Acetaminophen (Paracetamol / Tylenol) a Wɔnom boro So ne Nnɔnhwerew 8 Nnuru a Wɔde Ko Tia Mfɛnsere¶

Acetaminophen a wɔnom boro so (a wonim no wɔ amanaman ntam sɛ paracetamol na wɔtɔn no wɔ din ahorow te sɛ Tylenol, Panadol, Calpol, ne Excedrin ase, ne nnuru ɔhaha pii a ɛwɔ atiridiinini, atiridiinini, sinus, nna, ne opioid a wɔaka abom a wɔkyerɛw ma no mu) ne ade titiriw a ɛde mmerɛbo di huammɔ kɛse wɔ United States, United Kingdom, Canada, Australia, ne Europa nyinaa. Nea ɛma acetaminophen awuduru yɛ nsisi soronko ne ne nnaadaa "mfɛnsere a ɛyɛ komm" wɔ nnɔnhwerew 24 a edi kan no mu: obi a ɔmene dodow a ebetumi adi awu no taa te nka sɛ ɔte apɔw koraa, anaasɛ onya akisikuru ne fifiri a ɛnyɛ den nkutoo a ebesi adekyee anɔpa no ano aduru, na ɛma wɔne wɔn abusua gye di sɛ wɔaguan afi ɔhaw mu bere a awuduru a ɛma nipadua no yɛ adwuma no sɛe wɔn mmerɛbo mu nkwammoaa.

Esiane sɛ aduru a wɔde fa ntini mu anaa wɔnom N-acetylcysteine (NAC) no bɛn ɔha biara mu nkyem 98 kosi ɔha biara mu nkyem 100 a etu mpɔn wɔ mmerɛbo a ɛsɛe kɛse ne owu ano bere a wofi ase wɔ nnɔnhwerew 8 akyi wɔ bere a woanom denneennen nti, twɛn kosi sɛ wobɛte nka sɛ woyare, wunya yafunu nifa atifi yaw, anaasɛ wubehu honam ani kɔkɔɔ (jaundice) wɔ Da a ɛto so abien anaa Da a ɛto so abiɛsa no betumi ayɛ owuyare mfomso. Saa akwankyerɛ a egye ntɛmpɛ a ɛkɔ akyiri yi ka awuduru a wɔde siw ano ntɛm ara a wɔpaw, sɛnea wobu miligram-kilogram biara a wɔde di dwuma pɛpɛɛpɛ wɔ nnuru a wɔaka abom a ahintaw mu, ayaresa mu akwan anan a ɛma hepatotoxicity, Rumack-Matthew nnɔnhwerew 4 mogya mu nomogram vs. staggered supratherapeutic ingestions, ne ayaresabea ICU nkwagye nhyehyɛe ahorow a ɛne American Association of Poison hyia no mu kɔ akyiri Asoɛe a Ɛhwɛ Awuduru So (AAPCC), UK Ɔman Awuduru Ho Amanneɛbɔ Dwumadibea (NPIS / TOXBASE), ne Wiase Nyinaa Akwahosan Ahyehyɛde (WHO).

Yɛ eyi mprempren¶

Sɛ wo anaa obi foforo anom acetaminophen (paracetamol) pii prɛko pɛ, anaasɛ wanom dodow a ɛkɔ soro a ɛka bom wɔ akwanhyia mu wɔ nnɔnhwerew 24 kosi 72 mu a:

1. NHWƐ sɛ yareɛ no ho sɛnkyerɛnne no bɛda adi: Frɛ wo mpɔtam hɔ awuduru adwumayɛbea ntɛm ara (wɔ United States no, frɛ 1-800-222-1222; wɔ United Kingdom no, frɛ NHS 111 anaa 999; wɔ Australia no, frɛ 13 11 26; wɔ Canada no, frɛ 1-844-POISON-X anaa wo mantam line) anaa kɔ kɔ ayaresabea dwumadibea a ɛhwɛ ntɛmpɛ a ɛbɛn hɔ no so tẽẽ. Sɛ onipa no da, n’adwene atu afra, ɔfe mpɛn pii, anaasɛ ɔhyɛɛ da nom nnuru no a, frɛ wo mpɔtam hɔ nɔma a egye ntɛmpɛ (911 wɔ U.S. ne Canada, 112 wɔ Europa nyinaa, 999 wɔ UK) denam yɛn nɔma ahorow a egye ntɛmpɛ directory a wɔde kyerɛw nsɛm.
2. Boaboa nnuru toa biara, blister pack, ne atiridii/atiridiinini wrapper: Hwɛ "Active Ingredients" a wɔakyerɛw so wɔ aduru biara a wɔtɔn ne nnuru a wɔkyerɛw ma a wɔnom wɔ nnɔnhwerew 72 a atwam no mu ma Acetaminophen, Paracetamol, anaa APAP (aduru a wɔkyerɛw ma N-acetyl-para-aminophenol, a wohu wɔ hydrocodone/APAP anaa oxycodone/APAP nkotoku mu). Fa ade biara a wode gu mu no bra baabi a wɔhwɛ wɔn a wɔwɔ ayaresa a egye ntɛmpɛ mu.
3. Kyerɛw dɔnhwerew bere pɔtee a wɔde me ne onipa no mu duru: Ayaresabea nnuruyɛfo de wɔn ho to mogya mu nhwehwɛmu a wɔyɛ wɔ nnɔnhwerew 4 akyi wɔ anom (a wɔayɛ ho mfonini wɔ Rumack-Matthew nomogram so) so de ahu awuduru a ɛwɔ mu bere a wɔanom boro so pɛnkoro akyi. Ka simma pɔtee a wɔmenee nnuru no (anaasɛ bere a edi kan ne nea etwa to sɛ wɔnom no bɛboro nnɔnhwerew pii a) ne onipa no nipadua mu duru wɔ kilogram (anaa nkaribo) mu kyerɛ ɔyarehwɛfo a ɔhwɛ ayarefo no.
4. Mma obi nfe wɔ fie da: Mfa ipecac syrup, nkyene nsu, anaa nsateaa a wɔde hyɛ mu nni dwuma. Sɛ wɔma ɔfe a, eyi nnuru a wɔapete no mfi hɔ yiye na ebetumi ama ahurututu mu yare a wɔde aspiration ayɛ anaasɛ akyɛ fango a wɔnom ne N-acetylcysteine ​​a wɔde ma wɔ ayaresabea no ase.
5. Bisa Activated Charcoal ho asɛm sɛ ɛba nnɔnhwerew 1 kosi 2 ntam (ɛkɔ nnɔnhwerew 4 ma yafunu no mu bere tenten): Sɛ onipa no du baabi a wɔhwɛ ntɛmpɛ so wɔ ** nnɔnhwerew 1 kosi 2** akyi bere a wamene awuduru dodow bi (anaasɛ ɛkɔ ** nnɔnhwerew 4** wɔ ntini mu yare a ɛma yafunu mu 650 mg a wɔayi no adi bere tenten anaa nea ɛka bom a ɛma yafunu no mu da hɔ brɛoo ho) a, adwumayɛfo a wɔhwɛ ntɛmpɛ so betumi de ama fango a wɔde yɛ adwuma (gram 1 kilogram biara, ɛkɔ gram 50) a wɔnom pɛnkoro de kyekyere acetaminophen a wɔannye no wɔ yafunu mu ansa na akɔ mogya no mu.
6. Hwɛ sɛ wofi ase N-acetylcysteine ​​(NAC) wɔ nnɔnhwerew 8 sika kɔkɔɔ mfɛnsere no mu sɛ wɔakyerɛ a: Sɛ mogya mu dodow biako ntumi mma ansa na ** nnɔnhwerew 8 wɔ anom akyi**, anaasɛ sɛ ɔyarefo no faa dodow a ɛboro so a ɛyɛ ahodwiriw nna pii a, ayaresabea akwankyerɛ kyerɛ sɛ wofi ase de fa ntini mu anaa wɔnom N-acetylcysteine ​​(NAC) wɔ osuahu mu ntɛm ara bere a ɔretwɛn nea ebefi awotwaa mu aba no.

