3/4/2014

1
1
c cht hc lm sng
PGS. TS. Nguyn Ngc Khi
BM. Dc lm sng, Khoa Dc
H Y Dc TP. H Ch Minh

Mc tiu
1. Trnh by c nguyn tc iu tr ng c
2. Trnh by c cch x tr mt s trng hp ng c
Paracetamol
Benzodiazepin
Ethanol
Methanol v etylen glycol
2
3/4/2014
2
Ni dung
1. i cng
2. Mt s trng hp ng c
Paracetamol
Benzodiazepin
Ethanol
Methanol v etylen glycol

3
i cng
Tp trung vo cc tnh trng gy bi mt /nhiu cht c.
iu tr bnh nhn nhim c do thuc v ha cht
Pht trin k thut mi chn on v iu tr
4
3/4/2014
3
5
c tnh nh hng trn:
Thn kinh trung ng: Hn m mt phn x h hp (an
thn, gy ng - vd: barbiturat, ru...)
Tim mch: h huyt p do c ch co bp tim
Gim lu lng mu: do nn ma, tiu chy,
Lon nhp tim: ephedrin, amphetamin, cocain, theophylin...
Thiu oxy t bo: cyanid, carbon monoxid
Co git, cng c: thuc chng trm cm, isoniazid (INH),
diphenhydramin, cocain, amphetamin
i cng
2. Khng c thuc gii c c hiu
Ch yu l cc bin php h tr
"iu tr bnh nhn, khng phi l cht c"
Chin lc: chm sc h tr triu chng
6
Tc nhn c c chia lm hai loi khi x tr:
1. C thuc gii c c hiu
i cng
3/4/2014
4
7
1. Duy tr cc chc nng c bn
2. Gi cho nng cht c trong m cng thp cng tt:
- ngn s hp th
- tng cng thi tr
3. Lm gim cc tc dng dc l bt li v c tnh ti ni
tc ng
i cng
Nguyn tc iu tr
8
i cng
Nguyn tc iu tr
Gim hp thu
Gy nn, ra d dy
Than hot

Gim phn b
Khng th, chelat

Trn chuyn ha
c ch, bt gi cc
cht chuyn ha c

Nguyn tc chung
Tng thi tr (thn)
Li tiu, kim/acid ha
Tng thi tr (tiu ha)
Ngn chu trnh gan rut,
thm phn
Stan Bardal, Applied Pharmacology, Saunders, 2010
3/4/2014
5
9
Duy tr cc chc nng c bn
A: Airway ng th
B: Breathing H hp
C: Circulation Tun hon
D: Drug Thuc
i cng
Nguyn tc iu tr
10
ng th: ty theo tnh trng v cht gy c
Thng ng th: ht, t ni kh qun
Suy h hp do thuc
Opioid: Heroin: naloxon < 2 mg (IM IV)
Dn xut fentanyl: naloxon < 10 mg (IMIV)
Benzodiazepin: dng cht i khng
benzodiazepin (phc tp)
i cng
3/4/2014
6
11
H hp: spO
2
L t l phn trm hemoglobin ca mu kt hp vi oxy.
= bo ha oxy trong mu
= T l HbO
2
/ (HbO
2
+Hb)
i cng
12
Tun hon
Nhp tim nhanh
Khng km h huyt p v au ngc: an thn
Do tc ng trn giao cm: esmolol 0,02-0,1 mg/kg/ min IV
Tc ng khng cholinergic:
physostigmin, 0,01-0,03 mg/kg IV

