Department of Medicine and Emergency Medicine, Maine Medical Center and Northern New England Poison Center, 901 Washington Avenue, Portland, ME 04102, USA.
Clin Toxicol (Phila). 2010 Feb;48(2):156-9. doi: 10.3109/15563650903524142.
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).
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.
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.
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）。
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。
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。
