Section of Emergency Medicine, Children's Hospital, University of Colorado, Denver, Colorado, USA.
Pediatrics. 2011 Apr;127(4):e1077-80. doi: 10.1542/peds.2010-2521. Epub 2011 Mar 14.
We describe the case of a patient with massive acetaminophen-diphenhydramine overdose and a 4-hour serum acetaminophen concentration of 653 μg/mL. The patient was treated with acetylcysteine 5 hours after ingestion. Because of a persistently elevated serum acetaminophen level of 413 μg/mL 45 hours after ingestion, a medical toxicologist recommended that the patient be treated with a second bolus of acetylcysteine (150 mg/kg followed by 12.5 mg/kg per hour for 4 hours, then 6.25 mg/kg per hour). On hospital day 3, she developed hepatic failure despite early treatment. Her transaminase levels and hepatic synthetic function began to improve on hospital day 6, and acetylcysteine was discontinued on hospital day 10. In cases of massive acetaminophen overdose, standard acetylcysteine dosing may not be adequate. We suggest that elevated serum acetaminophen concentrations at the end of a standard 20-hour acetylcysteine infusion should be discussed with the local poison center.
我们描述了一位患者同时过量服用扑热息痛和苯海拉明的病例，摄入后 4 小时血清中扑热息痛浓度为 653μg/mL。摄入后 5 小时给予患者乙酰半胱氨酸治疗。由于摄入后 45 小时血清中扑热息痛水平持续升高至 413μg/mL，一位毒理医学专家建议患者接受第二次乙酰半胱氨酸冲击治疗（150mg/kg，随后每小时 12.5mg/kg，持续 4 小时，然后每小时 6.25mg/kg）。入院第 3 天，尽管早期治疗，她仍出现肝衰竭。入院第 6 天，她的转氨酶水平和肝脏合成功能开始改善，入院第 10 天停止使用乙酰半胱氨酸。在大量扑热息痛过量的情况下，标准剂量的乙酰半胱氨酸可能不够。我们建议，应与当地中毒中心讨论在标准 20 小时乙酰半胱氨酸输注结束时升高的血清扑热息痛浓度。
