Cohen Phillip D, Schultz Brian R E, Schuette Jennifer, Kudchadkar Sapna R
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Am J Case Rep. 2025 Aug 12;26:e948715. doi: 10.12659/AJCR.948715.
BACKGROUND Acetaminophen toxicity is a leading cause of liver injury in adolescents and is usually treated with N-acetylcysteine (NAC). Rarely, adjunctive therapies, including hemodialysis (HD) and fomepizole, are required. This report describes the case of a 15-year-old male adolescent who required 2 hemodialysis sessions greater than 24 hours apart after a massive, intentional ingestion of acetaminophen. CASE REPORT A 15-year-old male patient presented to care after a single, intentional ingestion of approximately 195 g of extended-release acetaminophen. He was started on NAC therapy, and due to concern for early mitochondrial failure, he underwent intermittent HD, with reduction of his acetaminophen level. However, over 24 hours later, his transaminases increased and liver synthetic function declined, and he underwent HD a second time. There was no evidence of bezoar formation on computed tomography (CT) scan, suggesting that ongoing absorption was due to the extended-release formulation consumed. After his second HD session, his laboratory values normalized and he was medically cleared for transfer to psychiatry. CONCLUSIONS The need for a second HD session in acetaminophen toxicity >24 hours after an initial successful HD session is unprecedented. Given an increasing market of extended-release products and the potential for co-ingestions with medications that slow gastrointestinal motility, HD may be more frequently employed going forward, potentially multiple times. While central lines should be removed promptly when no longer needed, we advise caution in removing dialysis catheters within 24 hours of initial HD in these patients, given the need to repeat HD in this case.
对乙酰氨基酚中毒是青少年肝损伤的主要原因，通常用N - 乙酰半胱氨酸（NAC）治疗。很少需要包括血液透析（HD）和甲吡唑在内的辅助治疗。本报告描述了一名15岁男性青少年的病例，该患者在大量故意摄入对乙酰氨基酚后，需要间隔超过24小时进行两次血液透析。
一名15岁男性患者在单次故意摄入约195克缓释对乙酰氨基酚后前来就医。他开始接受NAC治疗，由于担心早期线粒体功能衰竭，他接受了间歇性血液透析，对乙酰氨基酚水平有所降低。然而，24小时后，他的转氨酶升高，肝脏合成功能下降，于是再次接受血液透析。计算机断层扫描（CT）扫描未发现胃石形成的证据，这表明持续吸收是由于摄入的缓释制剂所致。在第二次血液透析后，他的实验室检查值恢复正常，并在医学上获准转至精神科。
在首次成功进行血液透析24小时后，对乙酰氨基酚中毒患者需要进行第二次血液透析的情况是前所未有的。鉴于缓释产品市场不断扩大，以及与减缓胃肠蠕动的药物同时摄入的可能性，未来可能会更频繁地使用血液透析，甚至可能多次使用。虽然在不再需要时应及时拔除中心静脉导管，但鉴于该病例需要重复进行血液透析，我们建议在这些患者首次血液透析后24小时内拔除透析导管时要谨慎。
