a Department of Emergency Medicine , Oregon Health and Science University , Portland , OR , USA.
Clin Toxicol (Phila). 2019 Aug;57(8):686-691. doi: 10.1080/15563650.2019.1579914. Epub 2019 Feb 19.
While the traditional intravenous -acetylcysteine (NAC) dosing regimen works well for the vast majority of acetaminophen overdoses, there may be cases of massive overdose where additional NAC may be necessary. Recent evidence suggests that patients with acetaminophen concentrations above the "300-line" develop hepatotoxicity at a higher rate than those below the 300-line, suggesting that an increase of dose may be beneficial at this cut-off. Additional clinical data suggest a further increase in doses at the 450-line and 600-lines. I propose a strategy for step-wise increases in NAC dosing in response to high acetaminophen concentrations at the 300-, 450-, and 600-lines after acute massive acetaminophen overdoses.
虽然传统的静脉内乙酰半胱氨酸（NAC）给药方案对绝大多数对乙酰氨基酚过量有效，但在某些大剂量用药的情况下，可能需要额外的 NAC。最近的证据表明，血清对乙酰氨基酚浓度高于“300 线”的患者比浓度低于 300 线的患者发生肝毒性的速度更快，这表明在此截止值增加剂量可能有益。额外的临床数据表明，在 450 线和 600 线时，剂量进一步增加。我提出了一种策略，即在急性大剂量对乙酰氨基酚过量后，根据血清对乙酰氨基酚浓度在 300 线、450 线和 600 线时的升高情况，逐步增加 NAC 的剂量。
