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ZASTRUPITEV OTROKA Z DROGAMI IN PREDSTAVITEV TESTOV
CHILD POISONING WITH DRUGS AND PRESENTATION OF TESTS
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ABSTRACT
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Akutno zastrupitev s heroinom zdravimo z antago- QLVWRPRSLRLGQLKUHFHSWRUMHYQDORNVRQRP,QGLFLUDQ je pri zastrupitvi s heroinom in sorodnimi drogami ter pri zastrupitvi z opioidnimi analgetiki. Deluje Y QHNDM PLQXWDK =DþHWQL RGPHUHN MH í PJ LQWUDYHQVNR NL JD SR SRWUHEL SRQDYOMDPR QD í minute ali dajemo v infuziji. Pri odvisnikih od opio- LGRYODKNRQDORNVRQVSURåLDEVWLQHQþQRNUL]R]DWR PRUDPREROQLNHVNUEQRRSD]RYDWL
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2SUDYLPR WXGL VSORãQH ODERUDWRULMVNH SUHLVNDYH SOLQVND DQDOL]D KHPRJUDP HOHNWUROLWL XUHD NUH- DWLQLQ NUHDWLQLQ NLQD]D &. NUYQL VODGNRU LQ SR PRåQRVWLWXGL(.*
6SHFLILþQH ODERUDWRULMVNH SUHLVNDYH VR RGYLVQH RG NOLQLþQHVOLNHSULEROQLNX
3RPHPEQR MH GD RE ]DVWUXSLWYDK Y]RUFH NUYL urina in åHORGþQega izpirka shranimo za morebitne NDVQHMãH WRNVLNRORãNH DQDOL]H 1DSRWQLFD ]D WRNVL- NRORãNR DQDOL]R PRUD YVHERYDWL SRGDWNH R YUVWL LQ RGPHUNX]GUDYLONLMLKMHEROQLNGRELOY]DGQMLK XUDK VLFHU ODKNR DQDOLWLND ]DYHGHMR SUL SUHSR]QD- YDQMX VWUXSD 9]RUFH NL MLK QH RGSRãOMHPR WDNRM shranimo v hladilniku.
Bolniku predpiãHPR LQWUDYHQVNR LQIX]LMVNR PHãD- nico.
TESTI NA PRISOTNOST PAS
7HVWLUDQMH ELRORãNHJD PDWHULDOD QD SULVRWQRVW 3$6 in njihovih metabolitov nam ponudi podatke o PRUHELWQL XSRUDEL 3$6 9VDND 3$6 LPD Y WHOHVX VYRMVWYHQRSUHVQRYQRSRWLQVHODKNRL]WHOHVDL]ORþL ] XULQRP EODWRP ]QRMHP V VOLQR DOL ] L]GLKDQLP ]UDNRP5H]XOWDWWHVWDSRNDåHNYDOLWDWLYQRSUHOLPL- QDUQRRFHQRNLSDMH]HOR]DQHVOMLYD=DSRWUGLWHY rezultata analize v sodnih postopkih moramo opra- YLWLãHNYDQWLWDWLYQRPHWRGRVSOLQVNRNURPDWRJUDIL- MR]PDVQLPVSHNWRPHWURP*&06
9UVWDLQNDNRYRVWLQIRUPDFLMHVWDRGYLVQLRG
• L]ELUH WHVWLUDQHJD Y]RUFD ELRORãNHJD PDWHULDOD NULEODWRXULQVOLQD]QRML]GLKDQL]UDN