i cng
3/4/2014
7
13
Thuc:
Tnh trng Thuc s dng
H ng huyt Glucose
Hn m do benzodiazepin Flumazenil
Qu liu opioid Naloxon
Nghin ru Thiamin
i cng
14
i cng
Thuc gii c c cht Ghi ch
Acetylcystein Paracetamol Tt nht sau ng c 810 h
L nng paracetamol
Atropin Anticholinesterase:
phosphat hu c,
carbamat
Liu u 12 mg (tr em
0,05 mg/kg) IV lp li n
khi tim nhanh, dn ng t
Na bicarbonat TCA, quinidin 12 mEq/kg IV bolus
Cn thn khi suy tim (trnh
qu nhiu Na).
Calci Fluorid; CCB Khi u 15 mg/kg IV.
3/4/2014
8
15
i cng
Thuc gii c c cht Ghi ch
Deferoxamin Mui st TH nng: 15 mg/kg/h IV.
100 mg deferoxamin gn 8,5
mg st.
Digoxin antibody Digoxin v cc
glycosid tim
Mt ng gn 0,5 mg digoxin;
C khi lon nhp nng, tng
kali huyt.
Esmolol Theophylin, cafein,
metaproterenol
2550 mcg/kg/min IV.
Ethanol Methanol, ethylen
glycol
Liu np sao cho nng >
100 mg/dL (42 g/ cho ngi
70 kg).
16
i cng
Thuc gii c c cht Ghi ch
Flumazenil Benzodiazepin Ngi ln 0,2 mg IV, ti a 3
mg. Khng dng cho BN co
git, nghin benzodiazepin
hay qu liu TCA
Fomepizol Methanol,
ethylen glycol
5 mg/kg; lp li sau mi12 g.
Glucagon -blocker 510 mg IV bolus o
ngc tnh trng h huyt
p, chm nhp tim
Hydroxocobala
min
Cyanid 5 g IV.
3/4/2014
9
17
i cng
Thuc gii c c cht Ghi ch
Naloxon Opioid Khi u 12 mg IV, IM, SC
Oxy Carbon monoxid
Physostigmin antimuscarinic
anticholinergic
0,51 mg IV chm. Khng
dng cho ng c TCA
Pralidoxim
(2-PAM)
Phosphat hu c,
c ch
cholinesterase
1 g IV, lp li sau 34 h
18
Than hot
Ngi ln: liu 50 g (ung / hoc ng thng mi - d dy)
Tr em: liu 25 g
C th lp li sau 2-4 gi, nu:
Cc cht c hp ph c vo than hot
ng tiu ha cn nguyn vn
i cng
Kh nhim ng tiu ha (gastrointestinal decontamination)
3/4/2014
10
19
i cng
Lc u
Rt ra
Ung
Kh nhim ng tiu ha
Than hot
20
Than hot
u im:
c s dng nhanh chng
Hiu qu ngay khi khng r tin s ng c
D dng qua cc mn v n v tr hp thu ti rut non
i cng
Kh nhim ng tiu ha
3/4/2014
11
21
Than hot
Nhc im:
C th gy nn
Mc d than c tnh tr, khi ht vo phi c th gy
tc nghn h hp
Gy to bn v tc rut c hc khi s dng nhiu liu
Tr em: khng thch s dng
C th hp th thuc gii c ng ung
i cng
Kh nhim ng tiu ha
i cng
Kh nhim ng tiu ha
Than hot
St
Lithi
Borat
Bromid
Kali
Kim
Ethanol
Cyanid
Malathion
Parathion
Diazinon
Dichlorvos
DDT
Carbamat
Mercuric clorid
Methanol
N-methyl carbamat
Ethylen glycol
Du ha
Isopropyl alcohol
Tolbutamid
Hp ph km Hp ph tt
22
3/4/2014
12
23
Ra d dy (nc / nc mui sinh l)
Ngi ln: 250 mL / ln bm
Tr em: 50-100 ml / ln bm
n khi dch ra trong
khng nn s dng thng xuyn
bnh nhn sd cht c kh nng e da mng sng
/ trong vng 60 pht
i cng
Kh nhim ng tiu ha (gastrointestinal decontamination)
24
L hn hp ca alkaloid: emetin v cephaelin
L tc nhn gy nn mnh
Siro d s dng v hp thu nhanh
i cng
Siro ipeca (sirup of ipecac)
3/4/2014
13
25
Chng ch nh
Khng cn tnh to
Co git
Sc
Tnh trng lm sng suy gim nhanh
Ng c cc cht nh hng thn kinh
/ gy co git / suy h hp

i cng
Siro ipeca (sirup of ipecac)
26
i cng
Hot cht Liu IV (ngi ln)
Prochlorperazin 2,510 mg mi 4 gi
Promethazin 12,525 mg mi 4 gi
Metoclopramid 10 mg
Droperidol 1,255 mg mi 4 gi khi cn
Ondansetron 432 mg /ngy
Granisetron 10 g/kg /ngy
Dolasetron 12,5 mg /ngy
Cc thuc chng nn ng tim cho BN ng c
3/4/2014
14
27
i cng
Lc mu
Dan L. Longo et al, Harrison's Principles of Internal Medicine, McGraw-Hill , 2012
28
i cng
Thm phn phc mc
Maarten W. Taal et al, Brenner & Rectors the kidney, Elsevier, 2012
3/4/2014
15
29
i cng
Lc mu
- Nng mu hoc lng ung c th gy ng c nng hoc
t vong.

