Acetaminofen (Paracetamol / Tylenol) Kurenza urugero hamwe na Window ya Antidote yamasaha 8¶

Kurenza urugero rwa acetaminofeni (izwi ku rwego mpuzamahanga nka parasetamol kandi ikagurishwa ku mazina nka Tylenol, Panadol, Calpol, na Excedrin, ndetse no mu magana amagana y'ibicurane bikonje, ibicurane, sinus, ibitotsi, hamwe n'imiti ivura indwara ya opioid) ni yo mpamvu nyamukuru itera umwijima ukabije muri Amerika, Ubwongereza, Kanada, Ositaraliya, na Amerika. Igitera uburozi bwa acetaminofeni ni ubuhemu budasanzwe ni ** buriganya "idirishya ryicecekeye" mu masaha 24 yambere **: umuntu umira ikinini gishobora guhitana abantu akenshi yumva ari ibisanzwe rwose, cyangwa akagira isesemi yoroheje gusa no kubira ibyuya bikemura mugitondo cyakurikiyeho, bikabayobora numuryango wabo kwizera ko bahunze ibyago mugihe metabolite yuburozi yangiza bucece selile yumwijima.

Kuberako imiti igabanya ubukana cyangwa umunwa ** N-acetylcysteine ​​(NAC) ** yegera ** 98 ku ijana kugeza ku ijana ku ijana mu gukumira kwangirika kw’umwijima n’urupfu iyo byatangiye mu masaha 8 nyuma yo gufatwa cyane **, gutegereza kugeza igihe uzumva urwaye, ukagira ububabare bwo mu nda bwo hejuru, cyangwa ukabona uruhu rwumuhondo (jaundice) ku munsi wa 2 cyangwa ku munsi wa 3 bishobora kuba ikosa ryica. Iyi mfashanyigisho yuzuye yihutirwa irasobanura uburyo bwo kurwanya uburozi bwihuse, uburyo bwo kubara miligarama imwe kuri kilo ikoresheje imiti ihuriweho, ibyiciro bine byubuvuzi bwa hepatotoxicity, Rumack-Matayo amasaha 4 yo mu rwego rwa maraso na progaramu ya supratherapeutic, hamwe n’ibitaro bya ICU by’ubutabazi (NPIS) Ishami ry'ubuzima (OMS).

Kora ubu¶

Niba wowe cyangwa undi muntu wafashe icyarimwe acetaminofeni (paracetamol) icyarimwe, cyangwa ugahita ufata inshuro nyinshi kurenza amasaha 24 kugeza 72:

1. ** Ntutegereze ibimenyetso bigaragara **: Hamagara ikigo cyawe cy’uburozi mu karere ako kanya (muri Amerika, hamagara ** 1-800-222-1222 **; mu Bwongereza, hamagara ** NHS 111 ** cyangwa ** 999 **; muri Ositaraliya, hamagara ** 13 11 26 ; muri Kanada, hamagara ** 1-844-POISON-X ** cyangwa umurongo w’intara wegereye). Niba umuntu asinziriye, arangaye, aruka inshuro nyinshi, cyangwa yafashe ibinini nkana, hamagara nimero yawe yihutirwa ( 911 ** muri Amerika na Kanada, ** 112 ** muburayi, ** 999 ** mubwongereza) ukoresheje uwacu nimero yihutirwa ububiko.
2. ** Kusanya icupa ryimiti yose, ipaki ya blister, hamwe nubukonje / ibicurane ** Zana ibikoresho byose hamwe nawe mubyihutirwa.
3. ** Andika isaha nyayo yo gufata hamwe nuburemere bwumuntu **: Abaganga bibitaro bashingira ku kizamini cyamaraso cyashizwe kuri ** amasaha 4 nyuma yo gufatwa ** (giteganijwe kuri nomero ya ** Rumack-Matayo **) kugirango umenye uburozi nyuma yo kunywa birenze urugero. Bwira umuforomo wa triage umunota nyawo ibinini byamizwe (cyangwa ibihe bya mbere kandi bigezweho iyo bifashwe mu masaha menshi) hamwe nuburemere bwumubiri wumuntu mubiro (cyangwa pound).
4. ** Ntuzigere utera kuruka murugo **: Ntukoreshe sirupe ya ipecac, amazi yumunyu, cyangwa gutunga urutoki. Gutera kuruka ntibikuraho rwose ibinini byashonze kandi birashobora gutera umusonga cyangwa gutinda gucunga amakara yakoreshejwe mu kanwa na N-acetylcysteine ​​mu bitaro.
5. ** Baza amakara akoreshwa niba uhageze mugihe cyamasaha 1 kugeza kuri 2 (kugeza kumasaha 4 kugirango yongere-arekurwe) **: Niba umuntu ageze mubutabazi bwihuse mugihe cyamasaha 1 kugeza 2 amasaha ** yo kumira ikinini cyuburozi (cyangwa kugeza kumasaha ** 4 ** kugirango yongere-arekure 650 mg arthritis caplet cyangwa gufatanya guterura igifu 1 kuri kilo imwe ya kilo imwe). garama) ** guhambira acetaminofeni idasukuye mu nzira ya gastrointestinal mbere yuko yinjira mumaraso.
6. ** Menya neza ko N-acetylcysteine ​​(NAC) yatangiriye mumadirishya ya zahabu yamasaha 8 niba yerekanwe **: Niba urwego rumwe rwamaraso rudashobora kuvamo mbere yamasaha 8 nyuma yo gufatwa **, cyangwa niba umurwayi yafashe ibiyobyabwenge birenze urugero muminsi myinshi, amabwiriza yibitaro atangiza imitsi cyangwa umunwa ** N-acetylcysteine ​​(NAC) ** mugihe gito mugihe utegereje ibisubizo bya laboratoire.

