Bisschops Lauke A, Bisschops Wim A H, Vroegop Maurice P, van Rossum Lyonne K, Kramers Cees
UMC St Radboud, Nijmegen, the Netherlands.
Ned Tijdschr Geneeskd. 2011;155:A2132.
As paracetamol is widely used and easily available acetaminophen auto-intoxication is frequently seen. In the majority of patients no complications will occur, but in a small group it may lead to liver damage and death. Children are less susceptible to complications than adults. Cornerstone of treatment is the antidote acetylcysteine, administration of which can be based on the Rumack-Matthew nomogram. This nomogram has only been validated in adults, but nevertheless is also used in children. Gastric lavage should not be implemented, active charcoal can be given to a conscious cooperative patient within 1 hour of ingestion of acetaminophen. A multidisciplinary approach to treatment is needed with the collaboration of an emergency physician, paediatrician or internist, pharmacist and also a child psychiatrist.
由于对乙酰氨基酚使用广泛且容易获取,对乙酰氨基酚自体中毒现象屡见不鲜。大多数患者不会出现并发症,但一小部分患者可能会导致肝损伤甚至死亡。儿童比成人更不易出现并发症。治疗的关键是使用解毒剂乙酰半胱氨酸,其给药可依据鲁马克-马修列线图。该列线图仅在成人中得到验证,但仍用于儿童。不应进行洗胃,对于意识清醒且配合的患者,在摄入对乙酰氨基酚1小时内可给予活性炭。治疗需要多学科协作,涉及急诊医生、儿科医生或内科医生、药剂师,还有儿童精神科医生。