Lystbaek B B, Nørregaard P
Medicinsk afdeling C, Amtssygehuset i Glostrup.
Ugeskr Laeger. 1995 Feb 13;157(7):899-900.
A case of fatal paracetamol (acetaminophen) poisoning in a 26-year-old woman who developed liver necrosis is described. The patient reported having ingested 11 g of a slow-release paracetamol preparation and a certain amount of alcohol and benzodiazepine. An unknown dose of phenobarbital (phenemal) had been ingested 24 hours previously, leading to a serum phenobarbital concentration of 0.195 mmol/l at the time of admission. The patient was initially treated with N-acetylcysteine intravenously. This treatment was discontinued after five hours due to a serum paracetamol concentration of 0.49 mmol/l, well below the "treatment line" paracetamol concentration of 0.8 mmol/l six hours after ingestion. Possible aggravating factors are discussed, including sustained high serum concentration of paracetamol due to the slow-release preparation and enzyme induction caused from concomitant phenobarbital and alcohol intake, as well as benzodiazepines displacing paracetamol from liver enzymes. These factors make serum paracetamol concentrations undependable; the importance of continuing N-acetylcysteine treatment in spite of "safe" serum concentrations in the above cases is stressed.
描述了一名26岁女性因服用扑热息痛（对乙酰氨基酚）中毒导致肝坏死的病例。患者称摄入了11克缓释扑热息痛制剂以及一定量的酒精和苯二氮䓬。24小时前摄入了未知剂量的苯巴比妥，入院时血清苯巴比妥浓度为0.195毫摩尔/升。患者最初接受了静脉注射N - 乙酰半胱氨酸治疗。5小时后因血清扑热息痛浓度为0.49毫摩尔/升而停止治疗，该浓度远低于摄入后6小时“治疗线”的扑热息痛浓度0.8毫摩尔/升。讨论了可能的加重因素，包括缓释制剂导致扑热息痛血清浓度持续升高、同时摄入苯巴比妥和酒精引起的酶诱导作用，以及苯二氮䓬将扑热息痛从肝酶中置换出来。这些因素使得血清扑热息痛浓度不可靠；强调了在上述病例中尽管血清浓度“安全”仍继续进行N - 乙酰半胱氨酸治疗的重要性。