Acetaminofen irenze urugero triage hamwe na NAC antidote igihe cyagenwe¶

flowchart TD
    Start["Ukekwaho Acetaminophen / Paracetamol Kurenza urugero <br/> (Kwinjiza inshuro imwe cyangwa gusubiramo inshuro nyinshi)"] --> TimeCheck["Andika Isaha Neza (s) yo Kwinjira, Gutegura Ibinini <br/> (Ako kanya vs Yaguwe-Kurekura vs Amazi), hamwe nuburemere bwumubiri (kg)"]

    TimeCheck --> CallPoison["Hamagara Kurwanya Uburozi (1-800-222-1222 muri Amerika) cyangwa Jya mu Bitaro ED <br/> Reba ibimenyetso byose bikonje Ubukonje / ibicurane / Gusinzira / amacupa ya APAP kumupanga wihishe"]

    CallPoison --> TypeSplit{"Nibi Byinjira Byinshi <br/> (ibinini byose byafashwe mumadirishya <4 kugeza 8)"}

    TypeSplit -->|Single Acute Ingestion<br/>(<8 hours since first pill)| CharcoalCheck{"Igihe cyo kurya?"}

    CharcoalCheck -->|Within 1 to 2 hours<br/>(or up to 4 hours for Extended-Release)| GiveAC["Umuyobozi Ushinzwe Amakara Akoresha Amakara (1 g / kg kugeza kuri 50 g) <br/> niba umurwayi ari maso kandi akingira inzira"]
    CharcoalCheck -->|2 to 8 hours post-ingestion| DrawLabs4h["Shushanya Serum Acetaminofen Urwego RUKURIKIRA Amasaha 4 Nyuma yo Kwinjira <br/> (cyangwa ako kanya ukimara kuhagera niba utanze hagati yamasaha 4 na 8)"]
    GiveAC --> DrawLabs4h

    DrawLabs4h --> Nomogram["Tegura amasaha 4 kugeza kuri 24 Urwego rwa Serumu kuri Rumack-Matayo Nomogram <br/> (Umurongo wo kuvura Amerika: 150 mcg / mL mu masaha 4 / Umurongo w’Ubwongereza: 100 mg / L mu masaha 4)"]

    Nomogram --> AboveLine{"Urwego kurwego cyangwa hejuru yumurongo wo kuvura, <br/> CYANGWA ibisubizo bizatinda kumasaha 8 ashize?"}
    AboveLine -->|Yes| StartNAC["Tangira N-ACETYLCYSTEINE (NAC) ANTIDOTE AKANYA <br/> Hafi 100% birinda kunanirwa umwijima mugihe byatangiye mumasaha 8"]
    AboveLine -->|No (and ER repeat level negative)| SafeDischarge["Ubuvuzi nyuma yo kwemeza AST / ALT isanzwe <br/> hamwe nisuzuma ryumutekano wo mumutwe niba ubishaka"]

    TypeSplit -->|Late Presentation (>8 hours post-ingestion)<br/>OR Unknown Time of Ingestion<br/>OR Staggered / Repeated Overdose (>24 hours)| EmpiricNAC["NTIMWITEGEREZE IBISUBIZO BY'UMURIMO: Rumack-Matayo Nomogram NTIBIKORESHE <br/> 1. Tangira Empiric IV / Umunwa N-Acetylcysteine ​​(NAC) ako kanya <br/> 2. Shushanya STAT Serum Acetaminophen, AST, ALT, INR, Bilirubin, Creatinine, Lactate, pH <br/> 3. Komeza NAC niba Acetaminophen iboneka (> 10 mcg / mL) CYANGWA AST / ALT irazamutse"]

Pathophysiology: Uburyo Acetaminofeni Yangiza Umwijima (NAPQI & Glutathione Crisis)¶

Ni ukubera iki acetaminofeni ifite umutekano rwose kandi yoroheje ku gifu ku kigero gisanzwe cyo kuvura, nyamara ikaba ishobora gutera catrostrophic centrilobular hepatic necrosis hamwe na nerose ikaze yimpyiko iyo ifashwe birenze urugero?

