Ali Muzzammil, Misurati Mohammad, Rodgers Rebekah, Pooni Jagtar
Intensive Care Unit, New Cross Hospital, Wolverhampton, Wolverhampton, UK.
BMJ Case Rep. 2019 Apr 5;12(4):e228920. doi: 10.1136/bcr-2018-228920.
An 84-year-old woman presented to hospital with severe clinical and metabolic sequelaesequelae of a massive paracetamol overdose (concentration=822 mg/L). In spite of N-acetylcysteine therapy, she deteriorated with evidence of mitochondrial dysfunction. Although the EXtracorporeal TReatments In Poisoning group recommend adjunct haemodialysis (HD) in such a context, this was difficult to start due to haemodynamic instability. Instead, a trial of continuous venovenous haemodiafiltration (CVVHDF) was initiated in an attempt to restore normal mitochondrial function, normal pH and to actively remove the offending drug. Fortunately, plasma paracetamol levels fell exponentially over the subsequent 24-48 hours without the need to commence HD. The patient made a full recovery and was later discharged from the hospital. This case highlights that CVVHDF can be a reasonable alternative to HD for managing massive paracetamol overdoses in the context of mitochondrial dysfunction.
一名84岁女性因对乙酰氨基酚大量过量服用（浓度=822mg/L）出现严重的临床和代谢后遗症而入院。尽管接受了N-乙酰半胱氨酸治疗，但她仍因线粒体功能障碍而病情恶化。尽管中毒体外治疗组建议在这种情况下辅助进行血液透析（HD），但由于血流动力学不稳定，难以启动。取而代之的是，开始进行持续静脉-静脉血液透析滤过（CVVHDF）试验，试图恢复正常的线粒体功能、正常的pH值并积极清除致病药物。幸运的是，在随后的24至48小时内，血浆对乙酰氨基酚水平呈指数下降，无需开始进行HD。患者完全康复，随后出院。该病例表明，在存在线粒体功能障碍的情况下，CVVHDF可以作为管理对乙酰氨基酚大量过量服用的一种合理替代HD的方法。