• L]EUDQHPHWRGHR]LURPDSRVWRSNDDQDOL]H
• L]ELUH3$6R]LURPDWHVWRY]DGRORþDQMH3$6NL MLKGRORþDPR
'RND]RYDQMHSULVRWQRVWLGRORþHQH3$6YRGY]H- WHPY]RUFXMHSRYH]DQRVþDVRYQLPLQWHUYDORPSR jemanju droge. Rezultat je odvisen od:
• þDVDRGNULWMDSRVDPH]QH3$6
• ODVWQRVWL3$6
• lastnosti biokemijske presnove pri preiskovani RVHEL
• QDþLQDXSRUDEH3$6LQKDOLUDQMH]DXåLWMHLSG
• WHOHVQHJDVWDQMDRVHEH
• SRJRVWRVWLMHPDQMD3$6
• KLGULUDQRVWL
• L]ORþDQMD
• YUHGQRVWLSKWHOHVQHWHNRþLQH
• þDVDRGY]HPDY]RUFD
• QDþLQDKUDQMHQMDY]RUFD
• PHGVHERMQHLQWHUDNFLMHUD]OLþQLK3$6 .DNRYRVW L]YLGD DQDOLWLþQHJD Y]RUFD WHVWLUDQMD QD 3$6 MH RGYLVQD RG VSHFLILþQRVWL LQ REþXWOMLYRVWL XSRUDEOMHQLKWHVWRY$QDOLWLþQRWHVWLUDQMHQDSULVRW- QRVW3$6ODKNRRSUDYLPRQDSULVRWQRVWSRVDPH]QH SVLKRDNWLYQHVQRYLDOLYHþSVLKRDNWLYQLKVQRYLKNUD-
WL2ELþDMQRRSUDYLPRXYRGQRDQDOLWLþQRWHVWLUDQMHV KLWULPLWHVWLQDMSRJRVWHMHQDSRGODJLY]RUFHYXULQD DOLVOLQH
7HVWLUDQMHQDSULVRWQRVW3$6DOLQMLKRYLK PHWDEROLWRYYXULQX
3RVWRSHN WHVWLUDQMD MH VSHFLILþHQ 0HG WHVWLUDQ- MHP SRVHEQR SR]RUQRVW QDPHQLPR SUDYQL ]DãþLWL in zagotavljanju zasebnosti preiskovanca kot tudi SRVWRSNX V NDWHULP ]DJRWRYLPR GD ER Y]RUHF RG WUHQXWND RGY]HPD GR NRQþQHJD UH]XOWDWD ]DãþLWHQ NDNUãQLKNROL]XQDQMLKYSOLYRY
=DGRND]RYDQMH3$6XSRUDEOMDPRSDQHOQHWHVWHV NDWHULPL GRND]XMHPR DPIHWDPLQ NRNDLQ NDQDELV PHWDGRQ LQ PRUILQH WHU HQRMQH WHVWH V NDWHULPL dokazujemo prisotnost benzodiazepinov v urinu.
Prisotnost marihuaneLQKDãLãDMHRGYLVQDRGJODY- QHJDPHWDEROLWD7+&R]þLVWRVWL3$67+&YXULQX lahko pri enkratni uporabi dokaåHPRYREGREMXí dni. Pri dolgotrajni uporabi lahko prisotnost THC GRND]XMHPRGRGQLSULNURQLþQLXSRUDELSDFHOR GQL3DVLYQRNDMHQMHSUDYLORPDQHSRNDåHSR]L- tivnega izvida.
=Dkokain MH ]QDþLOHQ KLWHU PHWDEROL]HP LQ KLWUR L]ORþDQMH 9 XULQX MH L]MHPQR NUDWHN þDV LQ JD Y SRYSUHþMXODKNRGRNDåHPRGRXUSRMHPDQMX3UL NURQLþQLKXåLYDOFLKJDODKNRGRNDåHPRYREGREMX GRGQL
EkstaziLQSRGREQHVQRYLODKNRGRNDåHPRíGQL SR]DXåLWMX
,PXQRNHPLMVNL WHVW RGNULYD YHþ UD]OLþQLKopiatov.