Acetaminophen dodow a ɛboro so triage ne NAC antidote bere nhyehyɛe flowchart¶

flowchart TD
    Start["Wosusuw sɛ Acetaminophen / Paracetamol Dodow Bɛboro so<br/>(Wɔnom a Ɛyɛ Ntɛmntɛm Baako ANAA Dose a Wɔnom no Mpɛn pii a Wɔyɛ no Nsakrae) ."] --> TimeCheck["Kyerɛw Dɔn Bere (bere) Pɛpɛɛpɛ a Wɔde Di, Pill Formulation<br/>(Ntɛm ara vs Extended-Release vs Liquid), ne Nipadua Mu duru (kg) ."]

    TimeCheck --> CallPoison["Frɛ Poison Control (1-800-222-1222 wɔ U.S.) anaa Kɔ Ayaresabea ED<br/>Hwɛ Atiridii/Atiridii/Dada/APAP nkotoku a ɛwɔ sɛnkyerɛnne ahorow pii no NYINAA sɛ ebia dodow a ahintaw anaa"]

    CallPoison --> TypeSplit{"So eyi yɛ Single Acute Ingestion<br/>(aduru a wɔnom nyinaa wɔ nnɔnhwerew <4 kosi 8 mfɛnsere mu)<br/>ANAA Staggered / Repeated Supratherapeutic Ingestion?"}

    TypeSplit -->|Single Acute Ingestion<br/>(<8 hours since first pill)| CharcoalCheck{"Bere a atwam fi bere a wɔnom no?"}

    CharcoalCheck -->|Within 1 to 2 hours<br/>(or up to 4 hours for Extended-Release)| GiveAC["Fa Single-Dose Activated Charcoal (1 g/kg kosi 50 g)<br/>sɛ ɔyarefo no ani da hɔ na ɛbɔ mframa kwan ho ban a"]
    CharcoalCheck -->|2 to 8 hours post-ingestion| DrawLabs4h["Twe Serum Acetaminophen Level wɔ Nnɔnhwerew 4 PƐPƐƐPƐƐPƐ mu Post-Ingestion<br/>(anaasɛ ntɛm ara bere a woadu hɔ sɛ ɛba nnɔnhwerew 4 kosi 8 ntam a)"]
    GiveAC --> DrawLabs4h

    DrawLabs4h --> Nomogram["Plot 4-to-24 Hour Serum Level on Rumack-Matthew Nomogram<br/>(US Ayaresa Line: 150 mcg/mL wɔ nnɔnhwerew 4 / UK Line: 100 mg/L wɔ nnɔnhwerew 4)<br/>NHYƐ NO NSO: Wɔ Extended-Release (ER) 650 mg tablets ho no, san yɛ level nnɔnhwerew 4-6 akyi"]

    Nomogram --> AboveLine{"So level wɔ ayaresa line no so anaasɛ ɛboro saa,<br/>ANAA ɛbɛkyɛ nea ebefi mu aba no bɛkyɛ nnɔnhwerew 8?"}
    AboveLine -->|Yes| StartNAC["FIE N-ACETYLCYSTEINE (NAC) ANTIDOTE NTƐM<br/>Ɛkame ayɛ sɛ ɛbɔ ho ban 100% fi mmerɛbo a entumi nyɛ adwuma yiye ho bere a wofi ase wɔ nnɔnhwerew 8 mu no"]
    AboveLine -->|No (and ER repeat level negative)| SafeDischarge["Aduruyɛ mu kwan a wɔde ma bere a wɔahyɛ AST/ALT<br/>a ɛteɛ no so dua akyi ne adwenemyare ahobammɔ nhwehwɛmu sɛ wɔahyɛ da ayɛ a"]

    TypeSplit -->|Late Presentation (>8 hours post-ingestion)<br/>OR Unknown Time of Ingestion<br/>OR Staggered / Repeated Overdose (>24 hours)| EmpiricNAC["NTWƐN LAB NSƐM: Rumack-Matthew Nomogram NNYƐ ADWUMA<br/>1. Fi ase fa Empiric IV/Oral N-Acetylcysteine ​​(NAC) ntɛm ara<br/>2. Twe STAT Nkwammoaa mu Acetaminophen, AST, ALT, INR, Bilirubin, Creatinine, Lactate, pH<br/>3. Toa NAC so sɛ Acetaminophen yɛ nea wotumi hu (>10 mcg/mL) ANAA AST/ALT kɔ soro a"]

Pathophysiology: Sɛnea Acetaminophen Sɛe Mmɛn (NAPQI & Glutathione Ɔhaw) .¶

Dɛn nti na acetaminophen yɛ nea ahobammɔ wom koraa na ɛyɛ brɛoo wɔ yafunu no so wɔ ayaresa dodow a ɛfata mu, nanso etumi de asiane kɛse ba centrilobular hepatic necrosis ne acute renal tubular necrosis bere a wɔnom boro so no?