1. Metabolisme isanzwe ivura (Glucuronidation Yizewe na Sulfation)¶

Iyo umuntu mukuru ukize amira igipimo gisanzwe cyo kuvura acetaminofeni (urugero, mg 500 kugeza mg 1.000):

• Hafi ya ** 85 ku ijana kugeza kuri 90 ku ijana ** yibiyobyabwenge bitunganyirizwa mumwijima mumisemburo ya Phase II conjugation enzymes (** glucuronosyltransferase ** na ** sulfotransferase **), ifata glucuronide cyangwa sulfate molekile kuri acetaminofeni kugirango isohoke nta nkomyi mu nkari.
• Hafi ya ** 2 ku ijana kugeza 5 ku ijana ** isohoka idahindutse nimpyiko.
• Ibisigaye ** 5 ku ijana kugeza 10 ku ijana ** bihindurwamo okiside na sisitemu yo mu bwoko bwa hepatike cytochrome P450 (cyane cyane ** CYP2E1 *, hamwe na CYP1A2 na CYP3A4) ihinduka metabolite ikora cyane, electrophilique, kandi ifite ubumara bukabije bwitwa ** NAPQI ( N-acetyl-p-benzoquinone imine *) **.
• Mubihe bisanzwe, umwijima ufite ububiko bwinshi bwa antioxydeant antioxydeant tripeptide, ** glutathione (GSH) . Glutathione ihita ihuza NAPQI, ikayitandukanya na aside ya mercapturic itagira ingaruka na conjugate ya cysteine ​​ isohoka mu nkari.

2. Kurenza urugero Metabolism: Kugabanuka kwa Glutathione kuri 30 ku ijana¶

Iyo umuntu amize ibiyobyabwenge birenze urugero, cyangwa agafata inshuro nyinshi cyane umunsi kuwundi:

1. ** Kwuzuza inzira zifite umutekano **: Inzira zisanzwe zumwijima na glucuronidation zuzuye zuzuye kandi zirengerwa, bituma igice kinini cya acetaminofeni kinyura munzira ya okiside ya ** CYP2E1 ** kandi kibyara uburozi bwinshi ** NAPQI **.
2. ** 70% kugeza 80% Glutathione Depletion Cliff **: Mugihe cyose umwijima ufite ** glutathione ihagije (GSH) **, nta selile yumwijima ipfa. Nyamara, iyo amaduka ya glutathione yo mu nda amaze kugabanukaho ** 70 ku ijana kugeza kuri 80 ku ijana (kugabanuka munsi ya 30% yubushobozi busanzwe) **, umwijima ubura ingabo.
3. ** Guhuza covalent hamwe na Centrilobular (Zone 3) Necrosis : Bidafite aho bibogamiye ** NAPQI ** ihuza hamwe na sisitemu ya sulfhydryl ya sisitemu kuri poroteyine zikomeye za mitochondrial imbere muri hepatocytes, bigatuma habaho imbaraga nyinshi za okiside ya mitochondrial, peroxynitrite, kugabanuka kwa ATP, no gucamo ADN. Kuberako ** Hepatic Zone 3 (agace ka centrilobular ikikije imitsi yo hagati) ** ifite ubunini bwinshi bwa enzymes ya ** CYP2E1 ** hamwe na ogisijeni yo hasi cyane ya ogisijeni na glutathione, Zone 3 hepatocytes yaturitse kandi ipfa mumiraba, yohereza imisemburo yumwijima ( AST na ALT **) yazamutse hejuru ya ** 1.000 kugeza 10,000 IU / L ** mugihe cyo guhagarika amaraso ya ** ** ammonia (itera ** hepatike encephalopathie na cerebral edema ), kandi ikagumana isukari mu maraso ( hypoglycemia **).
4. ** Uburozi bwimpyiko butaziguye **: Kuberako impyiko nazo zigaragaza imisemburo ya CYP2E1 hamwe na synthase ya prostaglandine, NAPQI itabogamye yabyaye imbere mumyanya yimpyiko irashobora gutera ** acute tubular necrosis (ATN) no kunanirwa nimpyiko **, rimwe na rimwe no mubarwayi bafite ibikomere byumwijima bitangiye gukira.

