Saab Sammy, Konyn Peter G, Viramontes Matthew R, Jimenez Melissa A, Grotts Jonathan F, Hamidzadah Wally, Dang Veronica P, Esmailzadeh Negin L, Choi Gina, Durazo Francisco A, El-Kabany Mohamed M, Han Steven-Huy B, Tong Myron J
Department of Medicine, the University of California at Los Angeles, Los Angeles, CA, USA; Department of Surgery, the University of California at Los Angeles, Los Angeles, CA, USA.
Department of Surgery, the University of California at Los Angeles, Los Angeles, CA, USA.
J Clin Transl Hepatol. 2016 Dec 28;4(4):281-287. doi: 10.14218/JCTH.2016.00049. Epub 2016 Dec 27.
Unintentional acetaminophen overdose remains the leading cause of acute liver failure in the United States. Patients with underlying liver disease are at higher risk of poor outcomes from acetaminophen overdose. Limited knowledge of acetaminophen may be a preventable contributor to elevated rates of overdose and thus acute liver failure. The purpose of this study is to assess knowledge of acetaminophen dosing and presence of acetaminophen in common combination products in patients with liver disease. We performed a cross-sectional study of patients with liver disease at the Pfleger Liver Institute at the University of California, Los Angeles between June 2015 and August 2016. Patients completed a demographic questionnaire and an acetaminophen knowledge survey. Additional information was obtained from the medical record. Of 401 patients with liver disease, 30 (15.7%) were able to correctly identify that people without liver disease can safely take up to 4 g/day of acetaminophen. The majority of patients (79.9%-86.8%) did not know that Norco® (hydrocone/acetaminophen), Vicodin® (hydrocone/acetaminophen) and Percocet® (oxycodone/acetaminophen) contained acetaminophen. Only 45.3% of the patients knew that Tylenol® #3 contained acetaminophen. We conclude that patients with liver disease have critically low levels of knowledge of acetaminophen, putting them at risk both of acetaminophen overdose, as well as undermedication, and inadequate management of chronic pain. We recommend an increase in education efforts regarding acetaminophen dosage and its safety in the setting of liver disease. Increasing education for those at risk of low acetaminophen knowledge is essential to minimizing acetaminophen overdose rates and optimizing pain management.
在美国，非故意的对乙酰氨基酚过量服用仍是急性肝衰竭的首要原因。患有基础肝病的患者因对乙酰氨基酚过量服用而出现不良后果的风险更高。对乙酰氨基酚知识的匮乏可能是导致过量服用率升高进而引发急性肝衰竭的一个可预防因素。本研究的目的是评估肝病患者对乙酰氨基酚剂量的了解情况以及常见复方制剂中对乙酰氨基酚的存在情况。我们于2015年6月至2016年8月在加利福尼亚大学洛杉矶分校的普弗莱格肝脏研究所对肝病患者进行了一项横断面研究。患者完成了一份人口统计学调查问卷和一项对乙酰氨基酚知识调查。还从病历中获取了其他信息。在401名肝病患者中，30名（15.7%）能够正确识别出没有肝病的人每天安全服用对乙酰氨基酚的剂量可达4克。大多数患者（79.9% - 86.8%）不知道诺科（氢可酮/对乙酰氨基酚）、维柯丁（氢可酮/对乙酰氨基酚）和派酷西特（羟考酮/对乙酰氨基酚）含有对乙酰氨基酚。只有45.3%的患者知道泰诺3号含有对乙酰氨基酚。我们得出结论，肝病患者对乙酰氨基酚的了解程度极低，这使他们面临对乙酰氨基酚过量服用、用药不足以及慢性疼痛管理不当的风险。我们建议加大关于对乙酰氨基酚剂量及其在肝病情况下安全性的教育力度。对那些对乙酰氨基酚知识匮乏风险较高的人群加强教育对于将对乙酰氨基酚过量服用率降至最低以及优化疼痛管理至关重要。