1. Ayaresa mu Nkwammoaa a Ɛyɛ Fɛ (Glucuronidation ne Sulfation a Ahobammɔ Wom) .¶

Sɛ ɔpanyin a ɔwɔ apɔwmuden mene acetaminophen dodow a ɛfata a wɔde sa yare (sɛ nhwɛso no, 500 mg kosi 1,000 mg):

• Bɛyɛ ɔha biara mu nkyem 85 kosi ɔha biara mu nkyem 90 no, wɔde Phase II conjugation enzymes (glucuronosyltransferases ne sulfotransferases) di dwuma dwoodwoo wɔ mmerɛbo no mu, a ɛde glucuronide anaa sulfate molecules bata acetaminophen no ho ma enti wobetumi ayi afi nsu mu a asiane biara nni ho.
• Bɛyɛ ɔha biara mu nkyem 2 kosi ɔha biara mu nkyem 5 na asaabo no yi fi nipadua no mu a ɛnsakra.
• ɔha biara mu nkyem 5 kosi ɔha biara mu nkyem 10 a aka no nam hepatic cytochrome P450 enzyme system (titiriw CYP2E1, ne CYP1A2 ne CYP3A4) so ​​ma ɛyɛ oxidized ma ɛbɛyɛ metabolite a ɛyɛ adwuma kɛse, electrophilic, na awuduru a ano yɛ den a wɔfrɛ no NAPQI (N-acetyl-p-benzoquinone imine).
• Wɔ tebea horow a ɛfata mu no, mmerɛbo no wɔ n’abɔde mu nkwammoaa mu antioxidant tripeptide, glutathione (GSH) akorae pii. Glutathione kyekyere NAPQI ntɛm ara, na ɛma ɛyɛ nea ɛnyɛ hwee ma ɛbɛyɛ mercapturic acid ne cysteine ​​conjugates a asiane biara nni ho a wɔhohoro gu nsu mu.

2. Overdose Metabolism: Glutathione a ɛso tew wɔ Ɔha biara mu nkyem 30¶

Sɛ obi mene nnuru a ɛboro so a emu yɛ den kɛse, anaasɛ ɔnom nnuru a ɛboro so a ɛkyinkyin da biara da a:

1. Akwan a ahobammɔ wom a ɛyɛ ma: Mmerɛbo no sulfation ne glucuronidation akwan a ɛfata no yɛ saturated na ɛboro so, na ɛhyɛ acetaminophen no ɔha biara mu nkyem kɛse koraa ma ɛfa CYP2E1 oxidative kwan no mu na ɛma awuduru NAPQI pii ba.
2. Glutathione Depletion Cliff a ɛyɛ 70% kosi 80%: Bere tenten a mmerɛbo no wɔ glutathione (GSH) a ɛdɔɔso no, mmerɛbo mu nkwammoaa biara nwu. Nanso, sɛ glutathione a ɛwɔ nkwammoaa mu no so tew ɔha biara mu nkyem 70 kosi 80 (ɛkɔ fam sen nea ɛfata ɔha biara mu nkyem 30) pɛ a, mmerɛbo no sa ne kyɛm no.
3. Covalent binding ne Centrilobular (Zone 3) Necrosis: NAPQI a enni afã biara no de covalent kyekyere cysteine ​​sulfhydryl akuw a ɛwɔ mitochondrial protein ahorow a ɛho hia wɔ hepatocytes no mu, na ɛkanyan mitochondrial oxidative stress kɛse, peroxynitrite a ɛba, ATP a ɛso tew, ne DNA a ɛpaapae. Esiane sɛ Hepatic Zone 3 (centrilobular beae a atwa mfinimfini ntini no ho ahyia) na CYP2E1 enzymes dɔɔso sen biara na ɛwɔ mfiase oxygen ne glutathione nhyɛso a ɛba fam koraa nti, Zone 3 hepatocytes no pae na wowuwu wɔ asorɔkye mu, na ɛma mmerɛbo mu enzymes (AST ne ALT) kɔ soro boro 1,000 kosi 10,000 IU/L bere a ɛto mmerɛbo no tumi a ɛde yɛ nneɛma a ɛma mogya tu (ɛma INR/PT kɔ soro), yi ammonia fi hɔ (ɛde hepatic encephalopathy ne cerebral edema ba), na ɛma asikre a ɛwɔ mogya mu (hypoglycemia) kɔ so tra hɔ no ano.
4. Direct Renal Toxicity: Esiane sɛ asaabo no nso da CYP2E1 enzymes ne prostaglandin synthases adi nti, NAPQI a enni afã biara a ɛba wɔ renal tubules no mu tẽẽ no betumi ama acute tubular necrosis (ATN) ne asaabo no ayɛ adwuma yiye, ɛtɔ mmere bi mpo wɔ ayarefo a wɔn mmerɛbo a wɔapirapira afi ase renya ahoɔden no mu.