7HVW MH UHDNWLYHQ QD KHURLQ PRUILQ LQ NRGHLQ Heroin ima zelo kratko razpolovno dobo in ga ]DUDGL KLWUHJD PHWDEROL]PD Y WHOHVX SUDNWLþQR QH PRUHPRRGNULWL2SLDWHODKNRGRNDåHPRYXULQXY SRYSUHþMXíGQL
,]ORþDQMHmetadona iz organizma je odvisno od posameznega primera. Razpolovna doba metadona MHíXUSRYSUHþQLGHWHNFLMVNLþDVXULQVNHDQD- OL]HSDíGQL
Benzodiazepini %=2 VR Y XULQX SUL REþDVQHP XåLYDQMXSULVRWQLíGQLSULSRJRVWHPXåLYDQMXSD íGQL
= RPHQMHQLPL WHVWL VPR QDMYHþNUDW GRND]DOL SUL- VRWQRVW 7+& 9 SUHWHNOHP OHWX VPR RE REUDYQDYL
mladostnikov z akutnim alkoholnim opojem med REUDYQDYDQLPLRWURFLNUDWSRWUGLOLSULVRWQRVW 7+& Y XULQX9 QHNDM SULPHULK VPR GRND]DOL WXGL SULVRWQRVW NRNDLQD PRUILQRY LQ EHQ]RGLD]HSLQRY Pozitivni rezultat glede prisotnosti benzodiazepi- nov smo ugotovili predvsem pri zastrupitvah s WDEOHWDPL9OHWXVPRQHNDMNUDWRSUDYLOLWXGL SDQHOQL KLWUL XULQVNL WHVW YHQGDU QRYLK 3$6 QLVPR RGNULOL 'DQHV WDNR ãH YHGQR XSRUDEOMDPR VDPRSDQHOQHWHVWH
2GY]HPXULQDL]YDMDPRQDXVWUH]HQQDþLQLQSRG nadzorom ter v varnem okolju.
• Pred odvzemom pridobimo soglasje bolnika L]MHPRPDQHSULXUJHQWQLREUDYQDYLýH bol- QLNSUHLVNDYRRGNORQLWRREUDYQDYDPRNRWSR- zitivni rezultat testiranja.
• Odvzem in nadzor opravlja za to usposobljena RVHEDSRPRåQRVWLLVWHJDVSRODNRWSUHLVNRYD- nec.
• Pred uriniranjem si preiskovanec temeljito umi- MHURNHLQMLKRVXãL
• Med uriniranjem nima neposrednega dostopa GRWHNRþHYRGHLQPLOD
• 3URVWRU ]D RGY]HP PRUD RPRJRþLWL L]YDMDQMH neposrednega nadzora.
• 3UHLVNRYDQHF XULQLUD Y þLVWR LQ VXKR SRVRGR ORQþHN]DåHOHQMHVUHGQMLFXUHN
• .ROLþLQD]EUDQHJDXULQDQDMERíPO Preverjamo temperaturo urina (normalna tempera- WXUDMHí&YRNYLUXPLQXWLQXJRWDYOMDPR PRUHELWQHYLGQHVOHGLSULPHVL9]RUHFR]QDþLPR]
QDOHSNR QD NDWHUR ]DEHOHåLPR EROQLNRYH SRGDWNH (dopiãHPR WXGL GDWXP LQ XUR RGY]HPD 9]RUHF urina lahko pred testiranjem shranjujemo v hladilni- NXGRXU]DGDOMãHVKUDQMHYDQMHSDPRUDPRXULQ VKUDQMHYDWLSULWHPSHUDWXUL&
3ULDNXWQR]DVWUXSOMHQLRVHELNLVHVODERRG]LYDDOL MHQHRG]LYQDRGY]DPHPRXULQVSRPRþMRNDWHWUD
=D L]YHGER WHVWD SULSUDYLPR WHVWQR SORãþLFR NL MH VKUDQMXMHPR QD VREQL WHPSHUDWXUL LQ ]DãþLWQD sredstva. Test izvedemo po navodilih proizvajalca.
1DG]RUQDGSUDYLOQLPSRWHNRPWHVWLUDQMDMHYJUDMHQ YVDPWHVW2EDUYDQDþUWLFD]R]QDNR&MHQRWUDQML nadzor pravilno izvedenega testa. ýHNRQWUROQHþUWH
&QLWRSRPHQLGDMHUH]XOWDWQHYHOMDYHQ5H]XOWDW
WHVWD PRUDPR RGþLWDWL Y í PLQXWDK RG L]YHGEH NDVQHMãHRGþLWDYDQMHODKNRSRNDåHODåQRSR]LWLYHQ UH]XOWDW
3R]LWLYHQUH]XOWDWWHVWD2GVRWQRVWUGHþHþUWHYSROMX ÄWHVW³ SRPHQL GD VR Y Y]RUFX SULVRWQL GURJD R]
QMHQLK PHWDEROLWL QH SRNDåH SD VWRSQMH LQWRNVLND- FLMH =D GRORþLWHY NRQFHQWUDFLMH 3$6 Y]RUHF XULQD SRãOMHPRQDNYDQWLWDWLYQRDQDOL]R
1HJDWLYHQUH]XOWDWWHVWD9SROMXSRVDPH]QHJDWHVWD VH SRNDåH UGHþD þUWD %DUYD WHVWQH þUWLFD MH ODKNR UD]OLþQRLQWHQ]LYQDRGEOHGRURåQDWHGRLQWHQ]LYQR UGHþH5H]XOWDWMHQHJDWLYHQWXGLþHMHþUWLFDNRPDM vidna.
