
0 g
26.4891 34.5542 TD
0 Tw
( )Tj
0 0 0 1 k
-6.7269 -34.5542 TD
( : )Tj
/F10 1 Tf
0 g
6.9769 34.5542 TD
( )Tj
0 0 0 1 k
-6.0591 -34.5542 TD
0.0834 Tw
(les salicylŽs \(avec la rŽaction de Forrest\))Tj
ET
/Cs12 cs 1 scn
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BT
/F11 1 Tf
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1 g
0 Tw
( )Tj
0 0 0 0 k
-25.6562 -36.9543 TD
0.0834 Tw
(MŽthode de dŽpistage)Tj
-0.8059 -1.125 TD
(spŽcifique dÕune molŽcule)Tj
ET
/Cs12 cs 1 scn
169.714 396.699 230.2 -28.2 re
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BT
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0 0 0 0 k
0 Tw
(Limites)Tj
/F10 1 Tf
0 g
0.6916 37.5168 TD
( )Tj
0 0 0 1 k
-27.3641 -41.0418 TD
0.0834 Tw
(MŽthadone \(IA\))Tj
14.4534 0.5625 TD
[(Faux positifs )83.4(: vŽrapamil, cyamŽmazine, lŽvomŽpromazine, )]TJ
0 -1.125 TD
(alimŽmazine, diphŽnydramine, doxylamine)Tj
-14.4534 -2.4 TD
[(BuprŽnorphine \(IA\))-6304.9(Faux positifs )83.4(: dihydrocodŽine, tramadol)]TJ
T*
[(Dextropropoxyphne \(IA\))-3693(Faux positifs )83.4(: diphŽnydramine, dŽrivŽs tricycliques)]TJ
T*
[(Cannabis \(IA\))-8696.4(Faux positifs )83.4(: acide niflumique, ibuprofne)]TJ
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[(co-f)17.7(ondateurs)]TJ
ET
EMC
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( )Tj
0 0 0 1 k
/GS4 gs
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(LE SCREENING TOXICOLOGIQUE AUX URGENCES)Tj
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0 Tw
( )Tj
0 0 0 1 k
-22.8913 -40.2368 TD
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[(Ç )106.7(barbituriques, benzodiazŽpines, antidŽpresseurs tricycliques, opiacŽs )106.7(È\) qui ne)]TJ
0 -1.2 TD
0.0663 Tw
[(recherchent pas certains produits tels que )66.3(: inhibiteurs calciques, btabloquants,)]TJ
T*
0.0702 Tw
(clonidine, anti-arythmiques, digitaliques, colchicine, antipaludŽens, Žthylne gly-)Tj
T*
-0.0278 Tw
(col, mŽthanol, amatoxines.)Tj
0 -2.4126 TD
0.1561 Tw
(La recherche non ciblŽe des opiacŽs dans les urines est basŽe sur la prŽsence)Tj
0 -1.2 TD
0.0883 Tw
[(dÕun noyau morphinane )88.3(: elle nÕindique pas la nature de lÕopiacŽ \(mme positi-)]TJ
T*
0.0918 Tw
(vitŽ sans distinction pour la morphine, hŽro•ne, codŽ•ne, codŽthylineÉ\). Elle ne)Tj
T*
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T*
0.0739 Tw
(le tramadol )Tj
/F4 1 Tf
0.85 0.3 0 rg
23.1913 51.0493 TD
0 Tw
( )Tj
/Cs12 cs 1 scn
-17.9339 -51.0493 TD
(\(27\))Tj
/F10 1 Tf
0 g
18.2339 51.0493 TD
( )Tj
0 0 0 1 k
-16.4566 -51.0493 TD
0.0739 Tw
(. Il faut utiliser des tests avec un anticorps spŽcifique si on veut)Tj
-7.0347 -1.2 TD
0.0833 Tw
(les rechercher.)Tj
0 -2.4126 TD
0.0133 Tw
(LÕinterprŽtation des rŽsultats est parfois difficile, il faut tenir compte des donnŽes)Tj
0 -1.2 TD
0.0285 Tw
[(toxicocinŽtiques et toxicodynamiques de la substance retrouvŽe )28.5(: il est important)]TJ
T*
0.086 Tw
(de conna”tre le dŽlai entre lÕingestion du toxique et le prŽlvement. Trop court,)Tj
T*
0.1414 Tw
(le produit nÕest pas encore absorbŽ mais trop long, la molŽcule-mre est dŽjˆ)Tj
T*
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(mŽtabolisŽe voire ŽliminŽe.)Tj
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0.85 0.3 0 rg
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( )Tj
/Cs12 cs 1 scn
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(Tableau 2 Ð )Tj
/F10 1 Tf
0 g
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( )Tj
0 0 0 1 k
-20.8047 -6.6334 TD
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(Test DRI)Tj
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0 Tw
( )Tj
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( )Tj
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-17.2762 -6.6334 TD
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0.3612 0 TD
0.0832 Tw
[(Benzodiazepines SŽrum Tox )83.2(: concentration de benzodiazŽpines )]TJ
-10.1864 -1.1111 TD
[(nŽcessaires pour produire un rŽsultat positif \(calibrateur )83.2(: diazŽpam ˆ 50 ng/mL\))]TJ
ET
/Cs12 cs 1 scn
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BT
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0 Tw
( )Tj
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(\(en ng/mL\))Tj
ET
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BT
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0 Tw
( )Tj
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ET
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BT
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0 0 0 1 k
(200)Tj
ET