3. Sɛnea Antidote N-Acetylcysteine (NAC) Gye Mmerɛbo no Wɔ Akwan Abien So¶

N-acetylcysteine (NAC) yɛ sulfhydryl-kuw a wɔde ma na edi L-cysteine anim tẽẽ, amino acid a ɛma mmerɛbo no hwehwɛ na ama ayɛ glutathione foforo:

• Adwuma a Edi Kan (Nnɔnhwerew 0 kosi 8+, Nkwammoaa Owu a Wosiw Ano): Sɛ wɔde ma wɔ ** nnɔnhwerew 8** akyi wɔ anom a emu yɛ den (ansa na glutathione akorae bɛkɔ fam akɔ fam asen 30% a ɛho hia no), NAC san hyɛ mmerɛbo mu glutathione (GSH) ma ntɛmntɛm na ɛsan nso ma sulfhydryl akuw tẽẽ a ɛkyekyere NAPQI na ɛma nea enni awuduru no yɛ kɛse sulfation nipadua mu nneɛma a ɛsakra. Sɛ wofi ase wɔ nnɔnhwerew 8 ntam a, NAC siw hepatotoxicity ano wɔ ɛkame ayɛ sɛ ayarefo ɔha biara mu nkyem 100 mu, ɛmfa ho sɛnea na acetaminophen dodow a ɛwɔ mogya mu mfiase no dɔɔso no.
• Late Mechanism (8 to 72+ hours, Rescue in Established Liver Failure): Sɛ mpo ɔyarefo bi du ayaresabea hɔ ** nnɔnhwerew 12, 24, anaa 48 akyi** a AST/ALT dodow a ɛkɔ soro dedaw ne mmerɛbo a entumi nyɛ adwuma yiye a, NAC NNI "aka akyi dodo" DA sɛ wɔde bɛma. Wɔ nsɛm a wɔka akyiri mu no, NAC yɛ adwuma sɛ free-radical scavenger, ɛma hepatic microcirculatory blood flow ne nitric oxide a wɔde ma no tu mpɔn, ɛma mitochondrial oxygen a wɔde di dwuma no yɛ kɛse, ɛtew amemene mu edema so, na ɛma nkwa a wɔmfa nsi ananmu no tu mpɔn kɛse.

Acetaminophen Afiri a Ahintaw: Sɛnea Akwanhyia "Double-Dosing" Ba¶

Ɛkame ayɛ sɛ mmerɛbo a entumi nyɛ adwuma yiye a ɛfa acetaminophen ho wɔ Amerika Atifi fam ne Europa nyinaa mu fã yɛ wɔnhyɛ da ("ayaresa mu akwanhyia"): efi obi a ɔwɔ sẽ mu yaw kɛse, akyi yaw, anaa atiridii a ɛyɛ awerɛhow a ɔnom nnuru ahorow abien anaa abiɛsa bere koro mu a onnim sɛ acetaminophen wɔ toa biako biara mu.

Awuduru Ahorow a Wobɛbu Ho Akontaabu: Bere Bɛn na Ɛsɛ sɛ Wokɔ Ayaresabea?¶

Aduruyɛ mu awuduru ho animdefo ne mmeae a wɔhwɛ awuduru so no kyekyɛ acetaminophen a wɔde di dwuma no mu yɛ no akwan horow abien a ɛsono emu biara: Single Acute Ingestion (wɔmene nnuru a wɔde di dwuma wɔ mfɛnsere biako mu a ennu nnɔnhwerew 4 kosi 8) ne Repeated Supratherapeutic Ingestion (RSTI / Staggered Overdose) (dodow a ɛboro so a wɔnom mpɛn pii bɛboro nnɔnhwerew 8 kosi 24).

1. Single Acute Ingestion Thresholds (Asoɛe a Ɛho Hia Ntɛmntɛm a Wɔde Kɔma Wɔn Ho Nhwehwɛmu) .¶

Kɔ ayaresabea dwumadibea a wɔhwɛ ntɛmpɛ so ntɛm ara (anaasɛ frɛ Poison Control wɔ 1-800-222-1222 wɔ U.S.) sɛ nea wonom denneennen pɛnkoro no du anaasɛ ɛboro nea edidi so yi mu biara so a:

• Mpanyimfo ne Mmabun a Wɔwɔ Apɔwmuden a Wɔpɛ: Sɛ wɔmene gram 7.5 kosi gram 10 (7,500 mg kosi 10,000 mg) nyinaa, ANAA 150 mg kosi 200 mg kilogram biara (68 kosi 90 mg wɔ nkaribo biara mu) wɔ nipadua mu duru mu (nea ɛsua biara) wɔ nnɔnhwerew 8 mu.
• Nhwɛsoɔ a wɔkan no ntɛmntɛm: Extra-Strength (500 mg) Acetaminophen aduru 15 kɔsi 20, ANAA **Acetaminophen a ɛyɛ Regular-Strength (325 mg) ** aduru 24 kɔsi 30.
• Mmofra a wonnii mfe 6: Sɛ wɔmene 200 mg wɔ nipadua mu duru kilogram biara mu (90 mg wɔ nkaribo biara mu) anaa nea ɛboro saa wɔ anom a emu yɛ den pɛnkoro mu (efisɛ mmofra nkumaa wɔ mmerɛbo ne nipadua mu duru kɛse kakra na wotumi de sulfation tumi kɔ soro, ɛwom sɛ sɛ wɔnom biara a ɛboro 150 mg/kg a, ɛfata sɛ wobu Poison Control ho akontaa ntɛm ara).
• Ankorankoro a Asiane Kɛse (Lower Threshold: 75 to 100 mg/kg anaa > 4 grams): Wɔ ankorankoro a wɔn CYP2E1 enzymes no yɛ nea wɔde ma bere tenten anaasɛ wɔn mfitiase glutathione (GSH) akorae no so atew dedaw mu no, hepatotoxicity a emu yɛ den betumi aba wɔ dodow a ɛba fam te sɛ 75 kosi 100 mu mg/kg (anaasɛ ɛboro 4,000 mg kosi 6,000 mg kakra). Tebea horow a asiane kɛse wom no bi ne:
• Nsa a wɔde di dwuma kɛse ho haw a enni sabea (ethanol a enni sabea ma CYP2E1 ma NAPQI pii bere a aduan pa a wonnya nni ma glutathione so tew; hyɛ no nsow sɛ acute nsa a wɔnom pɛnkoro no ne CYP2E1 di akan ankasa, bere a asadweam a enni sabea ma awuduru no yɛ kɛse kɛse).
• Mmuadadi a ɛkyɛ, ɔkɔm, adidi mu haw (anorexia nervosa), anaasɛ ɔfe/nsu a ɛho ntew kɛse (ɛma mmerɛbo mu glutathione akorae no so tew).
• ** mmerɛbo mu yare a enni sabea a na ɛwɔ hɔ dedaw** (cirrhosis, Hepatitis B anaa C a enni sabea, mmerɛbo mu srade a ɛma nipadua no yɛ adwuma a ɛkɔ anim).
• Nnuru a wɔde ma CYP450 a wɔde di dwuma bere koro mu: te sɛ isoniazid (nsamanwaw aduru), carbamazepine, phenytoin, phenobarbital, rifampin, anaa St. Yohane Nsõ.
• Biribiara a Wɔhyɛɛ Da a Wɔde Pira Wɔn Ho: Ɛmfa ho sɛnea wɔaka nnuru dodow a wɔde di dwuma boro so no, aduru biara a wɔhyɛ da de di dwuma boro so no hwehwɛ sɛ wɔyɛ ayaresabea nhwehwɛmu ntɛm ara na wɔde nnɔnhwerew 4 serum acetaminophen dodow, efisɛ ayarefo abakɔsɛm a ɛfa nnuru dodow a wɔkan wɔ ɔhaw bi mu ho no taa nyɛ nokware.