- Suy cc c ch thi tr t nhin.

- Tnh trng lm sng xu i d c hi sc tch cc.

- C bng chng lm sng ng c nng gm: tt huyt p, hn
m, toan chuyn ha, c ch h hp, lon nhp

- Ung cc cht c nguy him c tc dng chm.
Ch nh
30
i cng
Lc mu
Carbamazepin
Ethylen glycol
Lithium
Methanol
Metformin
Phenobarbital
Salicylat
Theophyllin
Acid valproic
Ch nh c li Khng hiu qu
Amphetamin
Thuc chng trm cm
Cc thuc hng thn
Benzodiazepin
Calcium channel blocker
Digoxin
Metoprolol v propranolol
Opioid
Bertram G. Katzung, Basic & Clinical Pharmacology, McGraw-Hill , 2009
3/4/2014
16
31
Mt s trng hp ng c
1. Paracetamol
2. Benzodiazepin
3. Ethanol
4. Methanol v etylen glycol
32
Mt s trng hp ng c

1. Paracetamol

3/4/2014
17
33
Mt s trng hp ng c
Paracetamol
Ng c cp:
Bun nn v nn ma / c th khng c triu chng
Tng men gan xy ra trong vng 36 gi sau khi ung
iu tr vi N-acetylcystein trong vng 8 gi sau khi ung

Ng c mn (ung > 4 g / ngy)
iu tr nu aspartat transaminase (AST) tng cao

34
Mt s trng hp ng c
Paracetamol
Ng c khi sd: > 150 mg / kg (tr em)
> 7,5 g (ngi ln)
Nguy c c gan tng khi:
Tr em vi cc bnh cp tnh c st
Bnh nhn c bnh gan t trc
Bnh nhn s dng thuc gy cm ng P450 2E1
(ethanol v isoniazid)
3/4/2014
18
35
Mt s trng hp ng c
Paracetamol
Cc thuc cm ng cyt P450 lm tng c tnh
Carbamazepin
Ethanol
Isoniazid
Phenobarbital
Phenytoin


Sulfinpyrazon
Sulfonylureas
Rifampin
Primidon

36
Mt s trng hp ng c
Paracetamol
Joseph T. DiPiro et al, Pharmacotherapy: A Pathophysiologic Approach, Sixth Edition, McGraw-Hill, 2005
Lin hp
glucoronid
Lin hp sulfat
Paracetamol
Khng i
qua nc tiu
H thng
Cytochrom P450
NAPQI
Liu
iu tr
Cht chuyn ha
mercapturat
Liu
gy c
Cht
chuyn ha
c
Hoi t gan
lng
glutathion
Cn
glutathion
3/4/2014
19
37
Mt s trng hp ng c
Paracetamol
ng Rumark-Matthew
38
Mt s trng hp ng c
Paracetamol
FRED F. FERRI, FERRIS CLINICAL ADVISOR, Elservier, 2012
3/4/2014
20
39
Mt s trng hp ng c
Paracetamol
Giai
on
Thi gian c im
I 0,5
n 24 gi
Chn n, bun nn, nn ma,
mt mi, xanh xao
II
24 n 48
gi
Ht cc c im trn, au gc phn t
trn phi, tng bilirubin, tng thi gian
prothrombin, tng INR, tng transaminase
gan, thiu niu
40
Mt s trng hp ng c
Paracetamol
Giai
on
Thi gian c im
III
72
n 96 gi
Ri lon chc nng gan cc i,
chn n, bun nn, kh chu, nn
ma, km toan chuyn ha, INR>6
v ri lon chc nng thn
IV
4 ngy
n 2 tun
Ht ri lon chc nng gan nhng
ngi sng st. C th tin trin suy
thn thiu niu, bnh nhn suy gan
kch pht c th t vong.
3/4/2014
21
41
Mt s trng hp ng c
Paracetamol
(NAC)


42
Mt s trng hp ng c
Paracetamol
Ng c cp :
Than hot tnh, 1 g / kg trong vng 4 gi
N-acetylcystein: iu tr nu nng 4 gi trn mc
di (Hoa K) hoc trn mc trn (chu u v Canada)

