通过 N-乙酰半胱氨酸、福美唑和肾脏替代疗法成功控制了对乙酰氨基酚的大量摄入。

Clinical nephrology. Case studies Pub Date : 2024-03-02 eCollection Date: 2024-01-01 DOI:10.5414/CNCS111275
Elizabeth E Williams, Duc Quach, Arthur Daigh
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引用次数: 0

摘要

对乙酰氨基酚摄入后通常会使用解毒剂 N-乙酰半胱氨酸(NAC)。使用福美匹唑和血液透析等辅助疗法也能成功治疗对乙酰氨基酚大面积中毒。福美匹唑的作用是抑制细胞色素 p560,防止泰诺形成其毒性代谢物 NAPQI。先前的病例表明,在间歇性血液透析和连续静脉-静脉血液滤过(CVVH)的单次治疗后,对乙酰氨基酚的浓度会有良好的结果和显著的下降。然而,关于患者在接受 CVVH 治疗期间如何调整 NAC 和福美嘧啶的推荐剂量的报道并不多。我们介绍了一例 18 岁男性患者的病例,他在摄入 125 克泰诺林后就诊。他的 4 小时对乙酰氨基酚水平为 738.6 µg/mL。他接受了 NAC、福美唑和单次 4 小时血液透析治疗。尽管进行了血液透析,他的对乙酰氨基酚水平仍高达 730 微克/毫升。开始进行 CVVH,并给他静脉注射 12.5 毫克/千克/小时的 NAC、每 4 小时口服 70 毫克/千克的 NAC 和每 6 小时静脉注射 10 毫克/千克的福美皮唑。在摄入泰诺57小时后,他体内的泰诺水平就检测不到了,也没有出现永久性肝中毒。本病例鼓励在间歇性血液透析一次不能有效降低泰诺水平的情况下,使用 CVVH 治疗大量摄入泰诺。如果以适当的剂量和频率提供 NAC、福美匹唑和 CVVH,就能防止大量摄入对乙酰氨基酚后出现不良后果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Massive acetaminophen ingestion managed successfully with N-acetylcysteine, fomepizole, and renal replacement therapy.

Acetaminophen ingestion is routinely managed with the antidote, N-acetylcysteine (NAC). Massive acetaminophen poisoning has been treated successfully with adjunctive therapies such as fomepizole and hemodialysis. Fomepizole functions by inhibiting cytochrome p560, which prevents tylenol from forming its toxic metabolite, NAPQI. Prior cases have demonstrated favorable outcomes and a significant drop in acetaminophen levels after a single session of intermittent hemodialysis and continuous veno-venous hemofiltration (CVVH). However, the recommended dosage adjustments of NAC and fomepizole while a patient is undergoing CVVH has not been well reported. We present a case of an 18-year-old male who presented after ingesting 125 g of tylenol. His 4-hour acetaminophen level was 738.6 µg/mL. He was treated with NAC, fomepizole, and a single 4-hour session of hemodialysis. His acetaminophen level remained elevated at 730 µg/mL despite the hemodialysis session. CVVH was initiated, and he was given intravenous NAC at 12.5 mg/kg/h, oral NAC at 70 mg/kg every 4 hours, and intravenous fomepizole at 10 mg/kg every 6 hours. His tylenol levels became undetectable 57 hours after ingestion, and he did not develop permanent liver toxicity. This case encourages the use of CVVH for massive tylenol ingestion when a single run of intermittent hemodialysis is not effective in lowering the tylenol level. NAC, fomepizole, and CVVH can prevent unfavorable outcomes in massive acetaminophen ingestion when provided at an appropriate dose and frequency.

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