2. Supratherapeutic Ingestion (RSTI / Staggered Overdose) a Wɔde Di Dwuma Mpɛn pii¶

Esiane sɛ Rumack-Matthew nomogram wontumi mfa nni dwuma bere a wɔnom nnuru pii wɔ dodow a ɛboro nnɔnhwerew 8 kosi 24 mu nti, ɛho hia sɛ wɔyɛ ayaresabea mogya mu nhwehwɛmu (Serum Acetaminophen concentration + AST/ALT mmerɛbo enzymes) sɛ ɔyarefo bi anom:

• Wɔ nnɔnhwerew 24 mu: Ne nyinaa bɛboro gram 10 (10,000 mg) ANAA bɛboro 200 mg/kg (nea esua koraa) wɔ nnɔnhwerew 24 mfɛnsere biako mu.
• Wɔ nnɔnhwerew 48 mu: Bɛboro gram 6 (6,000 mg) wɔ nnɔnhwerew 24 biara mu ANAA bɛboro 150 mg/kg wɔ nnɔnhwerew 24 biara mu nnɔnhwerew 48 anaa nea ɛboro saa.
• Wɔ Ayarefo a Asiane Kɛse Mu (Wɔnom nsa bere tenten, mmuadadi/aduan pa a wonnya nni, mmerɛbo mu yare, anaa mmofra a nsu nnim atiridii): Bɛboro gram 4 (4,000 mg) da biara (anaasɛ bɛboro 100 mg/kg/da wɔ abofra mu) bɛboro nnɔnhwerew 24 kosi 48, ANAA ɔyarefo biara a ne yafunu mu yɛ no yaw, ne ho yɛ no yaw, anaasɛ ne nifa so yɛ no yaw yafunu bere a wanom acetaminophen dodow a ɛdɔɔso akyi.

Acetaminophen Awuduru a Wɔde Ma Ayaresabea Akwan Anan (Dɔnhwerew biara Bere Nhyehyɛe) .¶

Sɛ yɛte ayaresabea afã anan no ase a, ɛkyerɛkyerɛ nea enti a nnuruyɛfo a wɔhwɛ ntɛmpɛ so de mogya dodow ne dɔn nnɔnhwerew sa acetaminophen awuduru, na ɛnyɛ sɛnea ɔyarefo no hwɛ apɔwmuden wɔ dan a wɔtwɛn mu no so da.

Ayaresabea Nhwehwɛmu ne Antidote Protocols: Nea Ɛsɛ sɛ Wɔhwɛ kwan wɔ ER no mu¶

1. Rumack-Matthew Nomogram (Nea Enti a Nnɔnhwerew 4 Mogya a Wɔtwe no Ho Hia) .¶

Sɛ ɔyarefo bi du ayaresabea bere a wanom dodow a ɛboro so pɛnkoro a wonim bere akyi a:

• Nea enti a wontumi nkyerɛw mogya ho mfonini ansa na nnɔnhwerew 4 aba: Acetaminophen a wɔnom no gye ** nnɔnhwerew 4** na ama yafunu mu a ɛtwetwe ne ntini mu kyekyɛ a ɛsen biara no awie. Mogya dodow a wɔtwe wɔ nnɔnhwerew 1 anaa 2 akyi wɔ anom akyi nkyerɛ dodow a ɛsen biara na wontumi mfa nni dwuma mfa nnye awuduru ntom.
• Nnɔnhwerew 4 kosi Nnɔnhwerew 24 Ayaresa Ntrɛwmu: Wɔ Nnɔnhwerew 4 wɔ anom akyi (anaasɛ bere a wɔadu hɔ ntɛm ara sɛ bɛboro nnɔnhwerew 4 atwam dedaw a), wɔtwe mogya ma wonya serum acetaminophen dodow:
• United States / Canada / Australia ("150-Line" / Rumack-Matthew Treatment Line): Sɛ serum dodow no yɛ anaa ɛboro 150 mcg/mL (150 mg/L anaa 993 micromol/L) wɔ nnɔnhwerew 4 (ɛkɔ fam a nnɔnhwerew 4 fã nkwa nna kɔ 75 mcg/mL wɔ nnɔnhwerew 8 mu, 37.5 mcg/mL wɔ nnɔnhwerew 12, 18.8 mcg/mL wɔ nnɔnhwerew 16, ne 4.7 mcg/mL wɔ nnɔnhwerew 24), wofi ase de N-acetylcysteine (NAC) ma ɔyarefo no.
• United Kingdom ("100-Line" / MHRA & TOXBASE Guideline): Efi afe 2012 no, UK ayaresabea ahorow de ayaresa kwan biako a ɛyɛ katee kɛse mpo a efi ase fi 100 mg/L (100 mcg/mL) wɔ nnɔnhwerew 4 (ɛkɔ fam kodu 15 mg/L wɔ nnɔnhwerew 16) di dwuma ma nnuru a wɔde di dwuma boro so a emu yɛ den nyinaa.
• The Extended-Release (ER) 650 mg Caplet Rule: Sɛ ɔyarefo no menee extended-release (8-hour arthritis) acetaminophen tablets, anaasɛ nnuru a ɛma awotwaa no kɔ baabiara brɛoo (opioids anaa anticholinergics te sɛ diphenhydramine/Benadryl) a, nea ɛtwetwe no betumi akɔ soro yiye wɔ nnɔnhwerew 4 akyi. Sɛ nnɔnhwerew 4 dodow a edi kan no sen ayaresa kwan no so a, nnuruyɛfo a wɔhwɛ ntɛmpɛ mu no twetwe mogya dodow a ɛto so abien a wɔsan yɛ no nnɔnhwerew 4 kosi 6 akyi (wɔ nnɔnhwerew 8 kosi 10 wɔ aduru no akyi)**; sɛ level biara twa line no a, wɔhyɛ NAC ase ntɛm ara.

