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題名 | Hemodialysis as Adjunctive Therapy for Severe Acetaminophen Poisoning: A Case Report=以血液透析輔助治療嚴重乙醯氨酚中毒:一病例報告 |
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作者 | 吳明玲; 蔡維禎; 鄧昭芳; 楊振昌; Wu, Ming-ling; Tsai, Wei-jin; Deng, Jou-fang; Yang, Chen-chang; |
期刊 | 中華醫學雜誌 |
出版日期 | 19991200 |
卷期 | 62:12 1999.12[民88.12] |
頁次 | 頁907-913 |
分類號 | 418.731 |
語文 | eng |
關鍵詞 | 乙醯氨酚; 急性中毒; 血液透析; Acetaminophen; Acute poisoning; Hemodialysis; |
中文摘要 | 乙醯氮酚過量是一種常見的藥物中毒,其主要治療方式為投予解毒劑(乙醯半胱氨酸)及良好的支持療法。本文報告1例重度乙醯氨酚過量的個案,在接受血液透析輔助治療後的療效及其血液動力學變化。1位37歲女性在服用100顆乙醯氨酚(每顆含5OO mg乙醴氨酣)企圖自殺後,產生嚴重嘔吐、吐血及腹痛等症狀。實驗室檢查發現其肝臟酵素升高、凝血時間延長、血清乙醯氨酚濃度大幅升高明(服藥後12小時之濃度為201 mg/l)及排除半衰期延長。病人於是在服藥19小時後接受血液透析,結果發現,4小時之血液透析共移除了病人體內乙醯氨酚總量之66%,清除速率增加2.75倍,半衰期由7.2小時縮短至2.6小時。因此,若病人發生重度乙醯氨酚中毒而無法有效地接受解毒劑療法時,血液透析可作為1種有效移除該藥物的方法。 |
英文摘要 | Acetaminophen overdose is a common intoxication in daily practice the standard treatment is N-acetylcysteine (NAC) antidotal therapy for possible poisoning. However, dialysis procedures can remove the drug from the body effectively. We describe a case of acetaminophen overdose that was treated with both hemodialysis (HD) and NAC due to severe intoxication and slow drug clearance. A 37-year-old woman attempted suicide by ingestion of 100 tablets (500 mg each) of acetaminophen, and presented with vomiting, hematemesis and abdominal pain. The patient had elevated liver enzymes, coagulation defects, thrombocytopenia a high serum acetaminophen level (201 mg/l at 12 hours post-ingestion) with a prolonged half-life. Oral NAC was given; however, it was ineffective due to severe vomiting and hematemesis. HD as adjunctive therapy was initiated at 19 hours post-ingestion. HD reduced the serum acetaminophen level from 102.77 to 35.77 mg/l. Severe hepatic injury, bacteremia and pancytopenia were noted in the following days. The patient later recovered after treatment with NAC, HD and intensive supportive care. HD removed .66% of the total acetaminophen body burden during a single four-hour session, increased the clearance by 2.75-fold and shortened the half-life from 7.2 hours to 2.6 hours during HD. Though NAC therapy is the standard regimen for acetaminophen poisoning, in the severely poisoned patient who cannot tolerate NAC therapy, HD may be used as adjunctive therapy to enhance the elimination of acetaminophen. |
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