Testiranje s hitrimi testi za dokazovanje drog v XULQX ODKNR SRNDåH WXGL ODåQR SR]LWLYHQ DOL ODåQR QHJDWLYHQ UH]XOWDW 1DYDGQR QHJDWLYHQ UH]XOWDW REUDYQDYDPR NRW QHJDWLYHQ PHGWHP NR SR]LWLYHQ UH]XOWDW GRGDWQR SRWUGLPR ] XVWUH]QR PHWRGR WM ] DQDOL]R XULQD QD SRGODJL QDSRWQLFH Y WRNVLNR- ORãNHP ODERUDWRULMX ,QãWLWXWD ]D VRGQR PHGLFLQR Y /MXEOMDQL
7HVWLQDSULVRWQRVW3$6DOLQMLKRYLKPHWDEROLWRY YVOLQLR]LURPDRUDOQLWHNRþLQL
ýH EROQLN L] NDNUãQHJD NROL Y]URND QH PRUH XUL- QLUDWLODKNRRSUDYLPRWHVWLUDQMHQDY]RUFXVOLQHR]
RUDOQHWHNRþLQH9SULPHUMDYL]XULQVNLPLY]RUFHP MHNRQFHQWUDFLMD3$6DOLQMLKRYLKSUHVQRYNRYYVOLQL ELVWYHQR PDQMãD 'HWHNFLMVNL þDV MH VLFHU NUDMãL YHQGDUSD3$6RGNULMHPR]HORKLWURWXGLWDNRMSR ]DXåLWMX8JRWDYOMDPRODKNRWXGLDNXWQRVWDQMHSRG YSOLYRP GURJ 7HVWL QD SULVRWQRVW 3$6 Y VOLQL VR L]YUVWHQ QDþLQ RULHQWDFLMVNHJD XYRGQHJD WHVWLUDQMD 3UDNVDNDåHVSUHMHPOMLYRVWRSQMRVHOHNWLYQRVWLVSH- FLILþQRVWLLQWRþQRVWL3RVWRSHNWHVWLUDQMDVVOLQRMH KLWUHMãLWHUEROMHQRVWDYHQLQGLVNUHWHQYSULPHUMDYLV SRVWRSNLSULDQDOL]LUDQMXXULQDNUYLDOLODV 9]RUFH VKUDQMXMHPR SUL VREQL WHPSHUDWXUL 7HVW L]YHGHPR SR QDYRGLOLK SURL]YDMDOFD 1D åOLþNL SRNURYþNXWHVWDMHJRELFDNLMRYVWDYLPRYXVWD 6OLQR ]EHUHPR V VHNXQGQLP EULVDQMHP MH]LND LQ notranje strani lic. Rumeno obarvanje testnih bla- ]LQLF SRWUMXMH SUDYLOQRVW Y]RUþHQMD äOLþNR ] JREL- FDPLSUDYLOQRQDPHVWLPRQD]DMQDWHVWQRSORãþLFR 3ORãþLFR REUQHPR Y QDYSLþQL SRORåDM LQ ] UDKOLP
SULWLVNRP QD R]QDþHQR PHVWR SULWLVQHPR QD UH]HU- YRDU ] UHDJHQWRP LQ SRþDNDPR VHNXQG 1DWR WHVWQRSORãþLFRRGORåLPRQDUDYQRSRGODJRUH]XOWDW WHVWLUDQMD SD RGþLWDPR SR PLQXWDK 1D WD QDþLQ XJRWDYOMDPR SULVRWQRVW NDQDELVD DPIHWDPL- QRYNRNDLQDLQRSLDWRY,]YLGWHVWLUDQMDWROPDþLPR WDNR NRW SUL XSRUDEL XULQVNH SORãþLFH 3ULVRWQRVW NRQWUROQH þUWH SRPHQL GD MH WHVW YHOMDYHQ 9LGQD þUWD Y SROMX SRPHQL GD Y Y]RUFX VOLQH QL GURJH RGVRWQRVWþUWHSDSRWUMXMHQMHQRSULVRWQRVW
=$./-8ý(.