2. N-Acetylcysteine (NAC) Nnuru a Wɔde Fa Ntini Mu ne Nnuru a Wɔnom¶

NAC a wɔde fa ntini mu (IV) (te sɛ Acetadote anaa generic IV acetylcysteine) ne NAC a wɔde fa anom (te sɛ Mucomyst) nyinaa yɛ adwuma pɛpɛɛpɛ bere a wofi ase wɔ nnɔnhwerew 8 ntam no:

1. Intravenous (IV) NAC (Wɔpɛ ma ɔfe, coma, nyinsɛn, anaa mmerɛbo a entumi nyɛ adwuma yiye):
2. Abakɔsɛm mu no, wɔde Nnɔnhwerew 21 Three-Bag Prescott Regimen (150 mg/kg bɛboro simma 60, afei 50 mg/kg bɛboro nnɔnhwerew 4, afei 100 mg/kg bɛboro nnɔnhwerew 16 = 300 mg/kg nyinaa).
3. Ɛnnɛ, mmeae dodow no ara a wɔde awuduru gu mu wɔ U.S., UK (** nnɔnhwerew 12 SNAP: Scotland ne Newcastle Anti-emetic Pre-treatment Paracetamol Poisoning Study nhyehyɛe**), ne Australia de Two-Bag IV NAC Regimen a wɔayɛ no mmerɛw di dwuma (sɛ nhwɛso no, 200 mg/kg over 4 hours [anaasɛ 100 mg/kg over 2 hours wɔ UK SNAP protocol no mu], a ɛno akyi no 100 mg/kg over 16 hours [anaasɛ 200 mg/kg over 10 hours wɔ SNAP mu]). Sɛ wɔka nkotoku abien a edi kan no bom a, ɛma infusion dodow a edi kan no brɛ ase na tew histamine/anaphylactoid a ɛnyɛ allergic reactions (flushing, hives, wheezing) dodow so bɛboro ɔha biara mu nkyem 75.
4. Nsɛm a ɛho hia wɔ NAC "Anaphylactoid" Flushing ho: Ayarefo a wɔde NAC kotoku a edi kan a wɔde fa IV mu ma wɔn no mu bɛyɛ 5% kosi 15% nya anim hohoro, ɛyaw, anaasɛ akisikuru a emu nyɛ den a non-IgE direct histamine release (nea ɛyɛ anigye no, eyi taa bere a serum acetaminophen dodow ba fam, efisɛ acetaminophen dodow a ɛkɔ soro no siw ano mast cells a ɛwɔ nipadua no mu). Ɛnyɛ ɛnyɛ allergy ankasa na ƐNYƐ nea enti a ɛsɛ sɛ wogyae aduru a egye nkwa no koraa: ayarehwɛfo gyae aduru a wɔde ma no simma 15 kosi 30 kɛkɛ, ma IV diphenhydramine (antihistamine) ne albuterol a wɔhome sɛ ɛyɛ ahometew a, na wɔsan fi NAC no ase brɛoo.
5. NAC a wɔde ano ka (Nnɔnhwerew 72 Nhyehyɛe):
6. Wɔde ma sɛ 140 mg/kg loading dose, na ɛno akyi no wɔde 17 doses a ɛyɛ 70 mg/kg nnɔnhwerew 4 biara (a ne nyinaa yɛ nnɔnhwerew 72, ɛwom sɛ wɔtaa twitwa so denam gyinapɛn a wogyae bere a labs mu ada hɔ no so).
7. Esiane sɛ NAC a wɔnom yɛ aduru a sulfur wom a ɛyɛ huam na ɛyɛ dɛ denneennen te sɛ nkesua a aporɔw nti, wɔde nsukyenee so yɛ nwini, wɔde cola anaa nnuaba nsu fra mu wɔ kuruwa a wɔakata so a wɔde sare ayɛ mu, na wɔde IV aduru a ɛko tia akisikuru te sɛ ondansetron (Zofran) di anim. Sɛ ɔyarefo no fe wɔ simma 60 akyi bere a wamene NAC dodow a wɔnom no a, ɛsɛ sɛ wɔsan yɛ saa dodow no bio (anaasɛ wɔdan kɔ IV NAC so).
8. Stopping Criteria (Nnyae NAC da wɔ Dɔn no nkutoo so):
9. Wɔ nnɔnhwerew 12 kosi 21 IV NAC nhyehyɛe a wɔahyɛ da ayɛ no awiei no, ayaresabea nnuruyɛfo san hwɛ serum acetaminophen dodow, AST, ALT, ne INR. Wogyae NAC sɛ: (a) wontumi nhu serum acetaminophen dodow nkutoo (< 10 mcg/mL), (b) AST ne ALT yɛ nea ɛfata (anaasɛ ɛda adi pefee sɛ ɛrekɔ fam fi nea ɛsen biara), ne © INR yɛ nea ɛfata (\(< 1.3\text{ kosi }1.5\)) na ɔyarefo no ho ye wɔ ayaresabea. Sɛ mmerɛbo mu enzymes rekɔ soro a, wɔtoa IV NAC kotoku a etwa to no so bere nyinaa kosi sɛ mmerɛbo no bɛsan ayɛ yiye.
10. Adjunctive Nkwagyeɛ ma Massive Overdoses (Fomepizole & Hemodialysis):
11. Wɔ nnuru a wɔde di dwuma boro so a asiane kɛse wom mu (acetaminophen dodow a ɛwɔ hɔ nnɔnhwerew 4 > 500 to 900 mcg/mL anaasɛ lactic acidosis a emu yɛ den ntɛm), nnuruyɛ mu awuduru ho animdefo de Fomepizole (4-methylpyrazole, 15 mg/kg IV) ka NAC ho kɛse, efisɛ fomepizole siw CYP2E1 (a ɛma NAPQI adebɔ foforo gyae) kwan tẽẽ na esiw c-Jun N-terminal kinase (JNK) mitochondrial necrosis ano, ne fi ase hemodialysis sɛnea EXTRIP (Extracorporeal Treatments in Poisoning) akwankyerɛ no kyerɛ no.