/Cs13 cs 1 scn
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BT
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0 0 0 1 k
(100)Tj
ET
/Cs13 cs 1 scn
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f
BT
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0 0 0 1 k
(BromazŽpam)Tj
ET
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f
BT
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0 0 0 1 k
(750)Tj
ET
/Cs13 cs 1 scn
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f
BT
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(300)Tj
/F10 1 Tf
0 g
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( )Tj
0 0 0 1 k
-30.8641 -20.3169 TD
[(ChlordiazŽpoxide)-12427(3 000)-11905.5(3 000)]TJ
0 -2.6249 TD
[(ClonazŽpam)-15318.9(150)-11905.5(1 000)]TJ
0 -2.625 TD
[(DiazŽpam)-16988.2(50)-11905.5(1 500)]TJ
T*
[(FlunitrazŽpam)-15210.4(50)-13296.5(50)]TJ
ET
/Cs13 cs 1 scn
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f
BT
/F9 1 Tf
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0 g
( )Tj
0 0 0 1 k
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(LorazŽpam)Tj
ET
/Cs13 cs 1 scn
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f
BT
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0 0 0 1 k
(600)Tj
ET
/Cs13 cs 1 scn
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f
BT
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0 0 0 1 k
(300)Tj
/F10 1 Tf
0 g
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( )Tj
0 0 0 1 k
-31.4891 -33.4417 TD
15.4875 Tw
[(NitrazŽpam 100)-11905.5(1 )15487.5(000)]TJ
0 -2.625 TD
15.2641 Tw
[(NordiazŽpam 50)-11905.5(1 )15264.1(500)]TJ
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ET
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BT
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(Nomogramme de Rumack et )Tj
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(indication de la N-acŽtylcystŽine)Tj
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0 Tw
(pŽdiatriques)Tj
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(38x[ng/mL]xpoids/100)Tj
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0.0055 Tw
(Calcul de la quantitŽ de fragments )Tj
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0.0834 Tw
(Fab ˆ administrer.)Tj
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[(SalicylŽs)-4768.9(ColorimŽtrique, )]TJ
8.2146 -1.125 TD
0.0834 Tw
[(IA)-7650.7(> 300 mg/L)]TJ
19.0765 1.125 TD
[(Nomogramme de Done )83.4(:)]TJ
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(Indication de la diurse alcaline )Tj
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[(> 900 mg/L)-5430.6(ƒpuration extra rŽnale)]TJ
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[(ThŽophylline )-2458.6(Emit, FPIA)-4177.1(> 100 µg/mL)-4874.2(Indication ƒpuration extrarŽnale)]TJ
T*
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T*
[(Lithium)-5046.5(SAA)-6704.7(> 2.5 ˆ 4 mEq/L)-3428.5(Indication ƒpuration extrarŽnale)]TJ
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(> 250 mg/L)Tj
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(> 500 mg/L)Tj
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(Indication de lÕhŽmodialyse )Tj
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T*
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T*
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(courbe\))Tj
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T*
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(rie UV)Tj
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T*
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[(\(ex. : cyanures )-43.2(et )-43.2(Cyanokit)]TJ
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T*
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T*
0.0836 Tw
[(dra du contexte et de lÕŽvolution clinique. Le screening Ç )83.6(aveugle )83.6(È est cožteux)]TJ
T*
0.2133 Tw
(et dÕune faible rentabilitŽ clinique. Aux urgences, les examens toxicologiques)Tj
T*
0.1228 Tw
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T*
0.0833 Tw
(sÕils ont une incidence sur la prise en charge du patient.)Tj
0 -1.8128 TD
-0.013 Tc
0.0089 Tw
(Cette demande de dosage doit tre sŽlective, motivŽe et accompagnŽe de donnŽes)Tj
0 -1.2 TD
0.0625 Tw
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T*
0.0672 Tw
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T*
0.2215 Tw
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T*
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(urgence.)Tj
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