3. Uburyo Antidote N-Acetylcysteine (NAC) ikiza umwijima muburyo bubiri¶

** N-acetylcysteine (NAC) ** numuterankunga wa sulfhydryl-groupe kandi ibanziriza ** L-cysteine **, aside igabanya igipimo cya aside amine isabwa numwijima kugirango ikore ** glutathione **:

• ** Mechanism Yambere (amasaha 0 kugeza 8+, Kwirinda Urupfu Rwakagari) **: Iyo itanzwe mumasaha ** 8 ** yo gufatwa cyane (mbere yuko amaduka ya glutathione agabanuka munsi yikigereranyo cya 30%), NAC yuzuza byihuse hepatiki ** glutathione (GSH) ** kandi inatanga amatsinda ya sulfhydryl ahuza NAPQI kandi yongerera imbaraga metabolism. Iyo itangiye mu masaha 8, NAC irinda hepatotoxicity muri ** hafi 100 ku ijana byabarwayi **, utitaye ku kuntu amaraso ya acetaminofeni yambere yari hejuru.
• ** Gutinda kwa Mechanism (amasaha 8 kugeza 72+, Gutabara mugushiraho kunanirwa kwumwijima) **: Nubwo umurwayi yagera mubitaro ** 12, 24, cyangwa amasaha 48 yatinze ** hamwe na AST / ALT yamaze kuzamuka cyane hamwe no kunanirwa kwumwijima, ** NAC NTIBIGEZE "gutinda" gutanga **. Mu gutinda kwerekanwa, NAC ikora nka scavenger yubusa, itezimbere amaraso ya microcirculaire yamaraso no gutanga nitide ya okiside, yongerera ikoreshwa rya ogisijeni ya mitochondial, igabanya ubwonko bwubwonko, kandi igateza imbere ubuzima butarimo transplant.

Umutego uhishe Acetaminofen: Ukuntu Impanuka "Gukubwa kabiri" Bibaho¶

Hafi ya kimwe cya kabiri cyindwara ziterwa na acetaminofeni muri Amerika y'Amajyaruguru n'Uburayi ni ** batabigambiriye ("therapy misadventures") **: iterwa n'umuntu ufite ububabare bukabije bw'amenyo, ububabare bw'umugongo, cyangwa ibicurane bibabaje bifata imiti ibiri cyangwa itatu icyarimwe icyarimwe utazi ko icupa rimwe ririmo acetaminofeni.

Kubara inzitizi z'uburozi: Ni ryari ugomba kujya mubitaro?¶

Inzobere mu buvuzi bw’ubuvuzi hamwe n’ibigo bishinzwe kurwanya uburozi bigabanya imiterere ya acetaminofeni mu buryo bubiri butandukanye: ** Ingiti imwe ikaze ** (ibinini byose byamize mu idirishya rimwe ritarenze amasaha 4 kugeza kuri 8) na ** Gusubiramo inshuro nyinshi (RSTI / Staggered Overdose) ** (dosiye ikabije yafashwe inshuro zirenga 8 kugeza 24).

1¶

Genda uhite ujya mubitaro byihutirwa byibitaro (cyangwa uhamagare kugenzura uburozi kuri 1-800-222-1222 muri Amerika) niba gufata inshuro imwe byujuje cyangwa birenze kimwe muribi bikurikira:

• ** Ubuzima bwiza bwabantu bakuru ningimbi **: Kumira garama ** 7.5 kugeza kuri garama 10 (mg 7.500 kugeza mg 10,000) zose hamwe **, CYANGWA ** mg 150 mg kugeza 200 mg kuri kilo (68 kugeza 90 mg kuri pound) yuburemere bwumubiri ** (iyo ari * munsi *) mugihe cyamasaha 8.
• • Kubara ibinini byihuse urugero: *
• ** Abana bari munsi yimyaka 6 y'amavuko **: Kumira ** 200 mg kuri kilo (90 mg kuri pound) yuburemere bwumubiri cyangwa kurenga ** muguterwa rimwe gukabije (kubera ko abana bato bafite igereranyo kinini cyumwijima-ku mubiri-hamwe nubushobozi bwa sulfation nyinshi, nubwo iyinjizwa ryose rirenga ** 150 mg / kg ** ryemerera kubara uburozi bwihuse).
• ** Abantu bafite ibyago byinshi (Threshold: 75 kugeza 100 mg / kg cyangwa> garama 4) **: Mu bantu bafite imisemburo ya ** CYP2E1 ** yatewe igihe kirekire cyangwa ububiko bwa ** glutathione (GSH) ** bumaze kugabanuka, hepatotoxicite ikabije ishobora kugaragara ku kigero kiri munsi ya ** 75 kugeza 100 mg / kg ** (cyangwa hejuru ya ** 4,000). Ibintu bishobora guteza ibyago byinshi birimo:
• ** Inzoga zirenze urugero zikoresha inzoga ** (Ethanol idakira itera CYP2E1 kubyara NAPQI nyinshi mugihe imirire mibi igabanya glutathione; menya ko * gukara * inshuro imwe inzoga zifatanije nazo zirwanya CYP2E1, mugihe * inzoga zidakira * zongera uburozi cyane).
• ** Kwiyiriza ubusa igihe kirekire, inzara, kurya nabi (anorexia nervosa), cyangwa kuruka cyane / kubura amazi ** (bigabanya ububiko bwa glutathione hepatike).
• ** Indwara y'umwijima idakira yabayeho ** (cirrhose, Hepatite B cyangwa C idakira, indwara y'umwijima yanduye).
• ** Gukoresha icyarimwe imiti itera CYP450 **: nka ** isoniazid ** (imiti yigituntu), ** karbamazepine **, ** phenytoin **, ** phenobarbital **, ** rifampin **, cyangwa ** St. Yohana Wort **.
• ** Icyifuzo cyose cyo Kwigirira nabi nkana **: Hatitawe ku mubare w’ibinini byavuzwe, ** buri kunywa birenze urugero bisaba ko hasuzumwa ibitaro byihuse kandi urwego rwa serumu acetaminofen yamasaha 4 **, kuko amateka y’abarwayi y’ibara ry’ibinini mu gihe cy’ibibazo usanga atari byo.