3. King’s College Criteria: Sɛnea Nnuruyɛfo Hu Ayarefo a Wohia Mmerɛbo a Wɔde Sisi Ntɛmntɛm¶

Wɔ ayarefo a wɔba akyiri wɔ Stage III (nnɔnhwerew 48 kosi 96 wɔ anom akyi) a fulminant hepatic failure, ICU hepatologists di King’s College Criteria akyi ma acetaminophen-induced acute liver failure de kyerɛw ɔyarefo no din sɛ super-urgent life-saving liver transplant ansa na amemene mu edema a wontumi nsakra no aba:

• Ahwehwɛde A (Agyiraehyɛde Baako): Mogya a ɛwɔ ntini mu \(\text{pH} < 7.30\) (or arterial lactate \(> 3.0\text{ mmol/L}\)) akyi nsuo a wɔde fa ntini mu a wɔsan de ma a ɛfata akyi, a amemene mu yareɛ dodoɔ mfa ho; ANAA
• Ahwehwɛdeɛ B (Ahyɛnsodeɛ Abiɛsa no Nyinaa a Ɛwɔ Hɔ Bere Koro mu wɔ nnɔnhwereɛ 24 mfɛnsere mu):
• Grade III anaa Grade IV Hepatic Encephalopathy (adwene mu naayɛ a emu yɛ den, akisikuru, anaa coma), NE
• Prothrombin Bere (PT) \(> 100\text{ sikani}\) (anaasɛ \(\text{INR} > 6.5\)), NE
• Serum Creatinine $> 3.4 nkyerɛwee { mg / dL} $ ($> 300 nkyerɛwee { micromol / L} $).

Nhwehwɛmu a Wɔde Siw Ano: Acetaminophen a Wɔde Di Dwuma a Dwoodwoo Wɔ Fie¶

• Di "Toa Baako wɔ Bere Biara mu" Mmara no akyi: Nnom nnuru abien a acetaminophen, paracetamol, anaa APAP wom da wɔ nnɔnhwerew 6 mfɛnsere koro no ara mu. Sɛ worenom nsu anaa aduru a ɛwɔ sɛnkyerɛnne ahorow pii a wɔde sa atiridiinini, atiridiinini, anaa sinus pressure a, fa nnuru a ɛnyɛ den a wɔde nneɛma biako na ɛyɛ adwuma sen sɛ wode nsu a wɔaka abom di dwuma.
• Bu Daa Daa Ɔdan no (Nea ɛkyɛn so 4,000 mg/da; 3,000 mg/da Wɔpɛ): Ɛnsɛ sɛ mpanyimfo a wɔwɔ apɔwmuden boro 4,000 mg (Ahoɔden a Ɛboro So 500 mg aduru 8 anaa Daa-Ahoɔden 325 mg aduru 12) da wɔ nnɔnhwerew 24 biara mu, na mmerɛbo ho abenfo pii kamfo kyerɛ sɛ wɔmfa kata so da biara da fa 3,000 mg/da (anaasɛ 2,000 mg/da sɛ wowɔ mmerɛbo mu yare, aduan pa a wunni, anaasɛ wonom nsa daa a).
• Fa Mmofra Dose Strictly by Weight (10 to 15 mg/kg per dose): Fa milliliter (mL) oral dosing syringe a wɔde ahyɛ adaka no mu no di dwuma bere nyinaa, fa adididan mu teaspoon biara nni dwuma da, na kyerɛw bere biara a wɔde ma no sɛnea ɛbɛyɛ a wɔn a wɔhwɛ mmofra baanu rennom abofra mmɔho abien anadwo wɔ akwanhyia mu.

Nsɛm a wɔtaa bisa¶

Dɛn nti na mintumi ntwɛn nkosi ɔkyena anɔpa kɛkɛ sɛ mɛte nka sɛ meyare ansa na makɔ ayaresabea bere a manom Tylenol / paracetamol pii awie no?¶

Twɛn kosi sɛ wobɛte nka sɛ woyare no ne mfomso biako pɛ a asiane wom sen biara wɔ acetaminophen awuduru mu. Wɔ nnɔnhwerew 24 a edi kan bere a wɔamene dodow a edi awu akyi no, nnipa dodow no ara nni sɛnkyerɛnne biara anaasɛ akisikuru a emu nyɛ den a ɛyera wɔ Da a ɛto so 2, bere a NAPQI nneɛma a awuduru wom reyɛ mmerɛbo mu glutathione asɛe komm na ɛrekunkum mmerɛbo mu nkwammoaa. Ɛkame ayɛ sɛ nnuru a wɔde kum yare a wɔfrɛ no N-acetylcysteine ​​(NAC) no tu mpɔn ɔha biara mu nkyem 100 wɔ mmerɛbo a ɛbɛsɛe no ano mu sɛ wofi ase wɔ nnɔnhwerew 8 akyi wɔ bere a woanom akyi, bere a woda so ara te nka sɛ wo ho ye koraa no. Edu bere a wo yafunu nifa a ɛwɔ soro no bɛyɛ wo yaw anaasɛ w’ani bɛdan kɔkɔɔ wɔ nnɔnhwerew 48 kosi 72 mu no, na mmerɛbo mu nkwammoaa awuwu kɛse dedaw.

