Toxicological analysis in agitated patients

Abstract

Objective: To assess the toxicological etiologies in agitated patients and to evaluate their initial clinical diagnosis in the light of toxicological results analysis. Design: Prospective clinical study. Setting: Emergency Department (ED) in a 2,650-bed University Hospital. Patients: Fifty-eight consecutively enrolled patients admitted to the ED in agitated states over a 6-month period. Measurements and results: All patients underwent laboratory tests including blood glucose, ethanol and serum drug screening. Toxicology tests were conducted by fluorescence polarization immunoassay and confirmed by high performance liquid chromatography/diode array detector and gas chromatography-mass spectrometry. The physician's initial diagnosis was evaluated in the light of toxicological analysis results. Serum toxicological analysis revealed that 50/58 patients were under the influence of alcohol and/or a drug. Benzodiazepines (22/58), selective serotonin reuptake inhibitors (5/58) and opiates (4/58) were the most frequently observed. The initial clinical diagnosis was alcohol intoxication in 39 patients, although 1 patient was not under the influence of alcohol and 16 also had benzodiazepine in their sera. Moreover, the diagnosis of serotonin syndrome was overlooked in two patients. Conclusion: Most agitated patients were under the influence of alcohol and/or a drug. Benzodiazepine alone or in association with alcohol was surprisingly frequent. A serotonin syndrome may explain the agitation state.