2. Gusubiramo inshuro nyinshi Supratherapeutic (RSTI / Kurenza urugero)¶

Kuberako nomero ya Rumack-Matayo ** idashobora gukoreshwa ** mugihe ibinini byafashwe inshuro nyinshi mumasaha arenze 8 kugeza 24, hasuzumwa amaraso mubitaro (Serum Acetaminophen concentration + AST / ALT enzymes yumwijima) niba umurwayi yafashe:

• ** Mugihe cyamasaha 24 **: Kurenza ** garama 10 (10,000 mg) zose hamwe ** CYANGWA zirenga ** 200 mg / kg ** (niyo yaba ari mike) hejuru yidirishya rimwe ryamasaha 24.
• ** Mugihe cyamasaha 48 **: Kurenza ** garama 6 (6,000 mg) mugihe cyamasaha 24 ** CYANGWA zirenga ** 150 mg / kg mugihe cyamasaha 24 ** kumasaha 48 cyangwa arenga.
• ** Mu barwayi bafite ibyago byinshi (Gukoresha inzoga zidakira, kwiyiriza ubusa / imirire mibi, indwara zumwijima, cyangwa abana bafite umwuma wa febrile) **: Kurenza garama ** 4 (mg 4000) kumunsi ** (cyangwa zirenga ** 100 mg / kg / kumunsi ** kumwana) mumasaha arenga 24 kugeza 48, CYANGWA ** umurwayi wese ufite uburibwe bwo munda, isesemi, cyangwa ubwuzu bukabije bwa **.

Ibyiciro bine byubuvuzi byuburozi bwa Acetaminofeni (Isaha-ku-isaha)¶

Gusobanukirwa ibyiciro bine byubuvuzi bisobanura impamvu abaganga byihutirwa bavura uburozi bwa acetaminofeni ukoresheje urugero rwamaraso nisaha yisaha **, ntabwo bigera nuburyo umurwayi asa neza mubyumba byo gutegereza.

Gusuzuma Ibitaro na Porotokole Antidote: Ibyo Gutegereza muri ER¶

1. Rumack-Matayo Nomogram (Impamvu Amasaha 4 Amaraso Akurura)¶

Iyo umurwayi ageze mubitaro nyuma ya ** inshuro imwe ikabije kurenza igihe kizwi **:

• ** Impamvu amaraso adashobora gutegurwa mbere yamasaha 4 **: Acetaminofeni yo mu kanwa ifata amasaha agera kuri ** amasaha 4 ** kugirango irangize igifu cya gastrointestinal no gukwirakwiza tissue. Urwego rwamaraso rwashizwe kumasaha 1 cyangwa 2 nyuma yo kuribwa ntirugaragaza * urwego rwo hejuru kandi ntirushobora gukoreshwa kugirango wirinde uburozi.
• ** Umurongo Wamasaha 4 kugeza 24-Umurongo wo Kuvura **: Kuri ** amasaha 4 nyuma yo gufatwa ** (cyangwa ako kanya ukihagera niba hashize amasaha arenga 4), amaraso akururwa kugirango yibanze kuri serumu acetaminofeni:
• ** Amerika / Kanada / Ositaraliya ("Umurongo wa 150" mcg / mL mu masaha 24 **), umurwayi atangirira kuri ** N-acetylcysteine (NAC) **.
• ** Ubwongereza ("100-Line" / MHRA & TOXBASE Guideline) **: Kuva mu mwaka wa 2012, ibitaro byo mu Bwongereza bifashisha umurongo umwe wo kuvura udasanzwe utangirira kuri ** 100 mg / L (100 mcg / mL) mu masaha 4 ** (ukamanuka kuri ** 15 mg / L mu masaha 16 **) kubera kurenza urugero.
• ** Kwagura-Kurekura (ER) 650 mg Itegeko rya Caplet : Niba umurwayi yamize ** yongerewe-kurekura (arthritis yamasaha 8) ** ibinini bya acetaminofeni, cyangwa imiti ifata imiti igabanya umuvuduko ukabije w'inda ( opioide cyangwa antikolinergique nka diphenhydramine / Benadryl **), iyinjizwa rishobora kugera kumasaha ashize. Niba urwego rwambere rwamasaha 4 ari * munsi yumurongo wokuvura, abaganga byihutirwa bashushanya ** isegonda ya kabiri isubiramo amaraso nyuma yamasaha 4 kugeza kuri 6 (kumasaha 8 kugeza 10 nyuma yo gufatwa) **; niba urwego rumwe rwambutse umurongo, NAC itangira ako kanya.