Liu: Liu tn cng: 140 mg / kg PO mt ln
Duy tr: 70 mg / kg PO mi 4 gi x 17 liu

3/4/2014
22
43
Mt s trng hp ng c


2. Benzodiazepin

44
Mt s trng hp ng c
Benzodiazepin
c ch thn kinh trung ng: l ln, bun ng, hn m..
Gim chc nng vn ng: gim thi gian phn ng,
gim trng lc.
Mt tr nh hay suy gim tr nh ngn hn.
Suy gim nhn thc, mt iu ha
c ch tim mch v h hp nh
3/4/2014
23
45
Mt s trng hp ng c
46
Mt s trng hp ng c
ng h hp: ht
Th: t ni kh qun vi th my / nu cn
Tun hon: Truyn dch v dopamin / nu cn
Khc:
nh gi tnh trng h ng huyt
Than hot tnh
Nguyn nhn khc ca tnh trng hn m
Benzodiazepin
3/4/2014
24
47
Mt s trng hp ng c
Flumazenil
Ch nh: qu liu benzodiazepin
Chng ch nh:
(a) Tin s ng kinh
(b) S dng benzodiazepin mn tnh
(c) ang s dng cc thuc chng trm cm, phenothiazin,
cocain
Benzodiazepin
48
Mt s trng hp ng c
Flumazenil
Liu lng:
Ngi ln: t 0,5-5 mg
Tr em: t 0,005-0,2 mg / kg
Benzodiazepin
3/4/2014
25
49
Mt s trng hp ng c


3. Ethanol

50
Mt s trng hp ng c
Ethanol
CH
3
CHO
Acetaldehyd
+ H
2
O
Aldehyd dehydrogenase
CH
3
COO
-
Acetat
NAD
+

NADH + H
+
NAD
+

NADH + H
+

CH
3
CH
2
OH

Ethanol
Acetyl CoA
CO
2
+ H
2
O
3/4/2014
26
51
Mt s trng hp ng c
1. Gim glucose
Glucose
Glycogen
Thc n
Pyruvat
1. Gim
2. Cn kit
3. Chn
Gia tng
Lactat
Ethanol Tc ng
52
Mt s trng hp ng c
2. c ch thn kinh
Ethanol
V no
c ch
tp trung v phn on
hng phn v mt c ch
huyt thanh: 150 mg / dL
mt iu vn
ni lu nhu
bun ng
200 mg / dL
hn m
Ethanol Tc ng
3/4/2014
27
53
Mt s trng hp ng c
Nng
/mu (mg/dl)
Biu hin lm sng
25-100
Hng phn, thn thin, mt c ch
Gim phn xt v kim sot
Tng thi gian phn ng
Gim chnh xc trong vic i hi t m
100-200
Phn khch, cm xc khng n nh
Gim phn on, km nh v hiu
Tng thi gian phn ng
Ni lu nhu
Vng v, mt cn bng
Ethanol Tc ng
2. c ch thn kinh
54
Mt s trng hp ng c
Nng
/mu (mg/dl)
Biu hin lm sng
150-300
Chng mt
Nhm ln, mt nh hng
Bun nn v i ma
Thay i / suy cm gic, nhn thc,
Ni lu nhu, mt iu vn, phi hp c
250-400
Lnh m, bun ng
Gim p ng vi cc kch thch
Gim phi hp c bp
i ma, khng kim sot tiu / phn
Ethanol Tc ng
2. c ch thn kinh
3/4/2014
28
55
Mt s trng hp ng c
Nng
/mu (mg/dl)
Biu hin lm sng
300-500
Hn m
Gim hoc khng c phn x
Gim thn nhit
S bt n nh huyt ng hc hoc h hp
C th t vong
>400 C th t vong
*Nhng ngi ung thng xuyn th cn nng cao hn
c ch h thng thn kinh trung ng
Ethanol Tc ng
2. c ch thn kinh
56
Mt s trng hp ng c
Ung ethanol mn tnh: gim magnesi huyt
Ch n ung ngho dinh dng
Gim hp thu qua tiu ha
Ethanol lm tng bi tit nc tiu.

