급성 아세트아미노펜 중독에서 N-acetylcysteine 투여 결정 관련 인자
Factors of Determining N-acetylcysteine Administration in Patients with Acute Acetaminophen Poisoning
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Purpose: In acute acetaminophen poisoning, the administration of N-acetylcysteine (NAC) can effectively treat the main complications, such as kidney injury and liver failure. In the current situation, measurements of the acetaminophen concentration are not checked in the usual medical facilities. Therefore, this study examined the factors of determining the administration of NAC in addition to the stated amount of intake. Methods: The medical records of patients who visited Ajou University Hospital emergency center with acetaminophen poisoning from January 2015 to December 2019 were reviewed retrospectively. One hundred and seventy-nine patients were initially included. Among these patients, 82 patients were finally selected according to the inclusion criteria in the study. The inclusion criteria were as follows: patients who were 15 years of age or older; those whose ingested dose, ingested time, and body weight were clearly identified; and patients whose acetaminophen sampling time was within 24 hours. Patients were divided into two groups: NAC administered vs. non-NAC administered. The following variables were compared in these two groups: ingested dose, ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, psychiatric disease history, classification of toxic/non-toxic groups, duration of hospitalization, and laboratory results. Results: Univariate analysis revealed the ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, and psychiatric disease history to be the determining factors in administering NAC. Logistic regression analysis confirmed that the ingested dose per body weight was the only significant factor leading to an NAC treatment decision. (Odds ratio=1.039, 95% Confidential interval=1.009-1.070, p=0.009) Conclusion: The ingested dose per body weight was the only determining factor for administering NAC in patients with acute acetaminophen poisoning. On the other hand, additional criteria or indicators for the NAC administration decision will be necessary considering the inaccuracy of the ingested dose per body weight and the efficiency of NAC administration.
Abstract
Purpose: In acute acetaminophen poisoning, the administration of N-acetylcysteine (NAC) can effectively treat the main complications, such as kidney injury and liver failure. In the current situation, measurements of the acetaminophen concentration are not checked in the usual medical facilities. Therefore, this study examined the factors of determining the administration of NAC in addition to the stated amount of intake. Methods: The medical records of patients who visited Ajou University Hospital emergency center with acetaminophen poisoning from January 2015 to December 2019 were reviewed retrospectively. One hundred and seventy-nine patients were initially included. Among these patients, 82 patients were finally selected according to the inclusion criteria in the study. The inclusion criteria were as follows: patients who were 15 years of age or older; those whose ingested dose, ingested time, and body weight were clearly identified; and patients whose acetaminophen sampling time was within 24 hours. Patients were divided into two groups: NAC administered vs. non-NAC administered. The following variables were compared in these two groups: ingested dose, ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, psychiatric disease history, classification of toxic/non-toxic groups, duration of hospitalization, and laboratory results. Results: Univariate analysis revealed the ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, and psychiatric disease history to be the determining factors in administering NAC. Logistic regression analysis confirmed that the ingested dose per body weight was the only significant factor leading to an NAC treatment decision. (Odds ratio=1.039, 95% Confidential interval=1.009-1.070, p=0.009) Conclusion: The ingested dose per body weight was the only determining factor for administering NAC in patients with acute acetaminophen poisoning. On the other hand, additional criteria or indicators for the NAC administration decision will be necessary considering the inaccuracy of the ingested dose per body weight and the efficiency of NAC administration.
참고문헌 (17)
- Ostapowicz G, "Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States", Ann Intern Med, 137, pp.124~ (2002)
- Kim GU, "Clinical toxicology", pp.418~424 (2006), KoonJa
- Prescott LF, "Intravenous N-acetylcyteine : The treatment of choice for paracetamol poisoning", Br Med J, 2, pp.1097~1100 (1979)
- Smilkstein MJ, "Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose : Analysis of the national multi-center study(1976 to 1985)", N Engl J Med, 319, pp.1557~1562 (1988)
- 김지현, "환자의 아세트아미노펜 중독 여부를 환자진술 만으로 확인하는 것이 타당한가? : 혈중에서 아세트아미노펜이 검출된 환자의 임상 양상 분석", 대한임상독성학회지, 15(2), pp.94~100 (2017), 대한임상독성학회[DOI]
- Mitchell JR, "Acetaminopheninduced hepatic necrosis. IV. Protective role of glutathione", J Pharmacol Exp Ther, 187, pp.211~217 (1973)
- Rumack BH, "Acetaminophen overdose : 662 cases with evaluation of oral acetylcysteine treatment", Arch Intern Med, 141, pp.380~385 (1981)
- Froberg BA, "Negative predictive value of acetaminophen concentrations within four hours of ingestion", Acad Emerg Med, 20(10), pp.1072~1075 (2013)
- Kim TG, "Is N-acetylcysteine treatment based on ingestion amount valid in acute acetaminophen overdose patients", J Korean Soc Clin Toxicol, 4(2), pp.107~112 (2006)
- Zyoud SH, "Reliability of the reported ingested dose of acetaminophen for predicting the risk of toxicity in acetaminophen overdose patients", Pharmacoepidemiol Drug Saf, 21(2), pp.207~213 (2012)
- Duffull SB, "Predicting the requirement for Nacetylcysteine in paracetamol poisoning from reported dose", Clin Toxicol(Phila), 51(8), pp.772~776 (2013)
- Ambre J, "Liver toxicity after acetaminophen ingestion. Inadequacy of the dose estimate as an index of risk", JAMA, 238(6), pp.500~501 (1977)
- 전병조, "아세트아미노펜 중독의 해독제: 아세틸시스테인", 대한의사협회지, 56(12), pp.1067~1075 (2013), 대한의사협회
- Wallace CI, "Paracetamol overdose : an evidence based flowchart to guide management", Emerg Med J, 19, pp.202~205 (2002)
- 박성진, "개정된 가이드라인에 따른 아세트아미노펜 급성 중독환자 치료 기준의 검증", 대한임상독성학회지, 16(2), pp.68~74 (2018), 대한임상독성학회[DOI]
- Bateman DN, "Effect of the UK’s revised paracetamol poisoning management guidelines on admissions, adverse reactions and cost of treatment", Br J Clin Pharmacol, 78, pp.610~618 (2014)
- Levine M, "Estimating the impact of adopting the revised United Kingdom acetaminophen treatment nomogram in the U.S.population", Clin Toxicol(Phila), 55(6), pp.569~572 (2017)