快樂小藥師 Im pharmacist nichts glücklich

原資料出處：

To the Editor: The only treatment approved by the Food and Drug Administration for acute acetaminophen poisoning is a 72-hour protocol of oral N-acetylcysteine administration. Clinical experience suggests that this protocol may be excessive for many episodes of acute acetaminophen poisoning. Hepatotoxicity from such poisoning is preventable when intravenous administration of N-acetylcysteine is initiated within 8 to 10 hours after ingestion and continued for 20 hours.^1,2

We investigated the use of a 20-hour protocol of oral N-acetylcysteine for the management of acute ingestion of an acetaminophen product (except sustained-release preparations) between 1996 and 1999. The investigation was approved by our institutional review board. The inclusion criteria were a precise and reliable history of the time of ingestion, a serum acetaminophen concentration above the possible-hepatotoxicity line (the line joining the plots of 150 µg per milliliter [992 µmol per milliliter] at four hours and 80 µg per milliliter [529 µmol per milliliter] at eight hours on the Rumack–Matthew nomogram), normal base-line levels of aspartate aminotransferase and alanine aminotransferase, and a normal base-line international normalized ratio (INR). Oral and written informed consent was obtained from the patients or their parents. The oral loading dose of N-acetylcysteine was 140 mg per kilogram of body weight, administered within eight hours after acetaminophen ingestion; the oral maintenance dose was 70 mg per kilogram, given every four hours for five additional doses. Hence a total of six doses were given in a 20-hour period. Laboratory studies were performed initially and 16, 36, and 48 hours after the administration of the acetaminophen loading dose.

A total of 34 patients (29 females and 5 males) were enrolled in the study. There were two children, 13 and 14 years old; both were girls. One child's acetaminophen level was above the possible-hepatotoxicity line, and the other was above the line joining the plots of 200 µg per milliliter (1323 µmol per milliliter) at four hours and 100 µg per milliliter (662 µmol per milliliter) at eight hours on the nomogram (i.e., the probable-hepatotoxicity line). The 32 adults (27 women and 5 men) were 18 to 48 years old. One adult was withdrawn from the study because of a treatment-protocol violation. Of the remaining 33 patients, 4 had an acetaminophen level above the probable-hepatotoxicity line, and 29 had a level above the possible-hepatotoxicity line. The peak ranges of the INR and of the aspartate aminotransferase and alanine aminotransferase levels in the group with possible hepatotoxicity were 1.0 to 1.5 U per liter, 16 to 41 U per liter, and 15 to 54 U per liter, respectively; the peak ranges in the group with possible hepatotoxicity were 1.2 to 1.3 U per liter, 18 to 28 U per liter, and 12 to 19 U per liter, respectively. All the patients were discharged from the hospital in good condition.

Thus, a 20-hour protocol of oral N-acetylcysteine was effective in preventing hepatic injury after an acute acetaminophen overdose when the loading dose was initiated within 8 hours after ingestion, especially in patients with an acetaminophen level below the probable-hepatotoxicity line. Further prospective studies will be needed to validate and refine this protocol.

其實有一篇更正的：Correction，我在原文中已經用紅色的字標起來了

A 20-Hour Treatment for Acute Acetaminophen Overdose . On page 2472, lines 11 and 12 of the left-hand column should have read "48 hours after the administration of the N-acetylcysteine loading dose," rather than "the acetaminophen loading dose," as printed; line 6 of the right-hand column should have read "probable hepatotoxicity" rather than "possible heptatotoxicity," as printed. We regret the errors.

^{有興趣的也可以去找這篇原文來看}

^{關鍵字： Acetaminophen Acetin Acetylcysteine N-acetylcysteine}