Magnesi (50-70 % xng)
magnesi huyt thanh c th khng phn nh s suy gim
(lu : ung ru mn tnh)
Ethanol Tc ng
3. Gim magnesi huyt
3/4/2014
29
57
Mt s trng hp ng c
Nhim ceton-acid do ru: anion gap
Thng ngi nghin ru mn tnh
Nhim ceton thng xy ra 2 n 3 ngy sau khi ung ru.
Gia tng
Catecholamin
Glucagon
Glucocorticoid
Ethanol Acetat
Acetyl CoA
Chuyn ha
acid tricarboxylic
Gp acid bo
Phn hy lipid
Gim insulin
Gim n
Gim thi tr
ceton
Ceton
Gim th tch
Nn ma v
c ch ADH
Gim chuyn
ha ceton
Ethanol Tc ng
4. Nhim ceton-acid do ru
58
Mt s trng hp ng c
Ngi nghin ru mn tnh, do thiu thiamin
(1) Suy dinh dng
(2) Ethanol cn tr hp thu thiamin
(3) Ri lon chc nng gan
(cn tr tch tr v kch hot thiamin).
Thiamin l mt cofactor quan trng pyruvat dehydrogenase
v -ketoglutarat dehydrogenase, tham gia vo chuyn ha
carbohydrat.
Ethanol Tc ng
5. Bnh no Wernicke
3/4/2014
30
59
Mt s trng hp ng c
Cc mi c trng ca ethanol
Bun nn, nn ma, au bng, mt bng, mt iu ha
v gim phn x
G u: Mt kim ch
Khi nhim c nng hn, suy nhc thn kinh trung ng
Mt iu vn, rung gin nhn cu, an thn.
Hn m, mt phn x, h thn nhit
Ethanol Triu chng trn lm sng
1. c tnh cp
60
Mt s trng hp ng c
(1) ri lon vn ng mt
(2) mt iu vn tiu no
(3) L ln
3. Nhim ceton-acid do ru
au bng, bun nn, nn ma v suy yu
Sinh hiu cho thy tng nhp tim, nhp th, h huyt p
Ethanol Triu chng trn lm sng
2. Hi chng Wernicke-Korsakoff
3/4/2014
31
61
Mt s trng hp ng c
Mt mi, suy nhc, chn n, bun nn, run, d cm,
mt iu vn, m sng, co git, ngt v hn m.

Lon nhp tht, c bit l xon nh
cp cu magnesi sulfat
4. Gim magnesi huyt
Ethanol Triu chng trn lm sng
62
Mt s trng hp ng c
1. H hp
2. Tnh trng tm thn bt thng
Glucose (25-50 g)
Naloxon (2 mg)
Thiamin (100 mg)
3. Ra d dy (ung ethanol ln 1 g / kg trong vng 30 pht)
4. Co git: benzodiazepin (v d: lorazepam, 2 mg IV, lp li khi cn)
Ethanol iu tr ng c
3/4/2014
32
63
Mt s trng hp ng c
5. Gim thn nhit: lm m
6. Mt nc v in gii hoc s mt cn bng acid-base
7. Thiu ht dinh dng:
Folat (1 mg)
Thiamin (100 mg)
Magnesi (2 g)
Vitamin tng hp
Ethanol iu tr ng c
64
Mt s trng hp ng c

4. Methanol v etylen glycol
3/4/2014
33
65
Mt s trng hp ng c
Chng ng
n nh m (thuc l, cc sn phm nng, kem nh rng)
Cht lm mm giy
n nh bt
Dung mi
Ha cht trung gian (si polyester, phim, nha)
Thay th glycerin (sn, keo, cht ty ra, m phm)
Ethylen glycol
Ethylen glycol
66
Mt s trng hp ng c
Ethylen glycol Chuyn ha
3/4/2014
34
67
Mt s trng hp ng c
Mc tiu: TK trung ng, thn, phi, tim, gan, c bp v vng mc.
Glyoxylat acid oxalic (calci oxalat)
H thng TK trung ng: ph no, vim mng no
mt t bo Purkinje tiu no
Thn: ph k
lng ng cc tinh th calci oxalat
Phi: ph n
vim phi k
vim ph qun xut huyt
Ethylen glycol Tc ng
68
Mt s trng hp ng c
Sn v vecni
Dung mi cng nghip
Sn xut formaldehyd, acid acetic,
cc dn xut methyl, acid v c
Chng ng
Nhin liu tng cng ch s octan
Methanol
Methanol
3/4/2014
35
69
Mt s trng hp ng c
Chuyn ha Methanol
70
Mt s trng hp ng c
Format hiu ng c hi lin quan n ng c methanol
Formaldehyd nhanh chng chuyn ha v khng tch ly
Format c ch cytochrom oxidase (cng v tr nh hng ca
carbon monoxid, cyanid, sulfur hydro v azid) gim sn xut ATP,
ph v ni cn bng t bo v tng phn hy glucose k kh
v sn xut lactat.
Methanol Tc ng
3/4/2014
36
71
Mt s trng hp ng c
Methanol Ethylen glycol
Thi gian 412 h 30 h
TKTW
Tru ng c
Hn m, co git
Co cng co git ton th
Ph no
Hi chng thot v
Lit thn kinh s
Nhc u, chng mt
Hn m, co git

