Senarathna S M D K G, Ranganathan S Sri, Dawson A H, Buckley N, Fernandopulle B M R
Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka.
Ceylon Med J. 2008 Sep;53(3):89-92. doi: 10.4038/cmj.v53i3.248.
To compare the management of acute paracetamol poisoning with the best evidence available, and to determine the effect of plasma paracetamol level estimation on the management.
Descriptive study with an intervention.
Medical wards of the National Hospital of Sri Lanka, Colombo.
Patients admitted with a history of acute paracetamol poisoning.
Measurement of plasma paracetamol.
Data were obtained from the patients, medical staff and medical records. Plasma paracetamol was estimated between 4-24 hours of paracetamol ingestion. The current management practices were compared with the best evidence on acute paracetamol poisoning management.
157 patients were included. The mean ingested dose of paracetamol was 333 mg/kg body weight. Majority of the patients (84%) were transfers. Induced emesis and activated charcoal were given to 91% of patients. N-acetylcysteine was given to 66, methionine to 55, and both to 2. Aclinically important delay in the administration of antidotes was noted; 68% of patients received antidotes after 8 hours of the acute ingestion. Only 31 (26%) had paracetamol levels above the Rumack-Matthew normogram. 74 patients received an antidote despite having a plasma paracetamol level below the toxic level according to the normogram.
Management of acute paracetamol poisoning could be improved by following best available evidence and adapting cheaper methods for plasma paracetamol estimation.
将对乙酰氨基酚急性中毒的处理方法与现有最佳证据进行比较，并确定血浆对乙酰氨基酚水平测定对处理的影响。
带有干预措施的描述性研究。
科伦坡斯里兰卡国立医院的内科病房。
有对乙酰氨基酚急性中毒病史的入院患者。
测定血浆对乙酰氨基酚。
从患者、医护人员及病历中获取数据。在摄入对乙酰氨基酚4 - 24小时之间测定血浆对乙酰氨基酚。将当前的处理方法与对乙酰氨基酚急性中毒处理的最佳证据进行比较。
纳入157例患者。对乙酰氨基酚的平均摄入剂量为333毫克/千克体重。大多数患者（84%）是转院而来。91%的患者接受了催吐和活性炭治疗。66例患者接受了N - 乙酰半胱氨酸治疗，55例接受了蛋氨酸治疗，2例同时接受了两者治疗。注意到解毒剂给药存在临床上重要的延迟；68%的患者在急性摄入8小时后才接受解毒剂治疗。只有31例（26%）患者的对乙酰氨基酚水平高于鲁马克 - 马修列线图标准。74例患者尽管血浆对乙酰氨基酚水平低于列线图所示的中毒水平，但仍接受了解毒剂治疗。
遵循现有最佳证据并采用更廉价的血浆对乙酰氨基酚测定方法，可改善对乙酰氨基酚急性中毒的处理。
