Intensive Care Unit, Flinders Medical Centre, Adelaide, SA, Australia.
Crit Care Resusc. 2011 Dec;13(4):275-7.
We report the case of a 29-year-old man who ingested about 50 g of standard-preparation paracetamol plus other medications. The serum paracetamol level remained low in the first 24 hours. It peaked 54 hours after ingestion and remained high for 5 days. An N-acetylcysteine (NAC) infusion was started at admission, but was ceased 36 hours later as the clinical and laboratory signs were reassuring. On Day 3, the patient's liver function deteriorated and a rising serum paracetamol level was noted; hence, an NAC infusion was reinitiated. Despite this, the patient developed fulminant hepatic failure. This case underlines the importance of monitoring paracetamol levels and liver function for at least 72 hours after a suspected large overdose of paracetamol before discontinuing NAC infusion.
我们报告了一例 29 岁男性患者，摄入约 50 克标准制剂对乙酰氨基酚加其他药物。摄入后 24 小时内血清对乙酰氨基酚水平持续较低，摄入后 54 小时达到峰值，持续 5 天。入院时开始给予 N-乙酰半胱氨酸（NAC）输注，但在 36 小时后停止，因为临床和实验室表现令人放心。第 3 天，患者肝功能恶化，且血清对乙酰氨基酚水平升高；因此，重新开始给予 NAC 输注。尽管如此，患者仍发展为暴发性肝衰竭。该病例强调了在停止 NAC 输注之前，至少在怀疑大剂量对乙酰氨基酚过量后 72 小时内监测对乙酰氨基酚水平和肝功能的重要性。
