Hengy Baptiste, Hayi-Slayman Davy, Page Mathieu, Christin Françoise, Baillon Jean-Jacques, Ber Charles-Eric, Allaouchiche Bernard, Rimmelé Thomas
Département d'anesthésie-réanimation, Pavillon P Réanimation, Hôpital Edouard Herriot, Place d'Arsonval, 69003 Lyon, France.
Can J Anaesth. 2009 Oct;56(10):770-4. doi: 10.1007/s12630-009-9155-1. Epub 2009 Jul 29.
Management of acetaminophen overdose focuses on the risk hepatic failure. However, acute renal failure, although less frequent, can lead to serious metabolic complications and require hemodialysis. We report three cases of acute renal failure related to acetaminophen overdose.
Three patients, aged 17-46 yr ingested acetaminophen 19 to 32 g, and were admitted to the intensive care unit because of acute liver failure without hepatic coma. While liver function improved, each patient developed acute renal failure starting on the fourth day. Four sessions of hemodialysis were required in one patient because of anuria. Hepatic function improved from the fourth to the ninth day in each case, whereas renal function recovered later, 10-20 days after ingestion. Investigations were negative for other causes of renal failure, and acute tubular necrosis due to acetaminophen was suspected.
The pathophysiology of this type of acute tubular necrosis remains unclear and thus, there is no specific treatment. Nevertheless, in all cases of acetaminophen overdose, we suggest following serum creatinine levels during the first week, regardless of the degree hepatic failure or quantity of acetaminophen ingested.
对乙酰氨基酚过量的处理主要关注肝衰竭风险。然而，急性肾衰竭虽较少见，但可导致严重的代谢并发症并需要血液透析。我们报告3例与对乙酰氨基酚过量相关的急性肾衰竭病例。
3例患者，年龄17 - 46岁，摄入对乙酰氨基酚19至32克，因急性肝衰竭未出现肝昏迷而入住重症监护病房。肝功能改善的同时，每位患者在第4天开始出现急性肾衰竭。1例患者因无尿需要进行4次血液透析。每位患者肝功能在第4至9天改善，而肾功能恢复较晚，在摄入药物后10 - 20天。排除了其他肾衰竭病因，怀疑是对乙酰氨基酚导致的急性肾小管坏死。
这类急性肾小管坏死的病理生理机制仍不清楚，因此没有特效治疗方法。尽管如此，对于所有对乙酰氨基酚过量病例，我们建议在第一周监测血清肌酐水平，无论肝衰竭程度或对乙酰氨基酚摄入量多少。
