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Intravenous acetaminophen associated with acute liver failure 静脉注射对乙酰氨基酚导致急性肝衰竭
Q4 Medicine Pub Date : 2024-01-31 DOI: 10.1136/dtb.2024.251305rep
Maunoo Lee, Joshua McCarron, Aaron Balinski, Richard Bower
In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. A woman in her mid-60s, without known liver disease, was admitted to the hospital with a partial malignant colonic obstruction. Over a 6-day course, she received a total of 13 g of intravenous acetaminophen not exceeding 4 g over a 24-hour period. She developed encephalopathy and an international normalised ratio of 6.1 meeting criteria for acute liver failure (ALF). She was treated with intravenous N-acetyl cysteine and other causes of liver failure were excluded. The patient was discharged with subsequent resolution of encephalopathy and improvement of her liver chemistries. Though ALF is rare, in countries where acetaminophen is readily available, almost 50% of ALF cases are acetaminophen-induced hepatotoxicity and most have been documented as oral ingestion of acetaminophen. We present a rare case of intravenous acetaminophen-induced ALF. Acute liver failure (ALF) is defined as new onset coagulopathy with international normalised ratio (INR) ≥1.5 and encephalopathy without pre-existing cirrhosis.1 Drug-induced liver injury (DILI) is the most common cause of ALF in the USA occurring at a rate of 20 cases per 100 000 persons.2 3 Of all DILI cases, acetaminophen-induced hepatotoxicity accounts for up to 46% of ALF cases.2 The two main aetiologies of acetaminophen overdoses are either intentional, often in context of suicide attempts, and unintentional overdoses, also known as therapeutic misadventures.3 4 Bower et al conducted a population-based surveillance for ALF that noted 55% of all acetaminophen-related ALF cases to be therapeutic misadventures.5 Current US Food and Drug Administration packaging …
DTB 将与 BMJ 病例报告合作,不定期刊登读者可能感兴趣的药物相关病例。这些病例包括近期上市的药物(对其不良反应了解有限),以及已上市数年的药物的异常反应。一位 60 多岁的妇女因部分恶性结肠梗阻入院,她没有已知的肝病。在为期 6 天的治疗过程中,她总共静脉注射了 13 克对乙酰氨基酚,24 小时内用药量不超过 4 克。她出现了脑病,国际正常化比率为 6.1,符合急性肝衰竭 (ALF) 的标准。她接受了 N-乙酰半胱氨酸静脉注射治疗,并排除了导致肝衰竭的其他原因。患者出院后,脑病得到缓解,肝脏化学指标也有所改善。虽然ALF很罕见,但在对乙酰氨基酚很容易买到的国家,几乎50%的ALF病例都是对乙酰氨基酚引起的肝中毒,而且大多数病例都有口服对乙酰氨基酚的记录。我们介绍了一例罕见的静脉注射对乙酰氨基酚诱发的 ALF 病例。急性肝衰竭(ALF)是指国际正常化比值(INR)≥1.5 的新发凝血病和无肝硬化的脑病。对乙酰氨基酚过量的两种主要病因是故意过量(通常是企图自杀)和非故意过量(也称为治疗失误)。3 4 Bower 等人对 ALF 进行了一项基于人群的监测,结果发现在所有与对乙酰氨基酚相关的 ALF 病例中,55% 属于治疗失误。
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引用次数: 0
Dupilumab-induced ocular surface disease: a primer. 杜比鲁单抗诱发的眼表疾病:入门指南。
Q4 Medicine Pub Date : 2024-01-30 DOI: 10.1136/dtb.2023.249019rep
Merin Anna Reji, Aaisha Haque, Supriya Goyal, Guha Krishnaswamy
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引用次数: 0
Limiting drugs prescribed in primary care. 限制初级保健处方药。
Q4 Medicine Pub Date : 2024-01-30 DOI: 10.1136/dtb.2023.000030
Michael Wilcock
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引用次数: 0
ADHD medication shortages: more than just a supply issue. 多动症药物短缺:不仅仅是供应问题。
Q4 Medicine Pub Date : 2024-01-30 DOI: 10.1136/dtb.2023.000062
Alexandra Lewis, Teck K Khong
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引用次数: 0
Can antidepressants worsen COPD? 抗抑郁药会加重慢性阻塞性肺病吗?
Q4 Medicine Pub Date : 2024-01-30 DOI: 10.1136/dtb.2024.000002

Overview of: Siraj RA, Bolton CE, McKeever TM. Association between antidepressants with pneumonia and exacerbation in patients with COPD: a self-controlled case series (SCCS). Thorax. 2023. doi:10.1136/thorax-2022-219736 [Epub ahead of print 19 June 2023].

