Toxicological analysis in agitated patients

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 nod results: All patients underwent laboratory tests including blood glucose, ethanol and serum drug screening. Toxicology tests were con ducted by fluorescence polarization immunoassay and confirmed by high perfo rmance liquid chromatography/diode array detector and gas chromatography-ma ss spectrometry. The physician's initial diagnosis was evaluated in the lig ht of toxicological analysis results. Serum toxicological analysis revealed that 50/58 patients were under the influence of alcohol andlor a drug. Ben zodiazepines (22/58), selective serotonin reuptake inhibitors (5/58) and op iates (4/58) were the most frequently observed. The initial clinical diagno sis was alcohol intoxication in 39 patients, although 1 patient was not und er the influence of alcohol and 16 also had benzodiazepine in their sera. M oreover, 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 surprisi ngly frequent. A serotonin syndrome may explain the agitation state.