孕期与营养不良相关的对乙酰氨基酚中毒
Malnourishment-Associated Acetaminophen Toxicity in Pregnancy.
作者信息
Dom Aaron M, Royzer Rebecca, Olson-Chen Courtney
机构信息
Department of Obstetrics and Gynecology, University of Rochester Medical Center, the University of Rochester School of Medicine and Dentistry, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York.
出版信息
Obstet Gynecol. 2021 May 1;137(5):877-880. doi: 10.1097/AOG.0000000000004351.
BACKGROUND
Although acetaminophen is commonly used in pregnancy, it can deplete glutathione concentrations and cause accumulation of 5-oxoproline, with subsequent metabolic acidosis.
CASE
A malnourished 25-year-old woman, G2P1001, with chronic acetaminophen use presented with abdominal pain and high anion gap metabolic acidosis. After ruling out other potential causes, her urine 5-oxoproline level was found to be elevated. She received N-acetylcysteine, with resolution of the acidosis.
CONCLUSION
Those who care for pregnant patients should remain alert to 5-oxoprolinemia as a cause of metabolic acidosis during pregnancy. Care must be taken when using acetaminophen in states of malnutrition. N-acetylcysteine seems to be an effective antidote.
背景
尽管对乙酰氨基酚在孕期常用，但它会消耗谷胱甘肽浓度并导致5-氧脯氨酸蓄积，继而引发代谢性酸中毒。
病例
一名25岁、孕2产1（G2P1001）、长期使用对乙酰氨基酚的营养不良女性，因腹痛和高阴离子间隙代谢性酸中毒就诊。排除其他潜在病因后，发现其尿中5-氧脯氨酸水平升高。她接受了N-乙酰半胱氨酸治疗，酸中毒得以缓解。
结论
照料孕期患者的人员应警惕5-氧脯氨酸血症作为孕期代谢性酸中毒的一个病因。在营养不良状态下使用对乙酰氨基酚时必须谨慎。N-乙酰半胱氨酸似乎是一种有效的解毒剂。
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