2. Imitsi iva mu kanwa N-Acetylcysteine (NAC) Imiti igabanya ubukana¶

Byombi ** Imitsi (IV) NAC ** (nka * Acetadote * cyangwa generic acetylcysteine ​​ya IV) na ** NAC yo mu kanwa ** (nka * Mucomyst *) ikora neza mugihe itangiye mumasaha 8:

1. ** Imitsi (IV) NAC (Bikunda kuruka, koma, gutwita, cyangwa kunanirwa kw'umwijima) **:
2. Amateka yatanzwe binyuze kuri ** Amasaha 21-Amashashi atatu ya Prescott Regimen ** (150 mg/kg hejuru yiminota 60, hanyuma 50 mg/kg amasaha arenga 4, hanyuma 100 mg/kg amasaha arenga 16 = ** 300 mg / kg yose hamwe **).
3. Muri iki gihe, ibigo byinshi by’uburozi muri Amerika, mu Bwongereza (** SNAP yamasaha 12: Scottish na Newcastle Anti-emetic Pre-treatment Paracetamol Poisoning Study regimen **), na Ositaraliya bakoresha ** byoroheje-Imifuka ibiri ya IV NAC Regimen ** (urugero, 200 mg/kg over 4 hours [cyangwa 100 mg/kg over 2 hours mu Bwongereza SNAP protocole], ikurikirwa na 100 mg/kg over 16 hours [cyangwa 200 mg/kg over 10 hours muri SNAP]). Ugeranije imifuka ibiri yambere itinda kwambere kwinjizwamo kandi ** igabanya igipimo cya non-allergique histamine / anaphylactoid reaction (flushing, imitiba, kuzunguruka) hejuru ya 75% **.
4. • Icyitonderwa cyingenzi kuri NAC "Anaphylactoid" Flushing *: Abagera kuri 5% kugeza kuri 15% byabarwayi bakira umufuka wa mbere wa NAC bafite uburibwe bwo mumaso, guhinda, cyangwa imitiba yoroheje iterwa na ** non-IgE itaziguye ya histamine irekura ** (birashimishije, ibi * birasanzwe * mugihe urugero rwa acetaminofeni ya serumu ari * munsi *, kuko selile ya acetaminofeni ikabije. Ntabwo ** atari allergie yukuri kandi ntabwo arimpamvu yo kureka burundu antidote irokora ubuzima **: abaforomo bahagarika gusa kwinjiza muminota 15 kugeza 30, guha IV ** diphenhydramine (antihistamine) ** hanyuma ugahumeka ** albuterol ** niba uhuha, hanyuma ugatangira NAC kumuvuduko gahoro.
5. ** Umunwa NAC (Gahunda yamasaha 72) **:
6. Uhaye nka ** 140 mg / kg yipakurura dose **, ugakurikirwa na ** 17 17 ya 70 mg / kg buri masaha 4 ** (yose hamwe ni amasaha 72, nubwo akenshi bigabanywa no guhagarika ibipimo bimaze laboratoire isobanutse).
7. Kuberako umunwa NAC numusemburo urimo sulfure unuka kandi uryoshye cyane nka ** amagi yaboze **, akonjeshwa hejuru yurubura, akavangwa na cola cyangwa umutobe wimbuto mugikombe gitwikiriwe nicyatsi, kandi kibanzirizwa numuti wa IV urwanya isesemi nka ** ondansetron (Zofran) **. Niba umurwayi arutse mu minota 60 60 ** yo kumira umunwa wa NAC mu kanwa, uwo muti ugomba gusubirwamo (cyangwa ugahinduka kuri IV NAC).
8. ** Guhagarika Ibipimo (Ntuzigere Uhagarika NAC nisaha wenyine) **:
9. Mugihe cyo kurangiza protocole isanzwe ya 12 kugeza kuri 21-isaha ya IV NAC, abaganga b'ibitaro bareba ** serum acetaminophen yibanze, AST, ALT, na INR **. NAC ihagarikwa ** gusa niba **: (a) urwego rwa serumu acetaminofeni itamenyekana (< 10 mcg/mL),. Niba imisemburo yumwijima izamuka, umufuka wanyuma wa IV NAC urakomeza ubudahwema kugeza umwijima ukize.
10. ** Gutabara Adjunctive Kubirenze urugero (Fomepizole & Hemodialysis) **:
11. Mugihe kinini kirenze urugero (urugero rw'amasaha 4 ya acetaminofeni > 500 to 900 mcg/mL cyangwa acide ya lactique ikabije), abahanga muburozi bwubuvuzi barushaho gutanga ** Fomepizole (4-methylpyrazole, 15 mg / kg IV) ** kuruhande rwa NAC, kuko fomepizole ihagarika ** CYP2E1 ** (guhagarika ibyaremwe bishya bya NAPQI) ikanabuza ** c-Jun N-terminal kinase (JNK) ** mitochondrial necrosis. (Ubuvuzi bwa Extracorporeal muburozi) ** amabwiriza.