概述:Siraj RA、Bolton CE、McKeever TM。抗抑郁药与慢性阻塞性肺病患者肺炎和病情加重之间的关系:自控病例系列(SCCS)。Thorax.2023. doi:10.1136/thorax-2022-219736 [Epub ahead of print 19 June 2023].
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引用次数: 0
Risk of recurrence after first unprovoked seizure. 首次无诱因癫痫发作后的复发风险。
Q4 Medicine Pub Date : 2024-01-30 DOI: 10.1136/dtb.2024.000006

Overview of: Neligan A, Adan G, Nevitt SJ, et al. Prognosis of adults and children following a first unprovoked seizure. Cochrane Database Syst Rev. 2023:10.1002/14651858.CD013847.pub2.

概述:Neligan A, Adan G, Nevitt SJ, et al. 首次无诱因癫痫发作后成人和儿童的预后。Cochrane Database Syst Rev. 2023:10.1002/14651858.CD013847.pub2。
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引用次数: 0
Low-dose aspirin and anaemia in older people. 低剂量阿司匹林与老年人贫血。
Q4 Medicine Pub Date : 2024-01-30 DOI: 10.1136/dtb.2024.000001

Overview of: McQuilten ZK, Thao LTP, Pasricha SR, et al. Effect of low-dose aspirin versus placebo on incidence of anemia in the elderly: a secondary analysis of the aspirin in reducing events in the elderly trial. Ann Intern Med. 2023;176:913-21.

概述:McQuilten ZK、Thao LTP、Pasricha SR 等:低剂量阿司匹林与安慰剂对老年人贫血发生率的影响:阿司匹林减少老年人贫血试验的二次分析。Ann Intern Med.2023;176:913-21.
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引用次数: 0
Managing acne vulgaris: an update 管理寻常痤疮:最新进展
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.1136/dtb.2023.000051
Miriam Santer, Esther Burden-Teh, Jane Ravenscroft
Acne vulgaris is very common and can have significant negative impact on people. While sometimes a transient problem, acne may persist for many years and often leads to permanent scars or pigment changes. Guidelines unanimously advise topical treatments as first-line, although differ in recommending either topical benzoyl peroxide or topical retinoid (mainly adapalene) alone or in combination. Guidance published by the National Institute for Health and Care Excellence advises counselling patients regarding avoidance of skin irritation when starting topical treatments and promoting adherence (treatments take 6–8 weeks to work). Oral antibiotics are currently overprescribed for acne but have a role when coprescribed with a non-antibiotic topical treatment. Hormonal treatments, such as the combined contraceptive pill, are also effective and there is growing evidence for the use of spironolactone for women with persistent acne. Recent guidance from the Medicines and Healthcare products Regulatory Agency regarding isotretinoin has implications for specialist prescribing and monitoring, and increasing public awareness of potential risks of mental health problems and sexual dysfunction. Although acne is associated with psychiatric disorder, the mental health effects of isotretinoin remain controversial.
寻常痤疮很常见,会对人造成很大的负面影响。痤疮有时只是一过性的问题,但可能会持续多年,并常常导致永久性疤痕或色素改变。指南一致建议将外用治疗作为第一线治疗方法,但在建议外用过氧化苯甲酰或外用维甲酸(主要是阿达帕林)单独或联合使用方面存在差异。美国国家健康与护理卓越研究所发布的指南建议,在开始局部治疗时,应指导患者避免刺激皮肤,并促进患者坚持治疗(治疗需要 6-8 周才能见效)。目前,口服抗生素治疗痤疮的处方过多,但如果与非抗生素外用疗法同时使用,口服抗生素还是有一定作用的。荷尔蒙治疗,如联合避孕药,也很有效,而且越来越多的证据表明,螺内酯可用于治疗女性顽固性痤疮。最近,药品和保健品监管局发布了关于异维A酸的指南,这对专业处方和监测产生了影响,并提高了公众对精神健康问题和性功能障碍潜在风险的认识。虽然痤疮与精神障碍有关,但异维A酸对精神健康的影响仍存在争议。
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引用次数: 0
Changes in primary endpoints in cancer trials. 癌症试验主要终点的变化。
Q4 Medicine Pub Date : 2023-12-27 DOI: 10.1136/dtb.2023.000064

Overview of: Florez MA, Jaoude JA, Patel RR, et al. Incidence of primary end point changes among active cancer phase 3 randomized clinical trials.JAMA Netw Open2023;6:e2313819.

概述:Florez MA, Jaoude JA, Patel RR, et al. Inidence of primary end point changes among active cancer phase 3 randomized clinical trials.JAMA Netw Open2023;6:e2313819.
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引用次数: 0
Continuity of care: good for patients, good for prescribing. 护理的连续性:对病人有利,对处方有利。
Q4 Medicine Pub Date : 2023-12-27 DOI: 10.1136/dtb.2023.000033
Julian Treadwell
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引用次数: 0
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