- 期刊
Acetaminophen Overdose Induced Multiple Organ Failure: A Case Report
普拿疼中毒併發多重器官衰竭病例報告
摘要
我們報告一位24歲女性服用大量acetaminophen後，以昏迷狀態送到急診室然後加護病房到出院的整個治療過程。 當這位病人被送到急診室時人是昏迷的，家屬也不知她有自殺的企圖，但抽血報告顯示血糖高和嚴重的代謝性酸中毒，於是以糖尿病併發酮酸血症住進加護病房治療。當給予適當的生理食鹽水和校正酸中毒後，病人醒過來了，但肝功能卻逐日上升，經詢問病人她告知一次服用80顆的acetaminophen，這時我們就開始給她服用N-acetylcysteine，距離她服用acetaminophen的時間約55小時。在這段住院的日子＿, 這位病人陸續出現的併發症除了肝功能異常上升外，還有低血糖、急性呼吸衰竭、貧血、血小板過少、急性腎衰竭、胰臟酵素上升及肺炎。在住院將近一個月後病人平安出院。 由這個病例我們知道嚴重的acetaminophen中毒會引起嚴重的代謝性酸中毒及昏迷，故急診醫師應將acetaminophen中毒列為病史不明的嚴重性代謝性酸中毒的鑑別診斷原因之一。雖然遲至55小時才給病人解毒劑，病人也歷經一連串的併發症，但經過細心的加護照顧，病人也能康復的出院。
並列摘要
We report a 24-year-old female who took 40 gm of acetaminophen. She was subsequently sent to the emergency department because she was comatose. She also had severe metabolic acidosis, acute respiratory failure, and hyperglycemia. She was admitted to the intensive care unit under the impression of diabetic ketoacidosis, as there was no suspicion of suicidal intentions at that time. Her consciousness and hemodynamic status gradually improved after supportive treatment. N-acetylcysteine was not administered until 55 hours after acetaminophen ingestion when there was persistent elevation of liver function enzymes. Ventricular tachycardia, thrombocytopenia, anemia, hyperamylasemia, renal failure, and aspiratory pneumonia all occurred during her hospitalization. However, she recovered completely and was discharged one month later. Acetaminophen intoxication should be included in the differential diagnosis of comas, shock, and severe metabolic acidosis. N-acetylcysteine may serve as a critical antidote, even when administered late in the treatment course, improving respiratory, hematologic, and hepatic functions. However, hemodialysis may be needed in the event of acute renal failure.