title: 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.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Emergency Department (ED) in a 2,650-bed University Hospital.
  
  
  METHODS
  Fifty-eight consecutively enrolled patients admitted to the ED in agitated states over a 6-month period.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medical Emergency Department, Hôpital Charles Nicolle, Centre Hospitalier Universitaire, 1 rue de Germont, F-76 031 Rouen Cedex, France. Fabienne.Moritz@chu-rouen.fr
authors.forename: F
authors.initials: F
authors.lastname: Moritz
authors.forename: J P
authors.initials: JP
authors.lastname: Goullé
authors.forename: C
authors.initials: C
authors.lastname: Girault
authors.forename: F
authors.initials: F
authors.lastname: Clarot
authors.forename: J M
authors.initials: JM
authors.lastname: Droy
authors.forename: J M
authors.initials: JM
authors.lastname: Muller
mesh_terms: D000293:Adolescent; D000328:Adult; D001569:Benzodiazepines / Q000097:blood*; D001786:Blood Glucose / Q000032:analysis; D002851:Chromatography, High Pressure Liquid; D004636:Emergency Service, Hospital; D000431:Ethanol / Q000097:blood*; D005260:Female; D005602:France; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000209:etiology*; D020230:Serotonin Syndrome / Q000175:diagnosis; D019966:Substance-Related Disorders / Q000097:blood / Q000175:diagnosis*
chemical_list: D001786:Blood Glucose; D001569:Benzodiazepines; D000431:Ethanol