Graudins Andis
Monash Emergency Medicine Program and Clinical Toxicology-Addiction Medicine Service, Monash Health, Melbourne, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
Emerg Med Australas. 2014 Aug;26(4):398-402. doi: 10.1111/1742-6723.12249. Epub 2014 Jun 17.
There are currently no large cases series documenting poisoning with paracetamol modified-release (Panadol Osteo®, GlaxoSmithKline, Sydney, NSW, Australia). Management guidelines recommend at least two serum paracetamol concentrations 4 h apart and initiating treatment with N-acetylcysteine (NAC) if more than 10 g is ingested.
To describe a cohort of Panadol Osteo® poisoning and determine if the management of identified cases was consistent with existing guidelines.
Descriptive retrospective case series presenting to a metropolitan hospital network with paracetamol poisoning from October 2009 to September 2013.
There were 42 cases of Panadol Osteo® poisoning identified. Twenty-nine patients (median ingested dose 19 950 mg) were treated with NAC, of which 27 were acute single ingestions. Of NAC-treated patients, 85% (23/27) had an initial serum paracetamol concentration that was above the nomogram line. However, 15% (4/27) had an initial non-toxic concentration that later increased above the line. In 14 untreated patients (median ingested dose 7980 mg), one was an unrecognised late line-crosser with initial non-toxic serum paracetamol concentration. Only 43% (6/14) had a repeat paracetamol concentration measured. Three patients had a 4 h paracetamol >500 μmol/L. Late line-crossing was seen in the NAC-treated group at this level. In two untreated patients, NAC should have been commenced on the reported dose.
Most patients presenting with Panadol Osteo® poisoning requiring NAC treatment had an initial serum paracetamol concentration indicating need for treatment. A small number of late treatment nomogram line-crossers was seen on repeat paracetamol estimation. The current guideline for Panadol Osteo® poisoning would have detected all cases requiring NAC treatment.
目前尚无大量关于对乙酰氨基酚缓释制剂（必理通健骨配方，葛兰素史克公司，悉尼，新南威尔士州，澳大利亚）中毒的病例系列报道。管理指南建议至少间隔4小时检测两次血清对乙酰氨基酚浓度，若摄入量超过10克，则开始使用N - 乙酰半胱氨酸（NAC）进行治疗。
描述一组必理通健骨配方中毒病例，并确定已确诊病例的治疗是否符合现有指南。
对2009年10月至2013年9月期间因对乙酰氨基酚中毒就诊于一家大都市医院网络的病例进行描述性回顾性病例系列研究。
共确诊42例必理通健骨配方中毒病例。29例患者（摄入剂量中位数为19950毫克）接受了NAC治疗，其中27例为急性单次摄入。在接受NAC治疗的患者中，85%（23/27）的初始血清对乙酰氨基酚浓度高于列线图线。然而，15%（4/27）的患者初始浓度无毒，但后来升高至线以上。在14例未治疗的患者中（摄入剂量中位数为7980毫克），1例是未被识别的后期越过列线图线者，其初始血清对乙酰氨基酚浓度无毒。仅43%（6/14）的患者检测了重复的对乙酰氨基酚浓度。3例患者4小时时对乙酰氨基酚浓度>500μmol/L。在该水平上，NAC治疗组出现了后期越过列线图线的情况。在2例未治疗的患者中，应根据报告剂量开始使用NAC。
大多数因必理通健骨配方中毒而需要NAC治疗的患者，其初始血清对乙酰氨基酚浓度表明需要治疗。在重复对乙酰氨基酚检测中发现了少数后期越过治疗列线图线者。目前针对必理通健骨配方中毒的指南能够检测出所有需要NAC治疗的病例。