3. Ibipimo bya King's College: Uburyo abaganga bamenya abarwayi bakeneye guhindurwa umwijima byihutirwa¶

Mu barwayi bagaragaza bitinze mu cyiciro cya III (amasaha 48 kugeza kuri 96 nyuma yo gufatwa) bafite ikibazo cyo kunanirwa na hepatike yuzuye, abahanga mu kuvura indwara z’indwara ya ICU bakurikirana ibipimo ngenderwaho bya ** King's College Criteria ** kubera umwijima ukabije wa acetaminofeni watewe no kudashyira ku rutonde umurwayi w’umwijima wo mu bwoko bwa ** byihutirwa byangiza ubuzima bw’umwijima ** mbere yo kwandura ubwonko budasubirwaho:

• ** Ibipimo A (Ikimenyetso kimwe) : Amaraso ya Arterial ** $ inyandiko {pH} < 7.30$ (or arterial **lactate $> 3.0 inyandiko {mmol / L} $ **) * nyuma ya * kuzura amazi ahagije yimitsi, hatitawe ku ntera ya encephalopathie; ** CYANGWA **
• ** Ibipimo B (Ibimenyetso bitatu byose bitangirwa icyarimwe mumadirishya yamasaha 24) **:
• ** Icyiciro cya III cyangwa Icyiciro cya IV Hepatic Encephalopathie ** (urujijo rukabije, stupor, cyangwa coma), ** NA **
• ** Igihe cya Prothrombin (PT) $> 100 inyandiko {amasegonda} $ (cyangwa $ inyandiko {INR}> 6.5 $) **, ** NA **
• ** Serumu Creatinine $> 3.4 inyandiko {mg / dL} $ ($> 300 inyandiko {micromol / L} $) **.

Kugenzura Urutonde: Gukoresha Acetaminofeni Yizewe Murugo¶

• ** Kurikiza "Icupa rimwe icyarimwe" Itegeko **: Ntuzigere ufata imiti ibiri irimo acetaminofeni, parasetamol, cyangwa ** APAP ** mugihe cy'idirishya rimwe ryamasaha 6. Mugihe ufata ibimenyetso byinshi byamazi cyangwa ibinini kubukonje, ibicurane, cyangwa sinus, koresha imiti isanzwe yibigize aho gukoresha amazi.
• ** Wubahe Ceiling ya buri munsi (Ntarengwa 4000 mg / kumunsi; 3000 mg / kumunsi Bikunzwe) **: Abakuze bafite ubuzima bwiza ntibagomba na rimwe kurenga ** 4000 mg (8 extra-Strength 500 mg ibinini cyangwa 12 Ibisanzwe-Imbaraga 325 mg) mugihe cyamasaha 24 **, kandi inzobere nyinshi zumwijima zirasaba gufata buri munsi kuri ** 3000 mg / kumunsi ** (cyangwa ** 2000 mg / kumunsi **).
• ** Dose Abana Bikabije Kuburemere (10 kugeza 15 mg / kg kuri dose) **: Buri gihe ukoreshe ** mililitiro (mL) yo mu kanwa yo mu kanwa ** yapakiye mumasanduku, ntukigere ikiyiko cyigikoni, hanyuma wandike buri gihe cyinshyi kugirango abarezi babiri batabishaka inshuro ebyiri umwana nijoro.

Ibibazo bikunze kubazwa¶

Kuki ntashobora gutegereza kugeza ejo mugitondo kugirango ndebe niba numva ndwaye mbere yo kujya mubitaro nyuma yo gufata Tylenol / paracetamol cyane?¶

Gutegereza kugeza igihe uzumva urwaye ni ikosa rimwe riteye akaga cyane muburozi bwa acetaminofeni. Mu masaha 24 yambere nyuma yo kumira ikinini cyica, abantu benshi bafite ibimenyetso bya zeru cyangwa isesemi yoroheje ibura kumunsi wa 2, mugihe metabolite yubumara ya NAPQI irimo gucecekesha umwijima glutathione no kwica selile yumwijima. Umuti urwanya N-acetylcysteine ​​(NAC) ufite hafi 100 ku ijana mu gukumira kwangirika kw umwijima uramutse utangiye mu masaha 8 uhereye igihe winjiye, mugihe ukumva ari ibisanzwe rwose. Mugihe inda yawe yo hejuru yiburyo ibabaje cyangwa amaso yawe agahinduka umuhondo mumasaha 48 kugeza 72, urupfu rwumwijima rumaze kuba.

