Clark R F, Chen R, Williams S R, Johnson C L, Harchelroad F
University of California; San Diego Regional Poison Center, CA, 92103-8676, USA.
J Toxicol Clin Toxicol. 1996;34(2):163-7. doi: 10.3109/15563659609013765.
Nausea and vomiting associated with poisoning can complicate treatment and in some cases delay potential antidote administration. Side effect such as lowering the seizure threshold may at times discourage the use of traditional phenothiazine and butyrophenone antiemetics.
We performed a prospective, single arm, observational study examining the effectiveness of the 5HT3 receptor antagonist ondansetron in the management if nausea and vomiting associated with acetaminophen poisoning. Patients with a history or laboratory evidence of acetaminophen poisoning were eligible for inclusion in the study. Exclusion criteria included age less than 18 or greater than 65, use of other antiemetic therapy within the previous 12 hours, history of preexisting hepatic or hematologic disease, pregnancy, or significant ingestion of other substances. Upon meeting entry criteria, patients were administered 8 mg of intravenous ondansetron. Nausea was graded on a 100 mm scale with number of emetic episodes recorded before and after treatment.
Six patients were entered in the study. All patients had nausea and at least one emetic episode prior to ondansetron and prior to administration of N-acetylcysteine. All patients reported relief of nausea after ondansetron. The degree of nausea decreased by an average of 52% at 30 min and 88% at 60 min following ondansetron administration. No significant vital sign changes were recorded in any patient, and there were no complications related to therapy. Three patients were administered N-acetylcysteine, and all tolerated this therapy without vomiting after ondansetron.
Ondansetron appears to be a potentially useful adjunct in the management of nausea and vomiting associated with acetaminophen poisoning.
中毒相关的恶心和呕吐会使治疗复杂化，在某些情况下会延迟潜在解毒剂的使用。诸如降低癫痫发作阈值等副作用有时会阻碍传统吩噻嗪类和丁酰苯类止吐药的使用。
我们进行了一项前瞻性、单臂观察性研究，以检验5-羟色胺3（5HT3）受体拮抗剂昂丹司琼在治疗对乙酰氨基酚中毒相关恶心和呕吐方面的有效性。有对乙酰氨基酚中毒病史或实验室证据的患者符合纳入本研究的条件。排除标准包括年龄小于18岁或大于65岁、在过去12小时内使用过其他止吐疗法、既往有肝脏或血液系统疾病史、怀孕或大量摄入其他物质。符合入选标准后，给患者静脉注射8毫克昂丹司琼。恶心程度按100毫米量表分级，记录治疗前后的呕吐发作次数。
6名患者进入本研究。所有患者在使用昂丹司琼之前以及使用N-乙酰半胱氨酸之前均有恶心且至少有一次呕吐发作。所有患者在使用昂丹司琼后均报告恶心症状缓解。使用昂丹司琼后30分钟时恶心程度平均降低52%，60分钟时降低88%。没有患者记录到明显的生命体征变化，也没有与治疗相关的并发症。3名患者接受了N-乙酰半胱氨酸治疗，且在使用昂丹司琼后均耐受该治疗未出现呕吐。
昂丹司琼似乎是治疗对乙酰氨基酚中毒相关恶心和呕吐的一种潜在有用的辅助药物。
