大剂量对乙酰氨基酚摄入伴早期代谢性酸中毒和昏迷：IV NAC 和连续静脉-静脉血液透析滤过治疗。
Massive acetaminophen ingestion with early metabolic acidosis and coma: treatment with IV NAC and continuous venovenous hemodiafiltration.
机构信息
Department of Medicine and Emergency Medicine, Maine Medical Center and Northern New England Poison Center, 901 Washington Avenue, Portland, ME 04102, USA.
出版信息
Clin Toxicol (Phila). 2010 Feb;48(2):156-9. doi: 10.3109/15563650903524142.
CONTEXT
We report the extraction of acetaminophen by continuous venovenous hemodiafiltration (CVVHD) during treatment of an acute ingestion of 200 g with a peak recorded serum acetaminophen level of 1,614 mg/L (10,652 micromol/L).
CASE DETAILS
The patient presented with early onset of coma, metabolic acidosis, and hypotension in the absence of significant hepatic injury. In addition to N-acetylcysteine (NAC) therapy, CVVHD was performed to manage the acid-base disturbance. Flow rate, effluent volume, and serum and effluent drug concentrations were obtained at hourly intervals. During 16 h of CVVHD the acetaminophen level dropped from 1,212 to 247 mg/L.
DISCUSSION
The average clearance of acetaminophen by CVVHD was 2.53 L/h, with removal of 24 g of acetaminophen over 16 h. As NAC is effective in preventing hepatic injury after acute acetaminophen overdose, the role of dialysis or CVVHD is limited.
背景
我们报告了在治疗急性摄入 200 克对乙酰氨基酚时，通过连续静脉-静脉血液透析滤过（CVVHD）提取对乙酰氨基酚的情况，记录到血清对乙酰氨基酚水平的峰值为 1614mg/L（10652 微摩尔/L）。
病例详情
患者在无明显肝损伤的情况下出现昏迷早期、代谢性酸中毒和低血压。除了使用 N-乙酰半胱氨酸（NAC）治疗外，还进行了 CVVHD 以纠正酸碱失衡。在每小时间隔获得流速、流出量以及血清和流出液药物浓度。在 16 小时的 CVVHD 过程中，对乙酰氨基酚水平从 1212mg/L 降至 247mg/L。
讨论
CVVHD 对乙酰氨基酚的平均清除率为 2.53L/h，在 16 小时内清除了 24g 对乙酰氨基酚。由于 NAC 在急性对乙酰氨基酚过量后预防肝损伤有效，因此透析或 CVVHD 的作用有限。
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