"APAP" isobanura iki kumacupa yububabare bwanditseho imiti nka Hydrocodone-APAP cyangwa Oxycodone-APAP?¶

"APAP" ni impfunyapfunyo ya farumasi ya N-acetyl-para-aminophenol, izina ryimiti ya acetaminofeni (paracetamol). Icupa ryanditseho "Hydrocodone-APAP 5-325" ririmo mg 5 za hydrocodone ya opioid na 325 mg ya acetaminofeni muri buri kibaho. Ntuzigere ufata kuri konte ya Tylenol, Excedrin, cyangwa NyQuil / DayQuil mugihe ufata ibinini byandikirwa byanditseho "APAP," kuko dosiye ya acetaminofeni ihuriweho ishobora gutera umwijima ukabije.

Niba umuntu ageze mucyumba cyihutirwa nyuma yamasaha 16 cyangwa 24 nyuma yo kunywa birenze urugero bya acetaminofeni, biratinda ko antidote ya NAC ikora?¶

Oya: ntabwo bitinda gutangira N-acetylcysteine ​​(NAC). Mugihe NAC itanga uburinzi bwayo bukabije (hafi 100 ku ijana yo kwirinda indwara ya hepatotoxicite) mugihe yatangiriye mumasaha 8 yambere, ibizamini byamavuriro byerekana ko gutanga IV NAC kumasaha 12, 24, 48, cyangwa amasaha 72 nyuma yo gufatwa, nubwo nyuma yo kunanirwa gukabije kwumwijima bimaze gutangira, biracyateza imbere cyane microcirculation yumwijima, gutanga ogisijeni, ubwonko bwubwonko, hamwe no kubaho bidafite ubuzima.

Gufata ibuprofen (Inama / Motrin) cyangwa naproxen (Aleve) bibara urugero rwa acetaminofeni ya buri munsi?¶

No. No. Nyamara, ibimenyetso byinshi byumutwe cyangwa ibicuruzwa bikonje (nka Excedrin cyangwa Dual Action Acetaminophen + Ibuprofen ibinini) rimwe na rimwe bihuza ibyiciro byombi mubinini, bityo rero buri gihe usome agasanduku "Ibikoresho bifatika" inyuma yipaki.

• Aka gatabo kagenewe amakuru kandi ntigasimbuza isuzuma ryubuvuzi bwumwuga cyangwa inama yo kurwanya uburozi. Kubera ko imiti ikabije y’imiti ishobora gutuma imitekerereze ihinduka, kuruka, cyangwa guhungabana mu kirere, turasaba cyane ko twafasha ubufasha bwambere bwemewe n’amasomo ya CPR binyuze muri federasiyo mpuzamahanga y’umuryango utabara imbabare Croix Rouge (IFRC), umuryango w’igihugu cya Croix Rouge, St John Ambulance, cyangwa abatanga amahugurwa yemewe. *

Inkomoko yagenzuwe¶

• Ishyirahamwe ry’Abanyamerika rishinzwe kurwanya uburozi (AAPCC) & Ishuri Rikuru ry’Ubuvuzi ry’Abanyamerika (ACMT): * Amabwiriza y’ubwumvikane mu micungire y’uburozi bwa Acetaminofeni muri Amerika na Kanada (JAMA Network Open / Clinical Toxicology) *.
• Ikigo cy’igihugu gishinzwe amakuru y’uburozi (NPIS, Ubwongereza) & Imiti n’ibicuruzwa byita ku Buzima Ikigo gishinzwe kugenzura ibikorwa (MHRA): * TOXBASE Paracetamol Amabwiriza yo gucunga ibiyobyabwenge birenze urugero hamwe n’amasaha 12 ya SNAP.
• Ishami ry'Umuryango w'Abibumbye ryita ku Buzima (OMS): * Imicungire y’ubuvuzi y’uburozi bukabije: Paracetamol (Acetaminophen) na Antidotal N-Acetylcysteine ​​(NAC) Porotokole *.
• Ishyirahamwe ry’Abanyamerika ryiga ku ndwara z’umwijima (AASLD): * Amabwiriza ngenderwaho yo gucunga ikibazo cyo kunanirwa umwijima ukabije hamwe n’ibipimo byo kwimura King's College *.
• EXTRIP (Ubuvuzi bwa Extracorporeal muburozi) Itsinda ryakazi: * Gusubiramo buri gihe hamwe nibyifuzo byo kuvura Extracorporeal muburozi bwa Acetaminofeni *.

Kuyobora¶

• Uburozi ubufasha bwambere hamwe nuburozi bwo kurwanya uburozi
• Aspirine (salicylate), ibinini by'icyuma, n'imiti y'umuvuduko ukabije w'amaraso
• Opioid irenze urugero na naloxone (Narcan) gutabara
• Methanol, Ethylene glycol (antifreeze), n'uburozi bwa alcool
• Imibare yihutirwa ukurikije igihugu