Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)
- Volume 4 Issue 2
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- Pages.107-112
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- 2006
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- 1738-1320(pISSN)
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- 2508-6332(eISSN)
Is N-acetylcysteine Treatment Based on Ingestion Amount Valid in Acute Acetaminophen Overdose Patients?
급성 Acetaminophen 중독시 복용량에 의한 N-Acetylcysteine의 사용은 적절한가?
- Kim, Tae-Geun (Department of Emergency Medicine, Yonsei University College of Medicine) ;
- Kim, Min-Joung (Department of Emergency Medicine, Yonsei University College of Medicine) ;
- Lee, Jin-Hee (Department of Emergency Medicine, Yonsei University College of Medicine) ;
- Chung, Sung-Pil (Department of Emergency Medicine, Yonsei University College of Medicine) ;
- Lee, Hahn-Shick (Department of Emergency Medicine, Yonsei University College of Medicine) ;
- Park, Yoo-Seok (Department of Emergency Medicine, Yonsei University College of Medicine)
- 김태근 (연세대학교 영동세브란스병원 응급의학과) ;
- 김민정 (연세대학교 영동세브란스병원 응급의학과) ;
- 이진희 (연세대학교 영동세브란스병원 응급의학과) ;
- 정성필 (연세대학교 영동세브란스병원 응급의학과) ;
- 이한식 (연세대학교 영동세브란스병원 응급의학과) ;
- 박유석 (연세대학교 영동세브란스병원 응급의학과)
- Published : 2006.12.31
Abstract
Purpose: In many Korean hospitals, serum acetaminophen concentrations in cases of overdose cannot be measured initially because of inadequate laboratory facilities. Under these circumstances, physicians base the administration of the antidote, N-acetylcysteine, on ingestion amounts as determined by initial history taking. We therefore examined the correlated between ingested amounts and serum acetaminophen concentrations. Methods: Medical records were reviewed retrospectively for patients who presented to the ED with acetaminophen overdose between January 2002 and March 2006. Fifty-nine patients were recruited and sixteen patients were excluded. The forty-three remaining patients were placed into either the high-risk or low-risk group based on their ingested amount (140 mg/kg), and were separately categorized into the toxic or non-toxic group based on their serum acetaminophen concentrations, according to the Rurnack-Matthew nomogram. Results: Ten patients (83.3%) among twelve in the high-risk group were found to have non-toxic serum concentrations, and just one patient (3.2%) among thirty-one in the low-risk group fell into the toxic group based on their serum concentrations. The sensitivity and specificity of risk stratification of the ingested amount as a predictor of intoxication requiring antidote therapy were 66.7% and 75.0%, respectively. Conclusion: This study suggests that the therapeutic decision for acetaminophen overdose should not be based solely on ingested amount only, but requires assessment of acetaminophen concentration.