Clinical Toxicology, Pharmacology and Toxicology, Queen's Medical Research Institute, University of Edinburgh, UK.
Br J Clin Pharmacol. 2023 Jan;89(1):34-38. doi: 10.1111/bcp.15201. Epub 2022 Feb 3.
Paracetamol poisoning continues to be a worldwide problem and, despite the availability of an effective antidote, acetylcysteine (NAC), the optimal way to use this antidote, particularly following very large doses of paracetamol, has not been established. Recent case series have shown an increased toxicity from high doses of paracetamol, even in those receiving prompt NAC therapy, particularly in patients above the 300 mg/L nomogram treatment line. Clinical trial evidence supporting shorter NAC dosing now allows the possibility for intensifying treatment without the risk of very high rates of ADRs. New biomarkers also show the possibility of early identification of patients at risk of liver injury who might also benefit from increased intensity treatment. This article discusses these data and proposes a logical therapy for increasing NAC dosing which now requires clinical trial testing.
对乙酰氨基酚中毒仍然是一个全球性的问题，尽管有有效的解毒剂乙酰半胱氨酸（NAC）可用，但尚未确定使用这种解毒剂的最佳方法，特别是在服用大剂量对乙酰氨基酚后。最近的病例系列研究表明，即使在接受及时 NAC 治疗的患者中，高剂量对乙酰氨基酚也会增加毒性，尤其是在超过Nomogram 治疗线 300mg/L 的患者中。支持缩短 NAC 剂量的临床试验证据现在为强化治疗提供了可能性，而不会增加不良反应的极高发生率的风险。新的生物标志物也表明有可能早期识别有肝损伤风险的患者，他们也可能受益于强化治疗。本文讨论了这些数据，并提出了增加 NAC 剂量的合理治疗方法，现在需要临床试验测试。