Dɛn na "APAP" kyerɛ wɔ ɛyaw aduru toa a wɔkyerɛw ma obi te sɛ Hydrocodone-APAP anaa Oxycodone-APAP so?¶

"APAP" yɛ nnuruyɛ mu asɛmfua tiawa a wɔde di dwuma wɔ N-acetyl-para-aminophenol, nnuru din a wɔde frɛ acetaminophen (paracetamol). Toa a wɔkyerɛw ma nnuru a wɔakyerɛw so sɛ "Hydrocodone-APAP 5-325" no kura opioid hydrocodone mg 5 ne acetaminophen mg 325 wɔ aduru biako biara mu. Mfa Tylenol, Excedrin, anaa NyQuil/DayQuil a wɔtɔn no nnuruyɛ mu da bere a worenom aduru biara a wɔakyerɛw ama wo a wɔakyerɛw so sɛ "APAP," efisɛ acetaminophen dodow a wɔaka abom no betumi ama mmerɛbo no adi huammɔ kɛse ntɛmntɛm.

Sɛ obi du baabi a wɔhwɛ wɔn a wɔwɔ ayaresa a egye ntɛmpɛ mu wɔ nnɔnhwerew 16 anaa 24 akyi wɔ acetaminophen a wɔnom boro so akyi a, so aka akyi dodo sɛ NAC aduru a wɔde kum ɔyare mmoawa no bɛyɛ adwuma?¶

Dabi: ɛnka akyi dodo da sɛ wubefi ase de N-acetylcysteine ​​(NAC) adi dwuma. Bere a NAC de ahobammɔ a ɛkorɔn sen biara ma (ɛkame ayɛ sɛ ɛsiw hepatotoxicity ano ɔha biara mu nkyem 100) bere a wofi ase wɔ nnɔnhwerew 8 a edi kan no mu no, ayaresabea sɔhwɛ ahorow da no adi sɛ IV NAC a wɔde ma wɔ nnɔnhwerew 12, 24, 48, anaa 72 mpo akyi wɔ anom akyi, bere mpo a mmerɛbo no adi huammɔ kɛse dedaw mpo no, ɛda so ara ma mmerɛbo mu microcirculation, oxygen a wɔde ma, amemene mu no tu mpɔn kɛse edema, ne nkwa a wɔmfa nsi ananmu.

So ibuprofen (Advil / Motrin) anaa naproxen (Aleve) a mɛnom no bu akontaa ma me da biara da acetaminophen anohyeto?¶

Dabi, ibuprofen, naproxen, ne aspirin ka nnuru ahorow a ɛsono koraa a wɔfrɛ no Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) ho, a wɔnam asaabo so titiriw yi fi hɔ na ɛka yafunu no mu ntini sen sɛ ɛbɛtew mmerɛbo mu glutathione so denam NAPQI so. Nanso, ɛtɔ mmere bi a nnuru a ɛwɔ tiyɛ anaa atiridiinini a ɛwɔ sɛnkyerɛnne ahorow pii (te sɛ Excedrin anaa Dual Action Acetaminophen + Ibuprofen tablets) ka akuw abien no nyinaa bom wɔ aduru biako mu, enti bere nyinaa kenkan "Active Ingredients" adaka a ɛwɔ aduru no akyi no.

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Akwankyerɛ yi yɛ nsɛm a wɔde ma na ɛnsi adwumayɛfoɔ aduruyɛ mu nhwehwɛmu anaa Poison Control anim. Esiane sɛ nnuru a wɔnom boro so kɛse betumi ama adwene mu tebea asesa, ɔfe, anaa mframa kwan no ayɛ basaa nti, yɛhyɛ nyansa denneennen sɛ fa Amanaman Ntam Mmeamudua Kɔkɔɔ ne Ɔsram Kɔkɔɔ Fekuw (IFRC), wo man Mmeamudua Kɔkɔɔ fekuw, St John Ambulance, anaa mpɔtam hɔ nteteefo a ɔwɔ adansedi krataa so yɛ mmoa a edi kan ne CPR adesua a wɔagye atom.

Sources a wɔhwɛɛ mu¶

• Amerika Fekuw a Ɛhwɛ Awuduru So (AAPCC) & Amerika Aduruyɛ mu Awduru Ho Adesuabea (ACMT): Akwankyerɛ a Wɔapene so a ɛfa Acetaminophen awuduru a wɔde di dwuma wɔ United States ne Canada (JAMA Network Open / Clinical Toxicology).
• Ɔman Awuduru Ho Amanneɛbɔ Dwumadibea (NPIS, United Kingdom) & Nnuru ne Akwahosan ho nneɛma ho Mmarahyɛ Bagua (MHRA): TOXBASE Paracetamol Overdose Management Guidelines ne Nnɔnhwerew 12 SNAP Regimen.
• Wiase Nyinaa Akwahosan Ahyehyɛde (WHO): Ayaresa mu Awuduru a Ɛyɛ Hu a Wɔde Di Dwuma: Paracetamol (Acetaminophen) ne Antidotal N-Acetylcysteine ​​(NAC) Protocols.
• Amerika Fekuw a Ɛhwɛ mmerɛbo mu Nyarewa Ho Adesua So (AASLD): Adeyɛ ho Akwankyerɛ a Wɔde Di Mmerɛbo a Ɛyɛ Hu a Ɛyɛ Den ne King’s College Transplant Criteria ho dwuma.
• EXTRIP (Extracorporeal Treatments in Poisoning) Adwumakuo: Nhyehyɛeɛ mu Nhwehwɛmu ne Nyansahyɛ a ɛfa Extracorporeal Treatments wɔ Acetaminophen Poisoning ho.

Akwankyerɛ ahorow a ɛfa ho¶

• Mmoa a edi kan a wɔde ma awuduru ne awuduru a wɔde siw ano triage
• Aspirin (salicylate), iron pill, ne mogya mmoroso nnuru a wɔde di dwuma boro so
• Opioid a wɔde di dwuma boro so ne naloxone (Narcan) a wɔde gye nkwa
• Methanol, ethylene glycol (a ɛko tia awɔw), ne nsa a awuduru wom a ɛyɛ awuduru
• Nnɔmba a egye ntɛmpɛ sɛnea ɔman biara te