Rocky Mountain Poison and Drug Center, Aurora, Colorado, USA.
Clin Toxicol (Phila). 2012 Feb;50(2):91-8. doi: 10.3109/15563650.2012.659252.
Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.
乙酰半胱氨酸自 20 世纪 70 年代以来已成功应用于治疗对乙酰氨基酚过量。尽管进行了关于乙酰半胱氨酸疗效和安全性的前瞻性试验，但没有随机对照试验。本评论讨论了造成这种情况的原因，以及口服和静脉给药方案中使用的乙酰半胱氨酸剂量选择的背景。根据摄入对乙酰氨基酚的时间，基于预测可能发生肝毒性的诺模图，将毒性定义为天冬氨酸氨基转移酶/丙氨酸氨基转移酶（ALT/AST）大于 1000 IU/L。虽然这些方法已被证明是普遍有用的，但在对乙酰氨基酚过量后，患者仍会继续发生肝损伤，特别是在摄入后较晚时出现。这些患者的最佳治疗方案仍不清楚，一个不确定的领域是在不同情况下乙酰半胱氨酸的剂量和持续时间。本文讨论了需要阐明的问题，以更好地确定乙酰半胱氨酸剂量的变化。测量其他标志物以改善治疗选择的潜力是进一步研究的主题。
