Hewett David G, Shields Jennifer, Waring W Stephen
Acute Medical Unit, York Hospital, Wigginton Road, York, YO31 8HE, UK.
Curr Drug Saf. 2013 Jul;8(3):203-6.
Immediate management of drug overdose relies upon the patient account of what was ingested and how much. Paracetamol (acetaminophen) is involved in around 40% of intentional overdose episodes, and remains the leading cause of acute liver failure in many countries including the United Kingdom. In recent years, consumers have had increasing access to medications supplied by international retailers via the internet, which may have different proprietary or generic names than in the country of purchase. We describe a patient that presented to hospital after intentional overdose involving 'acetaminophen' purchased via the internet. The patient had difficulty recalling the drug name, which was inadvertently attributed to 'Advil', a proprietary non-steroidal anti-inflammatory drug. The error was later recognised when the drug packaging became available, but the diagnosis of paracetamol overdose and initiation of acetylcysteine antidote were delayed. This case illustrates the benefit of routinely measuring paracetamol concentrations in all patients with suspected poisoning, although this is not universally accepted in practice. Moreover, it highlights the importance of the internet as a source of medications for intentional overdose, and emphasises the need for harmonisation of international drug names to improve patient safety.
药物过量的紧急处理依赖于患者对所摄入药物及其剂量的描述。对乙酰氨基酚在约40%的故意过量用药事件中涉及，并且在包括英国在内的许多国家仍是急性肝衰竭的主要原因。近年来，消费者通过互联网越来越容易获得国际零售商供应的药物，这些药物可能具有与购买国不同的商品名或通用名。我们描述了一名患者，其在故意过量服用通过互联网购买的“对乙酰氨基酚”后入院。患者难以回忆起药物名称，该药物被误认作“艾德维尔”（Advil），一种商品名非甾体抗炎药。后来当药物包装可用时错误被发现，但对乙酰氨基酚过量的诊断及乙酰半胱氨酸解毒剂的使用被延迟。该病例说明了对所有疑似中毒患者常规检测对乙酰氨基酚浓度的益处，尽管在实际操作中这并未被普遍接受。此外，它凸显了互联网作为故意过量用药药物来源的重要性，并强调了统一国际药物名称以提高患者安全的必要性。