'URJHVRVQRYLNL]DUDGLVYRMHVHVWDYHYSOLYDMRQD PODGRVWQLNRYR UD]PLãOMDQMH SRþXWMH LQ YHGHQMH 5D]ORJRY ]D QMLKRYR XåLYDQMH MH YHþ 6HJDMR RG UDGRYHGQRVWLLQXSRUQLãWYDGREHJDSUHGWHåDYDPL 9åHOMLSRXJRGMXVHYHGQRYHþPODGRVWQLNRYRGOR- þD]DXåLYDQMHSVLKRDNWLYQLKVQRYLVþLPHUPRþQR RJURåDMRVYRMH]GUDYMH
8UJHQWQDREUDYQDYDSULORåQRVWQLKXåLYDOFHYSVLKR- DNWLYQLK VQRYL QDM ER XþLQNRYLWD LQ NDUVHGD KLWUD
=GUDYOMHQMHMHRE]DVWUXSLWYDK]GURJDPLVSHFLILþQR JOHGHQD]DXåLWR3$60ODGRVWQLNLNLMLKREUDYQD- YDPR QD 3HGLDWULþQL NOLQLNL QDMSRJRVWHMH SRWUHEX- MHMR ]GUDYQLãNR SRPRþ ]DUDGL NRPELQLUDQH ]DVWUX- SLWYH]GURJDPLLQDONRKRORP3ULQDWDQþQHPSUH- SR]QDQMXSVLKRDNWLYQLKVQRYLNLMLKMH]DXåLORWURN R]PODGRVWQLNQDPSRPDJDMRQDWDQþQDDQDPQH]D NOLQLþQL SUHJOHG ODERUDWRULMVNR GLDJQRVWLFLUDQMH LQ izvedba hitrih urinskih testov.
LITERATURA
3DQFH0'URJH7YRMYRGQLN/MXEOMDQD9ODGD 568UDG]DGURJH
'UHPHOM = .DVWHOLF $ .RVWQDSIHO 5LKWDU 7 Kako odkriti in dokazati prisotnost drog v urinu LQVOLQL/MXEOMDQD3URKHDOWK
0RåLQD 0 'LDJQRVWLND LQ ]GUDYOMHQMH DNXWQH ]DVWUXSLWYH0HGLFLQVNLUD]JOHGL .DVWHOLF$ 0LNXODQ 0 0ODGRVWQLN LQ GURJD
/MXEOMDQD'RPXV
%UYDU 0 =DVWUXSLWYH V KHURLQRP NRNDLQRP DPIHWDPLQL NDQDELVRP JDPDKLGURNVLEXWLUD- WRP LQ GLHWLODPLGRP OL]HUJLþQH NLVOLQH 0HGL- FLQVNLUD]JOHGL
'UHPHOM=7HVWLUDQMHQDSULVRWQRVWSVLKRDNWLY- QLKVXEVWDQFYNOLQLþQLSUDNVL=ERUQLNSULVSHY- kov: Obravnava bolnika odvisnega od prepove- GDQLKGURJ/MXEOMDQD0HGLV
'UXJ:LSHNUDWNDQDYRGLOD3ULVRWQRVW3$6Y slini.
.RQWDNWQDRVHED&RQWDFWSHUVRQ 1DGD)XMVGLSOPV
6OXåED]DXUJHQWQRSHGLDWULMR 3HGLDWULþQDNOLQLND
8QLYHU]LWHWQLNOLQLþQLFHQWHU/MXEOMDQD /MXEOMDQD
6ORYHQLMD
3ULVSHOR5HFHLYHG 6SUHMHWR$FFHSWHG
