Murphy Daniel, Khan Abrar, Borscheid Christine, Riad Samy
Department of Medicine and.
M Health Fairview, University of Minnesota, Minneapolis, MN, USA.
Clin Nephrol Case Stud. 2020 Sep 1;8:62-66. doi: 10.5414/CNCS109936. eCollection 2020.
Particularly large acetaminophen overdoses, termed massive, create a therapeutic challenge given the standardized, N-acetylcysteine-based treatment. One consideration in addition to N-acetylcysteine is the initiation of hemodialysis due to the dialyzable nature of acetaminophen, though encumbered by the concurrent removal of the antidote, N-acetylcysteine. Such cases of large acetaminophen overdose, along with possible concomitant ingestions of other drugs or inactive ingredients, can be complicated by challenging-to-interpret clinical signs and laboratory findings. We describe a case of a 46-year-old man for whom we were consulted regarding consideration of dialysis treatment 7 hours after ingestion of 125 g of acetaminophen. The patient developed multiple early signs and laboratory findings consistent with a significant acetaminophen overdose. He also developed a rarely described, likely acetaminophen-interference-induced laboratory abnormality. Finally, he possibly had toxicity from an "inactive" ingredient. He was treated with a single session of prolonged hemodialysis (9.5 hours) and increased dosing of N-acetylcysteine with a positive outcome. Herein, we discuss the decision making and interpretation of clinical data pertaining to dialysis treatment and other therapies after a massive acetaminophen overdose.
超大剂量对乙酰氨基酚中毒，即所谓的大量中毒，鉴于基于N - 乙酰半胱氨酸的标准化治疗，会带来治疗挑战。除N - 乙酰半胱氨酸外，鉴于对乙酰氨基酚的可透析性，还需考虑启动血液透析，尽管同时会清除解毒剂N - 乙酰半胱氨酸。这种大剂量对乙酰氨基酚中毒的病例，以及可能同时摄入的其他药物或非活性成分，可能会因难以解释的临床症状和实验室检查结果而变得复杂。我们描述了一例46岁男性病例，在其摄入125克对乙酰氨基酚7小时后，我们就其是否考虑透析治疗进行会诊。该患者出现了多个与严重对乙酰氨基酚中毒相符的早期症状和实验室检查结果。他还出现了一种很少被描述的、可能由对乙酰氨基酚干扰引起的实验室异常。最后，他可能因一种“非活性”成分而中毒。他接受了单次延长血液透析（9.5小时）治疗，并增加了N - 乙酰半胱氨酸的剂量，结果良好。在此，我们讨论在大量对乙酰氨基酚中毒后，有关透析治疗及其他疗法的临床数据的决策和解读。
