n -乙酰半胱氨酸一袋法摄食对乙酰氨基酚的不良反应

M. Mullins, Mary Yu, L. O'Grady, S. Khan, E. Schwarz
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引用次数: 5

摘要

摘要:对乙酰氨基酚(扑热息痛)仍然是北美过量用药的主要药物。三袋普雷斯科特方案静脉注射(IV)乙酰半胱氨酸是复杂的,容易出错。它有常见的不良反应,特别是非过敏性类过敏反应(NAARs)。15年前,我们采用了一种简化的单袋方案,使用标准浓度来减少错误。我们用这个方案报告不良反应。我们使用医院药房记录回顾性识别2005年1月12日至2016年6月20日期间接受静脉注射乙酰半胱氨酸的患者。我们排除了没有乙酰氨基酚过量或在医院外静脉注射任何部分乙酰半胱氨酸的患者。在开始静脉注射乙酰半胱氨酸后,我们检索了药房记录中苯海拉明或任何止吐药。我们回顾了病程记录中恶心、呼吸困难、瘙痒/瘙痒或皮疹的描述。在252例接受静脉注射乙酰半胱氨酸的患者中,202例符合我们的纳入标准。33例患者至少有一种不良反应,包括28例恶心和8例NAAR症状。28名患者服用了止吐药。11例患者接受苯海拉明治疗(9例用于NAAR, 2例用于丙氯拉嗪)。恶心是最常见的不良反应。单袋方案的非过敏性类过敏反应率为4%。
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Adverse reactions in patients treated with the one-bag method of N-acetylcysteine for acetaminophen ingestion
Abstract Acetaminophen (paracetamol) remains the leading pharmaceutical agent in overdoses in North America. The three-bag Prescott protocol for intravenous (IV) acetylcysteine is complex and prone to errors. It has frequent adverse reactions, particularly non-allergic anaphylactoid reactions (NAARs). Over 15 years ago, we adopted a simplified, one-bag protocol using a standard concentration to reduce errors. We report the adverse reactions with this protocol. We used hospital pharmacy records to retrospectively identify patients who received IV acetylcysteine between 12 January 2005 and 20 June 2016. We excluded patients without acetaminophen overdose or with any part of their IV acetylcysteine at an outside hospital. We searched pharmacy records for diphenhydramine or any antiemetic after commencing IV acetylcysteine. We reviewed progress notes for descriptions of nausea, dyspnea, itching/pruritus, or rash. Out of 252 patients receiving IV acetylcysteine, 202 met our inclusion criteria. Thirty-three patients had at least one adverse reaction including nausea in 28 patients and any symptom of NAAR in 8 patients. Twenty-eight patients received an antiemetic. Eleven patients received diphenhydramine (nine for NAAR and two with prochlorperazine). Nausea was the most common adverse reaction. The rate of non-allergic anaphylactoid reactions with the one-bag protocol was 4%.
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