University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Children's Hospital Colorado, Aurora, CO, USA.
Ann Pharmacother. 2023 Jan;57(1):36-43. doi: 10.1177/10600280221097700. Epub 2022 May 19.
Acetaminophen overdose is a leading cause of liver failure, and a leading cause of pediatric poisoning requiring hospital admission. The antidote, N-acetylcysteine (NAC), is traditionally administered as a three-bag intravenous infusion. Despite its efficacy, NAC is associated with high incidence of nonallergic anaphylactoid reactions (NAARs). Adult evidence demonstrates that alternative dosing regimens decrease NAARs and medication errors (MEs).
To compare NAARs and MEs associated with two- versus three-bag NAC for acetaminophen overdose in a pediatric population.
This is a retrospective observational cohort study comparing pediatric patients who received three- versus two-bag NAC for acetaminophen toxicity. The primary outcome was incidence of NAARs. Secondary outcomes were rates of MEs and relevant hospital outcomes (length of stay [LOS], intensive care unit (ICU) admission, liver transplant, death).
Two hundred forty-three patients met inclusion criteria (median age of 15 years): 150 (62%) three-bag NAC and 93 (38%) two-bag NAC. There was no difference in overall NAARs ( = 0.54). Fewer cutaneous NAARs were observed in the two-bag group, three-bag: 15 (10%), two-bag: 2 (2%), = 0.02. MEs were significantly decreased with the two-bag regimen, three-bag: 59 (39%), two-bag: 21 (23%), = 0.01. No statistical differences were observed in LOS, ICU admissions, transplant, or death.
A significant decrease in cutaneous NAARs and MEs was observed in pediatric patients by combining the first two bags of the traditional three-bag NAC regimen. In pediatric populations, a two-bag NAC regimen for acetaminophen overdose may improve medication tolerance and safety.
对乙酰氨基酚过量是导致肝衰竭的主要原因，也是导致需要住院治疗的儿科中毒的主要原因。解毒剂 N-乙酰半胱氨酸（NAC）传统上采用三袋静脉输注。尽管它有效，但 NAC 与高发生率的非过敏性类过敏反应（NAAR）有关。成人证据表明，替代剂量方案可降低 NAAR 和用药错误（ME）。
比较两种与三种 NAC 袋治疗儿童对乙酰氨基酚过量的 NAAR 和 ME。
这是一项比较接受三种与两种 NAC 袋治疗对乙酰氨基酚毒性的儿科患者的回顾性观察队列研究。主要结果是 NAAR 的发生率。次要结果是 ME 和相关的医院结果（住院时间[LOS]、重症监护病房[ICU]入院、肝移植、死亡）的发生率。
243 名患者符合纳入标准（中位年龄 15 岁）：150 名（62%）三袋 NAC 和 93 名（38%）两袋 NAC。总 NAAR 无差异（=0.54）。两袋组观察到较少的皮肤 NAAR，三袋组：15（10%），两袋组：2（2%），=0.02。两袋方案 ME 明显减少，三袋组：59（39%），两袋组：21（23%），=0.01。LOS、ICU 入院、移植或死亡无统计学差异。
通过组合传统三袋 NAC 方案的前两袋，观察到儿科患者皮肤 NAAR 和 ME 明显减少。在儿科人群中，乙酰氨基酚过量的两袋 NAC 方案可能会提高药物耐受性和安全性。