Ph no
Hi chng thot v
Nhi mu / xut huyt
Ethylen glycol & methanol Triu chng trn lm sng
72
Mt s trng hp ng c
Methanol Ethylen glycol
Tim-phi
Tng huyt p
Nhp tim nhanh
Nhp th nhanh
Ph phi
Tng huyt p
Nhp tim nhanh / chm
Nhp th nhanh
Thn
Suy thn cp
Tinh th calci oxalat niu
Ethylen glycol & methanol Triu chng trn lm sng
3/4/2014
37
73
Mt s trng hp ng c
Methanol Ethylen glycol
Th gic
M mt
S nh sng
Lon th
M (mt phn hay m hn)
Ethylen glycol & methanol Triu chng trn lm sng
Acid-baz
Anion gap (acid) Anion gap (acid)
Tiu ha
Bun nn/nn ma
au bng
Vim ty
Bun nn/ Nn ma
74
Mt s trng hp ng c
Theo di h hp, tim mch, gi tr xt nghim
Ethylen glycol v methanol tn ti dng lng
Lng ln: sc d dy
Lng nh: khng khuyn co
Than hot: khng hiu qu trong hp ph ru
Acid huyt: Tim tnh mch natri bicarbonat:
Kim ha c th lm trm trng thm h calci huyt
Chm sc h tr
Ethylen glycol & methanol iu tr ng c
3/4/2014
38
75
Mt s trng hp ng c
ng kinh: benzodiazepin v phenobarbital.
Cn co git hoc hn m: ch ph no

H calci huyt: tim tnh mch calci
C th tng cc tinh th oxalat calci
Chm sc h tr
Ethylen glycol & methanol iu tr ng c
76
Mt s trng hp ng c
c ch alcohol dehydrogenase nn dng ngay lp tc
Tim tnh mch
Fomepizol (4-methylpyrazol)
Ethanol

Ethanol (p.o khi khng c ch phm tim tnh mch)
liu ln
nng nh chm
Fomepizol: hiu qu v an ton
Fomepizol
Gii c
Ethylen glycol & methanol iu tr ng c
3/4/2014
39
77
Mt s trng hp ng c
Fomepizol (u tin)
pha long trong 250 ml NaCl 0,9%
hoc dextrose 5% (truyn tnh mch chm hn 30 pht)
A. Liu u: 15 mg / kg
B. Liu duy tr: 10 mg / kg mi 12 gi x 4 ln,
15 mg / kg mi 12 gi cho cc liu tip
C. Bnh nhn cn thm phn mu (tng tn sut s dng)
Gii c
Ethylen glycol & methanol iu tr ng c
78
Mt s trng hp ng c
Ethanol
A. Liu u: 0,8 g / kg (khong 1 ml / kg) ca ethanol 100%
IV: pha 5-10% trong dextrose 5% / PO: pha long 20-30%.

B. Liu duy tr
1. Bt u ng thi vi liu u
2. Liu khi u: 130 mg (0,16 ml) / kg / gi ethanol 100 %
Gii c
Ethylen glycol & methanol iu tr ng c
3/4/2014
40
79
Mt s trng hp ng c
Ethanol
3. Theo di ethanol n khi t c trng thi n nh.
a. Nng ethanol mc tiu 100-150 mg / dL.
b. < 100 mg / dL, dng mt liu nh sau:

Ethanol (mg) = [nng mong mun (mg / dL) - nng bit
(mg / dL)] Vd (0,6 L / kg) th trng (kg)
Gii c
Ethylen glycol & methanol iu tr ng c
80
Mt s trng hp ng c
Ethylen glycol
A. Thiamin, 100 mg / ngy IV
B. Magnesi b sung khi cn thit
C. Pyridoxin, 100 mg / ngy IV

Methanol
Acid folinic (leucovorin): 1 mg / kg / liu
(ti a 50 mg / liu) IV mi 4 gi
Acid folinic
Cofactor
Ethylen glycol & methanol iu tr ng c