Le Vaillant J, Pellerin L, Brouard J, Eckart P
Service de pédiatrie médicale, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France.
Arch Pediatr. 2013 Jun;20(6):650-3. doi: 10.1016/j.arcped.2013.03.027. Epub 2013 Apr 28.
Renal failure secondary to acetaminophen poisoning is rare and occurs in approximately 1-2 % of patients with acetaminophen overdose. The pathophysiology is still being debated, and renal acetaminophen toxicity consists of acute tubular necrosis, without complication if treated promptly. Renal involvement can sometimes occur without prior liver disease, and early renal manifestations usually occur between the 2nd and 7th day after the acute acetaminophen poisoning. While therapy is exclusively symptomatic, sometimes serious metabolic complications can be observed. The monitoring of renal function should therefore be considered as an integral part of the management of children with acute, severe acetaminophen intoxication. We report 3 cases of adolescents who presented with acute renal failure as a result of voluntary drug intoxication with acetaminophen. One of these 3 girls developed severe renal injury without elevated hepatic transaminases. None of the 3 girls' renal function required hemodialysis, but one of the 3 patients had metabolic complications after her acetaminophen poisoning.
对乙酰氨基酚中毒继发的肾衰竭很罕见，约1-2%的对乙酰氨基酚过量患者会出现。其病理生理学仍存在争议，肾脏对乙酰氨基酚毒性表现为急性肾小管坏死，若及时治疗则无并发症。肾脏受累有时可在无既往肝脏疾病的情况下发生，早期肾脏表现通常出现在急性对乙酰氨基酚中毒后的第2至7天。虽然治疗仅为对症治疗，但有时可观察到严重的代谢并发症。因此，肾功能监测应被视为急性、重度对乙酰氨基酚中毒儿童管理的一个组成部分。我们报告3例青少年因自愿服用对乙酰氨基酚导致急性肾衰竭的病例。这3名女孩中有1名出现严重肾损伤但肝转氨酶未升高。这3名女孩均无需进行血液透析来维持肾功能，但其中1名患者在对乙酰氨基酚中毒后出现了代谢并发症。
