Kearns G L, Leeder J S, Wasserman G S
Department of Pediatrics, University of Missouri-Kansas City, USA.
Clin Pediatr (Phila). 2000 Mar;39(3):133-44. doi: 10.1177/000992280003900301.
For over two decades, pediatricians have been made aware of the potential risk associated with the acute ingestion of large single and/or multiple doses of acetaminophen (APAP). Clearly, APAP-induced hepatotoxicity remains as a recognized medical emergency which, when treated promptly with appropriate gastrointestinal decontamination and when indicated, with the antidote N-acetylcysteine, has a uniformly good clinical outcome. Recently, the hepatotoxic potential associated with "therapeutic" APAP administration has been brought to the attention of the pediatric community. This review explores the issue of APAP toxicity with therapeutic intent by examining both the clinical literature and also, relevant information concerning the basic pharmacology and toxicology of this old and widely used nonprescription drug. A "risk profile" is developed with regard to factors that may predispose infants and children to this iatrogenic form of toxicity so that the awareness of physicians and other caregivers (including parents) can be heightened and preventative education administered. As is true for most all potentially beneficial medicines used in pediatrics, awareness of the actual amount of drug received from all sources and caution to not exceed the age-appropriate dosing guidelines (i.e., both amount and duration) contained in the approved labeling for all products containing APAP will insure safe and effective therapy.
二十多年来，儿科医生已经意识到急性摄入大剂量单次和/或多次对乙酰氨基酚（APAP）存在潜在风险。显然，APAP引起的肝毒性仍然是一种公认的医疗急症，若及时采用适当的胃肠道去污措施治疗，并在必要时使用解毒剂N-乙酰半胱氨酸，临床结果通常良好。最近，与“治疗性”使用APAP相关的肝毒性潜力已引起儿科界的关注。本综述通过研究临床文献以及有关这种古老且广泛使用的非处方药的基础药理学和毒理学的相关信息，探讨了具有治疗意图的APAP毒性问题。针对可能使婴儿和儿童易患这种医源性毒性的因素制定了“风险概况”，以便提高医生和其他护理人员（包括父母）的意识并进行预防教育。与大多数用于儿科的潜在有益药物一样，了解从所有来源获得的实际药物量，并注意不超过所有含APAP产品批准标签中包含的适合年龄的给药指南（即剂量和疗程），将确保治疗安全有效。
