aDepartment of Clinical Toxicolgy, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners bKing's College London, London, UK.
Eur J Emerg Med. 2014 Feb;21(1):57-60. doi: 10.1097/MEJ.0b013e328364eb22.
Adverse drug reactions (ADRs) to N-acetylcysteine (NAC) treatment for paracetamol overdose are typically anaphylactoid in origin and occur in 2-48% of treated patients. We explored the incidence and management of NAC ADR in our unit.
Case notes of patients who presented with paracetamol overdose and had ADR to NAC between February 2005 and June 2011 were reviewed. A total of 1648 patients presented with suspected paracetamol overdose and 660 received NAC treatment. Within this group, 82 patients had documented NAC-related ADR.
ADR developed in 12.4% (82/660) of patients receiving intravenous NAC and 59 had full documentation available and were included in this study (34 women, 25 men). ADR occurred in the 15-min (150 mg/kg) bag in 36 cases (61%), 22 in the 4-h (50 mg/kg) bag (37%) and one in the 16-h (100 mg/kg) bag (2%). Symptoms were classified as minimal (n=16, 27%), moderate (n=26, 44%) and severe (n=17, 29%). Asthma and female sex, which are reported risk factors for ADR, did not lead to the development of more severe ADR (P=0.771 and 0.330, respectively). Treatments administered included stopping the NAC infusion (n=32, 54%), administration of antiemetics (n=36, 61%), H1 antihistamines (n=26, 44%), steroids (n=16, 27%), inhaled B2 agonists (n=6, 10%) and adrenaline (n=3, 5%).
The incidence of ADR to NAC was comparable with published studies, although there was no association of severity with asthma or female sex. The management of ADRs is variable, with frequent, inappropriate use of steroids. Education about the pathophysiology of these ADRs may improve management.
对乙酰氨基酚过量患者使用 N-乙酰半胱氨酸（NAC）治疗的不良反应（ADR）通常源于过敏反应，发生于 2-48%的治疗患者中。我们探讨了本单位 NAC ADR 的发生率和处理方法。
回顾了 2005 年 2 月至 2011 年 6 月期间因对乙酰氨基酚过量就诊且对 NAC 出现 ADR 的患者的病历。共有 1648 例疑似对乙酰氨基酚过量患者，其中 660 例接受了 NAC 治疗。在此组中，82 例有记录的与 NAC 相关的 ADR。
接受静脉内 NAC 治疗的患者中，ADR 发生率为 12.4%（82/660），其中 59 例有完整记录并纳入本研究（34 例女性，25 例男性）。ADR 发生在 15 分钟（150mg/kg）袋中 36 例（61%），4 小时（50mg/kg）袋中 22 例（37%），16 小时（100mg/kg）袋中 1 例（2%）。症状分为轻度（16 例，27%）、中度（26 例，44%）和重度（17 例，29%）。哮喘和女性性别是 ADR 的报告危险因素，但并未导致更严重的 ADR 发生（P=0.771 和 0.330）。给予的治疗包括停止 NAC 输注（32 例，54%）、给予止吐药（36 例，61%）、H1 抗组胺药（26 例，44%）、类固醇（16 例，27%）、吸入 B2 激动剂（6 例，10%）和肾上腺素（3 例，5%）。
NAC ADR 的发生率与已发表的研究相似，尽管严重程度与哮喘或女性性别无关。ADR 的处理方法各不相同，类固醇的频繁、不适当使用较为常见。对这些 ADR 病理生理学的教育可能会改善管理。
